chapter twelve: personality disorders - wkupeople.wku.edu/rick.grieve/abnormal/lectures/ch12.pdf ·...

Chapter Twelve:Chapter Twelve:Personality DisordersPersonality Disorders

PSY 440: Abnormal PsychologyPSY 440: Abnormal PsychologyDr. Rick GrieveDr. Rick GrieveWestern Kentucky UniversityWestern Kentucky University

Personality DisordersPersonality Disorders

Personality DisorderPersonality DisorderExcessively rigid patterns of behavior Excessively rigid patterns of behavior or ways of relating to othersor ways of relating to othersPrevents people from adjusting to Prevents people from adjusting to external demandsexternal demandsBeginnings are present in childhoodBeginnings are present in childhood

Personality DisordersPersonality Disorders

Three clusters:Three clusters:Cluster A: People who are perceived as Cluster A: People who are perceived as odd or eccentricodd or eccentricCluster B: People whose behavior is Cluster B: People whose behavior is overly dramatic, emotional, and erraticoverly dramatic, emotional, and erraticCluster C: People who appear fearful or Cluster C: People who appear fearful or anxiousanxious

Personality Disorders Characterized Personality Disorders Characterized by Odd or Eccentric Behaviorby Odd or Eccentric Behavior

Paranoid Personality DisorderParanoid Personality DisorderDiagnostic CriteriaDiagnostic Criteria

Pervasive suspiciousnessPervasive suspiciousnessExcessive mistrust of othersExcessive mistrust of othersNo delusional thinkingNo delusional thinking

Associated FeaturesAssociated FeaturesOverly sensitive to criticismOverly sensitive to criticismEasily angeredEasily angered


Hold grudgesHold grudgesUnlikely to confide in othersUnlikely to confide in othersQuestion sincerity and trustfulness of othersQuestion sincerity and trustfulness of othersSuspect infidelitySuspect infidelityHypervigilentHypervigilentDeny blame for misdeedsDeny blame for misdeedsArgumentativeArgumentativeLitigiousLitigiousPerceived as aloof, cold, scheming, devious, Perceived as aloof, cold, scheming, devious, and humorlessand humorless


Prevalence ratePrevalence rate0.50.5--1%1%

Schizoid Personality DisorderSchizoid Personality DisorderDiagnostic CriteriaDiagnostic Criteria

Social isolationSocial isolationLacks interest in social relationshipsLacks interest in social relationshipsEmotions seem blunted or shallowEmotions seem blunted or shallow

Associated featuresAssociated featuresIndifferent to criticism or praiseIndifferent to criticism or praise


Wrapped up in abstract ideasWrapped up in abstract ideas

Usually recognized by early adulthoodUsually recognized by early adulthood

Schizotypal Schizotypal Personality DisorderPersonality DisorderDiagnostic CriteriaDiagnostic Criteria

Difficulties forming close relationshipsDifficulties forming close relationshipsBehavior, mannerisms and thought Behavior, mannerisms and thought patterns are odd, but not odd enough to patterns are odd, but not odd enough to warrant a diagnosis of schizophreniawarrant a diagnosis of schizophreniaWider range of behaviors, beliefs, and Wider range of behaviors, beliefs, and preoccupations than Schizoid PDpreoccupations than Schizoid PD


Associated FeaturesAssociated FeaturesAnxious in social settingsAnxious in social settings

Usually evident by early adulthoodUsually evident by early adulthoodPrevalence ratePrevalence rateEtiologyEtiology

geneticgenetic

Personality Disorders Characterized by Personality Disorders Characterized by Dramatic, Emotional, or Erratic BehaviorDramatic, Emotional, or Erratic Behavior

Antisocial Personality DisorderAntisocial Personality DisorderDiagnostic CriteriaDiagnostic Criteria

A pattern of irresponsible and antisocial A pattern of irresponsible and antisocial behavior in which the rights of others or behavior in which the rights of others or major social norms are violatedmajor social norms are violatedMust be 18 years old and have been Must be 18 years old and have been diagnosed with Conduct Disorder before diagnosed with Conduct Disorder before the age of 15the age of 15Aggressive and impulsive behaviorsAggressive and impulsive behaviors


Criminal behaviorCriminal behaviorLack of emotional commitmentLack of emotional commitment

Associated FeaturesAssociated FeaturesImpulsivityImpulsivityLack of guilt/remorseLack of guilt/remorseSuperficial charmSuperficial charmEgocentricityEgocentricityManipulativeManipulativeCallousness toward othersCallousness toward others


Failure to conformFailure to conformIrresponsibilityIrresponsibilityAimlessness and lack of longAimlessness and lack of long--term goalsterm goalsSubstance abuseSubstance abuseDisregard for the truthDisregard for the truthInterpret others’ behaviors as more Interpret others’ behaviors as more threatening than they arethreatening than they are

Two components:Two components:PersonalityPersonalitybehaviorbehavior


PrevalencePrevalenceAPD and criminal behaviorAPD and criminal behaviorEtiologyEtiology

Learning theoriesLearning theoriesUllman Ullman & & KrasnerKrasnerBanduraBandura

Family PerspectivesFamily PerspectivesGeneticGenetic


Borderline Personality DisorderBorderline Personality DisorderDiagnostic CriteriaDiagnostic Criteria

Pervasive pattern of instability of Pervasive pattern of instability of relationships, selfrelationships, self--image, and mood, and image, and mood, and a lack of control over impulsesa lack of control over impulsesUncertain about personal identitiesUncertain about personal identitiesNagging feeling of boredom and Nagging feeling of boredom and emptinessemptinessCannot tolerate being aloneCannot tolerate being alone


Instability of moodsInstability of moods

Associated Associated FeatursFeatursImpulsiveImpulsiveSelfSelf--mutilationmutilationSuicide attemptsSuicide attemptsTrouble familial relationshipsTrouble familial relationshipsView relationships as problematicView relationships as problematicDifficult to work with in psychotherapyDifficult to work with in psychotherapy

Prevalence RatePrevalence Rate


EtiologyEtiologyPsychodynamic PerspectivePsychodynamic Perspective

Otto Otto KernbergKernberg

Family PerspectiveFamily PerspectiveGeneticGenetic

Histrionic Personality DisorderHistrionic Personality DisorderDiagnostic CriteriaDiagnostic Criteria

Excessive emotionality and an Excessive emotionality and an overwhelming need to be the center of overwhelming need to be the center of attentionattention


Tendency to be dramatic and emotionalTendency to be dramatic and emotional

Associated FeaturesAssociated FeaturesDemand that others meet their need for Demand that others meet their need for attentionattentionSelfSelf--centered and intolerantcentered and intolerantGrow restless with routine and crave Grow restless with routine and crave novelty and stimulationnovelty and stimulationFlirtatious and seductiveFlirtatious and seductiveUse physical appearance as a means of Use physical appearance as a means of drawing attention to themselvesdrawing attention to themselves


Lack in selfLack in self--esteemesteem

Prevalence RatePrevalence RateEtiologyEtiology

Learning PerspectivesLearning PerspectivesTheodore Theodore MillonMillon

Narcissistic Personality DisorderNarcissistic Personality DisorderDiagnostic FeaturesDiagnostic Features

Inflated or grandiose sense of self and Inflated or grandiose sense of self and extreme need for admirationextreme need for admiration


Enjoy basking in the light of adulationEnjoy basking in the light of adulation

Associated FeaturesAssociated FeaturesSelfSelf--absorbedabsorbedLack empathyLack empathyPreoccupied with fantasies of success and Preoccupied with fantasies of success and power, ideal love, or recognitionpower, ideal love, or recognitionGravitate to careers where they can be Gravitate to careers where they can be the center of attentionthe center of attentionEnvious of those who have greater Envious of those who have greater successsuccess


Insatiable ambitionInsatiable ambitionStrained interpersonal relationshipsStrained interpersonal relationships


Psychodynamic PerspectivePsychodynamic PerspectiveHans Hans KohutKohut

Personality Disorders Characterized Personality Disorders Characterized by Anxious or Fearful Behaviorsby Anxious or Fearful Behaviors

Avoidant Personality DisorderAvoidant Personality DisorderDiagnostic CriteriaDiagnostic Criteria

Terrified of rejection and criticismTerrified of rejection and criticismUnwilling to enter into a relationship Unwilling to enter into a relationship unless there are strong reassurances of unless there are strong reassurances of acceptanceacceptanceAvoid group occupational or recreational Avoid group occupational or recreational activitiesactivitiesPrefer to spend time alonePrefer to spend time alone


Have an interest in social relationships Have an interest in social relationships but are paralyzedbut are paralyzed

Associated FeaturesAssociated FeaturesSocial isolationSocial isolationFear public embarrassmentFear public embarrassmentStay with usual routinesStay with usual routines

Prevalence RatePrevalence Rate


Dependant Personality DisorderDependant Personality DisorderDiagnostic CriteriaDiagnostic Criteria

Excessive need to be taken care of by Excessive need to be taken care of by othersothersOverly submissiveOverly submissiveExtremely fearful of separationExtremely fearful of separation

Associated FeaturesAssociated FeaturesFind it difficult to do things on their ownFind it difficult to do things on their ownVery reliant on others for support and Very reliant on others for support and guidanceguidance


Avoid positions of responsibilityAvoid positions of responsibilityOverly sensitive to criticismOverly sensitive to criticismPreoccupied with fears of rejection and Preoccupied with fears of rejection and abandonmentabandonmentHigher rate of “oral” behaviorsHigher rate of “oral” behaviors

Prevalence RatePrevalence RateComorbid Comorbid DisordersDisorders

PsychologicalPsychologicalPhysicalPhysical


EtiologyEtiologyPsychodynamicPsychodynamicLearningLearningFamilyFamily

ObsessiveObsessive--Compulsive Personality Compulsive Personality DisorderDisorder

Diagnostic CriteriaDiagnostic CriteriaExcessive degree of orderliness, Excessive degree of orderliness, perfectionism, and rigidityperfectionism, and rigidity


Difficulty coping with ambiguityDifficulty coping with ambiguityDifficulty expressing feelingDifficulty expressing feelingMeticulousness in work habitsMeticulousness in work habitsNo obsessions or compulsionsNo obsessions or compulsions

Associated FeaturesAssociated FeaturesCannot complete things in a timely Cannot complete things in a timely fashionfashionFocus on details rather than wholesFocus on details rather than wholesImpaired social relationshipsImpaired social relationships


Do not participate in social or leisure Do not participate in social or leisure activitiesactivitiesStingy with moneyStingy with moneyDifficulties making decisionsDifficulties making decisionsOverly rigid in terms of moralityOverly rigid in terms of morality


LearningLearningTheodore Theodore MillonMillon

Problems with the Classification Problems with the Classification of Personality Disordersof Personality Disorders

Undetermined reliability and Undetermined reliability and validityvalidityProblems distinguishing between Problems distinguishing between Axis I and Axis II disordersAxis I and Axis II disordersOverlap among disordersOverlap among disordersProblems distinguishing between Problems distinguishing between normal and abnormal behaviornormal and abnormal behavior

Problems with the Classification Problems with the Classification of Personality Disordersof Personality Disorders

Sexist biasSexist biasConfusing labels with explanationsConfusing labels with explanations

TreatmentTreatment

Personality Disorders are difficult Personality Disorders are difficult to treatto treatPsychodynamic ApproachesPsychodynamic Approaches

Help people become more aware of Help people become more aware of the root of the disorder and deal the root of the disorder and deal adaptively with the problemadaptively with the problemSome successSome success

TreatmentTreatment

Behavioral ApproachBehavioral ApproachFocus on changing clients’ behaviors, Focus on changing clients’ behaviors, not personality structuresnot personality structuresCBT has been successfulCBT has been successfulDialectical Behavioral Therapy also is Dialectical Behavioral Therapy also is successful at treating BPDsuccessful at treating BPD

CBT and supportive therapy combinedCBT and supportive therapy combined

TreatmentTreatment

Biological ApproachesBiological ApproachesNot successfulNot successful

ReferencesReferences

American Psychiatric Association (1994). Diagnostic and statistical manual of mental disorders (Fourth Ed.). Washington, D. C.: Author.Kassler, R. C., McGonagle, K. A., Zhao, S., Nelson, C. R., Hughes, M.,Eshleman, S., Wittchen, H. U., & Kendler, K. S. (1994). Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States: Results from the National Comorbidity Survey. Archives of General Psychiatry, 51, 8-19.Nairne, J. S. (1999). Psychology: The adaptive mind (2nd Ed.). Albany, NY: Brooks/Cole Publishing Company.Nevid, J. S., Rathus, S. A., & Greene, B. (2003). Abnormal psychology in a changing world. Upper Saddle River, NJ: Prentice Hall.

chapter twelve: personality disorders - wkupeople.wku.edu/rick.grieve/abnormal/lectures/ch12.pdf ·...

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