CHAPTER 9

PERSONALITY DISORDERS

FEATURES OF PERSONALITY DISORDERS

Early onset Evident at least since late adolescence

Stability No significant period when not evident

Pervasive Evident across a wide range of personal,

social, and occupational situations Clinically significant maladaption

Personal distress or impairment in social and occupational functioning

CLASSIFYING PERSONALITY DISORDERS

Personality disorders are long-standing, maladaptive, inflexible ways of relating to the environment.

Diagnosed on AXIS-II of the DSM-IV. Three categories:

Odd or eccentric behavior Dramatic, emotional, or erratic behavior Anxious or fearful behavior

FREQUENCY OF PERSONALITY DISORDERS

ODD OR ECCENTRIC BEHAVIOR

Paranoid personality disorder Suspicious or mistrusting of others Hypersensitive

Schizoid personality disorder Withdrawn and reclusive Not interested in relationships with

other Schizotypal personality disorder

Odd ways of thinking, perceiving, communicating, and behaving

May be a weak form of schizophrenia

DRAMATIC, EMOTIONAL, OR ERRATIC BEHAVIOR

Histrionic Personality Disorder Self-centered and manipulative Have stormy relationships

Narcissistic Personality Disorder Extreme sense of self-importance, yet with fragile

self-esteem Need for constant attention, lack of empathy for others

Borderline Personality Disorder Threaten and engage in self-destructive behavior Impulsive Unstable relationships, dependency on and

manipulation of others Antisocial Personality Disorder

Chronic behavior that violates others’ rights and which began before the age of 15

Likely to be reckless and sexually promiscuous Lack of remorse for hurting others

CAUSES OF BORDERLINE PERSONALITY DISORDER

Disturbed early relationship with parent

Some have been physically or sexually abused

Genetic vulnerability Splitting - Failure to integrate

positive and negative experiences that occur between individual and other people

TREATMENT OF BORDERLINE PERSONALITY DISORDER

Identify its most distinctive features Psychodynamic therapy Cognitive therapy Behavior therapy Biological – Medication Combination of approaches is most

effective Long-term prognosis is poor, though

some improve Risk for alcoholism High suicide risk – 8 to 10% commit

suicide; far more attempt suicide.

SELF-DESTRUCTIVE ACTS DESCRIBED BY PEOPLE WITH BORDERLINE PERSONALITY

DISORDER

DISTINGUISHING BORDELINE PERSONALITY DISORDER FROM OTHER

GROUPS

CHARACTERISTICS OF ANTISOCIAL SUBJECTS

CAUSES OF ANTISOCIAL PERSONALITY DISORDER

Family history – Heredity Childhood history of conduct

disorder Neurochemistry- Low levels of

serotonin Brain activity – Low arousal levels Low anxiety levels Deficit in moral development

TREATMENT OF ANTISOCIAL PERSONALITY DISORDER

Traditional psychotherapy not effective

Highly structured, residential treatment, especially in correctional settings, is effective.

Structured community alternatives to prison have some effect.

Prognosis is poor.

ANXIOUS OR FEARFUL BEHAVIOR Avoidant Personality Disorder

Low-self esteem Worry about negative evaluation by others, but

desire affection and relationships Avoid social interaction

Dependent Personality Disorder Lack confidence in ability to function

independently Subordinate their needs to wishes of others to

maintain relationship Obsessive-Compulsive Personality Disorder

Extreme perfectionism Rigid approach to doing things Lack of ability to express warm emotions