Personality Disorders BY DR. RAJA ROY CHOUDHURY. What is Personality? “You have a strong need for...

Personality Disorders

BYDR. RAJA ROY CHOUDHURY

What is Personality?

“You have a strong need for other people to like & admire you. You have a tendency to be critical of yourself. You have a great deal of unused capacity, which you have not turned to your advantage… disciplined & controlled on the outside, you tend to be worrisome & insecure inside…at times, you’re extraverted, affable, & sociable; at other times, you’re introverted, wary, & reserved”

Personality

• Unique, relatively consistent pattern of thinking, feeling and behaving.

• It is how you handle situations, yoursense of humor, or your expectations of others

Psychoanalytic approach

• Sigmund Freud (1856 – 1939)– Josef Breuer’s “talking cure”.

– Individuals are ruled by unconscious forces, they resist painful insights, and that transfer feelings for one object to another.

– Iceberg Metaphor.

Freud’s Structure of Personality

Conscious—Acuteawareness

Preconscious—Justunder awareness;easily known

Unconscious—Wellbelow awareness;Difficult to know but very influential

Sup

ere

go

Consciousness

Ego

Id

Psychoanalytic Approach

• Personality is result of the battle for control between id, ego & superego

• Defense mechanisms (or defense mechanisms) are unconscious psychological strategies brought into play by various entities to cope with reality and to maintain self-image.

Freud’s Psychosexual Stages of Development

• Oral (Birth to 1½ years)

• Anal (1½ to 3 years)

• Phallic (3 to 6 years)

• Latency (6 years to puberty)

• Genital (puberty – adulthood)

Allport’s Trait Theory

• Trait– Relatively enduring, consistent personality characteristics -

inferred from behavior

• 3 types of traits– Cardinal traits

– Central traits

– Secondary traits

Type theories

• 5-factor model of personality– 5 different dimensions determines personality type

– Dimensions• Openness to experience

• Conscientiousness

• Extraversion

• Agreeableness

• Neuroticsm

Behaviorist perspective

• Albert Bandura– Self Efficacy: The more influence a person thinks they have

on a behavior, the more likely they are to engage in it, especially to the degree that it has positive outcomes.

• Mischel– Situational specificity– Interactionism: both traits and situations interact to

produce behavior, thoughts

Humanist Perspective

• Focuses on the positive aspects of being human (e.g., goodness, creativity, free will)

• Rogers: Person-centered therapy

• Congruence vs. incongruence

Personality in the contemporary era

• The challenges faced in the current era is different.

• They exert a pressure on the shaping of personality.

Factors influencing the development of personality

• Parenting styles and parental values.

• New and advanced technology.

• Need for achievement.

• Cut-throat competition.

• Societal pressures.

• Value system.

Personality Disorder

Psychological disorders characterized by inflexible and enduring behavior patterns that impair social functioning.

DSM IV Criteria for Personality Disorder

• An enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s culture. Manifested in two or more of the following:

Cognition Affectivity Interpersonal functioning Impulse control

DSM IV General Criteria for Personality Disorder

• Pattern is inflexible and pervasive across a broad range of personal and social situations

• Pattern leads to clinically significant impairment or distress

• Pattern is stable and of long duration and onset can be traced to adolescence or early childhood

• Maladaptive behavior leads to poor life functioning

DSM IV General Criteria for Personality Disorder

• Pattern not better accounted for as a manifestation of another disorder

• Not due to substance or Medical Condition (e.g., head trauma)

• Ego syntonic (feels like a normal part of oneself, and that others are the root of all problems)

Disorder Vs. Trait

• Conscientiousness and scrupulosity in small doses is advantageous (trait).

• In the extreme, leads to paralyzing over attention to detail with interferes with finishing tasks (disorder).

• Some traits are maladaptive at either extreme:– Too little trust: paranoid– Too much trust: gullibility leading to being taken advantage of

The history of personality disorders

• The Greek and Roman Gods and Goddess were the personality disorder types of the ancient world.

• Most of the disorders describe their traits.

Paranoid personality disorder.

• Hera-Juno, Wife of Zeus- Queen of the gods• Archetype of the suspicious Paranoid.

Paranoid personality disorder

Pervasive distrust and suspiciousness, sees motives of

others as malevolent.

• Suspects, without sufficient basis, that others are

exploiting, harming, or deceiving him or her

• Preoccupied with unjustified doubts about the

loyalty or trustworthiness of friends or associates

• Reluctant to confide in others due to lack of trust

Paranoid personality disorder

• Persistently bears grudges, i.e., is unforgiving of insults,

injuries, or slights.

• Reads hidden demeaning or threatening meanings into benign

remarks/events.

• Perceives attacks on character that are not apparent to others

and responds with counterattacks.

• Has recurrent suspicions, without justification, regarding

fidelity of spouse or sexual partner.

Schizoid personality disorder

• Athena-Minerva - Virgin goddess of wisdom. • She had a Schizoid aspect to her personality.


Pervasive detachment from social relationships and a

restricted range of emotional expression interpersonally.

• Neither desires nor enjoys close relationships,

including being part of a family

• Almost always chooses solitary activities

• Exhibits little interest in having sexual experiences

with another person.


• Takes pleasure in few, if any, activities.

• Lacks close friends or confidants.

• Appears indifferent to the praise or criticism of

others.

• Emotionally cold, detached.

Schizotypal personality disorder

• Artemis- twin sister of Apollo.

• She is a goddess of transitions, a hunter, a virgin, and

one of the goddesses who assists at childbirth

• Most often off by her self in her Schizotypal world of

wild things and strange thoughts.


Exhibit little capacity for close relationships accompanied by

cognitive or perceptual disturbances and eccentricities of

behavior

• Ideas of reference

• Odd beliefs or magical thinking, inconsistent with cultural

norms

• Unusual perceptual experiences, including bodily illusions

• Excessive social anxiety related to paranoid fears.


• Odd thinking and speech (e.g. vague,

circumstantial,metaphorical,over elaborate)

• Suspiciousness or paranoid ideation

• Inappropriate or constricted affect

• Behavior or appearance that is odd, eccentric, or

peculiar

• Lack of close friends or confidants

Antisocial personality disorder

• Ares - war god and god of violence • He was not well-liked or trusted by the ancient

Greeks• He does not care who suffers from his violent

behavior.


Pervasive pattern of disregard for and violation of

rights of others since age 15.

• Repeatedly breaking the law

• Deceitfulness - repeated lying, use of aliases,

conning others for personal profit or pleasure

• Impulsivity or failure to plan ahead


• Irritability and aggressiveness, as indicated by repeated

physical fights or assaults

• Reckless disregard for safety of self or others

• Consistent irresponsibility - inconsistent work behavior,

doesn’t pay bills/debts

• Lack of remorse, as indicated by being indifferent to or

rationalizing having hurt, mistreated, or stolen from

another


• The individual is at least age 18 years.• ASPD vs. criminality– “criminal” is a legal term denoting conviction for

breaking a law:• Not all people with ASPD are criminals (or in jails)• Not all people with ASPD are psychopaths

Borderline personality disorder

• Aphrodite- Goddess of beauty, love, and sexuality

• Has love affairs with gods and mortals.• Archetype of a love addicted Borderline.


Pervasive instability of interpersonal relationships, self-

image and affect with marked impulsivity by early

adulthood.

• Frantic efforts to avoid real or imagined abandonment

• Pattern of intense and unstable interpersonal

relationships, alternating between extremes of

idealization and devaluation


• Identity disturbance: markedly and persistently

unstable self-image or sense of self

• Impulsivity in at least two potentially self-

damaging areas (sex, spending, substance abuse,

reckless driving, binge eating)

• Recurrent suicidal behavior, gestures, or threats,

or self-mutilating behavior


• Chronic feelings of emptiness

• Inappropriate and intense anger

• Transient, stress-related paranoid ideation or

severe dissociative symptoms.

• Affective instability with marked reactivity of

mood, lasting few hours to few days

Histrionic personality disorder

• Hermes- the messenger god.• Tricking the other gods and sometimes making

a public show of himself.


Pervasive excessive emotionality and attention seeking.

• Uncomfortable in situations in which he or she is not

the center of attention

• Interaction with others is often characterized by

inappropriate sexually seductive or provocative

behavior


• Displays rapidly shifting and shallow expression of

emotions

• Consistently uses physical appearance to draw attention

to self

• Has a style of speech that is excessively impressionistic

and lacking in detail

• Shows self-dramatization, theatricality, and exaggerated

expression of emotion


• Suggestible, i.e., easily influenced by others.

• Considers relationships to be more intimate than they

actually are.

• Inability to maintain deep, long-lasting attachments

• Exaggeration of thoughts and feelings - everything is

catastrophic or of extreme importance.

• Endless need for reassurance

• Superficial relationships, vain, self-absorbed

Narcissistic Personality Disorder

• Narcissus- A handsome and Proud Hunter.• He became so enamored with his own image

in the water. He remained at the water's edge until he eventually wasted to death.


Pervasive grandiosity, need for admiration, lack

of empathy.

• Grandiose sense of self-importance, expects

to be recognized as superior

• Preoccupied with fantasies of unlimited

success, power, brilliance, beauty, or ideal love


• Believes he/she is “special,” unique and can only be

understood by or should associate with other

special people

• Requires excessive admiration

• Sense of entitlement

• Interpersonally exploitative, i.e., takes advantage of

others to achieve his or her own ends


• Lacks empathy: is unwilling to recognize or

identify with the feelings and needs of others.

• Is often envious of others or believes that

others are envious of him or her.

• Shows arrogant, haughty behaviors or

attitudes.


• Become enraged at criticism

• Fragile self-esteem, prone to depression

• Their behavior produces interpersonal

difficulties, rejection, loss, occupational

problems, which they can’t handle

Avoidant personality disorder

• Poseidon- The sea God.• Avoidant tendencies in his desire to hide away

in the deep parts of the sea.


Pervasive social inhibition, feelings of inadequacy,

hypersensitivity to negative evaluation.

• Avoids occupational activities that involve

significant interpersonal contact because of fears

of criticism, disapproval or rejection

• Unwilling to get involved with people unless

certain of being liked


• Shows restraint within intimate relationships because of

the fear of being shamed or ridiculed

• Preoccupied with being criticized or rejected in social

situations

• Inhibited in new interpersonal situations because of

feelings of inadequacy

• Extreme sensitivity to rejection leads to socially

withdrawn life


• Views self as socially inept, personally

unappealing, or inferior to others

• Unusually reluctant to take personal risks or to

engage in new activities for fear of embarrassment

• Withdraw and feel hurt if a request is refused or if

they feel rejected or ridiculed

Dependent personality disorder

• Vesta- goddess of the hearth, home, and family.

• The Dependent personality type, who does her job and keeps out of the way of the others.


Pervasive and excessive need to be taken care of, leads to

submissive and clinging behavior and fears of separation.

• Has difficulty making everyday decisions without an

excessive amount of advice and reassurance from others

• Needs others to assume responsibility for most major

areas of his or her life

• Has difficulty expressing disagreement


• Has difficulty initiating or doing things on own

• Goes to excessive lengths to obtain nurturance and

support from others

• Feels uncomfortable or helpless when alone because of

exaggerated fears of being unable to care for himself or

herself

• Urgently seeks another relationship as a source of care

and support when a close relationship ends


• Unrealistically preoccupied with fears of being

left to take care of himself or herself

• May stay with an abusive, unfaithful or

alcoholic partner rather than face being alone

Obsessive-Compulsive personality disorder

• Hephaestus- The God of Fire.• Compulsive tendencies that kept him at work

making things for the Olympians.


A pervasive pattern of preoccupation with orderliness,

perfectionism, and mental and interpersonal control, at

the expense of flexibility, openness, and efficiency.

• Preoccupied with details, rules, lists, order,

organization, schedules to the extent that the major

point of the activity is lost

• Shows perfectionism that interferes with task

completion


• Excessively devoted to work and productivity to the

exclusion of leisure activities and friendships (not

accounted for by obvious economic necessity)

• Overly-conscientious, scrupulous, and inflexible about

matters of morality, ethics, or values (not accounted for

by cultural or religious identification)

• Unable to discard worn-out or worthless objects even

when they have no sentimental value


• Reluctant to delegate tasks or to work with others

unless they submit to exactly his or her way of doing

things

• Adopts a miserly spending style toward both self and

others; money is viewed as something to be hoarded

for future catastrophes

• Shows rigidity and stubbornness


• Do well with routines and poorly with changes

• Unable to compromise in interpersonal

relationships

Personality Disorder clusters

• Cluster A:

– Main feature is odd or eccentric in nature

• Paranoid PD – distrust and suspiciousness

• Schizoid PD – detachment from social relationships

(does not want them)

• Schizotypal PD – social deficits and perceptual

distortions or eccentricities


• Cluster B

– Main feature is dramatic, emotional, or erratic

• Antisocial PD – disregard for social norms and rights of others

• Borderline PD – instability in relationships, self-image, and

mood; impulsivity

• Histrionic PD – excessive emotionality and attention seeking

• Narcissistic PD – grandiosity, need for admiration, self-centered


• Cluster C

– Main feature involves anxiety or fearfulness

• Dependent PD – submissive, need to be taken care of

• Avoidant PD – social inhibition and inadequacy

• Obsessive-compulsive PD – orderliness, perfectionism,

need to control things

Uncertainty

For all of its uncertainty, we cannot flee the future. Barbara Jordan

• Does personality change?

Personality Disorders BY DR. RAJA ROY CHOUDHURY. What is Personality? “You have a strong need for...

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