chapter 12 personality disorders
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Chapter 12 Personality Disorders. Amber Gilewski Tompkins Cortland Community College. Personality Disorders: Overview. The Nature of Personality Disorders Enduring and relatively stable predispositions - PowerPoint PPT PresentationTRANSCRIPT
Chapter 12Chapter 12 Personality Disorders Personality Disorders
Amber GilewskiAmber Gilewski
Tompkins Cortland Community CollegeTompkins Cortland Community College
Personality Disorders: OverviewPersonality Disorders: Overview
The Nature of Personality DisordersThe Nature of Personality Disorders
Enduring and relatively stable predispositions
Inflexible and maladaptive, causing distress and/or impairment
Coded on Axis II of the DSM-IV-TR
May not perceive the need for change
Dimensions of personality or categories?
Personality Disorders: ClustersPersonality Disorders: Clusters
Cluster ACluster A – Odd or eccentric
(Paranoid, Schizoid, Schizotypal)
Cluster BCluster B – Dramatic, emotional, erratic
(Antisocial, Borderline, Histrionic, Narcissistic)
Cluster CCluster C – Fearful or anxious
(Avoidant, Dependent, Obsessive-Compulsive)
Personality Disorders: Personality Disorders: Statistics & DevelopmentStatistics & Development
Prevalence of Personality DisordersPrevalence of Personality Disorders
Affects about 0.5% to 2.5% of the general population
Rates are higher in inpatient and outpatient settings (10-20% - inpatient settings; 2-10% -outpatient settings)
Origins and Course of Personality DisordersOrigins and Course of Personality Disorders
Thought to begin in childhood
Tend to run a chronic course
Comorbidity rates are high
Personality Disorders: Diagnoses & Personality Disorders: Diagnoses & Gender DifferencesGender Differences
Gender bias exists in the diagnosis
Criterion and/or assessment gender bias
Borderline, histrionic, dependent personality disorders more often diagnosed in females
Antisocial personality disorder more often diagnosed in males
Paranoid Personality DisorderParanoid Personality Disorder Pervasive and unjustified mistrust and suspicion
Causes
Biological and psychological contributions are unclear
Early learning that people and the world is a dangerous place
Treatment Options
Few seek professional help on their own
Treatment focuses on development of trust
Cognitive therapy to counter negativistic thinking
Lack of good outcome studies
Schizoid Personality DisorderSchizoid Personality Disorder Pervasive pattern of detachment from social
relationships
Very limited range of emotions in interpersonal situations
Causes
Etiology is unclear
Preference for social isolation resembles autism
Treatment Options
Few seek professional help on their own
Focus on the value of interpersonal relationships
Building empathy and social skills
Lack of good outcome studies
Schizotypal Personality DisorderSchizotypal Personality Disorder Behavior and dress is odd and unusual
Socially isolated and highly suspicious
Magical thinking, ideas of reference, and illusions
Many meet criteria for major depression
Causes
A phenotype of a schizophrenia genotype?
More generalized brain deficits
Treatment Options
Main focus is on developing social skills
Medical treatment is similar to that used for schizophrenia
Treatment prognosis is generally poor
Antisocial Personality Disorder: Antisocial Personality Disorder: CharacteristicsCharacteristics
Failure to comply with social norms
Violation of the rights of others
Irresponsible, impulsive, and deceitful
Lack a conscience, empathy, and remorse
Higher prevalence in men
Poor prognosishttp://en.wikipedia.org/wiki/Image:Ted_Bundy_3.jpg#file
Antisocial Personality Disorder: Antisocial Personality Disorder: Psychopathy & ASPDPsychopathy & ASPD
Psychopathy (Cleckley): 16 major characteristics: superficial charm, good intelligence, no delusions or irrational thinking, absence of nervousness, unreliability, insincere, lack of remorse/shame, etc.
DSM criteria focuses on observable behaviors Cleckley/Hare criteria focuses on underlying
personality traits Some psychopaths are not criminals nor
are all criminals, psychopaths Dyssocial psychopathy: culturally deviant
Antisocial Personality Disorder: Antisocial Personality Disorder: CausesCauses
Families with inconsistent parental discipline and support
Families often have histories of criminal and violent behavior
Gene-environment interaction
Underarousal Hypothesis: low levels of cortical arousal
Fearlessness Hypothesis: higher threshold for fear
Antisocial Personality Disorder: Antisocial Personality Disorder: TreatmentTreatment
Few seek treatment on their ownFew seek treatment on their own
Antisocial behavior is predictive of poor Antisocial behavior is predictive of poor prognosisprognosis
Emphasis is placed on prevention and Emphasis is placed on prevention and rehabilitationrehabilitation
Often incarceration is the only Often incarceration is the only viable alternativeviable alternative
Borderline Personality Disorder: Borderline Personality Disorder: CharacteristicsCharacteristics
Unstable moods and relationships
Impulsivity, fear of abandonment, very poor self-image
Self-mutilation and suicidal gestures
Very common in psychiatric settings
Comorbidity rates are high
Borderline Personality DisorderBorderline Personality Disorder Causes
Runs in families
Early trauma and abuse seem to play some etiologic role
Treatment Options
Few good outcome studies
Antidepressant medications provide some short-term relief
Dialectical behavior therapy (DBT) is most promising treatment
Histrionic Personality DisorderHistrionic Personality Disorder Overly dramatic, sensational, and sexually
provocative; often impulsive, need to be center of attention
Thinking and emotions are perceived as shallow
Common diagnosis in females
Causes
Largely unknown: Variant of ASPD?
Treatment Options
Focus on attention seeking and long-term negative consequences
Targets may also include problematic interpersonal behaviors
Little evidence that treatment is effective
Narcissistic Personality DisorderNarcissistic Personality Disorder
Exaggerated and unreasonable sense of self-importance; preoccupied w/receiving attention
Lack sensitivity and compassion for other people Highly sensitive to criticism, envious, and arrogant
Causes Failure to learn empathy as a child Sociological view – Product of the “me” generation
Treatment Options Focus on grandiosity, lack of empathy, unrealistic
thinking May also address co-occurring depression Little evidence that treatment is effective
Avoidant Personality DisorderAvoidant Personality Disorder
Extreme sensitivity to the opinions of others
Highly avoidant of most interpersonal relationships
Are interpersonally anxious and fearful of rejection
Causes
Numerous factors have been proposed
Difficult temperament and early rejection
Treatment Options
Treatment is similar to that used for social phobia
Treatment targets include social skills and anxiety
Dependent Personality DisorderDependent Personality Disorder Reliance on others to make major and minor life
decisions; clingy & submissive in relationships
Unreasonable fear of abandonment
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
Obsessive-Compulsive Obsessive-Compulsive Personality DisorderPersonality Disorder
Excessive and rigid fixation on doing things the right way
Highly perfectionistic, orderly, and emotionally shallow
Obsessions and compulsions are rare
Causes
Are largely unknown
Treatment Options
Data supporting treatment are limited
Addresses fears related to the need for orderliness, rumination, procrastination, and feelings of inadequacy