etiology and cluster a

• Personality Disorders refer to long-standing, pervasive and inflexible patterns of behavior– Depart from cultural expectations– Impair social and occupational functioning– Cause emotional distress

• Personality disorders are coded on Axis II of the DSM– Personality disorders can be a co-morbid condition for

an Axis I disorder

Personality Disorders

Ch 13.1

Personality Disorders: Facts and

Statistics • Prevalence of Personality Disorders

– About 0.5% to 2.5% of the general population– Rates are higher in inpatient and outpatient settings

• Origins and Course of Personality Disorders– Thought to begin in childhood – Tend to run a chronic course if untreated

• Co-Morbidity Rates are High • Gender Distribution and Gender Bias in Diagnosis

– Gender bias exists in the diagnosis of personality disorders

– Such bias may be a result of criterion or assessment gender bias

• Personality disorders fall into three general clusters:– Persons in cluster A seem odd or eccentric

• Paranoid, schizoid, schizotypal

– Persons in cluster B seem dramatic, emotional or erratic

• Antisocial, borderline, histrionic, narcissistic

– Persons in cluster C appear as anxious or fearful• Avoidant, dependent, obsessive-compulsive

Personality Disorder Clusters

Ch 13.2

Odd/Eccentric Cluster

• Paranoid personality disorder (PD) involves suspicion of others, hostility, jealousy– No hallucinations and no full-blown delusions

are present in paranoid PD

• Paranoid PD occurs more frequently in men than in women

• Lifetime prevalence is about 1 percent

Ch 13.3

• Schizoid personality disorder (PD) involves– Reduced social relations and few friends– Reduced sexual desire and few pleasurable activities– Indifference to praise or criticism– Lonely life style

• Prevalence of schizoid PD is less than 1 percent and occurs more commonly in men than women

Odd/Eccentric Cluster

Ch 13.4

• Schizotypal personality disorder (PD) involves – An attenuated form of schizophrenia

• Odd beliefs and magical thinking• Recurrent illusions (things not present)• Ideas of reference (hidden meaning)• Behavior and appearance is eccentric

• Prevalence of schizotypal PD is about 3 percent and occurs slightly more commonly in men than women

Odd/Eccentric Cluster

Ch 13.5

Paranoid Personality Disorder

Pervasive distrust and suspiciousness, sees motives of others as malevolent. Four or more of the following:

(1) suspects, without sufficient basis, that others are exploiting, harming, or deceiving him or her

(2) preoccupied with unjustified doubts about the loyalty or trustworthiness of friends or associates

(3) reluctant to confide in others b/c lack of trust

(4) persistently bears grudges, i.e., is unforgiving of insults, injuries, or slights(5) reads hidden demeaning or threatening meanings into benign remarks/events(6) Perceives attacks on character or reputation that are not apparent to others and responds with counterattacks(7) has recurrent suspicions, without justification, regarding fidelity of spouse or sexual partner

Characteristics of Paranoid Personality Disorder

•Aloof, emotionally cold

•Unjustified suspiciousness, hostility

•Hypersensitivity to slights, jealousy

•Rigid, unforgiving, sarcastic, litigious

•Prevalence: 1-2%; M>F

•Therapy, including meds, of little value – trusting relationship is key but hard to come by b/o ‘self-fulfilling prophecy’

Schizoid Personality Disorder

Pervasive detachment from social relationships and a restricted range of emotional expression interpersonally. Four or more of the following:

(1) neither desires nor enjoys close relationships, including being part of a family

(2) almost always chooses solitary activities

(3) little interest in having sexual experiences with another person

(4) takes pleasure in few, if any, activities

(5) lacks close friends or confidants

(6) appears indifferent to the praise or criticism of others

(7) emotionally cold, detached

Characteristics of Schizoid Personality Disorder

•Can perform well in solitary activities (computers, night watchman)•Limited emotional range, detached, daydream a lot•NO increased risk for schizophrenia but many may actually suffer from autism-spectrum disease•“Loners” not necessarily schizoid, unless functioning impaired (traits vs disorder)•Treatment of little help •Prevalence 2%; M>F

Schizotypal Personality Disorder

(diagnostic criteria)Little capacity for close relationships accompanied by cognitive or perceptual disturbances and eccentricities of behavior

(1) ideas of reference

(2) odd beliefs or magical thinking, inconsistent with cultural norms

(3) unusual perceptual experiences, including bodily illusions

(4) odd thinking and speech (e.g.,vague, circumstantial,metaphorical,over elaborate)

(5) suspiciousness or paranoid ideation

(6) inappropriate or constricted affect

(7) behavior or appearance that is odd, eccentric, or peculiar

(8) lack of close friends or confidants

(9) excessive social anxiety r/t paranoid fears

Characteristics of Schizotypal Personality Disorder

•Isolated, anhedonic, aloof but also “peculiar”

•Strange intra-psychic experiences, odd and magical beliefs

•Reason in odd ways (ideas of reference)

•Anxious, detached

•NOT psychotic proportions

•3% incidence; M=F

Etiology of the Odd/Eccentric Cluster

• These disorders are linked to schizophrenia and may represent a less severe form of the disorder– Schizophrenia has clear genetic determinants– Family studies reveal that relatives of schizophrenic patients

are at increased risk for developing schizotypal PD as well as paranoid PD

• No clear pattern for schizoid PD

• Additional similarities for Schizotypal PD– Have cognitive and neuropsychological problems similar to

those found in individuals with schizophrenia.– Have enlarged ventricles and less temporal lobe gray matter.

Ch 13.6

• Borderline personality disorder (PD) involves – Impulsivity (gambling, spending, sexual sprees)– Instability in relationships, mood and self-image– Borderline PD persons are argumentative and difficult to live with

• Prevalence of Borderline PD is about 1-2 percent and occurs more commonly in women than men

• Linehan’s diathesis-stress theory– Difficulty controlling emotions (biological diathesis)– Raised in “invalidating” family environment

Dramatic/Erratic Cluster

Ch 13.7

Figure 13.1 Linehan’s Diathesis-Stress theory: Etiology of borderline personality disorder

•Emotional dysregulation in child (diathesis) and a failure to validate the child’s feelings by the parents (stress) leads to a vicious cycle.

–The emotional dysregulation may be inadvertently reinforced by parents if it becomes one of the only times the child receives parental attention.

Etiology of Antisocial PD• Family issues may play a role in the development of antisocial PD

– Lack of affection– Severe parental rejection– Inconsistent (or no) discipline

• Twin studies show a greater concordance for antisocial PD in MZ twins relative to DZ twins

• Adoption studies (e.g., Cadoret et al., 1995)– Adverse adoptive environment may be the stressor triggering the ASPD

biological diathesis

• Psychopaths– Have reduced gray matter in frontal lobes– Perform more poorly on tests of frontal lobe functioning– These findings are supportive of a key role for impulsivity in psychopathy

Ch 13.11

Cluster B: Antisocial Personality Disorder

Figure 12.2 Barlow/Durand, 3rd. EditionOverlap and lack of overlap among antisocial personality disorder, psychopathy, and criminality

Dimensional Approach to Personality Disorders

• Five-Factor Model (McRae & Costa, 1990)– Neuroticism

– Extroversion/introversion

– Openness to experience

– Agreeableness/antagonism

– Conscientiousness

• Relationship of PDs to FFM (Widiger & Costa, 1994)

• Advantages of dimensional model– Handles the comorbidity problem

– Makes a link between normal and abnormal personality

– Supported by behavior-genetic and statistical techniques

Therapies for Personality Disorders

• Therapists treating PD patients are concerned about co-morbid Axis I disorders

• Therapy modalities include:– Antianxiety or antidepressant drugs– Psychodynamic therapy aims to change the person’s understanding of the

childhood problems that underlie the PD– Behavioral and cognitive therapy focuses on specific symptoms and issues (e.g.

social skills)

• Overall therapeutic goal: change the “disorder’ into a “style”, except for ASPD (D&N, p.377)– Recent meta-analysis show promising results with CBT for younger

psychopaths.

Ch 13.15

Complications:

1- depression

2- anxiety

3- schizophrenia

4- substance abuse.