Personality Disorders: Understanding the Different Types, Causes, and Treatments - Prof. B, Study notes of Psychology

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Chapter 11: Personality Disorders -On Axis II because it is more engraved, permanent, enduring, and more difficult to treat Personality Disorders: An Overview • The Nature of Personality Disorders – Enduring and relatively stable predispositions (i.e., ways of relating and thinking and interacting with others) – Predispositions are inflexible and maladaptive, causing trouble, distress and/or impairment Disruptive in relationships with others – Coded on Axis II of the DSM-IV and DSM-IV-TR • DSM-IV and DSM-IV-TR Personality Disorder Clusters – be able to identify clusters on exam and figure out which disorder/cluster given symptoms – Cluster A – Odd or eccentric cluster (e.g., paranoid, schizoid, schizotypal) – Cluster B – Dramatic, emotional, erratic cluster (e.g., antisocial, borderline, histrionic, narcisstic) – Cluster C – Fearful or anxious cluster (e.g., dependent, avoidant, obsessive-compulsive) Personality Disorders: Facts and Statistics • Prevalence of Personality Disorders – Affect about 0.5% to 2.5% of the general population – Rates are higher in inpatient and outpatient settings • Origins and Course of Personality Disorders – Thought to begin in childhood when personality traits begin to develop • manifested in adulthood • Can’t be diagnosed with disorder until 18 – Tend to run a chronic course if untreated SEE TABLE IN BOOK (11.2) -Gender differences for personality disorder -Three that occur least frequently -Know which personality disorders occur in 1% or less of the clinical population Personality Disorders: Facts and Statistics (cont.) • Paranoid Personality Disorder – Pervasive and unjustified mistrust and suspicion of others – Belief that motives of others are bad or malevolent; people are always out to get you Frequently misinterpret remarks and looks from others as being bad They approach the world with very little trust • The Causes – Biological and psychological contributions are unclear – May result from early learning that people and the world is a dangerous place • Treatment Options – Few seek professional help on their own because they don’t trust others Don’t want people talking about them because they would say bad things – Treatment focuses on development of trust – Cognitive therapy to counter negativistic thinking – Lack good outcome studies showing that treatment is efficacious 1 Cluster A: Schizoid Personality Disorder • Overview and Clinical Features – Pervasive pattern of detachment from social relationships – Very limited range of emotions in interpersonal situations – Very few, if any, personal relationships – They neither desire or enjoy close relationships with others – loners by choice and are fine with it • The Causes – Etiology is unclear – Preference for social isolation in schizoid personality resembles autism • Treatment Options – Few seek professional help on their own – they are ok with how things are – Focus on the value of interpersonal relationships, empathy, and social skills – Treatment prognosis is generally poor – Lack good outcome studies showing that treatment is efficacious – Occurrence on chart Cluster A: Schizotypal Personality Disorder • Overview and Clinical Features – Behavior and dress is odd and unusual – Most are socially isolated and may be highly suspicious of others – Magical thinking, ideas of reference, and illusions are common – Risk for developing schizophrenia is high in this group – Have trouble keeping close relationships because of their odd behavior of dress • The Causes – Schizoid personality – A phenotype of a schizophrenia genotype? – Left hemisphere and more generalized brain deficits • Treatment Options – Main focus is on developing social skills – Treatment also addresses comorbid depression – Medical treatment is similar to that used for schizophrenia – Treatment prognosis is generally poor Cluster B: Antisocial Personality Disorder (George) • Overview and Clinical Features – Failure to comply with social norms and violation of the rights of others (stealing, lying for personal gain, conning others) – Irresponsible, impulsive, and deceitful – Lack a conscience (feelings of guilt), empathy for others, and remorse – Sometimes may develop psychopathic behaviors -MUST HAVE SYMPTOMS OF CONDUCT DISORDER PRIOR TO AGE OF 15 to qualify for diagnosis – shows these traits have been there a while • Relation Between Psychopathy and Antisocial Personality Disorder • Relation Between ASPD, Conduct Disorder, and Early Behavior Problems – Many have early histories of behavioral problems, including conduct disorder beginning in childhood – Many come from families with inconsistent parental discipline and support – Families often have histories of criminal and violent behavior 2 Cluster B: Narcissistic Personality Disorder • Overview and Clinical Features – Exaggerated and unreasonable sense of self-importance; love themselves Believe they are entitled to special treatment and attention – some people who are histrionic and look narcissistic – Preoccupation with receiving attention – Lack sensitivity and compassion for other people – Highly sensitive to criticism; get very defensive – Tend to be envious of others and arrogant • The Causes – Link with early failure to learn empathy as a child – Sociological view – Narcissism as a product of the “me” generation • Treatment Options – Extremely limited treatment research – Treatment focuses on grandiosity, lack of empathy, unrealistic thinking – Treatment may also address co-occurring depression – Little evidence that treatment is effective Cluster C: Avoidant Personality Disorder • Overview and Clinical Features – Extreme sensitivity to the opinions of others – Highly avoidant of most interpersonal relationships; don’t have a lot of friends; engage in friendships when they are almost certain they won’t be rejected – Are interpersonally anxious and fearful of rejection • The Causes – Numerous factors have been proposed – Early development – A difficult temperament produces early rejection • Treatment Options – Several well-controlled treatment outcome studies exist – Treatment is similar to that used for social phobia (social anxiety disorder) – Treatment targets include social skills and anxiety -Can look like schizoid on the surface (be able to distinguish) -Schizoid has very few or any friends because they neither desire or enjoy friendships – loners by choice -Avoidant wants friendships but they are afraid of rejection Cluster C: Dependent Personality Disorder • Overview and Clinical Features – Excessive reliance on others to make major and minor life decisions Might become involved in controlling or abusive relationships Base their decisions on the opinions of others – Unreasonable fear of abandonment; not same as those with borderline – Tendency to be clingy and submissive in interpersonal relationships • The Causes – Still largely unclear – Linked to early disruptions in learning independence • Treatment Options – Research on treatment efficacy is lacking – Therapy typically progresses gradually – Treatment targets include skills that foster independence 5 Cluster C: Obsessive-Compulsive Personality Disorder (OCPD) • Overview and Clinical Features – Excessive and rigid fixation on doing things the right way; rule-followers – Tend to be highly perfectionistic, orderly, and emotionally shallow – Obsessions and compulsions, as in OCD, are rare • The Causes – Are largely unknown • Treatment Options – Data supporting treatment are limited – Treatment may address fears related to the need for orderliness – Other targets include rumination, procrastination, and feelings of inadequacy -Not a symptom, but they tend to get caught up in the paralysis of perfection – have trouble completing a paper because it is not just right Summary of Personality Disorders • Personality Disorders – Long-standing, ingrained ways of thinking, feeling, and behaving • Disagreement Exists Over How to Categorize Personality Disorders – Categorical vs. dimensional, or some combination of both • DSM-IV and DSM-IV-TR Includes 10 Personality Disorder – Personality disorders fall in one of three clusters – Cluster A, B, or C • The Causes of Personality Disorders Are Difficult to Pinpoint • Treatment of Personality Disorders Is Often Difficult LOTS of personality disorder questions on exam – know clusters and identification by case study 6