Chapter 16 Flashcards
(27 cards)
Personality Disorder
An enduring, rigid pattern of inner experience and outward behavior that repeatedly impairs a person’s sense of self, emotional experiences, goals, capacity for empathy, and/or capacity for intimacy
- Impariment in knowing who we are, how to act, what relationships we want, etc.
- Symptoms last for years
- Typically become recognizable in adolescence of early adulthood
- Some symptoms are common in everyone, but when prolonged not normative
- Among most difficult psychological disorders to treat
- Affect ~15% of U.S. population at some point in life
- Comorbidity is common
“Odd” Personality Disorders
Cluster of “odd” personality disorders include
- Paranoid personality disorder
- Schizoid personality disorder
- Schizotypal personality disorder
- People w/ these disorders display similar behaviors to schizophrenia (not as extensive)
- Extreme suspiciousness, social withdrawal, and peculiar ways of thinking and perceiving things
- Odd behaviors leave individual isolated
- People w/ odd-cluster personality disorder often qualify for an additional diagnosis of schizophrenia or have close relatives w/ schizophrenia
- Few people w/ these disorders seek treatment; success is limited
- No treatment is very successful
Paranoid Personality Disorder (Odd)
Characterized by deep distrust and suspicion of others
- Limited close relationships; cold and distant affect
- Find “hidden” meanings, which are usually belittling or threatening, in ordinary life
- Not delusional: not so bizarre or so firmly held as to clearly remove individual from reality
- Excessive trust in own ideas and abilities; extremely sensitive to criticism
- Critical weakness and fault in others
- Experienced by ~ 4.4% of U.S. adults
- More common in men than women
Theoretical Explanations and Treatments for Paranoid Personality Disorder
Theoretical explanations
- Psychodynamic: linked to patterns of early interactions w/ demanding parents
- Particularly distant, rigid fathers and overcontrolling, rejecting mothers
- Cognitive-behavioral: tied to broad maladaptive assumptions
- “People are evil”
- Biological: genetic causes
- If one twin is excessively suspicious, other has an increased likelihood of being suspicious
- Little systematic research
- People w/ paranoid personality disorder do not typically see themselves as needing help, and few come to treatment willingly
Treatments
- Psychodynamic
- Object relations therapists try to work on underlying wish for satisfying relationship
- Behavioral: anxiety reduction and interpersonal problem solving improvement
- Cognitive: development of more realistic interpretations of words and actions of others
- Everyone makes faces sometimes, doesn’t mean it is directed @ you
- Biological: antipsychotic drug therapy of limited help
Schizotypal Personality Disorder (Odd)
Characterized by range of interpersonal problems, marked by extreme discomfort in close relationships, odd ways of thinking, and behavioral eccentricities
- Seek isolation & have few close friends
- Thoughts/behaviors can be noticeably disturbed
- Ideas of reference: beliefs that unrelated events pertain to them in some important way (believe you have an awareness others don’t)
- Bodily illusions such as sensing an external “force” or presence
- See themselves as having special extrasensory abilities
- Demonstrate difficulty keeping attention focused; conversation is typically digressive and vague, sprinkled w/ loose associations
- Affects 3.9% of adults; slightly more males than females
Theoretical Explanations and Treatments for Schizotypal Personality Disorder
Theoretical explanations
- Symptoms are often linked to family conflicts and to psychological disorders in parents
- Deficits in attention and short-term memory
- Linked to some of the same biological factors found in schizophrenia, such as high dopamine activity
- Links to mood disorders, especially depression
Treatments
- Overall goals:
- Help clients “reconnect” w/ world and recognize limits of their thinking/powers
- Increase positive social contacts, ease loneliness, reduce overstimulation, and help individuals become more aware of personal feelings
- Cognitive-behavioral: recognize unusal thoughts or perceptions objectively and try to ignore inappropriate ones (figure out what’s normative/how to follow norms)
- Speech lessons, social skills training, and tips on appropriate dress and manners
- Biological: some patients benefit from low-dose antipsychotic drugs
Schizoid Personality Disorder (Odd)
Characterized by persistent avoidance of social relationships; little demonstration of emotions
- Preference for being alone; weak social skills (don’t enjoy being around others)
- No effort to start/keep friendships
- Lack of interest in sexual relationships
- Individual focuses primarily on self and is generally unaffected by praise/criticism
- Rarely show feelings
- Present in 3.1% of U.S. adults; slightly more common in men than in women
Theoretical Explanations and Treatments for Schizoid Personality Disorder
Theoretical Explanations
- Psychodynamic: rooted in unsatisfied need for human contact
- Unaccepting and/or abusive parents
- Left unable to give/receive love
- Cognitive-behavioral
- Thoughts tend to be vague, empty, and w/out much meaning
- Trouble scanning environment to arrive at accurate perceptions
- Unable to pick up emotional cues from other (can’t read the room)
- Social withdrawal prevents most people w/ schizoid personality disorder from entering therapy unless some other disorder, such as substance abuse makes treatment necessary
Treatments
- Cognitive: presenting clients w/ lists of emotions to think about or having them write down and remember pleasurable experiences
- Behavioral: teaching social skills to such clients, using role-playing, exposure techniques, and homework assignments as tools
- Group therapy offers safe setting for social contact (helps practice social skills)
- Drug therapy is of limited help
“Dramatic” Personality Disorders
- Cluster of “dramatic” personality disorders includes
- Antisocial personality disorder
- Borderline personality disorder
- Histrionic personality disorder
- Narcissistic personality disorder
- Dramatic, emotional, or erratic problems make it difficult to establish relationships that are truly giving and satisfying
- More commonly diagnosed than other personality disorders
- Disorder causes are not well understood, treatments ineffective to moderately effective
- Room for improvement
Antisocial Personality Disorder (Psychopaths/Sociopaths, Dramatic)
- People with disorder persistently disregard and violate others’ rights (active opposition)
- At least 18 years of age to recieve diagnosis (DSM-5), behavior begins earlier
- Lie repeatedly, reckless, and impulsive
- Little regard for others individuals - can be cruel, sadistic, aggressive, and violent
- Because pain/damage they cause seldom concerns them, clinicians commonly say they lack a moral conscience (normally guilt leads people to avoid bad things)
- 3.6% of U.S. adults, 4:1 ratio men to women
- Sex diff could be due to biology (more testosterone = higher aggression), men externalize and women internalize
- Estimated that ~ 35% of people in prison meet diagnostic criteria
- Higher rates of substance use disorders vs. rest of population (cause/effect unknown)
Theoretical Explanations and Treatments for Antisocial Personality Disorder
Theoretical explanations
- Psychodynamic: absence of parental love leads to lack of basic trust
- Bond w/ others through use of power/destructiveness (inappropriate trust)
- Behavioral: antisocial symptoms learned through operant conditioning, modeling
- Higher rates of antisocial personality disorders found among parents/close relatives of people w/ this disorder
- Parents unintentionally teach antisocial behavior by regularly rewarding child’s aggressive behavior
- Cognitive: difficulty recognizing others’ viewpoints/feelings or trivialization of other peoples needs
- Biological:
- Genetic: 67% concordance among MZ, 31% DZ
- Underarousal in response to stress (arousal during stress feels bad, avoid stress)
- Treatments typically ineffective (struggle to feel bad for actions, disregard social norm)
- Lack of conscience, desire to change, or respect for therapy
Treatments
- Cognitive-behavioral: think about moral issues & needs of others
- Therapeutic community in hospitals and prisons: structured environment to teach responsibility to others
- Antipsychotic drugs
Borderline Personality Disorder (unstable sense of self, Dramatic)
Characterized by instability, including major shifts in mood, unstable self-image, and impulsivity (somewhat normal in adolescence)
- Unstable interpersonal relationships
- Prone to bouts of anger, sometimes result in physical aggression/violence
- 5.9% of U.S. adults; 75% are women
- As many as 85% of individuals w/ syndrome also experience another psychological disorder at some point in lives (high co-diagnosis rate, possibly misdiagnosed)
- Often mood disorders, PTSD, ED, bipolar, and/or another personality disorder
Theoretical Explanations and Treaments for Borderline Personality Disorder
Theoretical explanations
- Psychodynamic
- Object relations theorists propose early lack of acceptance by parents may lead to a loss of self-esteem and incomplete development of identity
- Biological
- Genetic predisposition: 35% MZ, 19% DZ concordance
- Lower brain serotonin activity
- Sociocultural: impact of rapidly changing culture
- As culture loses stability, members experience problems w/ identity, sense of emptiness, anxiety, and fears of abandonment
Treatments
- Psychodynamic
- Clients often interpret techniques as suggesting disinterest and have difficult tolerating interpretations
- Cognitive-Behavioral
- Dialectical behavior therapy: includes both individual therapy sessions (cognitive-behavioral interventions) and group sessions (featuring social skill-building and support)
- Distress tolerance
- More research support than any other treatment for BPD
- Biological: antidepressant, antibipolar, antianxiety, or antipsychotic drugs as adjuncts to psychotherapy
Histrionic Personality Disorder (Dramatic)
Individuals are extremely emotional and continually seek to be center of attention
- Engagement in attention-getting behaviors and always “on stage”
- Approval and praise are important
- Vain, self-centered, and demanding
- Suicide attempts often to manipulate others
- Exaggeration of physical illness or fatigue
- 1.8% of adults; equally common in both sexes
Theoretical Explanations and Treatments for Histrionic Personality Disorder
Theoretical perspective
- Psychodynamic: unhealthy relationships w/ cold, controlling parents in childhood; feelings of being unloved and fear of abandonment; dramatic crisis invented for protection
- Cognitive-behavioral: lack of substance and extreme suggestibility
- Self-focused & emotional behavior
- Search for others to meet needs
- Sociocultural/multicultural: partially influenced by cultural norms and expectations
- Vain, dramatic, and selfish behavior of histrionic personality may actually be exaggeration of femininity as culture once defined it
- More likely than those w/ most other personality disorders to seek out treatment alone
- Clients may pretend to have important insights/change during treatment merely to please therapist
Treatment
- Cognitive-behavioral therapists: change belief that they are not capable of controlling emotions; develop better/more deliberate ways of thinking and solving problems
- Psychodynamic and various group therapy formats
- Help clients find inner satisfaction, become more self-resilient
Narcissistic Personality Disorder (Dramatic)
People with disorder are generally grandiose, need much admiration, and feel no empathy w/ others
- Exaggerations of achievements/talents, often arrogance
- Selective about friends; often favorable first impression
- Seldom interested in feelings of others
- 6.2% of U.S. adults; 75% men
- Narcissistic-type behaviors/thoughts are common and normal among teenagers, doesn’t usually lead to adult narcissism
Theoretical Explanations and Treatments for Narcissistic Personality Disorde
Theoretical perspectives
- Psychodynamic: cold, rejecting parents
- Self-sufficiency replaces warm relationships
- Cognitive-behavioral: people treated too positively in early life; overvalue self worth
- Sociocultural theorists: link between narcissistic personality disorder and eras of narcissism in society
- Family values/social ideals in certain societies periodically break down; produces generations of young people who are self-centered, materialistic, and have short attention spans
Treatment
- One of most difficult personality patterns to treat
- Clients consult therapists due to related disorder (commonly depression)
- Individuals may try to manipulate therapists to support sense of superiority; love-hate relationships may evolve
- Psychodynamic: recognize and work through basic insecurities/defenses
- Cognitive-behavioral: focus on self-centered thinking and redirection; interpret criticism more rationally; increases empathy
- No major-treatment approaches have had much success
“Anxious” Personality Disorders
Cluster of “anxiety” personality disorders includes
- Avoidant personality disorder
- Dependent personality disorder
- Obsessive-compulsive personality disorder
- People w/ disorders typically display anxious and fearful behavior
- Researchers haven’t found direct links to anxiety/depressive disorders
- Treatments for disorders appear to be better than for other personality disorders
Avoidant Personality Disorder (Anxious)
Characterized by consistent discomfort/restrain in social situations, overwhelming feelings of inadequacy, and extreme sensitivity to negative evaluation
- Avoid social contact due to dread of criticism, disapproval, or rejection
- Similar to social anxiety disorder - many experience both
- Share fear of humiliation and low confidence
- Some theorists believe social anxiety disorder and avoidant personality disorder should be combined
- Others make distinction between fear of social circumstances (SAD) and fear of social relationships (APD)
- At least 2% of adults have disorder, equal frequency in men and women
Theoretical Explanations and Treatments for Avoidant Personality Disorder
Theoretical perspectives
- Theorists often assume avoidant personality disorder has same causes as social anxiety disorder
- Psychodynamic: focus on shame and insecurity traced to childhood experiences
- Cognitive-behavioral: harsh criticism in early childhood leads to expected rejection; failure to develop effective social skills
Treatment
- Therapy often sought for acceptance/affection
- Psychodynamic: recognize and resolve unconscious conflicts
- Cognitive-behavioral: change distressing beliefs and thoughts, carry on in face of painful emotions, and improve self-image
- Social skills training and exposure treatments that require people to gradually increase social contacts
- Antianxiety and antidepressant drugs are sometimes useful
Dependent Personality Disorder (Anxious)
- Individuals have pervasive, excessive need to be cared for
- Difficulty w/ separation is central feature
- Clinging/obedient; distress, lonely, sad, and prone to self-dislike
- Reliance on others (even for small decisions)
- Affects less than 1% of population, equal incidence for males/females
Theoretical Explanations and Treatments for Dependent Personality Disorder
Theoretical perspectives
- Psychodynamic: similar to depression
- Freudian: unresolved conflicts during oral stage
- Object relations theory: early parental loss/rejection prevents normal attachment and separation
- Behavioral: clinging and “loyal” behavior rewarded by dependent parents
- Cognitive
- Inadequate and helpless to deal with/ world
- Need to find person to provide protection
- Place responsibility for treatment and well-being on clinician
- Couple or family therapy may be suggested
Treatment
- Psychodynamic: transference of dependency needs
- Cognitive-behavioral
- Behavioral: assertiveness training to help individuals better express own wishes in relationships
- Cognitive: challenge incompetence and helplessness assumptions
Obsessive-Compulsive Personality Disorder (Anxious)
Intense focus on orderliness, perfectionism, and control
- Loss of flexibility, openness, and efficiency
- Unreasonably high standards for self and others
- Fear of decision making
- Difficulty expressing affection
- As many as 7.9% of adult population
- 2:1 ratio of men to women
- Many clinicians believe obsessive-compulsive personality disorder and obsessive-compulsive disorder are closely related
Theoretical Explanations and Treatments for Obsessive-Compulsive Personality Disorder
Theoretical perspective
- Freudian: overly harsh toilet training during anal stage
-Other psychodynamic theorists: any early struggles with parents over control may ignite impulses
- Cognitive-behavioral
- Dichotomous thinking
- Misread/exaggerate consequences of mistakes
Treatment
- People with disorder do not usually believe there is anything wrong with them
- Unlikely to seek treatment unless they have another disorder (typically anxiety or depression)
- Individuals respond well to psychodynamic or cognitive therapy
- Psychodynamic therapists: recognize, experience, and accept underlying feelings and insecurities, and perhaps take risks and accept personal limitations
- Cognitive therapists: change dichotomous thinking, perfectionism, indecisiveness, procrastination, and chronic worrying
- A number of clinicians report success with SSRIs
