Personality Disorders Flashcards
Personality Disorders, General
Chronic interpersonal difficulties
o That the individual is not able to overcome via adaptations
Long-standing maladaptive problems
o Including problems related to identity of sense of self
Unlike regular mental disorders
o Personality disorders typically do not involved acute episodes
• Instead they appear as chronic traits
Traits
Behaviors that are stable across time and settings
Occur on a continuum rather than a categorical present or not-present
In the context of psychopathology, personality traits that impair and cause prolonged stress
Barriers to Treatment
- Ego-syntonic
- Treatment Refractory
- More distressing for others than those with the personality disorder
- More likely to be comorbid with other disorders
Ego-syntonic
View personality disorders as just something that is a natural part of the oneself
Do not see these as problems with self but rather the problems are caused by problematic behaviors of others
Treatment Refractory
Because many feel these problems stem from others, many suffering from personality disorders are unwilling to cooperate with treatments
May require more rapport building than is typically expected in order to increase trust and chance of treatment
Typically takes significantly longer to complete treatment
Underlying personality disorders may account for those who respond poorly to psychotherapy
Comorbidity
Specifically mood, anxiety, substance, or other personality disorders
25-85% all of personality disorders are comorbid
Which causes which?
A personality disorder may prevent or impede the therapeutic process
It can decrease the chance of treatment, or increase the related symptoms
Personality Disorders: Clinical Features
Pervasive and inflexible
Stable and long duration
Clinically distressing and impairing
Manifested in at least two areas
Personality Disorders: Onset
Typically arises in young adulthood
o As one’s personality stabilizes
Treatment for personality disorders typically starts later however
o Only after years of failing to engage in “normal” behaviors do individual realize a problem exists
• Then they are willing to seek help
Many with personality disorders only enter therapy after experiencing depression stemming from prolonged social difficulties
Only at this point would the disorder become evident
Personality Disorders: Prevalence
Personality disorders are the most common psychological disorders
10-13% has at least one personality disorder
Most Common: Antisocial personality disorder
• ~4% of all personality disorder cases
Personality Disorders: Gender Bias
Males common dx:
- Antisocial
- Narcissistic
- Paranoid
Females common dx:
- Borderline
- Histrionic
Some diagnoses are more gender-neutral
- Dependent
- Avoidant
Personality Disorders: Cultural Differences
Non-European countries are less likely to diagnose individuals with a personality disorder
In Taiwan, only 0.4% of the population is diagnosed with one
Cluster A
The Odd, Eccentric Cluster
Odd people who live solitary lives with few stable relationships
Paranoid
Schizoid
Schizotypal
Cluster B
The Dramatic, Emotional, Erratic Cluster
Difficulty maintaining stable relations
Histrionic
Narcissistic
Antisocial
Borderline
Cluster C
The Anxious, Fearful Cluster
Pervasive anxiety coupled with chronicity and self-schema issues
These chronic and schema-related issues are what distinguishes anxiety disorders from Cluster C
Clinicians have difficulty distinguishing between anxiety disorders and Cluster C
Avoidant
Dependent
Obsessive-Compulsive
Difficulties Doing Research on Personality Disorders
Criteria overlaps between disorders
o e.g. lack of relations is apparent in schizoid and avoidant disorders
Diagnoses require long-standing behaviors
o Requires long-term and reliable histories
o Those with personality disorders may have a bias in describing their clinical histories
Categorical requirements of DSM requires a fixed number of symptoms to diagnose
o But there is a chance that we overlook some if we are following this strict rule
Five Factor Model of Personality
Neuroticism
Extraversion
Agreeableness
Openness to Experience
Conscientiousness
Some have proposed that the combination of different extremes may explain personality disorders
Despite this potential advantage of using these dimensional-based system, the DSM still relies on categorical diagnoses
Neuroticism
High score: emotion/temperament varies
Low score: emotions do not change in any setting
Extraversion
High score: active, optimistic, open
Agreeableness
High score: trusting and tender-hearted
Low score: rude, hostile
Openness to Experience
High score: sensation seeking
Low score: close-minded
Conscientiousness
High score: strive to achieve, motivated
Low score: less demanding, unreliable
Paranoid Personality Disorder
Hypersensitive to negative evaluation
Preoccupied by doubt or infidelity of others
Read into hidden meaning
Easily find threats when looking at the hidden meaning of the behaviors of others
Guarded and on alert for threat
Hold grudges for long durations
*Cannot diagnosis someone with this disorder if (s)he is a member of a prosecuted group
Paranoid PD: Treatment
Use hierarchy of threatening situations
Honest rapport is critical
Increase feelings of self-efficiency via
• Cognitive restructuring
• Social-sills training
Schizoid Personality Disorder
Emotionally cold
Flat affect
Little or no social interaction
• And no desire to increase this behavior
Summarized: social and physical anhedonia
• Although the individual is not complaining of these symptoms
Schizotypal Personality Disorder
Odd beliefs/thoughts
Magical thinking
Perceptual apparitions
Suspicious of others
Social anxiety
The disorder is on the schizophrenia spectrum
• The key difference: there is no active psychosis
• No hallucinations, delusions, or thought-disorder
Schizotypal Personality Disorder: Treatment
Teach the ability to critically evaluate ideas
Decrease anxiety and inappropriate social behavioral and increase social situations
Assist engaging in daily tasks and social networks
Histrionic Personality Disorder
Center of attention
Over-concerned with attractiveness
If not given attention, attempts to draw back others back to them
Narcissistic Personality Disorder
Grandiosity
Preoccupied with receiving attention
Self-promoting
Lack of empathy
Tendency to enjoy psychotherapy
*they get to spend 1 hour talking about themselves
Borderline Personality Disorder
Impulsive
Inappropriate behavior
Drastic mood shifts
Unstable self-images
Intense anger
Suicidality
Drastic reactions to stressors
Comorbid with anxiety and depression
Difficulty engaging in self-regulation
• Including eating behaviors
Self-mutilation
“Black-and-white” thinking
Treatment
• DBT is the most successful protocol in treating BPD
• SSRIs and other mood stabilizers are helpful
