SLK 310 Chapter 9 Personality Disorders 2 PDF

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Summary

Personality DisordersPersonality: enduring patterns of perceiving, feeling, thinking about and relating to oneself and the environmentDetermines how one feels, interacts and perceives eventsCore aspects of personality Your sense of self/identity  Distinct from others sense of meaning and purpose in...

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Personality Disorders Personality: enduring patterns of perceiving, feeling, thinking about and relating to oneself and the environment Determines how one feels, interacts and perceives events Core aspects of personality 1. Your sense of self/identity  Distinct from others sense of meaning and purpose in their life, pursue socially acceptable goals 2. The way we can relate to others  Personality trait: a prominent aspect of personality that is relatively consistent over time and across situations Five factor models: Dimensional perspective that maintains that personality is organized along five broad personality traits/factors 1. 2. 3. 4. 5.

Negative emotionality/ emotional stability Extraversion/ introversion Openness/ closedness to one’s own personal experience. Agreeableness/ antagonism Conscientiousness/ undependability

DSM-5 includes two models of personality disorders:  

Categorical and defines 10 different personality disorders in terms of distinct criteria sets. -This is intended for current clinical use Alternative dimension model was developed for DSM-5 and is included in a different section of the manual chosen for study.  Makes use of a continuum model of personality disorders such as that represented by the Big 5 models.  Assumes the normal and abnormal personality fall on an integrated continuum of personality, with personality disorders representing more extreme and maladaptive variants of personality traits.

General Definition of Personality Disorder Personality disorder: An enduring pattern of inner experience, thinking, feeling, behaviours that deviate from the expectation of the indv’s culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time, and leads to distress or impairment. Only when personality traits are inflexible across situations and pervasive, maladaptive, stable over time 

Onset in adolescence or early adulthood and deviate from expectations of one’s culture which can be seen in

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How one thinks about oneself and others or events. One’s emotional expressions/experience. One’s interpersonal functioning and/ ones’ impulse control ability. And causes significant functional impairment or subjective distress. Personality disorder clusters

People with PD present with fundamental deficits in terms of who they are, their ability to have relationships PD are pervasive and chronic and not discrete or acutely episodic Personality Disorder Clusters 1. Cluster A: Odd-Eccentric Personality  Paranoid Personality Disorder  Schizoid Personality Disorder  Schizotypal Personality Disorder 2. Cluster B: Dramatic-Emotional Personality Disorder  Borderline Personality Disorder(NB)  Histrionic Personality Disorder  Narcissistic Personality Disorder  Antisocial Personality Disorder 3. Cluster C: Anxious-Fearful Personality Disorders  Avoidant Personality disorder  Dependent Personality Disorder  Obsessive Compulsive Personality Disorder Clusters A: Odd-Eccentric Personality Paranoid, Eccentric Behaviours and Thinking (characterized by)       

Similar to schizophrenia Maintains grasp on reality to greater degree. May be paranoid speak in odd and eccentric ways that make them difficult to understand Have difficulty relating to another people Have unusual beliefs which are not hallucinations and delusions These disorders may be precursors to schizophrenia/ other psychotic disorders

Paranoid Personality Disorder Paranoid personality disorder: A pattern of distrust and suspiciousness such that others’ motives are interpreted as spiteful. Characteristics of Paranoid personality disorder:   

Distrust others and are suspicious. Believe that people are chronically trying to deceive or exploit them. Preoccupied with concern of being victimized or mistreated by others.

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Hypervigilant for evidence confirming their suspicions. Closely observe situations, noting details that others miss.  Consider such occurrences o be meaningful and as clues to other people’s true intentions. Very sensitive and angrily reactive to real or perceived criticism and tend to bear grudges. Misinterpret situations in line with their suspicions. (ex. spouse cheerfulness is evidence of an affair) Resistant to rational arguments against their beliefs and see the other person’s argument against their beliefs as evidence of a conspiracy against them. Some are secretive and withdraw to protect themselves. - Others become hostile and argumentative.

Theories of paranoid personality disorder Family history studies: More common in families of people with schizophrenia –suggest that paranoid personality disorder may be part of the schizophrenia spectrum of disorders. Cognitive theories: Cognitive theorists view paranoid personality disorder as the result of an underlying belief that people are malevolent and deceptive, combined with lack of self-confidence about being about to defend oneself against others. Thus, the person is vigilant for signs of others’ deceit or criticism and must be quick to act against others. Social contributors: Exposure to social and environmental risk factors that may lead to indv’s being mistrustful or suspicious. Differential exposure to discrimination, prejudice, childhood trauma, and especially socioeconomic status appear to contribute to paranoid personality disorder. Treatment of paranoid personality disorder  

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Seek treatment when they’re in crisis. Seek treatment for severe symptoms of depression and anxiety, doesn’t feel the need for treatment of paranoia. - Hard to gain trust due to guarded and suspicious style -therefore therapist must be calm, respectful and extremely straightforward but cannot directly confront the client’s paranoia. - Cannot directly challenge/confront paranoid thinking, likely be misinterpreted in line with their paranoia. - Use indirect means of raising questions in the patient’s mind of his/her typical way of interpreting situations. Do not expect full insight but aim to build some degree of trust for therapist from therapy → learn to trust others →improve interpersonal relationships.

Cognitive therapy: (paranoid personality disorder) 

For people diagnosed with this disorder focuses on increasing self-efficacy in dealing with difficult situations, thus decreasing their fear and hostility toward others.

Schizoid Personality Disorder Schizoid personality disorder: show a pervasive pattern of detachment from social relationships and a restricted range of emotional expression in interaction with others. Characteristics of schizoid personality disorder         

Prefer to turn attention inwards, away from the outside world, engage in solitary activities. Detached from social relationships. Restricted range of emotional expression in related to others. - Indifferent to forming close relationships and derive little/ no pleasure from family or social interactions. Expression and experience of positive emotions are very low Described as emotionally aloof (reserved) or cold, loners or bland, uninteresting and humourless. Take pleasure in few activities. Find relationships messy, unrewarding, and intrusive. Acknowledge painful feelings specifically related to social interactions. People with schizoid personality disorder can function in society, particularly in occupations with limited/ no interpersonal interactions.

Theories of schizoid personality disorder Slight increase in rate of schizoid personality disorder in relatives of persons with schizophrenia. - Traits may be inherited. - Traits associated with disorder such as low sociability, low warmth seem to partially inherit but it is only indirect. Treatment of schizoid personality disorder   

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People with schizoid personality disorder are not motivated for therapy. Interpersonal closeness of therapy is experienced as stressful rather than supportive. Psychosocial treatments (schizoid personality disorder)  Attempt to increase person’s awareness of feelings as well as increasing his or her social skills and social contacts.  Therapist can model the expression of feelings →help client identify and express own feelings. Social skills training done through role-playing with the therapist and homework assignments in which client tries new social skills with other people. –cognitive therapy component. Group therapy to increase social interaction –group members can model interpersonal relationships.

Schizotypal Personality Disorder

Schizotypal personality disorder: A pervasive pattern of social and interpersonal deficits marked by acute discomfort, and reduced capacity for close relationships, cognitive or perceptual distortions, and eccentricities of behaviour. –beginning by early adulthood. Similar symptoms to schizophrenia but milder. (NB) Symptoms include:    

Restricted range of emotion Uncomfortable interpersonal interactions Odd and eccentric behaviours Paranoia

Characteristics of schizotypal personality disorder:  

Patients are socially isolated, have a restricted range of emotions, uncomfortable with interpersonal relationships. As children –they are passive, socially unengaged, and hypersensitive to criticism, thus may attract teasing because they are odd or eccentric.

Distinguishing characteristics are: cognitive and perceptual distortions and, odd and eccentric behaviours. (NB) - Characteristics fall into 4 categories NB: 1. Paranoia/suspiciousness: perceive others as hostile and deceitful and much of their social anxiety emerges from this paranoia. 2. Ideas of Reference: tend to believe that random events, or circumstances have a particular meaning just for them. 3. Odd beliefs and Magical Thinking: believe that others know what they are thinking. 4. Illusions (just short of Hallucinations): may think they see people in patterns of wallpaper.  Misperceiving/ misinterpreting sensory stimuli. Thoughts, speech and behaviour:       

In addition to demonstrating cognitive and perceptual distortions. Tend to have speech that is tangential, circumstantial, vague, or over-elaborate. May have inappropriate emotional responses or no emotional response. Odd behaviour sometimes reflects their odd thoughts. May become fixated on an object for a long period of time, lost in thought or fantasy. Oddities of thought, speech, and behaviour is similar to that of schizophrenia, but less severe. Retain basic contact with reality.

Theories of schizotypal personality disorder Suggest it may be genetic. Cognitive theory: 

Show cognitive deficits such as problems with verbal fluency, inhibiting information when a task calls for it and memory –same as schizophrenia.

Childhood history: 

People with schizotypal personality disorder tend to have more frequent histories of a wide range of childhood adversities (difficulties); including physical, emotional, and sexual abuse and having a parent who was battered, abused substances, or spent time in jail.

Treatment of schizotypal personality Same drugs as schizophrenia are used. 1st Psychotherapy: it is important for therapist to establish a good relationship with the client because the clients tend to have few close relationships.  Client tend to struggle with paranoid thoughts and excessive social anxiety. 2nd Group therapy: Increase client’s social contacts and learn socially appropriate behaviours through social skills training. 

Helpful in increasing clients’ social skills.

3rd Cognitive therapies: involves teaching them to look for objective evidence in the environment to support their thoughts and to disregard bizarre thoughts. Cluster B: Dramatic-Emotional Personality Disorder Antisocial Personality Disorder, Histrionic Personality Disorder, Borderline Personality Disorder, and Narcissistic Personality Disorder   

Engage in behaviours that are dramatic, and impulsive. Often show little regard for their own safety and the safety of others. One core aspect is that the person has lack of concern for others.

Borderline Personality Disorder(NB) Borderline personality disorder: A pervasive pattern of instability in self-image, mood, and interpersonal relationship and marked impulsivity. –beginning early adulthood Symptoms of BPD:     

Out of control emotions that cannot be contained. Hypersensitivity to abandonment. Tendency to cling too tightly to other people.  History of hurting oneself. Worry about abandonment and misinterpret other peoples’ everyday actions as desertion or rejection. E.g. Friend being late. Emptiness leads them to cling to new acquaintances to fill internal void.

Pathological personality traits:   

Unstable self-concept and moods. High antagonism. Negative Affectivity.

Characteristics of borderline personality disorder: 

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Fundamental deficits in identity, self-concept and in interpersonal relationships.  Mood is unstable and have severe depression, anxiety without cause and this will cause some people to engage in impulsive, self-damaging behaviour. Unstable self-concept with periods of extreme self-doubt alternating with periods of grandiose self-importance accompanied by need for others to support their self-esteem. Prone to transient dissociative states –feel unreal, lose track of time, and forget who they are. Extremely unstable interpersonal relationships –switch form love to hate. More females than males. More commonly diagnosed in people of colour. Remission within 10-15 years.

Theories of Borderline personality disorder   

Theorist argue fundamental deficits in regulating emotions. Score higher than healthy patients on measures of difficulty in regulating emotion and unwillingness to tolerate emotional distress. Also, greater variability in their moods, particularly with regard to hostility, fear and sadness.

Cognitive theory:    

People with this disorder are hyper-attentive to negative emotional stimuli in the environment. Their memories are negative and tend to make negative biased interpretations of situations. They also tend to be ruminating about negative thoughts/ acting out impulsively or aggressively in response to them. Tend to hold more negative views of others and of relationships, sometimes struggling to emphasize with others perspective =poor problem solving in social scenarios.

Social contributions:  

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Childhood filled with instability, neglect and parental psychopathology. History of physical and sexual abuse during childhood.  Instability, abuse and neglect could contribute to difficulties in regulating emotions and in attaining a positive, stable identity through several mechanisms. Do not learn appropriate emotion-regulation skills, and to understand and accept their emotional reactions. Come to rely on others to help them cope but do not have the self-confidence to ask for this help in mature ways. They become manipulative and indirect in their attempt to gain support from others. Extreme emotional reactions = impulsive actions.

Psychoanalytic theory: 

Psychoanalytical theorists (in object relations school) suggest that people never fully learn to differentiate their view of themselves from their views of others –making them extremely reactive to others opinions of them and to possibility of abandonment.

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When perceiving others as rejecting =reject themselves and may engage in selfpunishment or self-mutilation. Never been able to integrate positive and negative qualities of either their self-concept or concept of others.  Due to early caregivers that were rewarding when they remained dependent and compliant but hostile when they tried to separate from the caregivers. Tend to see themselves and other people as either all good or all bad and vacillate between these 2 views in a process known as splitting.

Treatment of Borderline personality disorder (NB!!) Dialectical behaviour therapy: Focus on:      

Helping clients gain a more realistic and positive sense of self. Learn adaptive skills for solving problems and regulating emotions. Correcting dichotomous thinking. Teach patients to monitor self-disparaging thoughts. Teach assertiveness skills –patients learn to express needs and feelings maturely. Patients learn how to control impulsive behaviours and respond appropriately.

Cognitive therapy treatments: 

Systems training for emotional predictability and problem solving (STEPPS) is a group intervention.  Combines cognitive techniques and behavioural techniques addressing selfmanagement and problem solving.  Focus on challenging maladaptive cognitions.

Psychodynamic therapies: (NB!! 2015 test) (4) It provides patients with validation and support. Attempts to help patients appreciate alternatives to their own sense of self and others by using therapist and client relationship to illustrate alternatives. 

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Transference-focused therapy: Use relationship between patient and therapist to help patients develop a healthier and realistic understanding of themselves and their interpersonal relationships. Mentalization-based treatment: Based on theory that people with borderline personality disorder have fundamental difficulty understanding mental states of themselves and others, because of traumatic experiences and poor attachment relationship to caregiver.

Histrionic Personality Disorder Histrionic personality disorder: A pervasive pattern of excessive emotionality and attention seeking. – Beginning early adulthood and present in variety of contexts. Characteristics: 

Shares features with borderline personality disorder, including rapidly shifting emotions and intense, unstable relationships.

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However, people with histrionic personality disorder behave in ways to draw attention to themselves across situations.  Whereas borderline personality disorder shows self-destructiveness, angry disruptions in close relationships, chronic feelings of inner emptiness. Histrionic personality disorder wants flattering nurturance and preferential attention and may be overly trusting of and influenced by others and authority figures.  Borderline personality disorder desperately clings to others as an expression of selfdoubt and unstable identity. Highly dramatic to pursue others attention, and overtly seductive and flamboyantly emphasizing their positive qualities of physical appearance. Seen as self-centred and shallow, unable to delay gratification, demanding, and overly dependent, and they often end up alienating friends with the demands for constant attention. Tend to exaggerate medical problems, more medical visits =increased risk for suicidal threats. Often seek treatment for depression or anxiety. Similar to somatoform disorders and mood disorders

Theories of histrionic personality disorder Family history:  

Clusters in families. Little info of cause

Treatment of histrionic personality disorder Psychodynamic:  

Focus on uncovering repressed emotions and needs. Helps patient express emotions and needs in a more socially acceptable way.

Cognitive therapy:   

Focus on identifying patient’s unrealistic assumptions that they cannot function on their own. Help patients formulate goals and plans for their life that do not rely on approval of others. Help tone down dramatic evaluations of situations by challenging these evaluations and suggesting more adaptive ones.

Narcissistic Personality Disorder Narcissistic personality disorder: A pervasive pattern of grandiosity, need for admiration, and lack of empathy; entitled, arrogant and exploitative at...