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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persistent, and resistant to change • Must also be associated with significant life problems Three W’s: Wild, Weird and Withdrawn • Easier to remember than Clusters A, B, C • Wild – – – – 1. 2. 3. 4.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Personality Disorder Narcissistic Personality Disorder Antisocial Personality Disorder Three W’s: Wild, Weird and Withdrawn • Weird – 1.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 Schizotypal Personality Disorder Three W’s: Wild, Weird and Withdrawn • Withdrawn – Avoidant Personality Disorder – Dependent Personality Disorder – Obsessive-Compulsive Personality Disorder Borderline Personality Disorder • Intense,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 • • • • 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 • • • • 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 • • • • 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 – – – – 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)