Personality Disorder

Question 1

What are Personality Disorders?

Answer 1

A group of disorders marked by persistent, inflexible, maladaptive patterns of thought and behaviour that develop in adolescence or early adulthood and significantly impair an individual’s ability to function

Question 2

What are the characteristics of a personality disorder?

Answer 2

 Enduring pattern of behaviour that deviates markedly from expectations within the culture

 Associated with unusual ways of interpreting events, unpredictable mood swings or impulsive behaviour

 Result in impairments in social and occupational functioning

 Represent stable patterns of behaviour that can be traced back to adolescence or early childhood

 Previously characterized as Axis II disorders because they represent long-standing, pervasive and inflexible patterns of behaviour

Question 3

What are the primary clusters of personality disorders?

Answer 3

 DSM-IV-TR (APA, 2000) organised personality disorders into three clusters:

 Odd/Eccentric Personality Disorders

 Dramatic/Emotional Personality Disorders

 Anxious/Fearful Personality Disorders

Question 4

Odd/Eccentric Personality Disorders (Cluster A)

Disorder Characteristics

Answer 4

Paranoid
Suspiciousness and mistrust of others;
tendency to see self as blameless; on
guard for perceived attacks by others

Schizoid
Inability and lack of desire to form attachments to others; impaired social relationships

Schizotypal
Reduced capacity for close interpersonal relationships, eccentric behavior, and peculiar thought patterns

Question 5

Dramatic/Emotional Personality Disorders (Cluster B)

Disorder Characteristics

Answer 5

Histrionic

Excessive emotionality and attention seeking
behavior; sexually provocative and seductive; theatrical; overly concerned re: own attractiveness

Narcissistic

Grandiosity and need for admiration;
self promoting; lack of empathy

Antisocial

Disregard for and violation of rights of others;
Lack of moral development; deceitfulness;
shameless manipulation of others

Borderline

Instability in interpersonal relationships, affect,
and self-image, impulsiveness; chronic feelings of
boredom; attempts at self-mutilation or suicide

Question 6

Anxious/Fearful Personality Disorders (Cluster C)

Disorder Characteristics

Answer 6

Avoidant

Social inhibition and hypersensitivity to negative
evaluation; shyness; intimate relationships
difficult without guarantee of acceptance

Dependent

Excessive need to be taken care of leading to
submissive and clinging behavior; indecisiveness
– need others to make decisions for them or
reassure them; to avoid losing approval, never
disagree

Obsessive

Excessive concern with perfectionism,
Compulsive order, rules, and trivial details; lack of expressiveness
and warmth; difficulty in relaxing and having fun

Question 7

What are some conceptual issues with personality disorders?

Answer 7

 Personality Disorders may not be discrete disorders but represent extremes of normal personality (Costa & McRae, 1990)

 Many of the characteristics of different personality disorders overlap (e.g. impulsivity)

Question 8

What are the characteristics of anti social personality disorder?

Answer 8

 The term sociopath or psychopath is sometimes used to describe this personality type

 APD is now defined mainly in terms of violations of social norms

 Is highly associated with criminal and violent behaviour

 Prison populations have between 50-70% of inmates diagnosable with APD (Fazel & Danesh, 2002)

Question 9

What are the characteristics of borderline personality disorder?

Answer 9

 Features an enduring pattern of instability in personal relationships and lack of well-defined self-image

 Fear of abandonment is a central feature which leads to conflict-ridden relationships

 Associated with regular mood swings and aggressive behaviour

 Highly comorbid with Axis I disorders such as depression and anxiety disorders

Question 10

What Is ‘Disordered’ About Personality Disorders

Answer 10

 People with personality disorders are often referred for treatment because of the consequences of their behaviour:

 Some are unable to form lasting, close relationships

 Many often develop comorbid Axis I disorders

 Their behavioural style may be a risk to themselves or others

 Many behavioural styles interfere with an individual’s ability to achieve in occupational or educational spheres

Question 11

Gender Differences in Personality Disorders

Answer 11

 75% of individuals diagnosed with Borderline Personality Disorder are female (Widiger & Trull, 1993)

 Risk of avoidant, dependent and paranoid personality disorder is also greater in women

Question 12

Cultural Differences in Personality Disorders

Answer 12

 Little evidence to suggest that the prevalence of personality disorders differs across cultures

 There may be some ethnic differences – BPD is higher in Hispanic than Caucasian & African Americans (Grant et al., 2004)

Question 13

THE AETIOLOGY OF PERSONALITY DISORDERS

Answer 13

 Because most symptoms of personality disorders differ, there will be no over-arching theory of causation personality disorders

 One characteristic that is common to all is that their behaviour patterns are enduring, suggesting that inherited or developmental factors are important

Question 14

Cluster B: Antisocial Personality Disorder

Answer 14

 Because APD is closely related to criminal and antisocial behaviour attempts have been made to:

 Identify childhood behaviours that may predict later adult APD

 Identify the developmental factors that cause APD

 Ascertain whether there is an inherited component to APD

 Identify any biological or psychological processes that may be involved in APD

Question 15

Childhood & Adolescent Behavioural Precursors of APD

Answer 15

 The best predictor of APD is a diagnosis of conduct disorder during childhood

 Adolescent smoking, alcohol use, illicit drug use, police trouble and sexual intercourse before 15-years are strong predictors of APD

 Some theorists also suggest that ADHD is a predictor of APD (but see next slide)

Question 16

Developmental Factors - APD

Answer 16

 Antisocial behaviour may be learnt from parents (Paris, 2001)

 Parents may reinforce antisocial behaviour (Capaldi & Patterson, 1994)

 Lack of parental love may nurture antisocial behaviour (Gabbard, 1990)

 Inconsistent parenting may be important during the development of APD (Marshall & Cooke, 1999)

Question 17

Genetic Factors – APD

Answer 17

 APD appears to run in families

 Twin studies suggest higher concordance rates in MZ than DZ twins (Lyons et al., 1995)

 Incidence of APD in an adopted child is better predicted by APD in the biological than adopted mother (Ge et al., 1996)

Question 18

Cognitive Models - APD

Answer 18

 Individuals with APD may possess dysfunctional schemas that determine their antisocial reactions (Young et al., 2003)

 When responding to important events, individuals with APD may switch quickly and unpredictably between schemas to make their behaviour seem erratic (Horowtiz et al., 2001)

Question 19

Physiological & Neurological Factors – APD

Answer 19

 Individuals with APD exhibit physiological characteristics that may explain their APD:

 Have significantly lower levels of anxiety and lower levels of physiological reactivity

 Respond to emotional stimuli with slow autonomic arousal and low levels of EEG activity

 Frequently fail to exhibit fear learning in aversive classical conditioning procedures (Lykken, 1995)

Question 20

Risk Factors for BPD

Answer 20

 A history of difficulties in childhood, including childhood physical, verbal and sexual abuse, childhood neglect or rejection, inconsistent or loveless parenting, and inappropriate parental behaviour (e.g. substance misuse or sexual promiscuity)

 Academic underachievement, low intelligence and poor artistic skills

Question 21

Biological Theories of BPD

Answer 21

 Evidence for a genetic component (twin studies indicate concordance rates of 35% and 7% for MZ and DZ twins respectively) (Torgersen et al., 2000)

 44% of individuals with BPD belong to a broader bipolar disorder spectrum

 Individuals with BPD have a number of brain abnormalities e.g. dysfunctions in brain dopamine

 Neuro-imaging techniques reveal abnormalities in a number of brain areas

Question 22

Psychological Theories of BPD

Answer 22

 Object Relations Theory

 argues that individuals with BPD have received inadequate support and love from important others, resulting in an insecure ego which is likely to lead to lack of self-esteem and fear of rejection.

 Splitting

 A defence mechanisms in which aspects of others which are evaluated in a polarised fashion.

 As with APD, individuals with BDP may acquire a set of dysfunctional schemas that maintain their erratic and emotional behaviour (Young et al., 2003)

Question 23

Dialectical Behaviour Therapy (DBT)

Answer 23

 Developed in the 1990s by Marsha Linehan, particularly for the treatment of BPD

 Based on a biosocial theory of BPD (Linehan, 1993, cited in Palmer, 2002)

 Dialectical refers to contrasting views or positions taken by the client

 Emphasis on integrating opposing behaviours & on interconnectedness

 Brings together aspects of CBT and principles of Zen Buddhism e.g. acceptance
 Aims to foster the development of emotional regulation & tackle areas of skills deficit

 Linehan published Cognitive Behaviour Treatment of Borderline Personality Disorder in 1993

 Outpatient delivery

 Intervention lasts around one year

 Individual sessions, group skills training sessions and telephone support, plus weekly consultation group

 4 modules
 Emotion regulation, mindfulness, distress tolerance, interpersonal effectiveness

Question 24

Schema Therapy

Answer 24

 Developed by Young, Klosko & Weishaar (2003)
 Schema theory outlines three specific stages:

 Clients need to be convinced that their maladaptive schemas are actually a cause of their symptoms

 Attempts to identify and prevent schema avoidance responses

 Examination of the life events that have given rise to maladaptive schemas

Question 25

Schema Domains & Early Maladaptive Schemas

Answer 25

 Disconnection & Rejection

 Mistrust/abuse

 Abandonment/instability

 Defectiveness/shame

 Emotional deprivation

 Social isolation/alienation

 Impaired Autonomy & Performance

 Failure

 Dependence/incompetence

 Enmeshment/undeveloped self

 Vulnerability to harm or illness

Question 26

Schema Domains & EMSs

Answer 26

 Impaired Limits
 Entitlement/grandiosity

 Insufficient self-control/self-discipline

 Other-Directedness

 Subjugation

 Self-sacrifice

 Approval seeking

 Overvigilance & Inhibition

 Punitiveness

 Emotional inhibition

 Negativity/pessimism

 Unrelenting standards

Question 27

Schema Responses/Coping Styles

Answer 27

 Avoidance

 Overcompensation

 Surrender