Ch 12 Personality and personality disorders

  1. What is personality?
    Personality refers to a distinctive set of traits, behaviour styles, and patterns that make up our character individuality.

    • It refers to the individual differences in how people perceive, think and relate to their environment and themselves.
    • Not only includes temperament and learning, but also contains factors such as one’s values, attitudes, expectations, interpersonal interactions, coping strategies and self-perception.
    • Personality consists of overt and covert actions and conscious and unconscious processes in which all these elements interact with each other and the environment.
    • Preferable to talk about personality as a dynamic process rather than a set of characteristics that remain stable throughout the lifespan.
  2. Personality disorder
    A personality disorder is ‘an enduring pattern of inner experience and ­behaviour that deviates markedly from expectations of the individual’s culture, is pervasive and inflexible, has onset in adolescence or early adulthood, is stable over time and leads to distress or impairment

    Diagnosis of a personality disorder is applied when behaviour departs from cultural expectation and impairs social and occupational functioning.
  3. 3 clusters of personality disorders
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  4. Personality disorders comorbidity
    • Every 1/10 people meet diagnostic criteria for a personality disorder
    • Estimated people with a personality disorder were 7x more likely to have an anxiety disorder or mood disorder than people with no personality disorder
    • 4x as likely to have a substance use disorder
    • Links with anxiety, mood disorders are particularly pronounced for the cluster B.

    Positive relationship was found between cluster A and cluster B personality disorders with physical health comorbidities, in particular cardiovascular diseases and arthritis.
  5. Structured vs unstructured interviews
    • Most diagnoses of personality disorders have adequate or good reliability when structured interviews are used.
    • However most clinicians do not use structured interviews to assess personality.
    • When using unstructured interview, clinicians frequently disagreed whether antisocial and obsessive-compulsive personality disorders were present.

    • Clinicians using unstructured clinical interviews often miss personality disorder diagnoses.
    • Diagnoses based on structured interviews do a better job of predicting functioning and symptoms five years later than do those based on unstructured clinical interviews

    • Interviews with people who know the patient well improve the accuracy of diagnosis and enhance the ability to predict social outcomes across a several-year follow-up.
    • However, fewer than 10 percent of published studies of personality disorders gather data from people other than the person being diagnosed.
  6. Problems with the DSM-5 approach to personality disorders: Personality disorders are not stable over time
    • Personality disorders are not stable over time
    • Although the very definition of personality disorders suggests that they should be stable over time, about half of the people diagnosed with a personality disorder at one point in time had achieved remission (i.e., did not meet the criteria for the same diagnosis) when they were interviewed two years later.
    • When patients diagnosed with personality disorder were followed for 16 years, 99 percent of personality disorder diagnoses remitted.
    • Personality disorder symptoms appear to be most common during adolescence and then decline into the 20s with even more declines by late life.
    • These results, then, indicate that many of the personality disorders may not be as enduring as the DSM asserts.
    • Diagnosis still important because many people still have some symptoms after remission, just not at the levels required for diagnosis.
    • Second, even after remission, many problems with functioning persist.
    • Third, even years after remission, the risk of relapse remains high — symptoms of personality disorders often wax and wane over time.
  7. Problems with the DSM-5 approach to personality disorders: Personality disorders are highly comorbid
    • Personality disorders are highly comorbid.
    •  More than 50 percent of people diagnosed with a personality disorder meet the diagnostic criteria for another personality disorder.
    • The high rates of overlap among the personality disorders is discouraging when we try to interpret the results of research that compares people who have a specific personality disorder with some control group.
    • If, for example, we find that people with borderline personality disorder differ from healthy people, is our finding related to borderline personality disorder or to personality disorders in general?
  8. Alternative DSM-5 model for personality disorders
    • Added to the appendix as alternative approach.
    • Recommended reducing the number of personality disorders, incorporating personality trait dimensions and diagnosing personality disorders on the basis of extreme scores on personality trait dimensions.
    • Includes only 6 of the 10 DSM-5 personality disorders.
    • Schizoid, histrionic and dependent personality disorders are excluded from the alternative system because they rarely occur.
    • Paranoid personality disorder is also excluded because it frequently overlaps with other disorders.
    • interrater reliability is adequate for each of the six personality disorders included in the alternative system when assessed with a structured diagnostic interview.

    • Consists of 2 dimensional scores: 5 personality trait domains and 25 more specific personality trait facets within these.
    • Advantages:
    • Clinicians can specify which personality traits are of most concern for a given client. 25 dimensional scores provide richer detail than do the personality disorder diagnoses.
    • Personality trait ratings tend to be more stable over time than are personality disorder diagnoses.
    • Personality trait dimensions are related to many aspects of psychological adjustment and even physical outcomes. 
    •  A system based on personality traits helps link the DSM with a broad research literature on personality
  9. Children in the community study
    • Designed to assess the links between childhood adversity and personality disorders
    • 639 families with children between ages 1-11.
    • Families first interviewed in 1975 then 1984 then 1992, then offspring interviewed when reached age 33.
    • Conducted interviews to assess relationship between two parenting styles (aversive parental behaviour and lack of parental affection) and personality disorders

    • Findings:
    • Suggested that personality disorders were strongly related to early adversity.
    • Children who experienced abuse or neglect were 18 times as likely to develop narcissistic personality disorder and more than six times as likely to develop paranoid, borderline or dependent personality disorder, as were those with no history of abuse or neglect.
    • Offspring who had experienced aversive or unaffectionate parental styles were several times more likely to develop a personality disorder
  10. Common risk factors: genetic
    • Study using representative sample of twins showed heritability estimates for all personality disorders were at least moderately high.
    • Genetic influence means we need to be cautious about considering parenting and early environment effects.
    • many parents of those with Personality disorders are likely to experience at least mild personality problems themselves.
    • Correlation may not mean causation.
  11. Cluster A: Odd/eccentric cluster
    • Includes paranoid personality disorder, schizoid personality disorder and schizotypal personality disorder.
    • The symptoms of these three disorders bear some similarity to the types of bizarre thinking and experiences seen in schizophrenia.
    • In the cluster A personality disorders, though, the bizarre thinking and experiences are less severe than they are in schizophrenia.
  12. Cluster A: paranoid personality disorder
    DSM-5 criteria: Experience four or more of the following signs of distrust and suspiciousness from early adulthood across many contexts:

    • Unjustified suspiciousness of being harmed, deceived or exploited
    • Unwarranted doubts about the loyalty or trustworthiness of friends or associates
    • Reluctance to confide in others because of suspiciousness
    • The tendency to read hidden meanings into the benign actions of others
    • Bears grudges for perceived wrongs
    • Angry reactions to perceived attacks on character or reputation
    • Unwarranted suspiciousness of the partner’s fidelity.

    • Different from paranoid schizophrenia because other symptoms of schiz are not present such as hallucinations and cognitive disorganisation.
    • There is less impairment in social and occupational functioning.

    • Their lives tend to be filled with conflict, the conflicts tend to perpetuate their paranoia- frequent battles provide evidence that people just cannot be trusted.
    • Occurs more frequently in men than women.
    • Lifetime prevalence is 1%
  13. Cluster A: Schizoid personality disorder
    • Low frequency disorder.
    • Do not desire or enjoy social relationships, usually have no friends.
    • They appear dull, bland and aloof.
    • Tend to have no warm feelings for other people.
    • Are loners who pursue solitary interests.

    DSM criteria: experience four or more of the following signs of aloofness and flat affect from early adulthood across many contexts:

    • Lack of desire for enjoyment of close relationships
    • Almost always prefers solitude to companionship
    • Little interest in sex
    • Few or no pleasurable activities
    • Lack of friends
    • Indifference to praise or criticism
    • Flat affect, emotional detachment or coldness.

    • Prevalence is less than 1%.
    • Occurs more frequently in men than women.
  14. Cluster A: schizotypal personality disorder
    DSM criteria- five or more of the following signs of unusual thinking, eccentric behaviour and interpersonal deficits from early adulthood across many contexts:

    • Ideas of reference: belief that events have a particular and unusual meaning for them personally.
    • Odd beliefs or magical thinking, for example, belief in extrasensory perception (reading people's minds)
    • Unusual perceptions: eg. sensing the presence of a force or a person that is not actually there.
    • Odd thought and speech
    • Suspiciousness or paranoia
    • Inappropriate or restricted affect: flat affect and tend to be aloof from others.
    • Odd or eccentric behaviour or appearance: eg. talking to themselves or wear dirty and dishevelled clothing.
    • Lack of close friends
    • Social anxiety and interpersonal fears that do not diminish with familiarity.

    Study of relative importance of symptoms for diagnosis found that suspiciousness, ideas of reference and illusions were most telling.

    • Most do not develop delusions (convictions in patently absurd beliefs) or schizophrenia, some develop more severe psychotic symptoms over time and a small proportion do develop schizophrenia over time.
    • They may experience brief episodes of delusions or hallucinations but not as frequent or intense as schiz.
    • Also possible to make someone with schizotypal personality disorder aware of the difference between their distorted ideas and reality.

    • Prevalence: 3%, occurs slightly more in men than women.
    • Many also meet criteria for major depression.

    • Aetiology:
    • Genetic factors and childhood adversity are likely both involved.
    • Relatives of people with schizophrenia are at increased risk for schizotypal personality disorder.
    • Schizotypal personality disorder have deficits in cognitive and neuropsychological functioning that are similar to but milder than those seen in schizophrenia.
    • Paralleling findings from schizophrenia research, people with schizotypal personality disorder have enlarged ventricles and less temporal lobe grey matter.
  15. Cluster B: dramatic/erratic cluster
    • Disorders in this cluster include antisocial personality disorder, borderline personality disorder, histrionic personality disorder and narcissistic personality disorder.
    • Characterised by symptoms that range from highly inconsistent behaviour to inflated self-esteem, rule-breaking behaviour and exaggerated emotional displays, including anger outbursts.
  16. Cluster B: Antisocial personality disorder- clinical description
    • DSM-5 criteria for antisocial personality disorder
    • People with antisocial personality disorder are aged at least 18.
    • People with antisocial personality disorder display evidence of conduct disorder before age 15.
    • People with antisocial personality disorder display a pervasive pattern of disregard for the rights of others from the age of 15 as shown by at least three of the following:
    • repeated law breaking
    • deceitfulness, lying
    • impulsivity
    • irritability and aggressiveness
    • reckless disregard for own safety and that of others
    • irresponsibility as seen in unreliable employment or financial history
    • lack of remorse.

    • Men are about 5x more likely than are women to meet criteria for APD.
    • About three-quarters of people with APD meet the diagnostic criteria for another disorder, with substance abuse being very common.
    • High rates of APD are observed in drug and alcohol rehabilitation facilities.
    • About three-quarters of convicted felons meet the diagnostic criteria for APD.
  17. Psychopathy- clinical description
    • Concept of psychopathy predates DSM diagnosis of antisocial personality disorder.
    • Criteria focuses on person's thoughts and feelings.
    • Poverty of emotions (both positive and negative): tend to have no shame and their seemingly positive feelings for others are merely an act.
    • Superficially charming and use their charm to manipulate others for personal gain.
    • Lack of remorse
    • Impulsive
    • Researchers have argued that three core traits underpin these different symptoms: boldness, meanness and impulsivity.

    • Differences between APD and psychopathy: ­Psychopathy Checklist–Revised (PCL-R) includes more affective symptoms such as shallow affect and lack of empathy.
    • DSM requires that a person develop symptoms before age 15.
  18. Aetiology of antisocial personality disorder and psychopathy
    • Two issues that make findings hard to integrate: research has been conducted on persons diagnosed in different ways — some with APD and some with psychopathy.
    •  Second, most research on APD and psychopathy has been conducted on persons who have been convicted as criminals.
    • Thus results might not be applicable to those with APD who are not criminals.

    • Parenting qualities of negativity, inconsistency and low warmth predict antisocial behaviour.
    • Broader social factors, including poverty and exposure to violence, predict antisocial behaviour.
    • Effects of early adversity might be particularly negative for those who are genetically vulnerable.

    A polymorphism of the MAO-A gene has been found to predict psychopathy among males who had experienced childhood physical or sexual abuse or maternal rejection.
  19. Psychopathy and antisocial behaviour- psychological risk
    • Seem unable to learn from experience- often repeat misconduct that has been harshly punished.
    • Seem immune to the anxiety that keeps most of us from breaking the law, lying or injuring others.
    • Large body of work relates psychopathy to deficits in the experience of fear and threat.
    • Low skin conductance reactivity to aversive stimuli (loud tones) at age 3 was found to predict psychopathy scores at age 28.
    • Findings suggest that people with psychopathy show weakened classical conditioning to aversive stimuli.
    • Findings suggest that psychopathy is related to inattentiveness to threats when pursuing a goal.
    • Antisocial behaviour is associated with deficits in regions of the prefrontal cortex that are involved in attending to negative information during goal pursuit.

    In contrast to a general insensitivity to threat, some researchers believe that a lack of empathy, defined as the capacity to share the emotional reactions of others, could be the central deficit driving the callous exploitation of others observed in psychopathy.
  20. Cluster B: Borderline personality disorder- DSM
    DSM-5 criteria for borderline personality disorder

    People with borderline personality disorder display five or more of the following signs of instability in relationships, self-image and impulsivity from early adulthood across many contexts:

    • frantic efforts to avoid abandonment
    • unstable interpersonal relationships in which others are either idealised or devalued
    • unstable sense of self
    • self-damaging, impulsive behaviours in at least two areas, such as spending, sex, substance abuse, reckless driving and binge eating
    • recurrent suicidal behaviour, gestures or self-injurious behaviour (e.g., cutting self)
    • marked mood reactivity
    • chronic feelings of emptiness
    • recurrent bouts of intense or poorly controlled anger
    • during stress, a tendency to experience transient paranoid thoughts and dissociative symptoms.
  21. B: borderline personality disorder
    • Very common in clinical settings, hard to treat and associated with recurrent periods of suicidality.
    • Core features: impulsivity and instability in relationships and mood.
    • Attitudes and feelings towards others can change drastically.
    • Often have not developed a clear and coherent sense of self —often experience major swings in aspects of identity such as values, loyalties, career choices.
    • Cannot bear to be alone, have fears of abandonment and experience chronic feelings of depression and emptiness.
    • May experience transient psychotic and dissociative symptoms when stressed.
    • Very likely to have comorbid post-traumatic stress disorder and mood disorders, substance-related disorders and eating disorders.
    • When present, comorbid conditions predict greater likelihood that BPD symptoms will be sustained over several years
  22. Borderline personality disorder DSM-5
    People with borderline personality disorder display five or more of the following signs of instability in relationships, self-image and impulsivity from early adulthood across many contexts:

    • frantic efforts to avoid abandonment
    • unstable interpersonal relationships in which others are either idealised or devalued
    • unstable sense of self
    • self-damaging, impulsive behaviours in at least two areas, such as spending, sex, substance abuse, reckless driving and binge eating
    • recurrent suicidal behaviour, gestures or self-injurious behaviour (e.g., cutting self)
    • marked mood reactivity
    • chronic feelings of emptiness
    • recurrent bouts of intense or poorly controlled anger
    • during stress, a tendency to experience transient paranoid thoughts and dissociative symptoms.
  23. BPD aetiology
    • Neurobiological factors: lower serotonin function
    •  increased activation of the amygdala to emotional pictures
    • Deficits in prefrontal cortex (impulsivity)
    • Disrupted connectivity between the prefrontal cortex and the 

    • Social factors: tied to high rates of childhood abuse/neglect and heritability
    • One twin study showed childhood abuse did not predict BPD after genetic risk was controlled.

    • Linehan’s diathesis–stress theory: proposes that BPD develops when people who have difficulty controlling their emotions because of a biological diathesis (possibly genetic- of emotional dysregulation) are raised in a family environment that is invalidating.
    • emotional dysregulation and invalidation — interact with each other in a dynamic fashion
  24. Histrionic personality disorder
    • Key feature is overly dramatic and attention-seeking behaviour.
    • Often use their physical appearance, such as unusual clothes, make up or hair colour to draw attention to themselves.
    • Despite their expressions of extravagant and intense emotions, they are thought to be emotionally shallow.
    • Self centred and uncomfortable when not the centre of attention.
    • Can be inappropriately sexually provocative and seductive and easily influenced by others.
    • Speech is often impressionistic and lacking in detail.

    Prevalence: 2-3% and occurs slightly more commonly in women than men.
  25. Histrionic personality disorder DSM 5
    People with histrionic personality disorder display five or more of the following signs of excessive emotionality and attention seeking from early adulthood across many contexts:

    • strong need to be the centre of attention
    • inappropriate sexually seductive behaviour
    • rapidly shifting and shallow expression of emotions
    • use of physical appearance to draw attention to self
    • speech that is excessively impressionistic and lacking in detail
    • exaggerated, theatrical emotional expression
    • overly suggestible
    • misreads relationships as more intimate than they are.
  26. Narcissistic personality
    • Have a grandiose view of their qualities and are preoccupied with fantasies of great success.
    • Require almost constant attention.
    • Lack of empathy, arrogant, feelings of envy, habit of taking advantage of others and feelings of entitlement.
    • Tend to seek out high-status partners whom they idealise and proudly show off, only to change partners if given an opportunity to be with a person of higher status.
    • Fame and wealth are often valued as a way to gain admiration from others.
    • Bask in compliments and praise, also overly reactive to criticism.
    • Likely to be vindictive and aggressive when faced with a competitive threat or a put-down.
    • Expensive clothes and overinvestment in appearance.

    • Presidents who were rated as relatively more narcissistic were more likely to be seen as persuasive, able to win popular vote and to initiate legislation. Also more likely to get into trouble for unethical behaviour.
    • Those with clinical diagnoses of narcissism would be expected to have more trouble than those with subtle elevations of narcissistic traits.
  27. Narcissictic personality disorder- DSM-5
    Presence of five or more of the following signs of grandiosity, need for admiration and lack of empathy from early adulthood across many contexts:

    • grandiose view of one’s importance
    • preoccupation with one’s success, brilliance, beauty
    • belief that one is special and can be understood only by other high-status people
    • extreme need for admiration
    • strong sense of entitlement
    • tendency to exploit others
    • lack of empathy
    • envious of others
    • arrogant behaviour or attitudes.
  28. Aetiology of Narcissistic personality disorder
    • Parenting: Millon hypothesised that parents who are overindulgent foster children's belief that they are special and can lead to classic/grandiose type narcissism.
    • Fragile narcissism may be as a result of psychological abuse/neglect during childhood.
    • Grandiose behaviour in fragile narcissism actually serves a defensive function against underlying feelings of inferiority, inadequacy and emptiness.
    • FN often anxious, fearful of rejection and when abandoned, fall into depression.

    • Self-psychology: Kohut developed a model of narcissism based on self-psychology, a variant of psychodynamic theory.
    • Theorised that these characteristics mask a very fragile self-esteem and a defence against feelings of shame.
    • Research to support this- people diagnosed with NPD experience shame more frequently.

    • Social cognitive model: A model by Morf and Rhodewalt built around 2 basic ideas: 1 )fragile self-esteem 2) interpersonal interactions are important to them for bolstering self-esteem rather than for gaining closeness or warmth.
    • Cognitive biases that would help maintain grandiose beliefs about self.
    • Primary goal is to bolster self-esteem, this goal influences how they act towards others. 
    • Tend to brag a lot and denigrate others when they perform better on a task that is relevant to self esteem.
  29. Cluster C: Anxious/fearful cluster
    • Includes
    • 1. Avoidant personality disorder,
    • 2. dependent personality disorder
    • 3. Obsessive-compulsive personality disorder
    • People with these disorders are prone to worry and distress.
  30. C: avoidant personality disorder
    • So fearful of criticism, rejection and disapproval that they will avoid jobs or relationships to protect themselves from negative feedback.
    • Restrained and timid in social situations in fear of being embarrassed. 
    • Believe they are incompetent and inferior to others, and they are reluctant to take risks or try new activities.
    • Would like to form close relationships, their fears often make it difficult for them to do so.
  31. C: avoidant personality disorder DSM-5
    People with avoidant personality disorder display a pervasive pattern of social inhibition, feelings of inadequacy and hypersensitivity to criticism as shown by four or more of the following from early adulthood across many contexts:

    • avoidance of occupational activities that involve significant interpersonal contact, because of fears of criticism or disapproval
    • unwilling to get involved with people unless certain of being liked
    • restrained in intimate relationships because of the fear of being shamed or ridiculed
    • preoccupation with being criticised or rejected
    • inhibited in new interpersonal situations because of feelings of inadequacy
    • views self as socially inept, unappealing or inferior
    • unusually reluctant to try new activities because they may prove embarrassing.
  32. C: avoidant personality disorder comorbidity
    • Often co-occurs with social anxiety disorder probably because diagnostic criteria are so similar.
    • Genetic vulnerability for avoidant personality disorder and social anxiety disorder appears to overlap.
    • Some have argued that avoidant personality disorder might actually be a more chronic variant of social anxiety disorder.
    • About 80% have comorbid major depression.
    • Alcohol abuse is also common among those with this disorder.
  33. C: Dependent personality disorder
    • Core feature is excessive reliance on others. 
    • Intense need to be taken care of, which often leads them to feel uncomfortable with being alone.
    • Subordinate their own needs to ensure that they do not threaten the protective relationships they have established.
    • When a close relationship ends, they urgently seek another relationship to replace it.
    • See themselves as weak and they turn to others for support and decision making.
    • Fear of being alone.
  34. C: dependent personality disorder DSM-5
    People with dependent personality disorder have an excessive need to be taken care of, as shown by the presence of at least five of the following from early adulthood across many contexts:

    • difficulty making decisions without excessive advice and reassurance from others
    • need for others to take responsibility for most major areas of life
    • difficulty disagreeing with others for fear of losing their support
    • difficulty doing things on own or starting projects because of lack of self-confidence
    • doing unpleasant things as a way to obtain the approval and support of others
    • feelings of helplessness when alone because of fears of being unable to care for self
    • urgently seeking new relationship when one ends
    • preoccupation with fears of having to take care of self.
  35. C: Dependent personality disorder discussion
    • DSM diagnostic criteria portray people with DPD as being very passive however research indicates they can actually do what is necessary ti maintain close relationship- might involve being passive and deferential but it might also involve taking active steps to preserve relationship. 
    • Men with higher levels of dependency (perhaps because of their insecurity when their pertnerships are threatened), are at elevated risk of perpetrating domestic violence.

    • Likely to develop depression after interpersonal losses,
    • When depressed, they show more suicidality than do other depressed patients. 
    • Also at elevated risk for developing anxiety disorders and bulimia.

    • Theorists argue that overprotective parents may reinforce children for dependency, while authoritarian discipline may limit the opportunities for children to develop feelings of self efficacy.
    • Several studies support the idea that dependent personality traits are related to over protective and authoritarian parenting.
  36. C: Obsessive-compulsive personality disorder
    • Perfectionist, preoccupied with details, rules and schedules.
    • People with this disorder often pay so much attention to detail that they fail to finish projects.
    • More oriented towards work than pleasure and social relationships often suffer as the pursuit of perfection in the workplace takes time away from family and friends.
    • inordinate Difficulty making decisions and allocating time.
    • Interpersonal relationships are often troubled because they demand that everything be done the right way — their way.
    • Generally, they are serious, rigid, formal and inflexible, especially regarding moral issues.
    • likely to be
    • Excessively frugal to a level that causes concern among those around them.

    • Different to obsessive-compulsive disorder.
    • The personality disorder does not include obsessions and compulsions that define the latter.
    • The two conditions often co-occur and seem to have overlapping genetic vulnerability.
  37. C: Obsessive-compulsive personality disorder DSM-5
    People with obsessive-compulsive personality disorder have an intense need for order, perfection and control, as shown by the presence of at least four of the following from early adulthood across many contexts:

    • preoccupation with rules, details and organisation to the extent that the point of an activity is lost
    • extreme perfectionism interferes with task completion
    • excessive devotion to work to the exclusion of leisure and friendships
    • inflexibility about morals and values
    • difficulty discarding worthless items
    • reluctance to delegate unless others conform to one’s standards
    • miserliness (frugal?)
    • rigidity and stubbornness.
  38. Treatment of personality disorders
    • People with a personality disorder do not have particularly strong insight towards their problems; so many of them enter treatment for a condition other than their personality disorder.
    • Eg.  person with narcissistic personality disorder might seek treatment for depression after being rejected.
    • Clinicians are encouraged to consider whether personality disorders are present because their presence predicts slower improvement in psychotherapy.

    General approaches to treatment of personality disorders:

    • Psychotherapy is considered the treatment of choice- shown to provide small but positive effects.
    • Often supplemented with medications.
    • Eg. antidepressants are used to quell some of the depressive or impulsive symptoms that accompany personality disorders.
    • Psychodynamic theory: suggests childhood problems are at root of personality disorders. Aim is to help patient reconsider those early experiences and become more aware of how they drive their current behaviours and responses to those early events.
    • Cognitive theory: suggests negative cognitive beliefs are at the heart of personality disorders. Aim is to help a person become more aware of those beliefs and then to challenge maladaptive cognitions.
  39. Treatment of schizotypal personality disorder and avoidant personality disorder
    • Treatments for schizotypal draw on links with schizophrenia- antipsychotic drugs. Particularly helpful for reducing unusual thinking.
    • Little research available on psychological approaches to the treatment of schizotypal.

    • Avoidant personality disorder: appear to respond to same treatments that are effective for social anxiety.
    • Antidepressants as well as cognitive-behavioural treatment.
    • Cognitive-behavioural treatment might involve helping person challenge their negative beliefs about social interactions by teaching behavioural strategies for dealing with difficult social situations and by exposure treatment.
    • CBT lasting 20 sessions has been found to be more helpful than psychodynamic treatment for APD.
    • Group versions of cognitive–behavioural treatment have been found to be helpful and may offer chances to practise constructive social interactions in a safe environment.
  40. Treatment of borderline personality disorder
    • Great challenge, regardless of type of treatment being used.
    • Therapists find it challenging to develop and maintain therapeutic relationship.
    • Patients will alternately idealise and vilify therapist.
    • Suicide is a serious risk but often difficult to judge whether it is a call for help or manipulative gesture to test how special they are.
    • Hospitalisation is often necessary to protect against the threat of suicide.

    • Dialectical behaviour therapy (BDT): combines client-centred empathy and acceptance with cognitive-behavioural problem solving, emotion-regulation techniques and social skills training.
    • Term dialectical is used in two main ways:
    • 1. seemingly opposite strategies- Accepting them as they are and yet helping them change.
    • 2. It refers to the patient's realisation that splitting the world into good and bad is not necessary; instead one can achieve synthesis of these apparent opposites.
    • Cognitive-behavioural aspect of DBT involves 4 stages:
    • 1. Dangerously impulsive behaviours such as suicidal actions are addressed, with the goal of promoting greater control.
    • Client is taught to identify triggers for these behaviours and to apply coping strategies when triggers are present.
    • 2. Focus on learning to modulate the extreme emotionality.
    • Clients are taught to mindfully notice thier emotions in a non-judgemental manner, without rushing into impulsive actions.
    • 3. Focus on improving relationships and self esteem.
    • 4. Designed to promote connectedness and happiness. 
    • Basically, DBT involves cognitive–behavioural therapy combined with interventions to provide validation and acceptance to the client.

    • Trial of DBT vs treatment as usual.
    • Findings: DBT was superior to treatment as usual- less intentional self-injurious behaviour, dropped out of treatment less, better adjustment.
    • However, no differences in self-reported depression between the two treatment groups.
    • DBT was found to have moderate positive effects in reducing self-injury and suicidality compared to control conditions
Card Set
Ch 12 Personality and personality disorders
Ch 12 Personality and personality disorders 12.1 explain the DSM-5 approach to classifying personality disorders, key concerns with this approach and the DSM-5 alternative approach to diagnosis 12.2 describe commonalities in the risk factors across the personality disorders 12.3 discuss the clinical description and aetiology of the odd/eccentric cluster of DSM-5 personality disorders 12.4 discuss the clinical description and aetiology of the dramatic/erratic cluster of DSM-5 personality disorders 12.5 discuss the clinical description and aetiology of the anxious/fearful cluster of DSM-5 personality disorders 12.6 describe the available psychological treatments of the DSM-5 personality disorders.