Personality Disorders

• Personality Disorders


  Particularly extreme presentation of a particular constellation of normal traits
• Schizoid Personality Disorder


  • Impaired social relationships
  • Inability and lack of desire to form attachments to others (loners)
  • Unable to express feelings
  • Generally apathetic; rarely experience strong emotions
  • High levels of introversion
• Schizoid Personality Disorder (Symptoms)


  • Lack of interest in social relationships
  • Withdrawn/antisocial
  • Anhedonic
  • Appear cold/indifferent
  • Avoid social situations
  • Indifferent to criticism or praise
  • Indifference extends to appearance
  • Poor at reading non-verbal social cues
• Schizotypal Personality Disorder


  • Excessively introverted
  • Peculiar thought patterns
  • Oddities of perception and speech that interfere with communication and social interaction
  • Highly personalised and superstitious thinking
• Schizotypal Personality Disorder (Symptoms)


  • Magical thinking
  • Paranoia
  • Unusual perceptual experiences - weird tingling on arm when someone is around
  • Ideas of reference, unusual beliefs
  • Socially anxious
  • Social withdrawal
  • Seem eccentric and superstitious
• Paranoid Personality Disorder


  • Suspiciousness and distrustful of others
  • See hidden meaning in remarks
  • Tendency to see self as blameless
  • On guard for perceived attacks by others
  • Bear grudges
  • Usually don't experience psychosis - in touch with reality
• Paranoid Personality Disorder (Symptoms)


  • Suspicion of others that is not justified
  • Anticipate being exploited/manipulated
  • Self-conscious about public image
  • Jealous, hostile
  • Competitive with others
  • Test loyalty and trust
  • Fear they are victims of discrimination, manipulation or vindictive campaigns
• Schizoid PD has some links between it and autism spectrum disorders
• Schizotypal PD has heritability - increases for first degree relatives of someone with schizophrenia
• Schizotypal PD has other research suggesting relationship with schizophrenia (eye tracking, attention, working memory)
• Paranoid PD has possible genetic relationship with schizophrenia (but inconsistent results)
• Paranoid PD has attributional bias: tendency to blame others for negative events, personalised blame
• Paranoid PD has early adverse experiences - e.g., parental neglect, abuse
• Borderline Personality Disorder


  • Impulsiveness
  • Inappropriate anger
  • Affective instability
  • Drastic mood shifts
  • Chronic feelings of emptiness and boredom
  • Self-harm and suicide risk
• Borderline Personality Disorder (Symptoms)


  • Unstable mood, unstable relationships
  • Fears of abandonment
  • Identity problems, feelings of emptiness
  • Sometimes self-harm and suicidality
  • Sometimes dissociative experiences
  • Extreme loving and hating of people (splitting) → angry outbursts
• Borderline Personality Disorder has a strong link to verbal, physical and sexual abuse in childhood
• Borderline Personality Disorder is associated with the serotonin system (impulsivity/aggression)
• Borderline Personality Disorder is associated with attachment styles and mentalisation
• Narcissistic Personality Disorder


  • Grandiosity
  • Preoccupation with receiving attention
  • Self-promoting
  • Lack of empathy
  • Hypercritical and retaliatory
• Narcissistic Personality Disorder (Two-Types)


  • Grandiose: grandiosity, aggression, and dominance
  • Vulnerable: fragile and unstable sense of self-esteem; arrogance and condescension a façade for intense shame and hypersensitivity to rejection and criticism
• Grandiose Narcissistic Personality Disorder is associated with parental overvaluation
• Vulnerable Narcissistic Personality Disorder is associated with emotional, physical, and sexual abuse, as well as controlling/cold parenting
• Narcissistic Personality Disorder (Symptoms)


  • Self aggrandising, entitled
  • Lack empathy/exploitative
  • Envious
  • Preoccupied with power/success
  • Condescending
  • Hypersensitive and fragile (vulnerable)
  • Easily offended and unforgiving
• Personality Disorder Clusters

  • Cluster A: Paranoid, Schizoid and Schizotypal
  • Cluster B: Histrionic, Narcissistic, Antisocial and Borderline
  • Cluster C: Avoidant, Dependent and Obsessive-compulsive
• DSM Criteria


  Enduring behaviour pattern

  
• Histrionic Personality Disorder


  • Self-dramatisation
  • Overconcern with impression management
  • Irritability and temper outbursts if attention seeking is frustrated
• Histrionic Personality Disorder (Symptoms)


  • Overly dramatic
  • Focussed on appearances
  • Judge people on surface
  • Theatrical display of emotions
  • Interpersonal problems: Unquenchable need to be the centre of attention, difficulties having deeper relationships, 'Flakeyʼ in terms of delivering on promises
  • Possible causes: Some evidence for a genetic link with antisocial personality disorder
• Antisocial Personality Disorder


  • Persistently disregard and violate othersʼ rights
  • Inability to follow approved models of behaviour
  • Deceitfulness
  • Shameless manipulation of others
  • History of conduct problems as a child
• Antisocial Personality Disorder (Symptoms)


  • Disregard for rights and feelings of others
  • Donʼt obey social norms
  • Unable to plan ahead
  • Act impulsively
  • Substance abuse
  • Interpersonal problems: Premature death, Deceitful, Manipulative, Aggressive
  • Causes: Moderate evidence for heritability - but unsure what is inherited (e.g., impulsivity, aggressiveness)
• Avoidant Personality Disorder


  • Hypersensitivity to rejection or social derogation
  • Self-conscious and self critical
  • Shyness
  • Insecurity in social interaction and initiating relationships
• Avoidant Personality Disorder (Symptoms)


  • Feel inadequate
  • Hypersensitive to criticism
  • Believe they are inferior
  • Avoid novel situations
  • Interpersonal problems: Socially inhibited, few friends, socially isolated (like schizoid) BUT do not like being alone (different from schizoid)
  • Cause: "Inhibited temperamentˮ in infancy - shy and inhibited in novel situations
• Dependent Personality Disorder


  • Difficulty in separating in relationships
  • Discomfort at being alone
  • Subordination of needs to keep others involved in a relationship
  • Indecisiveness
• Dependent Personality Disorder


  • Lack of confidence
  • Inability to make any decisions
  • Never test themselves - never know you can be resilient
  • Hate being alone
  • Anxious
  • Interpersonal problems: Need to be told what to do, Wonʼt disagree with someone else, Open to manipulation by others
  • Causes: Authoritarian and overprotective parents, Separation anxiety as a child
• Obsessive-Compulsive Personality Disorder


  • Excessive concern with order, rules and trivial details
  • Control and perfectionism
  • Lack of expressiveness and warmth
  • Difficulty in relaxing and having fun
• Obsessive-Compulsive Personality Disorder (Symptoms)


  • Upset by low performance - perfectionism, undue focus on detail
  • Preoccupied with control and perfectionism
  • Stubborn
  • Interpersonal problems: Rigid, stick to rules and regulations, All work and no play, Work problems - procrastination, deadlines
  • Causes: High conscientiousness (e.g., perfectionism, need for control) and assertiveness
• Treatments for Personality Disorders


  • Cognitive Approaches - therapist targets core beliefs
• Treatment of BPD


  • Antidepressants (SSRIs)
  • Dialectical Behaviour Therapy (DBT)
  • Transference-focused psychotherapy
  • Mentalisation