Comer, Abnormal Psychology, 7th edition.ppt

Slides&Handouts by Karen Clay Rhines,Ph.D.Northampton Community CollegePersonality DisordersChapter 161PersonalityWhat is personality?Personality is a unique and long-term pattern of inner experience and outward behaviorPersonality tends to be consistent and is often described in terms of“traits”These traits may be inherited,learned,or bothPersonality is also flexible,allowing us to adapt to new environmentsFor those with personality disorders,however,that flexibility is usually missing2Personality DisordersWhat is a personality disorder?An inflexible pattern of inner experience and outward behaviorThis pattern is seen in most interactions,differs from the experiences and behaviors usually expected,and continues for yearsThe rigid traits of people with personality disorders often lead to psychological pain for the individual and social or occupational difficultiesThe disorder may also bring pain to others3Classifying Personality DisordersA personality disorder typically becomes recognizable in adolescence or early adulthoodThese are among the most difficult psychological disorders to treat Many sufferers are not even aware of their personality disorderIt has been estimated that 9%to 13%of all adults may have a personality disorder4Classifying Personality DisordersPersonality disorders are diagnosed on Axis II of the DSM-IV-TRThese patterns are not typically marked by changes in intensity or periods of clear improvementThose diagnosed with personality disorders are often also diagnosed with an Axis I disorderThis relationship is called“comorbidity”Axis II disorders may predispose people to develop an Axis I disorder,or Axis I disorders may set the stage for Axis II disorders,or some biological condition may set the stage for both!Whatever the reason,research indicates that the presence of a personality disorder complicates and reduces a persons chances for a successful recovery5Classifying Personality DisordersThe DSM-IV-TR identifies ten personality disorders and separates these into three categories or“clusters”:Odd or eccentric behaviorParanoid,schizoid,and schizotypal personality disordersDramatic,emotional,or erratic behaviorAntisocial,borderline,narcissistic,and histrionic personality disordersAnxious or fearful behaviorAvoidant,dependent,and obsessive-compulsive personality disorders6Classifying Personality DisordersThe various personality disorders overlap each other so much that it can be difficult to distinguish one from anotherThe frequent lack of agreement between clinicians and diagnosticians has raised concerns about the validity(accuracy)and reliability(consistency)of these categoriesIt should be clear that diagnoses of such disorders can easily be overdone7“Odd”Personality DisordersThe cluster of“odd”personality disorders includes:Paranoid personality disorderSchizoid personality disorderSchizotypal personality disorder 8“Odd”Personality DisordersPeople with these disorders display behaviors similar to,but not as extensive as,schizophreniaBehaviors include extreme suspiciousness,social withdrawal,and peculiar ways of thinking and perceiving thingsSuch behaviors leave the person isolatedSome clinicians believe that these disorders are actually related to schizophrenia,and thus call them“schizophrenia-spectrum disorders”9“Odd”Personality DisordersClinicians have learned much about the symptoms of odd personality disorders,but little of their causes or how to treat themIn fact,people with these disorders rarely seek treatment10Paranoid Personality DisorderThis disorder is characterized by deep distrust and suspicion of othersAlthough inaccurate,the suspicion is usually not“delusional”the ideas are not so bizarre or so firmly held as to clearly remove the individual from realityAs a result of their mistrust,people with paranoid personality disorder often remain cold and distant11Paranoid Personality DisorderThey are critical of weakness and fault in others,particularly at workThey are unable to recognize their own mistakes and are extremely sensitive to criticismThey often blame others for the things that go wrong in their lives and they repeatedly bear grudgesBetween 0.5%and 3%of adults are believed to experience this disorder,apparently more men than women12How Do Theorists Explain Paranoid Personality Disorder?The proposed explanations of this disorder,like those of most other personality disorders,have received little systematic researchPsychodynamic theorists trace the pattern back to early interactions with demanding parentsCognitive theorists suggest that maladaptive assumptions such as“People are evil and will attack you if given the chance”are to blameBiological theorists propose genetic causes and have looked at twin studies to support this model13Treatments for Paranoid Personality DisorderPeople with paranoid personality disorder do not typically see themselves as needing helpFew come to treatment willinglyThose who are in treatment often distrust and rebel against their therapistsAs a result,therapy for this disorder,as for most of the other personality disorders,has limited effect and moves slowly14Treatments for Paranoid Personality DisorderObject relations therapists try to see past the patients anger and work on the underlying wish for a satisfying relationshipBehavioral and cognitive therapists try to help clients control anxiety and improve interpersonal skillsCognitive therapists also try to restructure clients maladaptive assumptions and interpretationsDrug therapy is of limited help15Schizoid Personality DisorderThis disorder is characterized by persistent avoidance of social relationships and limited emotional expressionWithdrawn and reclusive,people with this disorder do not have close ties with other people;they genuinely prefer to be alonePeople with schizoid personality disorder focus mainly on themselves and are often seen as flat,cold,humorless,and dullThe disorder is estimated to affect fewer than 1%of the populationIt is slightly more likely to occur in men than in women16How Do Theorists Explain Schizoid Personality Disorder?Many psychodynamic theorists,particularly object relations theorists,link schizoid personality disorder to an unsatisfied need for human contactThe parents of those with the disorder are believed to have been unaccepting or abusive of their children17How Do Theorists Explain Schizoid Personality Disorder?Cognitive theorists propose that people with schizoid personality disorder suffer from deficiencies in their thinkingTheir thoughts tend to be vague and empty,and they have trouble scanning the environment for accurate perceptions18Treatments for Schizoid Personality DisorderTheir extreme social withdrawal prevents most people with this disorder from entering therapy unless some other disorder makes treatment necessaryEven then,patients are likely to remain emotionally distant from the therapist,seem not to care about treatment,and make limited progress19Treatments for Schizoid Personality DisorderCognitive-behavioral therapists have sometimes been able to help people with this disorder experience more positive emotions and more satisfying social interactionsThe cognitive end focuses on thinking about emotionsThe behavioral end focuses on the teaching of social skillsGroup therapy is apparently useful as it offers a safe environment for social contactDrug therapy is of little benefit20Schizotypal Personality DisorderThis disorder is characterized by a range of interpersonal problems,marked by extreme discomfort in close relationships,odd(even bizarre)ways of thinking,and behavioral eccentricitiesThese symptoms may include ideas of reference and/or bodily illusionsPeople with the disorder often have great difficulty keeping their attention focused;conversation is typically digressive and vague,even sprinkled with loose associations21Schizotypal Personality DisorderSocially withdrawn,people with schizotypal personality disorder seek isolation and have few friendsIt has been estimated that 2%to 4%of all people(slightly more males than females)may have the disorder22How Do Theorists Explain Schizotypal Personality Disorder?Because the symptoms of schizotypal personality disorder so often resemble those of schizophrenia,researchers have hypothesized that similar factors are at work in both disordersSchizotypal symptoms are often linked to family conflicts and to psychological disorders in parentsResearchers have also begun to link schizotypal personality disorder to some of the same biological factors found in schizophrenia,such as high dopamine activityThe disorder has also been linked to mood disorders,especially depression23Treatments for Schizotypal Personality DisorderTherapy is as difficult in cases of schizotypal personality disorder,as in cases of paranoid and schizoid personality disordersMost therapists agree on the need to help clients“reconnect”and recognize the limits of their thinking and powersCognitive-behavioral therapists further try to teach clients to objectively evaluate their thoughts and perceptions and provide speech lessons and social skills trainingAntipsychotic drugs appear to be somewhat helpful in reducing certain thought problems24“Dramatic”Personality DisordersThe cluster of“dramatic”personality disorders includes:Antisocial personality disorderBorderline personality disorderHistrionic personality disorderNarcissistic personality disorder25“Dramatic”Personality DisordersThe behaviors of people with these disorders are so dramatic,emotional,or erratic that it is almost impossible for them to have relationships that are truly giving and satisfyingThese personality disorders are more commonly diagnosed than the othersOnly antisocial and borderline personality disorders have received much studyThe causes of the disorders are not well understoodTreatments range from ineffective to moderately effective26Antisocial Personality DisorderSometimes described as“psychopaths”or“sociopaths,”people with antisocial personality disorder persistently disregard and violate others rightsAside from substance-related disorders,this is the disorder most linked to adult criminal behaviorThe DSM-IV-TR requires that a person be at least 18 years of age to receive this diagnosisMost people with an antisocial personality disorder displayed some patterns of misbehavior before they were 15 years old27Antisocial Personality DisorderPeople with the disorder are likely to lie repeatedly,be reckless,sexually promiscuous,and impulsiveThey have a disregard for other individuals,and can be cruel,sadistic,aggressive,and violent28Antisocial Personality DisorderSurveys indicate that 2%to 3.5%of people in the U.S.meet the criteria for this disorderThe disorder is 4 times more common in men than womenBecause people with this disorder are often arrested,researchers frequently look for people with antisocial patterns in prison populationsStudies indicate higher rates of alcoholism and other substance-related disorders among this group29Antisocial Personality DisorderChildren with a conduct disorder and an accompanying attention-deficit hyperactivity disorder apparently have a heightened risk of developing antisocial personality disorder30How Do Theorists Explain Antisocial Personality Disorder?Psychodynamic theorists propose that this disorder begins with an absence of parental love,leading to a lack of basic trustMany behaviorists have suggested that antisocial symptoms may be learned through modeling or unintentional reinforcement31How Do Theorists Explain Antisocial Personality Disorder?The cognitive view says that people with the disorder hold attitudes that trivialize the importance of other peoples needs A number of studies suggest that biological factors may play a roleLower levels of serotonin,impacting impulsivity and aggressionDeficient functioning in the frontal lobes of the brainLower levels of anxiety and arousal,leading them to be more likely than others to take risks and seek thrills32Treatments for Antisocial Personality DisorderTreatments are typically ineffectiveA major obstacle is the individuals lack of conscience or desire to changeMost have been forced to come to treatmentSome cognitive therapists try to guide clients to think about moral issues and the needs of other peopleHospitals and prisons have attempted to create therapeutic communitiesAntipsychotic drugs also have been tried but systematic studies are still needed33Borderline Personality DisorderPeople with this disorder display great instability,including major shifts in mood,an unstable self-image,and impulsivityInterpersonal relationships are also unstable People with borderline personality disorder are prone to bouts of anger,which sometimes result in physical aggression and violenceJust as often,however,they direct their impulsive anger inward and harm themselves34Borderline Personality DisorderMany of the patients who come to mental health emergency rooms are individuals with the disorder who have intentionally hurt themselvesTheir impulsive,self-destructive behavior can include:Alcohol and substance abuseReckless behavior,including driving and unsafe sexCutting themselvesSuicidal actions and threatsPeople with the disorder frequently form intense conflict-ridden relationships while struggling with recurrent fears of impending abandonment35Borderline Personality DisorderBetween 1.5%and 2.5%of the general population are thought to suffer from this disorderClose to 75%of those diagnosed are womenThe course of the disorder variesIn the most common pattern,the instability and risk of suicide reach a peak during young adulthood and then gradually wane with advancing age36How Do Theorists Explain Borderline Personality Disorder?Because a fear of abandonment tortures so many people with the disorder,psychodynamic theorists look to early parental relationships to explain the disorderObject-relations theorists propose a lack of early acceptance or abuse/neglect by parentsResearch has found some support for this view,including a link to early sexual abuse37How Do Theorists Explain Borderline Personality Disorder?Some features of the disorder have also been linked to biological abnormalitiesSufferers who are particularly impulsive apparently have lower brain serotonin activityClose relatives of those with borderline personality disorder are 5 times more likely than the general population to have the disorderA number of theorists currently use a biosocial theory,stating that the disorder results from a combination of internal and external forcesSome sociocultural theorists suggest that cases of borderline personality disorder are particularly likely to emerge in cultures that change rapidly38Treatments for Borderline Personality DisorderIt appears that psychotherapy can eventually lead to some degree of improvement for people with this disorderIt is extraordinarily difficult,though,for a therapist to strike a balance between empathizing with a patients dependency and anger and challenging his