Because personality disorders involve the whole fabric of an individual’s being, clinicians typically perceive them as the most challenging disorders to try to treat. A clinician has to consider the person’s life history when evaluating whether he or she has a personality disorder. Diagnosis is difficult because many personality disorders have similar features.
Evident in various personal and social situations; causes distress or impairment. Cognition: Ways of perceiving self, other people, and events. Affectivity: Range, intensity, and appropriateness of emotional expression. The pattern is inflexible and pervasive across a range of situations. The pattern is stable and of long duration.
Considerable controversy exists over whether personality disorders should be conceptualized in terms of dimensions. At present, though, the categorical system is being used.
Antisocial personality disorder and borderline personality disorder are the most extensively researched. For each of these disorders, there is a relatively specific set of theoretical perspectives and treatment approaches.
Associated with serial killers and other career criminals, but not all those with APD are criminal, nor vice versa.
Pinel recognized this disorder as a form of madness in which the individual exhibited impulsive and destructive behaviors while maintaining rational thought. Decades later, this disorder was labeled moral insanity . Cleckley developed a set of criteria for the condition, calling it psychopathy. Based upon large scale studies of forensic populations, Hare developed the PCL-R , which has two factors: (1) core psychopathic personality traits and (2) antisocial lifestyle.
An individual can be a criminal and can engage in adult antisocial behavior without qualifying for antisocial personality disorder. Nevertheless, many individuals who are sent to prison meet the psychological criteria for antisocial personality disorder. Estimates within prison populations range from 40% to 75%.
Defects have been found in the prefrontal areas of the cerebral cortex, in areas involved in planning future activities, and considering moral implications of one’s actions. These abnormalities may have genetic causes: It has been observed for decades that criminal behavior runs in families. Adoption findings: Adoptees whose biological parents had antisocial personality disorder were more likely to develop it too, particularly if raised in an adverse adoptive environment. Children without biological predisposition did not develop the symptoms even if raised in similarly harsh settings.
Neurological deficits: High psychopathy checklist scores were found to be strongly related to brain volume for the hippocampus , a brain area involved in learning. Originally the fearlessness hypothesis , the response modulation hypothesis holds that psychopaths are able to learn to avoid punishment when this is their main goal. However, if their attention is focused elsewhere, they do not pay attention to information that would let them avoid aversive consequences. Lack of emotional reactivity Unable to process information not relevant to their primary goals Low self-esteem leads to need to prove competence by aggression.
Family: Lee Robins (1966) - Divorce, conflict, inconsistent discipline, parental conflicts in parenting style, parents with antisocial traits raise likelihood. Abuse and neglect: Individuals with antisocial personality have more history of having been abused or neglected during childhood. Neglect has been found to precede 50% more arrests for violent crimes compared to matched comparison subjects. Physical abuse during childhood led to a rate double that of the comparison group.
Individuals with antisocial personality disorder rarely seek treatment except in legal context. Goal of treatment: Help the client feel better about himself; boost client’s self esteem. Techniques are confrontational: Refute the client’s fabrications, point out selfish and self-defeating behaviors. Group therapy may be helpful because peers are not easily accepted by client.
The female character Alex in the movie Fatal Attraction is a good example of what a person with borderline personality is like. In addition to having disturbed relationships, people with borderline personality disorder are often confused about their own identity , their concept of who they are. Chronic feelings of boredom lead them to seek stimulation.
Splitting: Perceiving other people as being all good or all bad. Parasuicide: A suicidal gesture to get attention from loved ones, family, or professionals.
Childhood sexual abuse may alter sympathetic nervous system that leads to hypersensitivity and impulsivity in adulthood. One study found that the hippocampus was 16% smaller in borderline women than in healthy control subjects, and the amygdala was 8% smaller.
Physical or sexual abuse, especially in women, leads to expectation of harm from others, therefore producing ambivalence in one’s relationship with others.
Psychodynamic theorists suggest the individual has failed to develop a consistent, independent, “real” self ( ego ). Caused by mother who is both overinvolved with child and inconsistent in emotional relatedness. Child develops distorted perceptions of others known as “splitting” (others are either all good or all bad). Child’s “false” self is fused with distorted perception of others.
Cognitive theorists also note the dichotomized thinking about self and others (“splitting”). Thoughts about self and others are either all negative or all positive. Perceived failure to achieve a goal leads to low sense of self-efficacy. Low self-efficacy leads to lack of confidence, low motivation, inability to seek long-term goals. Unstable family patterns: Living with child abuse, depression, substance abuse, antisocial parents.
Dialectical behavioral therapy integrates confrontive and supportive methods. DBT clients show considerable improvement in symptoms of depression, dissociation, anxiety, and anxiety. Although medication will not alter a person’s ingrained personality, it can help regulate some symptoms, reducing impulsivity and emotional volatility.
What differentiates people with this disorder from those who show appropriate emotionality is their low emotional stability, shown in the fleeting nature of their emotional states and their use of excessive emotions to manipulate others rather than express their true feelings.
Histrionic people are determined to be the center of attention and will behave in whatever way necessary to ensure that this happens. They seek attention and approval from others and become furious if they don’t get it.
They want immediate gratification of their wishes and overreact to even minor provocations, usually in an exaggerated way, such as by weeping or fainting. Although their relationships are superficial, they assume them to be intimate and refer to acquaintances as “dear” friends.
Cognitive-behavioral theorists propose that these people suffer from mistaken assumptions underlying their approach to life such as believing that eliciting admiration and support from others will make up for their perceived deficits.
Grandiosity: An exaggerated view of oneself as possessing special and extremely favorable personal qualities and abilities. Unrealistic, inflated sense of self-importance stemming from grave self-doubt. Common feature of other personality disorders, especially Histrionic and Borderline personality disorders
The elitist narcissists feel privileged and empowered, and tend to flaunt their status and achievements. The amorous narcissist tends to be sexually seductive, yet avoids real intimacy. The unprincipled narcissists are much like antisocial individuals in that they tend to be unscrupulous, arrogant, and exploitative. The compensatory narcissists tend to be negativistic, seeking to counteract their deep feelings of inferiority. They try to create illusions of being superior and exceptional.
Freud felt the narcissist was fixated in the phallic stage of psychosexual development. Later psychodynamic theorists attributed narcissism to an adult expression of childhood insecurity and need for attention due to failed parent-child relationship.
Some researchers refer to these three as schizophrenic spectrum disorders , implying that all three are on a continuum of psychological disturbance and may be related. Two (schizoid and schizotypal) share some aspects of symptoms found in schizophrenia.
Cognitive-behavioral therapy seems to be most effective. Out of all people with personality disorders, those with paranoid personality are least likely to seek treatment.
Treatment: Most promising is an approach geared toward helping them work on their styles of communication.
Schizotypal personality disorder: A personality disorder that primarily involves peculiarities and eccentricities of thought, behavior, appearance, and interpersonal style. People with this disorder may have peculiar ideas, such as magical thinking and beliefs in psychic phenomena.
This may be latent schizophrenia. People with schizoid and schizotypal personality are more likely to have biological relatives with schizophrenia.
Whereas the schizoid reduces interactions with others out of a lack of interest in people, the avoidant individual desperately wants social interactions yet also avoids them out of fear of social failure and humiliation. They have restrained and guarded social interactions. They feel the pain of emotional isolation.
The psychodynamic perspective focuses on fear of attachment. The cognitive-behavioral approach appears to work better in explaining and treating avoidant individuals.
These interventions are most successfully accomplished after the client comes to trust the therapist. Those who are most distrustful and angry seem to benefit from graduated exposure. Those who are easily coerced respond particularly well to social skills training.
Without others near them, people with dependent personality feel despondent and abandoned.
Convinced of their own inadequacies, they cannot make even the most trivial decisions on their own.
While helping this client, the therapist must avoid becoming an authority figure to the client because it would be counterproductive for the individual to become dependent on the therapist.
The words obsessive and compulsive in this context have a different meaning from their use in association with anxiety disorders. The individual with obsessive-compulsive personality does not have the strong obsessions and compulsions associated with the anxiety disorder known as obsessive-compulsive disorder.
In striving for perfection, they become caught up in a worried style of thinking, and their behavior is inflexible. They have poor ability to express emotion and have few intimate relationships. It is one of the more common personality disorders and is present in more men than women.
Failure to achieve their unrealistic standard of perfection makes them feel worthless.
It is quite likely that the diagnostic criteria for these disorders, and even their names, will undergo continued revision in future editions of DSM .