Personality Disorders Definition = maladaptive ways of interacting *Rigid *Pervasive Common Ego...
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Personality Disorders
Definition = maladaptive ways of interacting
• *Rigid
• *Pervasive
• Common
• Ego syntonic
-> don’t seek tx
-> less motivated to change
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“Medical Students’ Disease”
• Continuum of characteristics
• Disorder = greater degree & impairment
Course
• Originate in childhood & persists
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Sex Differences
1.Histrionic, dependent = women
2.Current research: Either > in males or equal
• Males = Paranoid, Schizoid, Schizotypal, Antisocial, Narcissistic, Obsessive-compulsive
• Equal = Histrionic, Avoidant, Dependent
• Females = Borderline
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Sex Bias: Ford & Widiger
• Histrionic/Antisocial case histories:
male diagnosed Antisocial PD
female diagnosed Histrionic PD
• Simple gender differences … bias
• But Histrionic PD may brand stereotypic women as mentally ill
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• Categories vs. Dimensions– Currently, categories– Possible move to dimensions– Reduces stigma– Reflects actual clients
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Cluster A: Odd, eccentric
Paranoid PD
= Excessively suspicious/mistrustful
Causes• Slight genetic evidence of link to schizophrenia• Cognitive errors• Parental teaching• Certain groups more susceptible
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Treatment
• Only seek for crisis
• Therapist provides trust
(cognitive therapy for errors)
• No clear evidence of change
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Schizoid PD
• Solitary, uninterested in others
• Not from fear
• But some are sensitive
• Extreme social deficiencies
• No unusual/bizarre thoughts
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Causes - unknown
• Isolation resembles autism
-> maybe shared biological mechanism
Treatment
• Help develop interest in relationships
• Little optimism
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Schizotypal PD
• Social isolation + unusual behaviors & thoughts
• Not full-blown hallucinations, but “as if”
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Causes - little known
• Genetic link to schizophrenia
• Probable environmental stressors
Treatment
• Social skills to improve relationships
• Help adjust to solitary life
• Antipsychotics (but side effects)
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Cluster B: Dramatic, emotional
Antisocial PD
• Disregard for social norms
• No remorse
• Substance abuse/sensation-seeking
• Age 18
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Causesa) Genetic influence on nonviolent criminalityb) Neurobiology: NOT brain damage
i. Low cortical arousal- stimulation-seeking behaviors- slower brain waves/heart rateii. Fearlessness hypothesis- higher threshold for fear & worse atdetecting danger cuesiii. Inhibition vs. reward systems: weakinhibition & strong reward (BAS vs. BIS)
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c) Aggression learned at home
- parents reward kid’s aggression
- inconsistent discipline
- low SES
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Treatment
• Behavior dies down by age 40
• But difficult to treat
• Manipulate therapist
• Few positive outcomes
• Focus: childhood prevention via parent training
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Borderline PD
*No sense of self• Instability in relationships -> fear abandonment• All-or-none thinking• Unstable moods• Poor self-image (“empty”)• Impulsive
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Causes
• Possible genetics – mood disorders
• Childhood trauma
• Psychodynamic: Abandonment fears
poor separation/individuation from mom
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Treatment
• Extremely difficult
• But: Linehan — help dev. identity
• Support/constancy, coping, identify & regulate emotions
• Medication (for depression & anxiety)
- poor compliance, abuse meds
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Histrionic PD
• Dramatic, self-centered, shallow
• Singers, actors
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Causes
• Learn appearance & performance-> attention
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Treatment
• Focus on problematic relationships
• Reward for appropriate & fine for inappropriate/attention-getting behavior
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Narcissistic PD
• Grandiose, exaggerated sense of own importance
• Preoccupation with gaining attention
• Lack sensitivity/compassion, exploit others
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Causes
• Inadequate admiration from parents
• Damaged sense of self
• Grandiosity = façade
• Current society (“me,” instant gratification)
-> increases prevalence
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Treatment: Cognitive
i. Replace grandiose fantasies
- attainable daily pleasures
ii. Coping with criticism
iii. Understand others’ feelings
iv. Treat depression
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Cluster C: Anxious, fearful
Avoidant PD
• Extreme sensitivity to rejection
• Actively avoid relationships
• Low opinion of self
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Causes
• May be more “difficult” infants
-> inadequate early unconditional positive regard
-> alienated & unworthy
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Treatment - many good studies
• Behavioral therapy for anxiety & social skills problems
• Systematic desensitization for specific situations
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Dependent PD
• Excessive reliance on others for everyday decisions
• Abandonment fears
• Submissive/agreeable to avoid rejection
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Causes
• Childhood assertiveness punished
• Parental overprotection
• Early parental loss/rejection -> abandonment fears
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Treatment - little research
• Appear to be ideal therapy clients
-> danger of over-dependence on therapist
• Develop independence & responsibility
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Obsessive-Compulsive PD
• Preoccupation with the “right way”
• Inflexible, perfectionistic, rigid
• Relationships often poor
• Only distantly related to OCD
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Causes
• Possible genetic basis, but weak
• Strong parental discipline & over-control
• No real understanding of causes
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Treatment - little research
• Attack fears underlying perfectionism
• Deal with possible anxiety regarding inadequacy
• Relaxation/distraction
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For all PDs, therapy involves
• Insight into how they affect other people & are perceived
• Insight into how their behavior causes them problems
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Ethical Issues
Therapy with Personality Disorders
• Very resistant to treatment
• Rarely seek treatment on own
-> When is treatment justifiable?
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Adopting a Potential Sociopath
• Strong genetic basis for APD/sociopathy
=> Should adoptive parents be told if child is offspring of sociopath?
=> Is revealing this information to prospective parents fair to the child?
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Interpersonal Psychotherapy
Rationale
• General style of interacting
• Most are flexible
• In people with personality disorders, style is rigid & pervasive
• Goal of interpersonal psychotherapy
= help people be more flexible
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Therapy
• Pull from usual part of circle to opposite
• Act in complementary manner to goal behavior
• Meta-communicate