Personality Disorders

Transcription

1 Personality Disorders Personality disorder inflexible and maladaptive personality traits cause significant functional impairment or distress Axis II of DSM-IV-TR Difficulties in diagnosis Everyone exhibits some of the traits Symptoms overlap other disorders Lack of adherence to diagnostic criteria Copyright Houghton Mifflin Company. All rights reserved. 8-1

2 Personality Disorders Five-factor model (FFM) of personality: Openness to experience Conscientiousness Extraversion Agreeableness Neuroticism (emotional adjustment and stability) Copyright Houghton Mifflin Company. All rights reserved. 8-2

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4 Disorders of Impulse Control Impulse control disorders Repeated expression of impulsive acts that lead to physical or financial damage to the individual or another person Characteristics: Failure to resist an impulse or temptation to perform an act known to be considered wrong by society or known to be harmful Tension or arousal before the act Sense of excitement, gratification, or release after the act is committed (guilt/regret may/ may not follow) Includes: Intermittent explosive disorder Kleptomania Pathological gambling Pyromania Trichotillomania Excludes Behaviors related to sexual conduct compulsive ingestion of drugs or alcohol Copyright Houghton Mifflin Company. All rights reserved. 8-4

5 Impulse Control Disorders Copyright Houghton Mifflin Company. All rights reserved. 8-5

6 It feels terribly lonely to be borderline. I am living in a castle, with very thick defensive walls and a very tightly closed draw-bridge and door. Outside is a crowd and they are having a party. But I can t hear what it s about and I can t join them, although part of me wants to. So I stand at the window and look outside and I don t understand what they are doing. Also I feel like they look at me all the time and laugh at me for not understanding and not belonging. I don t know what I have to do to belong or to understand. The castle is empty. I am the only thing in it. Not only the only living thing, but really the only thing: the castle is completely empty. There is no furniture, no wallpaper, no carpets. The wooden floors are bare, the closets are empty, and the doors are standing ajar. The castle is huge, with many floors, and every floor has many rooms and everything is empty. Try imagining living like this and you can, just for a little bit, understand how we feel. I see everything as good or bad. I want to live with someone else in my castle but I am afraid of intimate interactions. My relationships are unstable and often intense. The most effective therapy for me is Dialectical Behavior Therapy. I can learn skills to regulate myself, tolerate my unwanted thoughts/actions and allow me to be more effective in engaging other people. Copyright Houghton Mifflin Company. All rights reserved. 8-6

7 Odd or Eccentric Disorders Paranoid personality disorder Unwarranted suspiciousness Hypersensitivity reluctance to confide in others Unfounded beliefs are resistant to change Treatment Usually psychodynamic, but difficult to treat Schizoid personality disorder Social isolation emotional coldness indifference to others Unclear relationship with schizophrenia Treatment Aimed at crisis resolution Copyright Houghton Mifflin Company. All rights reserved. 8-7

8 Odd or Eccentric Disorders Schizotypal personality disorder Peculiar thoughts and behaviors poor interpersonal relationships Treatment Dynamic supportive cognitive-behavioral group therapy small doses of anxiolytics for anxiety Copyright Houghton Mifflin Company. All rights reserved. 8-8

9 Dramatic, Emotional, or Erratic Disorders Histrionic personality disorder Self-dramatization exaggerated expression of emotions attention-seeking behaviors Treatment: Psychodynamic Establish therapeutic alliance and provide insight Cognitive behavioral Focus on changing irrational thinking Narcissistic personality disorder Exaggerated sense of self-importance exploitative attitudes lack of empathy Treatment Individual psychotherapy and group therapy Copyright Houghton Mifflin Company. All rights reserved. 8-9

10 Borderline Personality Disorder Intense fluctuations in mood, self-image, and interpersonal relationships Transient, ego-dystonic psychotic symptoms Usually drop out of therapy before it can be effective CAUSES Psychodynamic Others seen as all good or all bad (object splitting), resulting in emotional fluctuations toward others Social Learning Faulty self-identity, difficulty coping Want attachment but dread engagement Dysfunction in emotions Copyright Houghton Mifflin Company. All rights reserved. 8-10

11 Causes of Borderline Personality Disorder Cognitive Difficulty regulating emotions Unstable, intense interpersonal relationships Distorted or inaccurate attributions Beck Thoughts influence perceptions, interpretations, and behavioral/emotional responses Dialectical behavior therapy (DBT) Teaches skills» emotional regulation,» distress tolerance» interpersonal effectiveness Copyright Houghton Mifflin Company. All rights reserved. 8-11

12 Antisocial Personality Disorder Antisocial personality disorder Failure to conform to social and legal codes lack of anxiety and guilt irresponsible behaviors Cleckley s description Superficial charm/good intelligence Shallow emotions lack of empathy, guilt, remorse Behaviors indicate little life plan or order Failure to learn from experiences absence of anxiety Unreliability, insincerity, and untruthfulness Copyright Houghton Mifflin Company. All rights reserved. 8-12

13 Causes of Antisocial Personality Disorder Psychopathy Checklist-Revised (PCL-R) suggests three factors Arrogant and deceitful interpersonal style deficient affective experience impulsive/irresponsible behavioral style Psychodynamic Faulty superego development allows free expression of id impulses Family and Socialization: Poor parental supervision and involvement Parental rejection/deprivation Dysfunctional family structure Parental separation or absence Do not learn to pay attention to social stimuli Antisocial father Copyright Houghton Mifflin Company. All rights reserved. 8-13

14 Antisocial Personality Disorder Genetic Central nervous system abnormality Autonomic nervous system abnormalities Fearlessness or lack of anxiety Arousal, sensation-seeking, and behavioral: Underarousal Low levels of ANS reactivity Impulsive unsocialized sensation-seeking varying levels of thrill-seeking ( Big T ) behaviors that can lead to constructive or destructive behaviors Differential responses to punishment Monetary loss is effective, but not physical or social punishment Copyright Houghton Mifflin Company. All rights reserved. 8-14

15 Treatment of Antisocial Personality Disorder Tranquilizing drugs Skill-based and behavioral treatment using material rewards not long-lasting Cognitive build rapport guide toward higher levels of thinking regarding self and others Need to involve families and peers The disorder diminishes with age Copyright Houghton Mifflin Company. All rights reserved. 8-15

16 Anxious or Fearful Disorders Avoidant personality disorder Fear of rejection and humiliation a reluctance to enter into social relationships Treatment Cognitive-behavioral Psychodynamic Interpersonal psychopharmacological Dependent personality disorder Reliance on others unwillingness to assume responsibility Treatment Various forms used more successful than with other personality disorders Copyright Houghton Mifflin Company. All rights reserved. 8-16

17 Anxious or Fearful Disorders Obsessive-compulsive personality disorder Perfectionism tendency to be interpersonally controlling devotion to details rigidity Differs from OCD Involves traits not recurrent thoughts and repetitive behaviors Treatment Cognitive-behavioral supportive forms of psychotherapy no medications are known to be helpful Copyright Houghton Mifflin Company. All rights reserved. 8-17

18 Impulse Control Disorders Intermittent Explosive Disorder Loss of control over aggressive impulses, resulting in serious assaults on others or destruction of property Often co-occurs with other disorders (e.g., mood, anxiety, substance use) Kleptomania Recurrent failure to resist impulses to steal objects (even though the objects aren t needed for personal use or monetary value) May be associated with depression Pyromania Characterized by deliberate and purposeful fire setting on more than one occasion Begins in childhood and associated with: Being a young male, overwhelming anger, having conduct/personality disorder Poor family environment and interpersonal maladjustment Stressful life events Copyright Houghton Mifflin Company. All rights reserved. 8-18

19 Impulse Control Disorders Pathological Gambling Chronic, progressive failure to resist impulses to gamble despite detrimental consequences Cognitive-behavioral therapies erroneous beliefs about ability to influence outcomes Brief therapy (motivational messages) also helpful Trichotillomania Inability to resist impulses to pull out one s own hair (primarily from the scalp, but also any other parts of the body) Associated with pleasure Copyright Houghton Mifflin Company. All rights reserved. 8-19

20 Impulse Control Disorders Psychodynamic: Pathological gambling likened to masturbation, or unconscious need to lose because of underlying guilt Kleptomania Attempt to gain esteem, nourishment, sexual gratification Pyromania Sexual gratification, feelings of impotence and inferiority, unconscious anger Trichotillomania Unhealthy parent-child relationships Copyright Houghton Mifflin Company. All rights reserved. 8-20

21 Causes Impulse Control Disorders Behavioral Learning principles Physiological Compulsive gambling related to: Abnormalities in noradrenergic systems, indicating greater sensation-seeking Neurotransmitter serotonin Copyright Houghton Mifflin Company. All rights reserved. 8-21

22 Treatment of Impulse Control Disorders No established psychological or medical treatment Behavioral and cognitive-behavioral Recognize tension states Rehearse alternative responses Aversive conditioning Change cognitive styles Insight-oriented approaches helpful with kleptomania Anger management and awareness techniques for intermittent explosive disorder Multimodal approaches involving family, friends, organizations may be helpful Copyright Houghton Mifflin Company. All rights reserved. 8-22