Download Personality Disorders

Personality Disorders
Thomas G. Bowers, Ph.D.
Penn State Harrisburg
General Characteristics
• Long-standing, maladaptive patterns of
behavior
• Generally recognizable by adolescence
• Tend to be inflexible, persistent, and
resistant to change
• Must also be associated with significant life
problems
Three W’s: Wild, Weird and
Withdrawn
• Easier to remember than Clusters A, B, C
• Wild
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1.
2.
3.
4.
Borderline Personality Disorder
Histrionic Personality Disorder
Narcissistic Personality Disorder
Antisocial Personality Disorder
Three W’s: Wild, Weird and
Withdrawn
• Weird
– 1. Paranoid Personality Disorder
– 2. Schizoid Personality Disorder
– 3. Schizotypal Personality Disorder
Three W’s: Wild, Weird and
Withdrawn
• Withdrawn
– Avoidant Personality Disorder
– Dependent Personality Disorder
– Obsessive-Compulsive Personality Disorder
Borderline Personality Disorder
• Intense, unstable relationships
• Instability in mood, self-image
– “Who am I?”
• Unpredictable and impulsive behavior
– Often self damaging, as gambling, sexual
behavior, spending sprees
Borderline Personality Disorder
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Intense fear of aloneness
Extreme fears of abandonment
Demand attention
Alternate between idealization and
devaluation
• Chronic feelings of emptiness and boredom
• Often suicidal feelings and gestures
Borderline Personality Disorder
• Long interest from psychoanalytic field (as
Kernberg)
• Thought to be “borderline” between
psychosis and neurosis
• Tend to decompensate into psychotic state
under stress
Borderline Personality Disorder
• Object relations theory
• Introjection of important values and images
of other important people (as parents) may
be faulty
• Frequently see issues as a weak, ineffectual
father (often totally absent, or even
abandoning family)
• Domineering mother
Borderline Personality Disorder
• Inconsistent provision of warmth and
affection
• Frequently reported childhood physical and
sexual abuse
• Some biological relationships
• Respond positively to SSRI
• Familial, thought to be be genetic links
• Related to bipolar affective disorder
Borderline Personality Disorder
• Video assignment: “Fatal Attractions” note
Glen Close in her role
Histrionic Personality Disorder
• Overly dramatic, attention-seeking
• Display excessive emotion, but in fact are
emotionally shallow
• Self-centered
• Inappropriately sexually provocative and
seductive
• Pseudohypersexuality
Narcissistic Personality Disorder
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Grandiose and exaggerated sense of self
Literary in love with themselves
Require constant attention and admiration
Lack of empathy, strong feelings of
arrogance, entitlement
• Take advantage of others
Antisocial Personality Disorder
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Psychopathy (or sociopathy)
Cleckly - The Mask of Sanity
Emotional aloofness and detachment
Hare - contemporary researcher
– Psychopathy appears to be distinct from ASPD
Antisocial Personality Disorder
• Little ability to profit from experience
– In particular, ASPD individuals do not seem to
learn well to aversive stimulus conditions
• Genetic factors appear to play a role, as do
environmental factors
– Lack of affection, severe rejection, inconsistent
discipline, fathers often are antisocial
Antisocial Personality Disorder
• Chronic cortical under arousal
• Impulsivity, difficulties in goal directed
behavior
• Noted increased slow wave activity,
temporal region spikes on EEG
“Weird” Cluster
• Paranoid Personality
– Highly suspicious of people, tends to mistrust
others, expects to be mistreated
– Extremely jealous
• Schzoid Personality
– Does not desire or enjoy social relationships
– Bland, aloof, loners
“Weird” Cluster
• Schizotypal Personality
• Attenuated form of schizophrenia
• Interpersonally similar to schizoid, with
eccentric nature
• Odd beliefs, magical thinking
• Illusions
“Weird” Cluster
• Etiology
– May be a variant of schizophrenic range
disorders
– Family patterns noted
Withdrawn Cluster
• Dependent Personality
– Lacks self-confidence, independence, selfreliance
– Passive and dependent stance
– Intense need to be taken care of, unable to make
demands on others
– Tends to sacrifice needs of self for others
– Fairly common
Withdrawn Cluster
• Avoidant Personality
– Keenly sensitive to rejection, disapproval
– Extremely restrained, easily embarrassed
– Exaggerate risks, dangers
Withdrawn Cluster
• Obsessive Compulsive Personality
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Perfectionistic, preoccupied with rules, details
Work excessively
Stubborn, rigid, demanding
Tend to be rigid and inflexible, moralistic
Diagnostic Issues
• Reliability problems been noted
• Structured interviews are now helpful
• Considerable comorbidity
Interrater and Test-retest
Reliability
Diagnosis
Paranoid
Schzoid
Schizotypal
Borderline
Histrionic
Antisocial
Dependent
Interrater
.75
.83
.82
.89
.81
.88
.89
Test-Retest
.57
NA
.11
.56
.40
.84
.15
Treatment of Personality
Disorders
• Psychodynamic therapy
– Object relations therapy (Kernberg)
• Focus on ego development
• Interpretative
• “Reality testing”
– Dialectical behavior therapy
• Linehan - Empirically tested
• Client centered and cognitive methods
Treatment of Personality
Disorders
• Dynamic-Cognitive Therapy
– Turner
• Cognitive Therapy
– Beck
– Negative schemata of world thought to operate
Treatment of Personality
Disorders
• Psychopathy is very difficult to treat
effectively
– May be unsuitable for psychotherapy (or any
type of personal relationship)