Sue/Sue/Sue Understanding Abnormal Behavior, 9 th edition 2010 Cengage Learning CHAPTER EIGHT. Personality Disorders

Transcription

1 Sue/Sue/Sue Understanding Abnormal Behavior, 9 th edition 2010 Cengage Learning CHAPTER EIGHT Personality Disorders

2 PERSONALITY DISORDERS Personality Disorder: Sue/Sue/Sue Understanding Abnormal Behavior, 9 th edition 2010 Cengage Learning Characterized by inflexible, long-standing, and maladaptive personality traits that cause significant functional impairment, subjective distress, or a combination of both

3 DIAGNOSING PERSONALITY DISORDERS According to DSM-IV-TR: Enduring pattern of cognition, affect, interpersonal functioning, or impulse controlthinking/behavior that deviates from person s culture. Relatively inflexible/pervasive across personal and social situations Significant distress or impairment in social, occupational functioning Stable and long-term since early childhood or adolescence Not accounted for by another medical condition

4 DIAGNOSING PERSONALITY DISORDERS Culture, ethnicity and gender affect diagnosis Under Axis II in DSM-IV-TR (not Axis I) Chronic, developmental, and relatively inflexible Can coexist with other disorders in Axis I Difficulties in diagnosis: Everyone exhibits some of the traits (med. Student phen.) Symptoms overlap other disorders Lack of adherence to diagnostic criteria

5 DISORDERS CHARACTERIZED BY ODD OR ECCENTRIC BEHAVIORS Paranoid Personality Disorder: Unwarranted suspiciousness, hypersensitivity, and reluctance to trust others Restricted affect, tend to be rigid, preoccupied Unfounded beliefs are resistant to change Culture must be taken into account to avoid misdiagnosis Prevalence: % Treatment: Usually psychotherapy, but difficult to treat

6 DISORDERS CHARACTERIZED BY ODD OR ECCENTRIC BEHAVIORS Schizoid Personality Disorder: Social isolation, emotional coldness, and indifference to others Prevalence: Uncommon, slightly more males than females Unclear relationship with schizophrenia Treatment: Psychotherapy; aimed at crisis resolution

7 DISORDERS CHARACTERIZED BY ODD OR ECCENTRIC BEHAVIORS Schizotypal Personality Disorder: Peculiar thoughts and behaviors and poor interpersonal relationships Many with disorder believe they have magical powers; some subject to illusions Prevalence: 3%; more males than females Treatment: Dynamic, supportive, cognitive-behavioral, and group therapy; small doses of anxiolytics for anxiety

8 DISORDERS CHARACTERIZED BY DRAMATIC, EMOTIONAL, OR ERRATIC BEHAVIORS Antisocial Personality Disorder: Chronic failure to conform to social and legal codes, lack of anxiety and guilt, and irresponsible behaviors Cleckley s (1976) description: Superficial charm and good intelligence Shallow emotions and lack of empathy Behaviors indicative of little life plan Do not learn from experiences; absence of anxiety Unreliability, insincerity, and untruthfulness

9 DISORDERS CHARACTERIZED BY DRAMATIC, EMOTIONAL, OR ERRATIC BEHAVIORS Antisocial Personality Disorder: DSM-IV-TR differs somewhat from Cleckley Research by Hare (DVD) Prevalence: %; more men than women Begins as Conduct Disorder Culture plays big factor in diagnosis The worst of the APD

10 ATTACHMENT DISORDER SYMPTOMS MAY INCLUDE THE FOLLOWING BEHAVIORS... (CHECKLIST APPROACH) Superficially charming Learning deficits Lack of eye contact Lacks cause/effect thinking* Overly affectionate Lack of conscience* Not cuddly Abnormal eating patterns Control problems* Poor peer relationships* Destructive Preoccupied with fire, blood, gore* Cruel to animals* Nonsense questions/chatter Chronic lying* Demanding No impulse control* Abnormal speech patterns 89% of APD have had prolonged separation from caregiver during childhood *may also be symptoms of ODD and Conduct Disorder

11 MULTIPATH ANALYSIS: ANTISOCIAL PERSONALITY DISORDER Biological Genetic Influences Heredity looks to be a factor Evidence supports for genetic basis does not preclude environmental factors; undoubtedly caused by both Genetic studies do not show how APD is inherited

12 MULTIPATH ANALYSIS: ANTISOCIAL PERSONALITY DISORDER Biological: Central nervous system abnormality Autonomic nervous system abnormalities Genetic predisposition to fearlessness or lack of anxiety Arousal, sensation-seeking, and behavioral perspectives

13 MULTIPATH ANALYSIS: ANTISOCIAL PERSONALITY DISORDER Psychological: Psychodynamic: Faulty superego development Cognitive: Stress core beliefs that influence behavior Learning: Neurobiological traits that delay/impede learning Lack of positive role models Presence of poor models

14 DISORDERS CHARACTERIZED BY DRAMATIC, EMOTIONAL, OR ERRATIC BEHAVIORS Borderline Personality Disorder: Fluctuations in mood, self-image, and interpersonal relationships Impulsive, chronic feelings of emptiness, and unstable relationships May be quite friendly one day and hostile the next Probability of suicide higher Prevalence: %; 3x as many females as males May exhibit auditory hallucinations and have ego-dystonic reaction to them (i.e., know it s unacceptable)

15 DISORDERS CHARACTERIZED BY DRAMATIC, EMOTIONAL, OR ERRATIC BEHAVIORS Borderline Personality Disorder: Diverse models used to conceptualize Psychodynamic Social learning Cognitive-oriented Most drop out of therapy before it can be effective Dialectic Behavior Therapy (DBT) Emotional regulation, distress tolerance, and interpersonal effectiveness; smaller drop-out rate

16 DISORDERS CHARACTERIZED BY DRAMATIC, EMOTIONAL, OR ERRATIC BEHAVIORS Histrionic Personality Disorder: Self-dramatization, exaggerated expression of emotions, and attention-seeking behaviors Prevalence: 1-3%; no gender differences Treatment: Psychodynamic: Establish therapeutic alliance and provide insight Cognitive behavioral: Focus on changing irrational thinking

17 DISORDERS CHARACTERIZED BY DRAMATIC, EMOTIONAL, OR ERRATIC BEHAVIORS Narcissistic Personality Disorder: Exaggerated sense of self-importance, exploitative attitudes, and lack of empathy Fantasies about power and glory Overestimate talents and importance Prevalence: 1-2%; more males than females Treatment: Individual and group therapy

18 DISORDERS CHARACTERIZED BY ANXIOUS OR FEARFUL BEHAVIORS Avoidant Personality Disorder: Fear of rejection and humiliation and a reluctance to enter into social relationships Want, but fear, social contacts Prevalence: Less than 1%; no gender differences Treatment: Cognitive-behavioral, psychodynamic, interpersonal, psychopharmacological

19 DISORDERS CHARACTERIZED BY ANXIOUS OR FEARFUL BEHAVIORS Dependent personality disorder: Reliance on others and unwillingness to assume responsibility Lack self-confidence and subordinate needs See themselves as inherently inadequate Find someone to take care of them Prevalence: 2.5%; unclear about gender differences Treatment: Various forms used; more successful than with other personality disorders

20 DISORDERS CHARACTERIZED BY ANXIOUS OR FEARFUL BEHAVIORS Obsessive-compulsive personality disorder (OCPD): Perfectionism, tendency to be interpersonally controlling, devotion to details, and rigidity Differs from OCD: Involves traits (e.g., perfectionism, inflexibility) rather than recurrent thoughts and repetitive behaviors Prevalence: 1%; twice as many males as females (recent study reported at 7.9%) Treatment: Cognitive-behavioral and supportive forms of psychotherapy; no medications are known to be helpful

21 2010 Cengage Learning MULTIPATH ANALYSIS: ANTISOCIAL PERSONALITY DISORDER Social: Family and Socialization: Sue/Sue/Sue Understanding Abnormal Behavior, 9 th edition Poor parental supervision and involvement Parental rejection/deprivation Dysfunctional family structure Parental separation or absence Do not learn to pay attention to social stimuli Antisocial parent, especially father

22 2010 Cengage Learning MULTIPATH ANALYSIS: ANTISOCIAL PERSONALITY DISORDER Sociocultural: Socioeconomic: Weak predictor Gender: Males more likely to exhibit both conduct disorders and ADP than females Cultural Values: Sue/Sue/Sue Understanding Abnormal Behavior, 9 th edition Competitive environment bred by US values could fuel aggressive and violent behavior of antisocials

23 Sue/Sue/Sue Understanding Abnormal Behavior, 9 th edition TREATMENT OF ANTISOCIAL 2010 Cengage Learning PERSONALITY DISORDER Little anxiety results in lack of motivation to change Cooperative approaches may be ineffective Tranquilizing drugs have reduced antisocial behavior, but patients unlikely to self-medicate Programs may need enough control to force them to confront their relationships and the effect their behavior has on others

24 Sue/Sue/Sue Understanding Abnormal Behavior, 9 th edition TREATMENT OF ANTISOCIAL 2010 Cengage Learning PERSONALITY DISORDER Behavior Modification: Most useful is skill-based and behavioral treatment using material rewards, but not long-lasting Cognitive: Therapist must build rapport and guide APD toward higher levels of thinking regarding self and others Current Treatments: Not effective Need to focus on antisocial youths who appear amenable to treatment and involve families and peers Good News: The disorder diminishes with age