Personality disorders, Study notes of Abnormal Psychology

Download Personality disorders and more Study notes Abnormal Psychology in PDF only on Docsity! Personality Disorders Introduction ● Personality is the set of unique characteristics/ traits and behaviours that defines an individual. ● Today there is reasonably broad agreement among personality researchers that about five basic personality trait dimensions can be used to characterize normal personality. ● This five-factor model of personality traits includes the following five trait dimensions: neuroticism, extraversion/ introversion, openness to experience, agreeableness/antagonism, and conscientiousness. Cluster A Disorders ● PARANOID PERSONALITY DISORDER: ● Pervasive suspiciousness and distrust of others, leading to numerous interpersonal difficulties. ● They tend to see themselves as blameless and are likely to blame others for their own mistakes and failures. ● Chronically tense ● “On guard,” constantly expecting trickery ● Looking for clues to validate their expectations while disregarding all evidence to the contrary. Cluster A Disorders ● Preoccupied with doubts about the loyalty ● They commonly bear grudges, refuse to forgive perceived insults and slights, and are quick to react with anger and sometimes violent behavior ● Paranoid personality disorder may consist of elements of both suspiciousness and hostility ● People with PPD are not psychotic as they are in touch with the reality, but they may experience transient psychotic symptoms due to intense stress. ● People with paranoid schizophrenia share some symptoms found in paranoid personality, but they have many additional problems including more persistent loss of contact with reality, delusions, and hallucination Cluster A Disorders ● Causal Factors: ● Possibility of partial genetic issues through genetically passed on low levels of agreeableness (that is high antagonism) neuroticism (anger and hostility). ● Psychosocial factors: parental neglect, abuse, exposure to violent adults. Cluster A Disorders ● Causal Factors: ● Early theorists considered a schizoid personality to be a likely precursor to the development of schizophrenia, but this viewpoint has been challenged, and any genetic link that may exist is very modest. ● Moderate heritability ● Severe impairment in underlying affiliation system ● Cognitive theorists propose that individuals with schizoid personality disorder exhibit cool and aloof behavior because of maladaptive underlying schemas that lead them to view themselves as self-sufficient loners and to view others as intrusive. (issues with core beliefs) Cluster A Disorders ● SCHIZOTYPAL PERSONALITY DISORDER: ● excessively introverted and have pervasive social and interpersonal deficits (like those that occur in schizoid personality disorder) ● But in addition they have cognitive and perceptual distortions, as well as oddities and eccentricities in their communication and behavior ● Mostly in contact with reality, they may experience psychotic symptoms when in intense stress. ● They often believe that they have magical powers and may engage in magical rituals. Cluster A Disorders ● Other cognitive–perceptual problems include ideas of reference (the belief that conversations or gestures of others have special meaning or personal significance), odd speech, and paranoid beliefs. ● Oddities in thinking, speech, and other behaviors are the most stable characteristics and this is very similar to what is seen in schizophrenia. ● Many researchers see STPD as a milder form of schizophrenia. ● Causal Factors: ● Moderate contribution of heritability. ● They have a difficulty in tracking a moving object Cluster B Disorders ● HISTRIONIC PERSONALITY DISORDER: ● Excessive attention-seeking behavior and emotionality are the key characteristics ● Tend to feel unappreciated if they are not the center of attention; their lively, dramatic, and excessively extraverted styles often ensure that they can charm others into attending to them. ● But these qualities do not lead to stable and satisfying relationships because others tire of providing this level of attention. ● In craving stimulation and attention, their appearance and behavior are often quite theatrical and emotional as well as sexually provocative and seductive. Cluster B Disorders ● Attempt to control their partners through seductive behavior and emotional manipulation, but they also show a good deal of dependence ● Their speech is often vague and impressionistic, and they are usually considered self- centered, vain, and excessively concerned about the approval of others. ● Other can see them as overly reactive, shallow, and insincere. ● More commonly found in women than in men due to the controversial idea that many characteristics found in HPD are also commonly found in women such as such as over dramatization, vanity, seductiveness, and over concern with physical appearance. Cluster B Disorders ● However, other personality traits prominent in histrionic personality disorder are actually more common in men than in women (e.g., high excitement seeking and low self-consciousness). ● Causal Factors: ● No clear causal factors found. ● Histrionic personality disorder is highly comorbid with borderline, antisocial, narcissistic, and dependent personality disorder diagnoses. ● Some evidence of genetic links have been found with Antisocial Personality Disorder, with the same genetic factors causing HPD in women and ASPD in men. Cluster B Disorders ● NARCISSISTIC PERSONALITY DISORDER: ● Exaggerated sense of self-importance, a preoccupation with being admired, and a lack of empathy for the feelings of others. ● Two subtypes of narcissism: grandiose and vulnerable narcissism. ● Grandiose narcissism: Traits related to grandiosity, aggression, and dominance. ● A strong tendency to overestimate their abilities and accomplishments while underestimating the abilities and accomplishments of others. ● Their sense of entitlement is frequently a source of astonishment to others, although they themselves seem to regard their lavish expectations as merely what they deserve. Cluster B Disorders ● They behave in stereotypical ways ● Unwillingness to forgive others for perceived slights, and they easily take offense. ● Vulnerable Narcissism: A very fragile and unstable sense of self-esteem, and for these individuals, arrogance and condescension is merely a façade for intense shame and hypersensitivity to rejection and criticism. ● May become completely absorbed and preoccupied with fantasies of outstanding achievement but at the same time experience profound shame about their ambitions. ● They may avoid interpersonal relationships due to fear of rejection or criticism. Cluster B Disorders ● Both subtypes are associated with: ● High levels of interpersonal antagonism/low agreeableness (which includes traits of low modesty, arrogance, grandiosity, and superiority), ● Low altruism (expecting favorable treatment and exploiting others) ● Tough-mindedness (lack of empathy). ● In grandiose narcissism, the distress can be seen more for the people around the person than the person themselves. ● In case of vulnerable narcissists, the high neuroticism can be experienced by them. Cluster B Disorders ● ANTISOCIAL PERSONALITY DISORDER: ● Key characteristic: continued violation and showing disregard for the rights of others through deceitful, aggressive, or antisocial behavior typically without remorse or loyalty to anyone. ● They tend to be impulsive, irritable, and aggressive and to show a pattern of generally irresponsible behavior. ● This pattern of behavior must have been occurring since the age of 15, and before age 15 the person must have had symptoms of conduct disorder, a similar disorder occurring in children and young adolescents who show persistent patterns of aggression toward people or animals, destruction of property, deceitfulness or theft, and serious violation of rules at home or in school. Cluster B Disorders ● BORDERLINE PERSONALITY DISORDER: ● A pattern of behavior characterized by impulsivity and instability in interpersonal relationships, self-image, and moods. ● Originally it was most often used to refer to a condition that was thought to occupy the “border” between neurotic and psychotic disorders (as in the term borderline schizophrenia). ● Later, however, this sense of the term borderline became identified with schizotypal personality disorder, which (as we noted earlier) is biologically related to schizophrenia. Cluster B Disorders ● The current diagnosis of BPD is no longer considered to be biologically related to schizophrenia. ● The central characteristic of BPD is affective instability, manifested by unusually intense emotional responses to environmental triggers, with delayed recovery to a baseline emotional state. ● Affective instability is also characterized by drastic and rapid shifts from one emotion to another. ● People with BPD have a highly unstable self-image or sense of self, which is sometimes described as “impoverished and/or fragmented” Cluster B Disorders ● As many as 75 percent of people with BPD have cognitive symptoms. These include relatively short or transient episodes in which they appear to be out of contact with reality and experience delusions or other psychotic-like symptoms such as hallucinations, paranoid ideas, or severe dissociative symptoms. ● Comorbidity with other disorders: ● Significant impairment in social, academic, and occupational functioning ● Unipolar and bipolar mood and anxiety disorders (especially panic and PTSD) to substance- use and eating disorders. ● BPD individuals show different neural responses to emotional stimuli than do individuals with chronic depression Cluster B Disorders ● There is also substantial co-occurrence of BPD with other personality disorders— especially histrionic, dependent, antisocial, and schizotypal personality disorders. ● Causal Factors: ● Genetic factors are evident ● This heritability may be partly a function of the fact that personality traits of affective instability and impulsivity, which are both very prominent in BPD, are themselves partially heritable. ● Certain parts of the 5-HTT gene implicated in depression may also be associated with BPD Cluster B Disorders ● Genes involved in dopamine transmission are also involved. ● People with BPD also have a lower serotonin neurotransmitter. ● This may be why they show impulsive-aggressive behavior, as in acts of self-mutilation; that is, their serotonergic activity is too low to “put the brakes on” impulsive behavior ● Patients with BPD may also show disturbances in the regulation of noradrenergic neurotransmitters that are similar to those seen in chronic stress conditions such as PTSD. ● Certain brain areas that inhibit aggressive responses due to serotonin show decreased activation in BPD. Cluster C Disorders ● Feeling incompetant and socially inadequate are the two most prevalent and stable features of avoidant personality disorder. ● More generalized timidity and avoidance of many novel situations and emotions (including positive emotions), and show deficits in their ability to experience pleasure as well. ● The key difference between the loner with schizoid personality disorder and the loner who is avoidant is that the latter is shy, insecure, and hypersensitive to criticism, whereas someone with a schizoid personality is more aloof, cold, and relatively indifferent to criticism. Cluster C Disorders ● The person with avoidant personality also desires interpersonal contact but avoids it for fear of rejection, whereas in schizoid personality disorder there is a lack of desire or ability to form social relationships. ● APD can be a severe manifestation of generalised anxiety disorder. ● APD is usually accompanied by certain generalized social phobia. ● Somewhat higher levels of dysfunction and distress are also found in the individuals with avoidant personality disorder, including more consistent feelings of low self- esteem. Cluster C Disorders ● Causal factors: ● Innate “inhibited” temperament that leaves the infant and child shy and inhibited in novel and ambiguous situations. ● Modest genetic influence and same genetic link as social phobia ● Fear of being negatively evaluated ● Introversion and neuroticism ● Early emotional abuse, rejection, or humiliation from parents who are not particularly affectionate. ● Likely to lead to anxious and fearful attachment patterns in temperamentally inhibited children Cluster C Disorders ● It is quite common The person with avoidant personality desires social contact but avoids it because of a fear of rejection. for people with dependent personality disorder to have a comorbid diagnosis of mood and anxiety disorders as well as eating disorders ● Some features of dependent personality disorder overlap with those of borderline, histrionic, and avoidant personality disorders, but there are differences as well. ● In terms of the five-factor model, dependent personality disorder is associated with high levels of neuroticism and agreeableness. Cluster C Disorders ● Causal Factors: ● Modest genetic influence. ● Neuroticism and agreeableness have a genetic link which can indirectly influence APD. ● Adverse effects of parents who are authoritarian and overprotective (not promoting autonomy and individuation in their child but instead reinforcing dependent behavior). ● Underlying maladaptive schemas for these individuals as involving core beliefs about weakness and competence and needing others to survive. Cluster C Disorders ● OBSESSIVE COMPULSIVE PERSONALITY DISORDER: ● Perfectionism and an excessive concern with maintaining order and control characterize individuals with obsessive-compulsive personality disorder (OCPD). ● Their preoccupation with maintaining mental and interpersonal control occurs in part through careful attention to rules, order, and schedules. ● They are careful in what they do so as not to make mistakes, but because the details they are preoccupied with are often trivial they use their time poorly and have a difficult time seeing the larger picture. Cluster C Disorders ● They are also high on assertiveness (a facet of extraversion) and low on compliance (a facet of agreeableness). ● Three primary dimensions of personality: novelty seeking, reward dependence, and harm avoidance. ● Individuals with obsessive compulsive personalities have low levels of novelty seeking (i.e., they avoid change) and reward dependence (i.e., they work excessively at the expense of pleasurable pursuits) but high levels of harm avoidance (i.e., they respond strongly to aversive stimuli and try to avoid them). Treatments and Outcomes for PDs ● Personality disorders are generally very difficult to treat, in part because they are, by definition, relatively enduring, pervasive, and inflexible patterns of behavior and inner experience. ● Many different goals of treatment can be formulated, and some are more difficult to achieve than others. ● Goals might include reducing subjective distress, changing specific dysfunctional behaviors, and changing whole patterns of behavior or the entire structure of the personality. Treatments and Outcomes for PDs ● In many cases, people with personality disorders enter treatment only at someone else’s insistence, and they often do not believe that they need to change. ● Moreover, those from the odd/ eccentric Cluster A and the erratic/dramatic Cluster B have general difficulties in forming and maintaining good relationships, including with a therapist. ● For those from the erratic/dramatic Cluster B, the pattern of acting out typical in their other relationships is carried into the therapy situation, and instead of dealing with their problems at the verbal level they may become angry at their therapist and loudly disrupt the sessions. Treatments and Outcomes for PDs ● For people with severe personality disorders, therapy may be more effective in situations where acting-out behavior can be constrained. (Eg: suicidal tendencies in BPD) ● Partial-hospitalization programs are increasingly being used as an intermediate and less expensive alternative to inpatient treatment. ● In these programs, patients live at home and receive extensive group treatment and rehabilitation only during weekdays. Treatments and Outcomes for PDs ● Specific therapeutic techniques are a central part of the relatively new cognitive approach to personality disorders that assumes that the dysfunctional feelings and behavior associated with the personality disorders are largely the result of schemas that tend to produce consistently biased judgments, as well as tendencies to make cognitive errors ● Such an approach uses standard cognitive techniques of monitoring automatic thoughts, challenging faulty logic, and assigning behavioral tasks in an effort to challenge the patient’s dysfunctional beliefs. Treating BPD ● Biological treatments: ● Antidepressant medications (most often from the SSRI category) are considered most safe and useful for treating rapid mood shifts, anger, and anxiety. ● Low doses of antipsychotic medication: patients show some improvement in depression, anxiety, suicidality, impulsive aggression, rejection sensitivity, and especially transient psychotic symptoms and cognitive and perceptual distortions. ● Mood-stabilizing medications such as carbazemine may be useful in reducing irritability, suicidality, affective instability and impulsive aggressive behavior. Treating BPD ● Patients receiving DBT show reductions in self-destructive and suicidal behaviors as well as in levels of anger. ● Other psychosocial treatments for BPD involve variants of psychodynamic psychotherapy adapted for the particular problems of people with this disorder. ● Kernberg (1985, 1996) and colleagues have developed a form of psychodynamic psychotherapy that is much more directive than is typical of psychodynamic treatment. ● The primary goal is seen as strengthening the weak egos of these individuals, with a particular focus on their primary primitive defense mechanism of splitting. Treating BPD ● Bateman and Fonagy have developed a new therapeutic approach called mentalization. ● This uses the therapeutic relationship to help patients develop the skills they need to accurately understand their own feelings and emotions, as well as the feelings and emotions of others. Treating Other Personality Disorders ● Treatment of Cluster A and other Cluster B personality disorders is not, so far, as promising as some of the recent advances that have been made in the treatment of BPD. ● Antidepressants from the SSRI category may also be useful. However, no treatment has yet produced anything approaching a cure for most people with this disorder. ● No systematic, controlled studies of treating people with either medication or psychotherapy yet exist for paranoid, schizoid, narcissistic, or histrionic disorder. ● One reason for this is that these people (because of the nature of their personality pathology) rarely seek treatment. Treatments and Outcomes in Psychopathic and Antisocial Personality ● Biological treatments: electroconvulsive therapy and drugs have shown modest difference. ● Drugs such as lithium and anticonvulsants used to treat bipolar disorder have had some success in treating the aggressive/impulsive behavior of violent aggressive criminals. ● Using antidepressants from the SSRI category, which can sometimes reduce aggressive/ impulsive behavior and increase interpersonal skills. Treatments and Outcomes in Psychopathic and Antisocial Personality ● Cognitive Behavioural Treatment: ● Common targets of cognitive-behavioral interventions include the following: ● (1) Increasing self-control, self-critical thinking, and social perspective taking; ● (2) Increasing victim awareness ● (3) Teaching anger management ● (4) Changing antisocial attitudes ● (5) Curing drug addiction. ● Thinking about management rather than treatment of psychopathic offenders due to the modest outcome of the treatment modalities. Treatments and Outcomes in Psychopathic and Antisocial Personality ● Fortunately, the criminal activities of many psychopathic and antisocial personalities seem to decline after the age of 40 even without treatment, possibly because of weaker biological drives, better insight into self-defeating behaviors, and the cumulative effects of social conditioning. ● They are also called ‘burned out psychopaths’. ● It is only the antisocial behavioral dimension of psychopathy that seems to diminish with age; the egocentric, callous, and exploitative affective and interpersonal dimension persists.