Download 15% of the population has a personality disorder

Personality
& Impulse-Control Disorders
I. Personality: the consistent ways in which
one person’s behavior differs from that of
others, especially in social contexts.
A. Trait: a consistent, long-lasting tendency in behavior, such
as sociability, shyness or assertiveness.
B. State: a temporary activation of a particular behavior.
Personality Disorders
I. Personality Disorders: overly rigid and
maladaptive patterns of behavior and ways of
relating to others that reflect extreme variations
of underlying personality traits, such as undue
suspiciousness, excessive emotionality, and
impulsivity.
It’s estimated that 10% - 15% of the population has a personality disorder.
A. Ego Syntonic: referring to behaviors or feelings that are
perceived as natural parts of the self.
B. Ego Dystonic: referring to behaviors or feelings that are
perceived not to be part of one’s self-identity.
C. Personality Disorder Clusters
1) Cluster A: people who are perceived as odd or eccentric.
This cluster includes paranoid, schizoid, and schizotypal
personality disorders.
People with these disorders display behaviors similar to, but not as
extensive as, schizophrenia.
2) Cluster B: people whose behavior is overly dramatic,
emotional, or erratic. This grouping consists of antisocial,
borderline, histrionic, and narcissistic personality disorders.
The behaviors of people with these disorders make it almost impossible
for them to have relationships that are truly giving and satisfying.
3) Cluster C: people who often appear anxious or fearful.
This cluster includes avoidant, dependent, and obsessive–
compulsive personality disorders.
Although many of the symptoms are similar to those of anxiety and
depressive disorders, researchers have found no direct links between this
cluster and those diagnoses.
D. Genetic Factors
II. Paranoid Personality Disorder:
characterized by deep distrust and suspicion of
others.
Although inaccurate, the suspicion is usually not delusional. The ideas are
not so bizarre or so firmly held as to clearly remove the individual from
reality.
They are critical of weakness and fault in others, particularly at work.
They are unable to recognize their own mistakes and are extremely sensitive
to criticism.
About 2% of adults are believed to experience this disorder, apparently more
men than women.
A. Evolutionary Perspective
1) The Fearful Protector
III. Schizoid Personality Disorder:
characterized by persistent avoidance of social
relationships and limited emotional expression.
People with this disorder do not have close ties with other people; they
genuinely prefer to be alone.
People with this disorder focus mainly on themselves and are often seen as
flat, cold, humorless, or dull.
The disorder is estimated to affect less than 1% of the population.
IV. Schizotypal Personality Disorder:
characterized by a range of interpersonal
problems, marked by extreme discomfort in
close relationships, odd (even bizarre) ways of
thinking, and behavioral eccentricities.
Symptoms may include ideas of reference and/or bodily illusions.
People with the disorder often have great difficulty keeping their attention
focused; conversation is typically digressive and vague, even sprinkled with
loose associations.
It has been estimated that 3% of all people (slightly more males than
females) have the disorder.
A. Biological Perspective
Researchers have begun to link schizotypal personality disorder to some of
the same biological factors found in schizophrenia, such as high dopamine
activity.
V. Antisocial Personality Disorder: a chronic
psychiatric condition characterized by behavior,
possibly criminal, that manipulates, exploits, or
violates the rights of others (a.k.a. the sociopath
or the psychopath).
A. Other Key Features
1) Lack the ability to experience fear.
2) Often will break social rules or norms.
3) Aggressive or hostile behavior.
4) Engage in reckless and irresponsible behavior.
5) Lack of truthfulness.
6) Prone to impulsive behavior.
7) Lack the ability to feel guilt, remorse, or empathy for
others.
8) Lack of a “Conscience”: internal standards of behavior,
which usually control one’s conduct and produce emotional
discomfort when violated.
9) Often remarkably charming.
10) Often excel at self-monitoring.
11) Some poor decision making skills.
12) Having Conduct Disorder prior to age 18 is often a
precursor to Antisocial Personality Disorder.
13) Mostly found among men between the ages of 18 and
40.
14) More than five times as common among men as
among women.
15) About 4% of the population has this disorder.
B. Criminal Activity
1) Most people with Antisocial Personality Disorder do
NOT commit crimes.
2) Most people with Antisocial Personality Disorder that
do commit crimes are NOT murderers.
3) Serial killers are often diagnosed with Antisocial
Personality Disorder and are often highly intelligent.
a) Examples...
C. Learning Perspective
Children and adolescents who develop antisocial personalities may be
“unsocialized” because their early learning experiences lack the consistency
and predictability that help other children and adolescents connect their
behavior with rewards and punishments.
ASPD may be the result of a lack of reinforcement for good behavior and a
lack of punishment for bad behavior in childhood and adolescence.
ASPD may also result from a crossing of reinforcement and punishment.
D. Family Perspective
Childhood abuse, particularly physical and emotional abuse and neglect, is
quite common among those with ASPD.
E. Biological Perspective
1) Lack of Emotional Responsiveness
People with antisocial personalities have lower galvanic skin response
levels when they are expecting painful stimuli than do normal controls.
2) The Craving-for-Stimulation Model
Perhaps they require a higher-than-normal threshold of stimulation to
maintain an optimum state of arousal.
People with ASPD generally have global under arousal in brain activity.
Low levels of the neurotransmitters dopamine and serotonin and the
stress hormone cortisol have been linked to ASPD.
3) The Brain Structures Abnormalities Model
Brain imaging links antisocial personality disorder to dysfunctions in parts
of the brain involved in regulating emotions and restraining impulsive
behaviors, especially aggressive behaviors.
Areas of the brain most directly implicated are the prefrontal cortex (gray
matter deficiency) and deeper brain structures in the limbic system such as
the amygdala (underactive).
F. Biopsychosocial Perspective
1) Nature and Nurture
ASPD is activated by genetic predispositions/biological factors in
conjunction with negative environmental influences.
Adopted Children Removed From Biological Mothers At Birth
Long Duration
in Orphanage
Short Duration
in Orphanage
Biological
Mother
With ASPD
High
Prevalence
of ASPD
Low
Prevalence
of ASPD
Biological
Mother
Without ASPD
Very Low
Prevalence
of ASPD
Very Low
Prevalence
of ASPD
G. Evolutionary Perspective
1) The Fearless Leader
VI. Borderline Personality Disorder:
characterized by features such as a deep sense
of emptiness, an unstable self-image, a history
of turbulent and unstable relationships, dramatic
mood changes, impulsivity, difficulty regulating
negative emotions, self-injurious behavior, and
recurrent suicidal behaviors.
BPD is at least three times more common in women than in men.
About 3% - 4% of the population has this disorder.
A. Emotional Swings
They experience a full rainbow of extreme emotional swings.
B. Harming Others and Self
Their overwhelming anger can result in physical aggression and violence.
Just as often, however, they direct their impulsive anger inward and harm
themselves.
They may engage in impulsive acts of self-mutilation, such as cutting
themselves, perhaps as a means of temporarily blocking or escaping from
deep, emotional pain.
1) Other impulsive, self-destructive behavior can
include...
a) Alcohol and substance abuse.
b) Suicidal threats and actions.
c) Reckless behavior, including driving and unsafe sex.
C. The BPD Relationship Cycle: Live, Die, Repeat
People with BPD may cling desperately to others whom they first idealize,
but then shift abruptly to utter contempt when they perceive the other as
rejecting them or failing to meet their emotional needs.
The centerpiece is a conflicting need for intimacy and recurrent fears of
impending abandonment.
D. Psychodynamic Perspective
1) Otto Kernberg
From this perspective, borderline individuals cannot synthesize
contradictory (positive and negative) elements of themselves and others
into complete, stable wholes.
Rather than viewing important people in their lives as sometimes loving
and sometimes rejecting, they shift back and forth between pure
idealization and utter hatred.
This rapid shifting back and forth between viewing others as either “all
good” or “all bad” is referred to as splitting.
E. Family Perspective
Childhood abuse, particularly sexual abuse coupled with neglect, is quite
common among those with BPD.
F. Biological Perspective: Brain Structures Abnormalities
VII. Histrionic Personality Disorder:
characterized by excessive emotionality, a
desire to be the center of attention, excessive
concern with one’s appearance, excessive
flirtatiousness and seductiveness, demanding of
praise and approval, and becoming furious if
rejected.
People with histrionic personality disorder tend to be dramatic and emotional,
but their emotions seem shallow, exaggerated, and volatile.
A. Other Key Features
1) They become unusually upset by news of a sad event
and exude exaggerated delight at a pleasant occurrence.
2) They tend to demand more than others.
3) They are intolerant of delays of gratification.
4) They grow quickly restless with routine and crave
novelty and stimulation.
5) Their attention-getting behaviors are so extreme that
they appear to be “on stage”.
6) Approval and praise are the lifeblood of these
individuals.
7) They often dress in a flamboyant way.
8) Found equally in men and women and in about 3% of
the population.
B. Family Perspective
Inconsistent attention from parents causes children to not take it for granted
and continually strive for it.
Social learning theory would suggest that they may be modeling their
parents’ dramatic and attention-seeking behavior.
Excessive sibling rivalry may motivate one to compete in dramatic ways for
attention.
VIII. Narcissistic Personality Disorder:
characterized by inflated or grandiose sense of
themselves and an extreme need for
admiration.
A. Other Key Features
1) They expect others to notice their special qualities,
even when their accomplishments are ordinary. They
often appear arrogant.
2) They are self-absorbed and lack empathy for others.
3) They tend to be preoccupied with fantasies of success
and power, ideal love, or recognition for brilliance or
beauty.
4) They seek the company of flatterers and, although they
are often superficially charming and friendly, their
interest in people is one-sided.
5) They have feelings of entitlement that lead them to
exploit others.
6) Around 1% of adults (3 times as many men as women)
display Narcissistic Personality Disorder.
B. Narcissistic Wound: a blow to the narcissist’s false sense of
importance that may never heal.
C. Psychodynamic Perspective
1) Hans Kohut
Early childhood involves a normal stage of healthy narcissism.
Infants feel powerful, as though the world revolves around them.
Empathic parents reflect their children’s inflated perceptions by making
them feel that anything is possible and by nourishing their self-esteem.
Lack of parental empathy and support, however, sets the stage for
pathological narcissism.
D. Family Perspective
Narcissistic Personality Disorder may develop when people are treated
too positively rather than too negatively in early life.
Those with the disorder have been taught to “overvalue their self-worth”.
IX. Avoidant Personality Disorder: these
people are very uncomfortable and inhibited in
social situations, overwhelmed by feelings of
inadequacy, and extremely sensitive to negative
evaluation.
The disorder is similar to social anxiety disorder, and many people with one
disorder experience the other. Similarities between the two disorders include
a fear of humiliation and low self-confidence.
A key difference is that people with social anxiety disorder mainly fear social
circumstances, while people with avoidant personality disorder tend to fear
close social relationships.
As many as 2% of adults have avoidant personality disorder, men as
frequently as women.
A. Family Perspective
Overly critical and punitive parental control may lead to feelings of
inadequacy.
X. Dependent Personality Disorder: these
people have a pervasive, excessive need to be
taken care of. The central feature of the disorder
is a difficulty with separation.
They are clinging and obedient, fearing separation from their loved ones.
They rely on others so much that they cannot make the smallest decision for
themselves.
Many people with this disorder feel distressed, lonely, and sad. Often they
dislike themselves.
They are at risk for depression, anxiety, and eating disorders and may be
especially prone to suicidal thoughts.
They have a very strong external locus of control.
Studies suggest that 2% of the population experience the disorder with men
and women affected equally.
A. Family Perspective
Children who are regularly discouraged from speaking their minds or
exploring their environments may develop a dependent behavior pattern.
Early parental loss or rejection may prevent normal experiences of
attachment and separation, leaving some children with lingering fears of
abandonment.
Other theorists argue that parents were overinvolved and overprotective,
increasing their children’s dependency.
Parents of those with dependent personality disorder unintentionally
rewarded their children’s clinging and “loyal” behavior while punishing acts of
independence.
XI. Obsessive-Compulsive Personality
Disorder: people with this disorder are
perfectionists (a.k.a. control freaks). They are
inflexible in personal habits, demand
orderliness, stick to established procedures and
patterns, and are very detail oriented. They
seek total control of themselves and their
environment.
They are meticulousness in work habits.
They set unreasonably high standards for themselves and others and,
fearing a mistake, may be afraid to make decisions.
They may have trouble expressing affection and their relationships are
often stiff and superficial.
They may exhibit extreme emotional outbursts to intimidate others and
may become physically violent if someone attempts to change their
behavior or lifestyle.
Around 5% of adults (twice as many men as women) display ObsessiveCompulsive Personality disorder.
A. Family Perspective
Children whose behavior is rigidly controlled and punished by parents, even for slight
transgressions, may develop inflexible, perfectionistic standards.
B. Evolutionary Perspective
1) The Maintainer of Order
XII. Recently Abandoned Personality
Disorders
A. Sadistic Personality Disorder
1) Humiliates or demeans people in the presence of
others.
2) Is amused by, or takes pleasure in, the psychological
or physical suffering of others (including animals).
3) Has lied for the purpose of harming or inflicting pain
on others (not merely to achieve some other goal).
B. Self-Defeating Personality Disorder (a.k.a. Masochistic
Personality Disorder)
1) Chooses people and situations that lead to
disappointment, failure, or mistreatment even when
better options are clearly available.
2) Following positive personal events (e.g., new
achievement), responds with depression, guilt, or a
behavior that produces pain (e.g. an accident).
3) Uninterested in or rejects people who consistently
treat them well (e.g. is not attracted to caring sexual
partners.)
XIII. Treatment of Personality Disorders
A. Psychodynamic Approaches
Psychodynamic approaches are often used to help people diagnosed with
personality disorders become aware of the roots of their self-defeating
behavior patterns and learn more adaptive ways of relating to others.
B. Cognitive-Behavioral Approaches
Cognitive behavior therapists focus on changing clients’ maladaptive
behaviors and dysfunctional thought patterns rather than their personality
structures.
They may use techniques such as modeling and reinforcement to help
clients develop more adaptive behaviors.
C. Biological Approaches
Drug therapy does not directly treat personality disorders. Antidepressants
or antianxiety drugs are sometimes used to treat associated depression or
anxiety in people with personality disorders.
XIV. Personality Disorders: Categories or
Dimensions?
A. Costa and McCrae’s “Big Five” Personality Traits
1) Neuroticism: the tendency to experience emotional
instability: anxiety, hostility, depression, self-consciousness,
impulsiveness, and vulnerability very easily.
2) Extraversion: the tendency to seek stimulation and enjoy
the company of other people.
3) Agreeableness: the tendency to be trusting and
compassionate rather than distrustful of and antagonistic
towards others.
4) Conscientiousness: the tendency to show self-discipline,
to be reliable, and to strive for competence and achievement.
5) Openness to Experience: the tendency to enjoy new
experiences and new ideas.
B. Issues with the “Big Five” Personality Traits
Impulse-Control Disorders
I. Impulse-Control Disorders: a category of
psychological disorders characterized by failure
to control impulses, temptations, or drives,
resulting in harm to oneself or others.
A. Kleptomania: characterized by repeated acts of compulsive
stealing.
The stolen objects are typically of little value or use to the person.
The person may give them away, return them secretly, discard them, or just
keep them hidden at home.
In most cases, people with kleptomania can easily afford the items they steal.
B. Intermittent Explosive Disorder (IED): characterized by
repeated episodes of impulsive, uncontrollable aggression in
which people strike out at others or destroy property.
People with IED have episodes of violent rage in which they suddenly lose
control and hit or try to hit other people or smash objects.
Typically, people with IED attempt to justify their behavior, but they also feel
genuine remorse or regret because of the harm their behavior causes.
Low levels of serotonin may be associated with this disorder as
antidepressants have shown promising results in terms of reducing IED
behavior.
C. Pyromania: characterized by repeated acts of compulsive fire
setting in response to irresistible urges.
People with pyromania feel a sense of release or psychological relief when
setting fires and report feeling empowered as the result of prompting
firefighters to rush to the scene of the blaze.
D. Gambling Disorder: characterized by repeated acts of
compulsive gambling in which an individual has extreme
difficulty disengaging from their gambling behavior.
The urge to gamble remains regardless of any patterns of winning or losing
although losing increases the strength of the urge.
Many compulsive gamblers have very low self-esteem and were abused as
children.
The thrill of winning may boost their self-esteem as they see themselves as
winners. However, the inevitable losses quickly shatter that self-esteem
boost.
They often become severely depressed and suicidal.
The prevalence rate is about 1% and more common in men than women.
1) Compulsive Gambling as a Nonchemical Addiction
2) Treatment of Compulsive Gambling
Antidepressants have proven to be moderately effective.
Attending self-help groups like Gamblers Anonymous (GA) can also be
helpful.
E. Compulsive Shopping???
F. Compulsive Internet Use???
G. Cybersex Addiction???