Personality DisordersPersonality Disorders
Definition of Personality?Definition of Personality? Definition of Personality DisorderDefinition of Personality Disorder
Manifest across many life areasManifest across many life areas InflexibleInflexibleMaladaptiveMaladaptiveCause either significant impairment or Cause either significant impairment or
distress to self distress to self or othersor others
Personality DisordersPersonality Disorders
Dimensions or Categories?Dimensions or Categories? DSM-IV DSM-IV
Consided as Categories (not dimensions)Consided as Categories (not dimensions) Axis II of the multiaxial systemAxis II of the multiaxial system
Not usually primary diagnosisNot usually primary diagnosis Ten Specific LabelsTen Specific Labels
Cluster A: “Odd / Eccentric”Cluster A: “Odd / Eccentric” Cluster B: “Dramatic / Emotional”Cluster B: “Dramatic / Emotional” Cluster C: “Anxious / Fearful”Cluster C: “Anxious / Fearful”
High Rates of ComorbidityHigh Rates of Comorbidity Gender Bias in Diagnosis?Gender Bias in Diagnosis?
Paranoid Personality DisorderParanoid Personality Disorder
Excessively Mistrustful Excessively Mistrustful Excessively SuspiciousExcessively Suspicious Without JustificationWithout Justification Treatment Options Treatment Options
Few seek professional help on their ownFew seek professional help on their own Treatment focuses on development of trustTreatment focuses on development of trust Cognitive therapy to counter negativistic thinkingCognitive therapy to counter negativistic thinking Lack good outcome studiesLack good outcome studies
Schizoid Personality DisorderSchizoid Personality Disorder
Extreme Social Detachment (Loner) Extreme Social Detachment (Loner) Appear Aloof, Cold, IndifferentAppear Aloof, Cold, Indifferent Limited Range of EmotionsLimited Range of Emotions Treatment Options Treatment Options
Few seek professional help on their ownFew seek professional help on their own Focus on the value of interpersonal relationships, Focus on the value of interpersonal relationships,
empathy, and social skillsempathy, and social skills Treatment prognosis is generally poorTreatment prognosis is generally poor Lack good outcome studiesLack good outcome studies
Schizotypal Personality Schizotypal Personality DisorderDisorder
Also Socially Isolated Also Socially Isolated BUT Behavior Is More Unusual BUT Behavior Is More Unusual Often Considered Odd or BizarreOften Considered Odd or Bizarre
Ideas of ReferenceIdeas of Reference Magical ThinkingMagical Thinking IllusionsIllusions
Apparent Connection to Schizophrenia (but be careful!)Apparent Connection to Schizophrenia (but be careful!) Treatment Options Treatment Options
Developing social skillsDeveloping social skills Treatment also addresses comorbid depressionTreatment also addresses comorbid depression Medical treatment is similar to that used for schizophreniaMedical treatment is similar to that used for schizophrenia Treatment prognosis is generally poorTreatment prognosis is generally poor
Antisocial Personality DisorderAntisocial Personality Disorder
Long Histories ofLong Histories of Violating Cultural NormsViolating Cultural Norms Violating Rights of OthersViolating Rights of Others Impulsivity & AggressivenessImpulsivity & Aggressiveness Lack of Remorse, Conscience, EmpathyLack of Remorse, Conscience, Empathy
Not Always CriminalNot Always Criminal Relation Between ASPD, Conduct Disorder, and Relation Between ASPD, Conduct Disorder, and
Early Behavior ProblemsEarly Behavior Problems
Antisocial PersonalityAntisocial Personality
Neurobiological TheoriesNeurobiological Theories Underarousal, Fearlessness, & Behavioral Inhibition Underarousal, Fearlessness, & Behavioral Inhibition
Treatment Treatment Few seek treatment on their ownFew seek treatment on their own Antisocial behavior is predictive of poor prognosis, Antisocial behavior is predictive of poor prognosis,
even in childreneven in children Emphasis is placed on prevention and rehabilitationEmphasis is placed on prevention and rehabilitation Often incarceration is the only viable alternative Often incarceration is the only viable alternative
Borderline Personality DisorderBorderline Personality Disorder
Unstable RelationshipsUnstable Relationships Love/Hate BehaviorLove/Hate Behavior Fear of AbandonmentFear of Abandonment
Poor Self-ImagePoor Self-Image Mood Swings, Feel EmptyMood Swings, Feel Empty
ImpulsivityImpulsivity Substance Abuse, Sex, SuicidalitySubstance Abuse, Sex, Suicidality
Self-mutilationSelf-mutilation
Borderline Personality DisorderBorderline Personality Disorder
Runs in familiesRuns in families Early trauma and abuse seem to play some roleEarly trauma and abuse seem to play some role Treatment Options Treatment Options
Few good treatment outcome studiesFew good treatment outcome studies Antidepressant medications provide some short-term Antidepressant medications provide some short-term
reliefrelief Dialectical behavior therapy is the most promising Dialectical behavior therapy is the most promising
psychosocial approachpsychosocial approach
Histrionic Personality DisorderHistrionic Personality Disorder
Overly DramaticOverly Dramatic Center of AttentionCenter of Attention Emphasis on AppearanceEmphasis on Appearance Emotions are ShallowEmotions are Shallow Seductive & ProvocativeSeductive & Provocative Treatment Options Treatment Options
Few good treatment outcome studiesFew good treatment outcome studies Treatment focuses on attention seeking and long-term negative Treatment focuses on attention seeking and long-term negative
consequencesconsequences Targets may also include problematic interpersonal behaviorsTargets may also include problematic interpersonal behaviors Little evidence that treatment is effectiveLittle evidence that treatment is effective
Narcissistic Personality DisorderNarcissistic Personality Disorder
Grandiose Sense of SelfGrandiose Sense of Self Exaggerated Self-ImportanceExaggerated Self-Importance
Preoccupied with AttentionPreoccupied with Attention Requires AdmirationRequires Admiration Little EmpathyLittle Empathy Highly Sensitive to CriticismHighly Sensitive to Criticism Treatment Options Treatment Options
Focuses on grandiosity, lack of empathy, unrealistic thinkingFocuses on grandiosity, lack of empathy, unrealistic thinking Treatment may also address co-occurring depressionTreatment may also address co-occurring depression Little evidence that treatment is effectiveLittle evidence that treatment is effective
Avoidant Personality DisorderAvoidant Personality Disorder Sensitive to Other’s OpinionsSensitive to Other’s Opinions Avoid Social RelationshipsAvoid Social Relationships Extreme Low Self-EsteemExtreme Low Self-Esteem Takes Few RisksTakes Few Risks Socially Inhibited & AnxiousSocially Inhibited & Anxious Treatment Options Treatment Options
Several well-controlled treatment outcome studies existSeveral well-controlled treatment outcome studies exist Treatment is similar to that used for social phobia Treatment is similar to that used for social phobia Treatment targets include social skills and anxietyTreatment targets include social skills and anxiety
Dependent Personality DisorderDependent Personality Disorder
Excessive Reliance on OthersExcessive Reliance on Others Submissive & PassiveSubmissive & Passive Rely on Others to Make Even Minor DecisionsRely on Others to Make Even Minor Decisions
Fear AbandonmentFear Abandonment ClingyClingy
Treatment Options Treatment Options Research on treatment efficacy is lackingResearch on treatment efficacy is lacking Therapy typically progresses gradually Therapy typically progresses gradually Treatment targets include skills that foster Treatment targets include skills that foster
independenceindependence
Obsessive-Compulsive Obsessive-Compulsive Personality DisorderPersonality Disorder
NOTNOT same thing as OCD same thing as OCD Fixation on Doing Things “The Right Way”Fixation on Doing Things “The Right Way” Preoccupation withPreoccupation with
PerfectionismPerfectionism ControlControl Orderliness, Details, and RulesOrderliness, Details, and Rules
Obsessions and Compulsions Are RareObsessions and Compulsions Are Rare Treatment Options Treatment Options
Data supporting treatment are limitedData supporting treatment are limited Treatment may address fears related to the need for orderlinessTreatment may address fears related to the need for orderliness Other targets include rumination, procrastination, and feelings of Other targets include rumination, procrastination, and feelings of
inadequacyinadequacy
Problems with Personality DisordersProblems with Personality Disorders
The Causes of Personality Disorders Are The Causes of Personality Disorders Are Difficult to Pinpoint Difficult to Pinpoint
Treatment of Personality Disorders Is Treatment of Personality Disorders Is Often Difficult Often Difficult
Often Comorbid IssuesOften Comorbid Issues Egosyntonic (vs. Egodystonic)Egosyntonic (vs. Egodystonic)