SA 202 Week 7 lecture 1 personality disorders part 2
- 1. Personality Disorders Part 2 Brent Scobie, PhD
- 2. Cluster A: Schizoid Personality Disorder The essential feature of schizoid personality disorder is a pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings--pattern begins by early adulthood and is present in a variety of contexts Lack a desire for intimacy, seem indifferent to opportunities to develop close relationships, and do not seem to derive much satisfaction from being part of a family or other social group Prefer spending time by themselves, rather than being with other people Appear to be socially isolated or “loners” and almost always choose solitary activities or hobbies that do not include interaction with others Prefer mechanical or abstract tasks, such as computer or mathematical games Little interest in having sexual experiences with another person and take pleasure in few, if any, activities Usually a reduced experience of pleasure from sensory, bodily, or interpersonal experiences, such as walking on a beach at sunset or having sex. These individuals have no close friends or confidants, except possibly a first- degree relative
- 3. Cluster A: Schizotypal Personality Disorder Apervasive pattern of social and interpersonal deficits marked by acute discomfort with, and reduced capacity for, close relationships, cognitive or perceptual distortions and eccentricities of behavior Often have ideas of reference (i.e., incorrect interpretations of casual incidents and external events as having a particular and unusual meaning specifically for the person) These individuals may be superstitious or preoccupied with paranormal phenomena that are outside the norms of their subculture They may feel that they have special powers to sense events before they happen or to read others’ thoughts. They may believe that they have magical control over others, which can be implemented directly Their speech may include unusual or idiosyncratic phrasing and construction. It is often loose, digressive, or vague, but without actual derailment or incoherence Responses can be either overly concrete or overly abstract, and words or concepts are sometimes applied in unusual ways (e.g., the individual may state that he or she was not “talkable” at work)
- 4. Cluster A: Paranoid Personality Disorder A pattern of pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent. This pattern begins by early adulthood and is present in a variety of contexts Assume that other people will exploit, harm, or deceive them, even if no evidence exists to support this expectation Suspect on the basis of little or no evidence that others are plotting against them and may attack them suddenly, at any time and without reason. Often feel that they have been deeply and irreversibly injured by another person or persons even when there is no objective evidence for this Preoccupied with unjustified doubts about the loyalty or trustworthiness of their friends and associates, whose actions are minutely scrutinized for evidence of hostile intentions Any perceived deviation from trustworthiness or loyalty serves to support their underlying assumptions If they get into trouble, they expect that friends and associates will either attack or ignore them reluctant to confide in or become close to others because they fear that the information they share will be used against them
- 5. Cluster B: Borderline Personality Disorder The essential feature of borderline personality disorder is a pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity that begins by early adulthood and is present in a variety of contexts Make frantic efforts to avoid real or imagined abandonment The perception of impending separation or rejection, or the loss of external structure, can lead to profound changes in self-image, affect, cognition, and behavior Sensitive to environmental circumstances Experience intense abandonment fears and inappropriate anger even when faced with a realistic time-limited separation or when there are unavoidable changes in plans (e.g., sudden despair in reaction to a clinician’s announcing the end of the hour; panic or fury when someone important to them is just a few minutes late or must cancel an appointment) May believe that this “abandonment” implies they are “bad.” These abandonment fears are related to an intolerance of being alone and a need to have other people with them Their frantic efforts to avoid abandonment may include impulsive actions such as self-mutilating or suicidal behaviors
- 6. Cluster B: Antisocial Personality Disorder The essential feature of antisocial personality disorder is a pervasive pattern of disregard for, and violation of, the rights of others that begins in childhood or early adolescence and continues into adulthood This pattern has also been referred to as psychopathy, sociopathy, or dyssocial personality disorder Because deceit and manipulation are central features of antisocial personality disorder, it may be especially helpful to integrate information acquired from systematic clinical assessment with information collected from collateral sources For this diagnosis to be given, the individual must be at least age 18 years and must have had a history of some symptoms of conduct disorder before age 15 years Conduct disorder involves a repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated The specific behaviors characteristic of conduct disorder fall into one of four categories: aggression to people and animals, destruction of property, deceitfulness or theft, or serious violation of rules Individuals with antisocial personality disorder also tend to be consistently and extremely irresponsible
- 7. Cluster B: Histrionic Personality Disorder The essential feature of histrionic personality disorder is pervasive and excessive emotionality and attention-seeking behavior. This pattern begins by early adulthood and is present in a variety of contexts Individuals with histrionic personality disorder are uncomfortable or feel unappreciated when they are not the center of attention Often lively and dramatic, they tend to draw attention to themselves and may initially charm new acquaintances by their enthusiasm, apparent openness, or flirtatiousness These qualities wear thin, however, as these individuals continually demand to be the center of attention They commandeer the role of “the life of the party.” If they are not the center of attention, they may do something dramatic (e.g., make up stories, create a scene) to draw the focus of attention to themselves This need is often apparent in their behavior with a clinician (e.g., being flattering, bringing gifts, providing dramatic descriptions of physical and psychological symptoms that are replaced by new symptoms each visit) The appearance and behavior of individuals with this disorder are often inappropriately sexually provocative or seductive The appearance and behavior of individuals with this disorder are often inappropriately sexually provocative or seductive These individuals have a style of speech that is excessively impressionistic and lacking in detail
- 8. Cluster B: Narcissistic Personality Disorder The essential feature of narcissistic personality disorder is a pervasive pattern of grandiosity, need for admiration, and lack of empathy that begins by early adulthood and is present in a variety of contexts Individuals with this disorder have a grandiose sense of self-importance They routinely overestimate their abilities and inflate their accomplishments, often appearing boastful and pretentious They may blithely assume that others attribute the same value to their efforts and may be surprised when the praise they expect and feel they deserve is not forthcoming Often implicit in the inflated judgments of their own accomplishments is an underestimation (devaluation) of the contributions of others. Individuals with narcissistic personality disorder are often preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love They may ruminate about “long overdue” admiration and privilege and compare themselves favorably with famous or privileged people. Individuals with narcissistic personality disorder believe that they are superior, special, or unique and expect others to recognize them as such Individuals with this disorder generally require excessive admiration--self-esteem is almost invariably very fragile
- 9. Cluster C: Dependent Personality Disorder The essential feature: a pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation This pattern begins by early adulthood and is present in a variety of contexts The dependent and submissive behaviors are designed to elicit caregiving and arise from a self-perception of being unable to function adequately without the help of others Have difficulty making everyday decisions (e.g., what color shirt to wear to work or whether to carry an umbrella) without an excessive amount of advice and reassurance from others Tend to be passive and to allow other people (often a single other person) to take the initiative and assume responsibility for most major areas of their lives Adults with this disorder typically depend on a parent or spouse to decide where they should live, what kind of job they should have, and which neighbors to befriend Adolescents with this disorder may allow their parent(s) to decide what they should wear, with whom they should associate, how they should spend their free time, and what school or college they should attend This need for others to assume responsibility goes beyond age-appropriate and situation- appropriate requests for assistance from others
- 10. Cluster C: Obsessive-Compulsive Personality Disorder The essential feature of obsessive-compulsive personality disorder is a preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency This pattern begins by early adulthood and is present in a variety of contexts Individuals with obsessive-compulsive personality disorder attempt to maintain a sense of control through painstaking attention to rules, trivial details, procedures, lists, schedules, or form to the extent that the major point of the activity is lost They are excessively careful and prone to repetition, paying extraordinary attention to detail and repeatedly checking for possible mistakes They are oblivious to the fact that other people tend to become very annoyed at the delays and inconveniences that result from this behavior Time is poorly allocated, and the most important tasks are left to the last moment The perfectionism and self-imposed high standards of performance cause significant dysfunction and distress in these individuals They may become so involved in making every detail of a project absolutely perfect that the project is never finished Deadlines are missed, and aspects of the individual’s life that are not the current focus of activity may fall into disarray
- 11. Cluster C: Avoidant Personality Disorder The essential feature of avoidant personality disorder is a pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation that begins by early adulthood and is present in a variety of contexts Avoid work activities that involve significant interpersonal contact because of fears of criticism, disapproval, or rejection Offers of job promotions may be declined because the new responsibilities might result in criticism from co-workers These individuals avoid making new friends unless they are certain they will be liked and accepted without criticism Until they pass stringent tests proving the contrary, other people are assumed to be critical and disapproving Individuals with this disorder will not join in group activities unless there are repeated and generous offers of support and nurturance Interpersonal intimacy is often difficult for these individuals, although they are able to establish intimate relationships when there is assurance of uncritical acceptance They may act with restraint, have difficulty talking about themselves, and withhold intimate feelings for fear of being exposed, ridiculed, or shamed Because individuals with this disorder are preoccupied with being criticized or rejected in social situations, they may have a markedly low threshold for detecting such reactions Individuals with avoidant personality disorder are inhibited in new interpersonal situations because they feel inadequate and have low self-esteem