Personality Disorders Definition maladaptive ways of interacting Rigid

Personality Disorders Definition = maladaptive ways of interacting • *Rigid • *Pervasive • Common • Ego syntonic -> don’t seek tx -> less motivated to change

“Medical Students’ Disease” • Continuum of characteristics • Disorder = greater degree & impairment Course • Originate in childhood & persists

Sex Differences 1. Histrionic, dependent = women 2. Current research: Either > in males or equal • Males = Paranoid, Schizotypal, Antisocial, Narcissistic, Obsessivecompulsive • Equal = Histrionic, Avoidant, Dependent • Females = Borderline

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

• Categories vs. Dimensions – Currently, categories – Possible move to dimensions – Reduces stigma – Reflects actual clients

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

Treatment • Only seek for crisis • Therapist provides trust (cognitive therapy for errors) • No clear evidence of change

Schizoid PD • Solitary, uninterested in others • Not from fear • But some are sensitive • Extreme social deficiencies • No unusual/bizarre thoughts

Causes - unknown • Isolation resembles autism -> maybe shared biological mechanism Treatment • Help develop interest in relationships • Little optimism

Schizotypal PD • Social isolation + unusual behaviors & thoughts • Not full-blown hallucinations, but “as if”

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)

Cluster B: Dramatic, emotional Antisocial PD • Disregard for social norms • No remorse • Substance abuse/sensation-seeking • Age 18

Causes a) Genetic influence on nonviolent criminality b) Neurobiology: NOT brain damage i. Low cortical arousal - stimulation-seeking behaviors - slower brain waves/heart rate ii. Fearlessness hypothesis - higher threshold for fear & worse at detecting danger cues iii. Inhibition vs. reward systems: weak inhibition & strong reward (BAS vs. BIS)

c) Aggression learned at home - parents reward kid’s aggression - inconsistent discipline - low SES

Treatment • Behavior dies down by age 40 • But difficult to treat • Manipulate therapist • Few positive outcomes • Focus: childhood prevention via parent training

Borderline PD *No sense of self • Instability in relationships -> fear abandonment • All-or-none thinking • Unstable moods • Poor self-image (“empty”) • Impulsive

Causes • Possible genetics – mood disorders • Childhood trauma • Psychodynamic: Abandonment fears poor separation/individuation from mom

Treatment • Extremely difficult • But: Linehan — help dev. identity • Support/constancy, coping, identify & regulate emotions • Medication (for depression & anxiety) - poor compliance, abuse meds

Histrionic PD • Dramatic, self-centered, shallow • Singers, actors

Causes • Learn appearance & performance -> attention

Treatment • Focus on problematic relationships • Reward for appropriate & fine for inappropriate/attention-getting behavior

Narcissistic PD • Grandiose, exaggerated sense of own importance • Preoccupation with gaining attention • Lack sensitivity/compassion, exploit others

Causes • Inadequate admiration from parents • Damaged sense of self • Grandiosity = façade • Current society (“me, ” instant gratification) -> increases prevalence

Treatment: Cognitive i. Replace grandiose fantasies - attainable daily pleasures ii. Coping with criticism iii. Understand others’ feelings iv. Treat depression

Cluster C: Anxious, fearful Avoidant PD • Extreme sensitivity to rejection • Actively avoid relationships • Low opinion of self

Causes • May be more “difficult” infants -> inadequate early unconditional positive regard -> alienated & unworthy

Treatment - many good studies • Behavioral therapy for anxiety & social skills problems • Systematic desensitization for specific situations

Dependent PD • Excessive reliance on others for everyday decisions • Abandonment fears • Submissive/agreeable to avoid rejection

Causes • Childhood assertiveness punished • Parental overprotection • Early parental loss/rejection -> abandonment fears

Treatment - little research • Appear to be ideal therapy clients -> danger of over-dependence on therapist • Develop independence & responsibility

Obsessive-Compulsive PD • Preoccupation with the “right way” • Inflexible, perfectionistic, rigid • Relationships often poor • Only distantly related to OCD

Causes • Possible genetic basis, but weak • Strong parental discipline & over-control • No real understanding of causes

Treatment - little research • Attack fears underlying perfectionism • Deal with possible anxiety regarding inadequacy • Relaxation/distraction

For all PDs, therapy involves • Insight into how they affect other people & are perceived • Insight into how their behavior causes them problems

Ethical Issues Therapy with Personality Disorders • Very resistant to treatment • Rarely seek treatment on own -> When is treatment justifiable?

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?

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

Therapy • Pull from usual part of circle to opposite • Act in complementary manner to goal behavior • Meta-communicate