Etiology and cluster a

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Etiology and cluster a

  1. 1. Personality Disorders• 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 Ch 13.1
  2. 2. 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
  3. 3. Personality Disorder Clusters• 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 Ch 13.2
  4. 4. 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
  5. 5. Odd/Eccentric Cluster• 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 Ch 13.4
  6. 6. Odd/Eccentric Cluster• 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 Ch 13.5
  7. 7. Paranoid Personality DisorderPervasive distrust and suspiciousness, seesmotives of others as malevolent. Four or more ofthe following:(1) suspects, without sufficient basis, that othersare exploiting, harming, or deceiving him or her(2) preoccupied with unjustified doubts about theloyalty or trustworthiness of friends or associates(3) reluctant to confide in others b/c lack of trust
  8. 8. (4) persistently bears grudges, i.e., isunforgiving of insults, injuries, or slights(5) reads hidden demeaning orthreatening meanings into benignremarks/events(6) Perceives attacks on character orreputation that are not apparent toothers and responds withcounterattacks(7) has recurrent suspicions, withoutjustification, regarding fidelity of spouseor sexual partner
  9. 9. 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 – trustingrelationship is key but hard to come by b/o ‘self-fulfilling prophecy’
  10. 10. Schizoid Personality DisorderPervasive detachment from socialrelationships and a restricted range ofemotional expression interpersonally.Four or more of the following:(1) neither desires nor enjoys closerelationships, including being part of afamily(2) almost always chooses solitaryactivities
  11. 11. (3) little interest in having sexualexperiences with another person(4) takes pleasure in few, if any,activities(5) lacks close friends orconfidants(6) appears indifferent to thepraise or criticism of others(7) emotionally cold, detached
  12. 12. Characteristics of Schizoid Personality Disorder•Can perform well in solitary activities (computers, nightwatchman)•Limited emotional range, detached, daydream a lot•NO increased risk for schizophrenia but many mayactually suffer from autism-spectrum disease•“Loners” not necessarily schizoid, unless functioningimpaired (traits vs disorder)•Treatment of little help•Prevalence 2%; M>F
  13. 13. Schizotypal Personality Disorder (diagnostic criteria)Little capacity for close relationshipsaccompanied by cognitive or perceptualdisturbances and eccentricities of behavior(1) ideas of reference(2) odd beliefs or magical thinking, inconsistentwith cultural norms(3) unusual perceptual experiences, includingbodily illusions
  14. 14. (4) odd thinking and speech (e.g.,vague,circumstantial,metaphorical,overelaborate) (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 paranoidfears
  15. 15. Characteristics of Schizotypal Personality Disorder•Isolated, anhedonic, aloof but also “peculiar”•Strange intra-psychic experiences, odd andmagical beliefs•Reason in odd ways (ideas of reference)•Anxious, detached•NOT psychotic proportions•3% incidence; M=F
  16. 16. 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
  17. 17. Dramatic/Erratic Cluster• 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 Ch 13.7
  18. 18. 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.
  19. 19. • Etiologyplay aAntisocial PDof Family issues may of role in the development 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
  20. 20. Cluster B: Antisocial Personality DisorderFigure 12.2 Barlow/Durand, 3rd. EditionOverlap and lack of overlap among antisocial personality disorder, psychopathy, and criminality
  21. 21. 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
  22. 22. 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
  23. 23. Complications:1- depression2- anxiety3- schizophrenia4- substance abuse.
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