Personality Disorders: Paranoid, Schizoid, Histrionic, Narcissistic, and Antisocial PDs - , Study notes of Abnormal Psychology

Download Personality Disorders: Paranoid, Schizoid, Histrionic, Narcissistic, and Antisocial PDs - and more Study notes Abnormal Psychology in PDF only on Docsity! Personality Disorders Chapter 12 Personality • Unique pattern of relatively enduring traits & behaviors that characterize an individual • Relatively stable traits are persistent over time/situations • Healthy personality associated with successful adjustment: flexibly adapting to changing demands, opportunities, and limitations associated with different stages of life Personality Disorders: Difficulties in Diagnosis  Lifetime prevalence estimates ~ 10%  Not diagnosable until 18 yrs old  We all exhibit some of the traits that characterize personality disorders (extreme versions of otherwise “normal” traits)  Similar features across personality disorders  Adherence to diagnostic criteria? Neuroticism Extraversion Openness to experience Agreeableness Conscientiousness Five Factor Model: Based on the Big 5 Personality Factors Classification of Personality Disorders Cluster A: Odd-Eccentric Personality Disorders  Symptoms similar to those for schizophrenia, including inappropriate or flat affect, odd thought and speech patterns, paranoia. People with these disorders maintain their grasp on reality, however. Cluster B: Dramatic Emotional Personality Disorders  Manipulative, volatile, and uncaring in social relationships. Impulsive, sometimes violent behavior that show little regard for their own safety or the safety or needs of others Cluster C: Anxious- Fearful Personality Disorders  Extremely concerned about being criticized or abandoned by others and thus have dysfunctional relationships with them. Cluster C: The Anxious-Fearful Personality Disorders Avoidant personality disorder Pervasive anxiety, a sense of inadequacy, and a fear of being criticized, which leads to the avoidance of social interactions and nervousness. Dependent personality disorder: Pervasive selflessness, need to be cared for, fear of rejection, leading to total dependence on and submission to others. . Obsessive-compulsive personality disorder Pervasive rigidity in one’s activities and interpersonal relationships, including emotional construction, extreme perfectionism, and anxiety about even minor disruptions in one’s routine. Cluster A: Odd or Eccentric Paranoid 0.5 - 5.6% Schizoid 0.4 - 1.7 % Schizotypal 0.6 - 5.2 % Basic Belief: People are potential adversaries Strategy: Wariness  I cannot trust other people.  Other people have hidden motives.  I have to be on guard at all times. Paranoid PD Felix  59-years old construction worker  Worries coworkers might hurt him: last week cut his hand on a table saw (thinks someone sabotaged him)  Notices coworkers watching him & whispering  Doesn’t have close friends, family avoids him (constantly accuses them of criticizing him)  Constantly expects someone to break into his house Jennifer  29 years old, convinced coworkers are scheming to make her look bad in front of her boss  Friendliness is a front, pages are missing from an important presentation  Left her last job abruptly after backstabbing coworkers  Becomes suspicious, jealous, vengeful towards friends Treatment of Paranoid PD  Maybe part of schizophrenic spectrum?  More common in families with schizophrenia  Cognitive Perspective:  Underlying fear/paranoid cognitions  Lack of self-confidence about defending against others  Goal is to establish some degree of trust, improve interpersonal relationships to some extent, increase self-efficacy (reduce sense of danger)  Cannot directly confront paranoid thinking Characterized by detachment from social relationships & restricted emotional expression • Neither desire nor enjoy close relationships, even family • Almost always choose solitary activities • Little or no desire to have sexual experiences with another person • Pleasure in few, if any activities • Lacks close friends or confidants other than relatives • Indifferent to the praise and criticism of others • Shows emotional coldness, detachment or flat affect Schizoid PD: Diagnostic Criteria Sara  22 year old, has spent most of her life doing things alone  During childhood, spent afternoons watching tv or working on her computer; no interest in making friends in high school  Currently works at a factory, has 1 friend who occasionally calls, spends most of her time with video games & tv  Has never been bothered by being alone Schizoid PD Treatment  Schizoid personality may function as a defensive withdrawal from others (avoid emotion, pain & disappointment)  Cognitive perspective: rigid beliefs & expectancies, view self as “loner” & value seclusion; difficulty interpreting & understanding emotional cues  Psychosocial treatments: focus on increasing social skills, social contact and awareness of feelings  Therapist modeling, role-play, homework assignments  Group therapy - practice new skills directly Schizotypal PD: Diagnostic Criteria Characterized by interpersonal problems & odd patterns of thinking, perceiving, & behaving • Ideas of reference • Odd beliefs, magical thinking that influences behavior (e.g., belief in clairvoyance, or bizarre fantasies) • Unusual perceptual experiences, including bodily illusions • Odd thinking or speech • Suspiciousness or paranoid ideation • Behavior or appearance that is odd, eccentric, or peculiar • Inappropriate affect or appearance • Lack of close friends other than first-degree relatives • Excessive social anxiety (doesn’t diminish with familiarity), often associated with paranoid fears Martin  Described as ‘eccentric’  As a teenager dressed in colors that described his mood for the day (i.e., all yellow, red, blue or black) & believed his mood could influence others  After high school, worked at a convenience store; often felt uncomfortable around customers (suspected they said mean things about him)  Had a crush on a coworker, but his strange ways pushed her away; wrote long, rambly love letters, told her he thought they were meant for each other because they worked at the same place; convinced he could make her love him if he thought nice thoughts about her each day Schizotypal Treatment • Mild form of schizophrenia? • Often treated with schizophrenia drugs – Atypical antipsychotics – Antidepressants • Psychotherapy goals: establish client-patient relationship, increase social contacts, learn socially appropriate behaviors • Group therapy Basic Belief: I need to impress Strategy: Dramatics  I am inadequate, unable to handle life on my own  Need other people to pay attention to me to be happy  Unless I entertain or impress people, I am nothing  To get what I want I need to dazzle or amuse  I should be the center of attention Histrionic PD Histrionic PD Profile  Seek continuous excitement, attention & appreciation  Easily hurt, deep dependency needs  Lively, dramatic, enthusiastic, & flirtatious  Inappropriately sexually provocative  Easily influenced by others  Use excessive emotions to manipulate others, rather than to express genuine feelings  May experience inconsistent parenting style:  parents are indifferent/ insensitive rather than punitive  Rewards for exhibitionist behavior Histrionic PD is marked by a pervasive pattern of excessive emotionality and attention seeking  Uncomfortable when not center of attention  Interactions characterized by inappropriate sexually seductive or provocative behavior  Use physical appearance to draw attention to self  Self-dramatization, theatricality, & exaggerated expression of emotion  Suggestible, i.e., easily influenced by others or circumstances  Considers relationships to be more intimate than they actually are Histrionic PD: Diagnostic C iteria Histrionic PD Treatment:  Often prompted by depression  Psychotherapy aimed at self-development  Resolution of conflict  Uncovering repressed emotions & needs  Express emotions in socially appropriate manner  Medication may be helpful with symptoms of depression  Group therapy not recommended  Often perpetuates histrionic behavior Narcissistic Personality Disorder <1% Basic Belief: I am special Strategy: Self-aggrandizement  I am a very special person  Since I am so superior, I am entitled to special treatment & privileges  I don't have to be bound by rules that apply to other people Narcissistic PD Kathy  Sought therapy after the end of a relationship, history of ended relationships  Initially charming and engaging, but ultimately superficial in therapy  Unable to articulate source of her distress, vague and imprecise  Interpreted all situations as “tragic”  Many relationships, no close friends  Described as flashy and shallow by co-workers Narcissistic PD Treatment  Medication & therapy not very effective  Schema Therapy (integrates psychodynamic, cognitive, behavioral etc.)  Individual & group therapy may be beneficial  Unusual for people to seek therapy for NPD  Subconscious fears of exposure or inadequacy -> defensive disdain of therapeutic processes  Co-existing conditions of depression & anxiety are typical Borderline Personality Disorder 1 -2% Borderline PD: Diagnostic Criteria Pervasive pattern of instability of interpersonal relationships, self image, & affect; marked impulsivity  Frantic efforts to avoid real or imagined abandonment  Unstable & intense interpersonal relationships (marked alternating between extremes of idealization & devaluation)  Identity disturbance: markedly/persistently unstable self- image  Impulsiveness: at least 2 potentially self-damaging areas  Inappropriate, intense anger or difficulty controlling anger  Affective instability: Drastic, unpredictable mood shifts, chronic feelings of emptiness  Recurrent attempts to self-mutilate or suicide  Transient, stress related paranoid ideation or severe dissociative symptoms Lou  27-year-old salesman  Long-term friendships with men, but “trouble with women.” Has many dates because of good looks & charm, but can’t sustain relationships  Becomes surprisingly angry when girlfriends have to cancel or change plans  Most recent relationship, fell madly in love in 2 days; became devastated when girlfriend had to leave town for the weekend; called her to tell her he felt alone & that if she didn’t come home he would have to hurt himself  Negative evaluation from boss because of missing work repeatedly, came as a complete surprise; responded by going home and drinking until he passed out Borderline Treatment  Problems often result from maladaptive attempts to cope with extreme emotional distress  Often history of abuse (40-76% report) and inadequate parental support  Black and white thinking  The world is dangerous & cruel  Others are all good or all bad  I am unacceptable  My feelings won’t be taken seriously  Externalize all feelings of “badness” outside the self Antisocial Behavior  “Moral Insanity,” “moral imbecility,” “moral defect”  “Psychopathic”  19th cent. reference to dangerous criminal behavior  “Sociopathic personality disturbance”  DSM-I description of aggressive, criminal personalities  “Antisocial”  DSM-II description; highlights criminality Irresponsible, Impulsive, Wreckless Dangerous Aggresion, Cold- blooded, Remorseless Antisocial PD Profile  Disregard for others’ rights  Focus on own interests at the expense of others  Lack of remorse, little guilt about misbehavior  Superficial charm & good intelligence  Shallow emotions & lack of empathy  Anger when confronted  Little life plan or order  Failure to learn from experiences  Unreliability, insincerity, untruthfulness Pervasive pattern of disregard, violation of the rights of others  Failure to conform to social norms of lawful behaviors  Deceitfulness - repeated lying, use of aliases, conning others for personal profit or pleasure  Impulsivity or failure to plan ahead  Irritability & aggressiveness - repeated physical fights/ assaults  Reckless disregard for safety of self or others  Consistent irresponsibility - repeated failure to sustain consistent work behavior or honor financial obligations  Lack of remorse – indifference to having hurt, mistreated another Antisocial PD: Diagnostic Criteria Etiology of Antisocial PD  Serotonin  Animal studies show impulsive & aggressive behaviors are linked to low levels of neurotransmitter serotonin  ADHD  Significant % of children who show antisocial tendencies also have ADHD  Executive Functions  Antisocial personalities show deficits in verbal skills and in executive functions (i.e., concentration, abstract reasoning, goal formation, self-monitoring, self-awareness, etc).  Differences have been reported in structure/function of temporal & frontal lobes between antisocial adults and general population. Etiology of Antisocial PD  Arousability  Low resting HR, low skin conductance activity, excessive slow- wave EEG -> low fear response/lack of typical anxiety response  Lykken’s classic research: He reported that psychopaths exhibited less aversion to frightening social and physical situations (heroes & psychopaths)  Chronic low arousal may lead to excessive stimulation seeking  Social Cognitive Factors  Harsh, neglectful parenting; punitive, physically abusive parents  Luntz & Widom -- Childhood victimization played major role in becoming antisocial adults  Low self-esteem, need to prove competence by engaging in aggressive acts Treatment of ASPD  Goal is often to get them to feel worse about themselves and situation in effort to make them realize what they have done is wrong  Reflection  Group therapy – feedback from peers has forceful impact  “Success” occurs when client begins to feel remorse and guilt  Although treatments have failed to produce positive results, there is a tendency for some ASPD clients to “burn out” as they age Basic Belief: I may get hurt. Strategy: Avoidance • I am socially inept and socially undesirable in work or social situations. • Other people are potentially critical, indifferent, demeaning, or rejecting. • If people get close to me, they will discover the "real" me and reject me. Avoidant PD Avoidant PD Profile  Shyness to a pathological extreme  Tense in social situations, fear seeming inadequate  Avoid social situations, socialize only when certain they will be liked or uncritically accepted  “Loners” who strongly desire relationships  Preoccupied with how they might potentially humiliate themselves  Pervasive and chronic compared to social phobia Pervasive pattern of social inhibition, feelings of inadequacy, hypersensitivity to negative evaluation  Avoids occupations involving significant interpersonal contact (ears of criticism & rejection)  Unwilling in relationships unless certain of being liked  Fear of shame or ridicule in romantic relationships  View self as socially inept, unappealing, or inferior  Preoccupied with being criticized or rejected in social situations  Avoids risks and new activities for fear of embarrassment Avoidant PD: Diagnostic C iteria Dependent Personality Disorder Basic Belief: I am helpless & inadequate. Strategy: Attachment  I am helpless when I am left on my own.  The worst possible thing would be to be abandoned.  I must do nothing to offend my supporter or helper. Dependent PD Dependent PD Profile  Feel that cannot care for self, make decisions, or take responsibility for their life  Depend on others for most minor situations & decisions even though they are capable  Clingy and needy in relationships  Worry about what will happen if left to care for self  Feel devastated and terrified when close relationships end; ctively seek another caretaking relationship  Allow others to take advantage of them in order to maintain the relationship Dependent PD Treatment  Psychodynamic Components:  Defense Mechanism: regression to protect from adult responsibilities; idealization of protector  CBT Components:  Challenge distorted beliefs that the individual is incapable of caring for self  Create opportunities for autonomy  Assertiveness training Obsessive-Compulsive Personality Disorder Basic Belief: Errors are bad. I must not make a mistake. Strategy: Perfectionism  I am fully responsible for myself and others.  I have to depend on myself to see that things get done.  Others tend to be too casual, often irresponsible, self-indulgent, or incompetent.  It is important to do a perfect job on everything. Obsessive-Compulsive PD Natalie  Supervisor at a company; employees frequently quit  Exacting and meaningless guidelines (i.e., proof of illness if called in sick)  Detailed lists for all tasks (including coffee)  Relationships seldom last (rigid, bossy)  Difficult to enjoy life OCPD Treatment  Psychodynamic Components  Defense Mechanisms: reaction formation, undoing (to negate unacceptable feelings); isolation of affect (separation of thought & emotions)  CBT Components  Cognitive style: “missing the forest for the trees”  Challenge irrationality of focusing on the details, productivity is more important than pleasure Impulse Control Disorders 1. Fail to resist an impulse or temptation to perform some act although know it is considered wrong 2. Experience tension or arousal before the act 3. After the act, they feel a sense of excitement, gratification or release (guilt may or may not follow)