Personality Disorders PDF

An Overview of Personality Disorders Personality disorders are persistent patterns of emotions, cognitions, and behaviors that cause significant distress or impairment in various aspects of a person's life. Unlike many other psychological disorders, personality disorders are chronic. DSM-5 lists 10...

An Overview of Personality Disorders Personality disorders are persistent patterns of emotions, cognitions, and behaviors that cause significant distress or impairment in various aspects of a person's life. Unlike many other psychological disorders, personality disorders are chronic. DSM-5 lists 10 specific personality disorders, grouped into three clusters based on their similarities. These disorders are controversial due to unresolved issues regarding their conceptualization and diagnosis. preencoded.png Personality Disorder Clusters DSM-5-TR divides personality disorders into three clusters based on similarities: 1 Cluster A: Odd or Eccentric Includes paranoid, schizoid, and schizotypal personality disorders. 2 Cluster B: Dramatic, Emotional, or Erratic Consists of antisocial, borderline, histrionic, and narcissistic personality disorders. 3 Cluster C: Anxious or Fearful Includes avoidant, dependent, and obsessive- compulsive personality disorders. preencoded.png Prevalence and Development Studies suggest that approximately 1 in 10 adults in the United States may have a diagnosable personality disorder. Worldwide, about 6% of adults may have at least one personality disorder. These disorders were traditionally thought to originate in childhood and continue into adulthood. Recent research indicates that personality disorders can remit over time, but they may be replaced by other personality disorders. The developmental course of these disorders is not fully understood, partly due to the difficulty in studying individuals from the early stages of their disorder. Childhood 1 Personality disorders often originate in childhood. 2 Early Adulthood Symptoms may become more pronounced and disruptive. Middle Adulthood 3 Some disorders may "burn out" or improve, while others persist. 4 Later Life Some individuals may still experience higher than average interpersonal difficulties. preencoded.png Gender Differences in Personality Disorders Gender differences in personality disorders have been observed, but their interpretation remains controversial. Men diagnosed with personality disorders tend to display more aggressive, structured, self-assertive, and detached traits, while women tend to present with more submissive, emotional, and insecure characteristics. Some disorders, like antisocial personality disorder, are more prevalent in males, while others, like dependent personality disorder, are more common in females. However, recent studies suggest that the prevalence of certain disorders, such as histrionic and borderline personality disorders, may be more equal between genders than previously thought. Men Women More aggressive, structured, More submissive, emotional, and self-assertive, and detached traits. insecure characteristics. preencoded.png preencoded.png preencoded.png Personality Disorders Under Study The field of personality disorders continues to evolve, with researchers studying potential new categories for inclusion in future diagnostic manuals. Two examples of personality disorders that have been studied but not included in DSM-5 are: Sadistic Personality Disorder Passive-Aggressive Personality Disorder Ongoing Research Characterized by individuals who receive Continued study of these and other potential pleasure from inflicting pain on others. Includes people who are defiant and refuse to personality disorders to determine their validity cooperate with requests, attempting to and clinical utility. undermine authority figures. preencoded.png Cluster A Personality Disorders Cluster A personality disorders encompass three conditions that share features resembling psychotic symptoms seen in schizophrenia: paranoid, schizoid, and schizotypal. These disorders are characterized as odd or eccentric. preencoded.png Clinical Description of Paranoid Personality Disorder The defining characteristic of paranoid personality disorder is a pervasive, unjustified distrust of others. Individuals with this disorder interpret neutral events as personal attacks and struggle to form meaningful relationships due to their suspicions. This can lead to argumentative behavior, complaints, or quietness, often resulting in discomfort for those around them. 1 Key Characteristics 2 Behavioral Manifestations Excessive mistrust and suspicion Argumentative, complaining, or quiet demeanor 3 Associated Risks 4 Life Impact Increased suicide attempts and Poor overall quality of life violent behavior preencoded.png Diagnostic Criteria A. A pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following: 1 Suspects, without sufficient basis, that others are exploiting, harming, or deceiving him or her. 2 Is preoccupied with unjustified doubts about the loyalty or trustworthiness of friends or associates. 3 Is reluctant to confide in others because of unwarranted fear that the information will be used maliciously against him or her. 4 Reads hidden demeaning or threatening meanings into benign remarks or events. 5 Persistently bears grudges (i.e., is unforgiving of insults, injuries, or slights). 6 Perceives attacks on his or her character or reputation that are not apparent to others and is quick to react angrily or to counterattack. 7 Has recurrent suspicions, without justification, regarding fidelity of spouse or sexual partner. preencoded.png Diagnostic Criteria B. Does not occur exclusively during the course of schizophrenia, a bipolar disorder or depressive disorder with psychotic features, or another psychotic disorder and is not attributable to the physiological effects of another medical condition. Note: If criteria are met prior to the onset of schizophrenia, add “premorbid,” i.e., “paranoid personality disorder (premorbid).” preencoded.png Biological Causes of Paranoid Personality Disorder Evidence for biological contributions to paranoid personality disorder is limited. Some research suggests a slightly higher prevalence among relatives of individuals with schizophrenia, although the association is not strong. Genetics appear to play a significant role in the development of paranoid personality disorder. There seems to be some relationship with schizophrenia, leading some researchers to suggest eliminating it as a separate disorder. However, more research is needed to fully understand the biological underpinnings of this condition. 1 Genetic Factors Strong role of genetics in paranoid personality disorder development 2 Schizophrenia Connection Slightly higher prevalence among relatives of individuals with schizophrenia 3 Ongoing Research Further studies needed to understand biological contributions fully preencoded.png Psychological Contributions to Paranoid Personality Disorder Psychological factors contributing to paranoid personality disorder are less certain, but some interesting speculations have been made. Retrospective research suggests that early mistreatment or traumatic childhood experiences may play a role in its development. However, caution is warranted when interpreting these results due to potential recall bias. Some psychologists focus on the thoughts or "schemas" of individuals with this disorder. They may hold basic mistaken assumptions about others, such as "People are malevolent and deceptive" or "They'll attack you if they get the chance." These maladaptive views pervade every aspect of their lives. Early Experiences Cognitive Schemas Pervasive Beliefs Possible role of childhood Mistaken assumptions about Maladaptive views affecting trauma or mistreatment others' intentions all aspects of life preencoded.png Cultural Factors in Paranoid Personality Disorder Cultural factors have been implicated in the development of paranoid personality disorder. Certain groups, such as prisoners, refugees, people with hearing impairments, and older adults, are thought to be particularly susceptible due to their unique experiences. For example, immigrants who struggle with language and customs in a new culture might misinterpret innocent behaviors as directed at them. The late musician Jim Morrison of The Doors described this phenomenon in his song "People Are Strange" (1967): "People are strange, / When you're a stranger, / Faces look ugly, / When you're alone." This illustrates how someone could misinterpret ambiguous situations as malevolent. Prisoners Refugees Hearing Impaired Older Adults Susceptible due to Challenges in Potential for Unique experiences their environment adapting to new misinterpreting social affecting perception cultures cues preencoded.png Treatment Challenges for Paranoid Personality Disorder Treatment of paranoid personality disorder presents significant challenges. Due to their mistrustful nature, individuals with this disorder are unlikely to seek professional help and struggle to develop the trusting relationships necessary for successful therapy. Establishing a meaningful therapeutic alliance becomes a crucial first step. Mistrust Barrier Crisis Trigger Trust Building Cognitive Approach Difficulty in seeking Therapy often Establishing Focusing on and accepting sought due to therapeutic alliance changing beliefs professional help external crises or as a crucial first step about others' related issues intentions preencoded.png Treatment Effectiveness and Prognosis This poor prognosis highlights the need for further research into effective treatment methods and the importance of early intervention. It also underscores the challenges faced by both individuals with the disorder and the mental health professionals attempting to help them. Therapists believing in 11% successful treatment Confirmed effective treatments None Main challenge Continuing therapy long enough preencoded.png Schizoid Personality Disorder Schizoid Personality Disorder (SPD) is characterized by a pervasive pattern of detachment from social relationships and a limited range of emotional expression. Individuals with this disorder often appear aloof, cold, and indifferent to others, preferring solitude over social interaction. This condition significantly impacts a person's ability to form close relationships and engage in normal social activities. The term "schizoid" was first used by Bleuler in 1924 to describe people who tend to turn inward and away from the outside world. These individuals typically lack emotional expressiveness and pursue vague interests, leading to a life of isolation and detachment. preencoded.png  Diagnostic Criteria A. A pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following: 1. Neither desires nor enjoys close relationships, including being part of a family. 2. Almost always chooses solitary activities. 3. Has little, if any, interest in having sexual experiences with another person. 4. Takes pleasure in few, if any, activities. 5. Lacks close friends or confidants other than first-degree relatives. preencoded.png  Diagnostic Criteria 6. Appears indifferent to the praise or criticism of others. 7. Shows emotional coldness, detachment, or flattened affectivity. B. Does not occur exclusively during the course of schizophrenia, a bipolar disorder or depressive disorder with psychotic features, another psychotic disorder, or autism spectrum disorder and is not attributable to the physiological effects of another medical condition. Note: If criteria are met prior to the onset of schizophrenia, add “premorbid,” i.e., “schizoid personality disorder (premorbid).” preencoded.png Causes of Schizoid Personality Disorder 1 Childhood Factors Childhood shyness is reported as a precursor to adult SPD. Abuse and neglect in childhood are also reported among individuals with this disorder. 2 Genetic Factors Inherited personality traits may serve as important determinants in the development of SPD. 3 Biological Factors Research suggests overlap between autism spectrum disorder and SPD, indicating possible shared biological dysfunctions. 4 Environmental Factors Early learning problems or difficulties with interpersonal relationships may contribute to the social deficits defining SPD. preencoded.png Treatment Approaches for Schizoid Personality Disorder Emphasize Social Value Social Skills Training Identify Support Network Emotional Education Therapists often begin by Patients receive training to Patients may be taught about highlighting the importance and establish and maintain social Therapists help identify a social emotions and empathy to benefits of social relationships. relationships, often through network of supportive improve interpersonal role-playing exercises. individuals to aid in treatment. understanding. preencoded.png Overlap with Autism Spectrum Disorder Characteristic Schizoid PD Autism Spectrum Disorder Social Difficulties Present Present Emotional Expression Limited Often limited Preference for Solitude Strong Often present Biological Factors Suspected Established Research demonstrates significant overlap in the occurrence of autism spectrum disorder and schizoid personality disorder. This overlap suggests possible shared biological dysfunctions, which may combine with early learning or interpersonal problems to produce the social deficits characteristic of both conditions. preencoded.png Schizotypal Personality Disorder Schizotypal Personality Disorder (SPD) is a complex mental health condition characterized by social isolation, unusual behaviors, and odd beliefs. It is considered to be on a continuum with schizophrenia, sharing some similarities but without the more severe symptoms like hallucinations and delusions. This disorder presents unique challenges in social interactions, cognitive processes, and overall functioning. Understanding SPD is crucial for mental health professionals and those affected by the disorder. It requires careful diagnosis, considering cultural factors, and a multifaceted approach to treatment. preencoded.png Clinical Description of Schizotypal Personality Disorder 1 Psychotic-like Symptoms 2 Social Deficits Individuals with SPD experience psychotic-like symptoms without People with SPD often have significant social deficits, leading to full psychosis. They may believe everything relates to them isolation and difficulty in interpersonal relationships. personally but can acknowledge the unlikelihood of such beliefs. 3 Unusual Perceptions and Beliefs 4 Behavioral Oddities Those with SPD may report unusual perceptual experiences and Individuals may dress or behave in unusual ways, such as wearing engage in magical thinking, such as believing they have clairvoyant multiple layers of clothing in summer or mumbling to themselves. or telepathic abilities. preencoded.png Diagnostic Criteria A. A pervasive pattern of social and interpersonal deficits marked by acute discomfort with, and reduced capacity for, close relationships as well as by cognitive or perceptual distortions and eccentricities of behavior, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following: 1. Ideas of reference (excluding delusions of reference). 2. Odd beliefs or magical thinking that influences behavior and is inconsistent with subcultural norms (e.g., superstitiousness, belief in clairvoyance, telepathy, or “sixth sense”; in children and adolescents, bizarre fantasies or preoccupations). 3. Unusual perceptual experiences, including bodily illusions. 4. Odd thinking and speech (e.g., vague, circumstantial, metaphorical, overelaborate, or stereotyped). 5. Suspiciousness or paranoid ideation. 6. Inappropriate or constricted affect. preencoded.png Diagnostic Criteria 7. Behavior or appearance that is odd, eccentric, or peculiar. 8. Lack of close friends or confidants other than first-degree relatives. 9. Excessive social anxiety that does not diminish with familiarity and tends to be associated with paranoid fears rather than negative judgments about self. B. Does not occur exclusively during the course of schizophrenia, a bipolar disorder or depressive disorder with psychotic features, another psychotic disorder, or autism spectrum disorder. Note: If criteria are met prior to the onset of schizophrenia, add “premorbid,” e.g., “schizotypal personality disorder (premorbid).” preencoded.png Causes and Genetic Factors of Schizotypal Personality Disorder 1 Historical Perspective The term "schizotype" was originally used to describe individuals predisposed to develop schizophrenia. Schizotypal PD is viewed by some as one phenotype of a schizophrenia genotype. 2 Genetic Research Family, twin, and adoption studies have shown an increased prevalence of Schizotypal PD among relatives of people with schizophrenia. This suggests a genetic link between the two disorders. 3 Environmental Factors Research indicates that environmental factors, particularly childhood maltreatment, can strongly influence the development of Schizotypal PD. In men, it's associated with schizotypal symptoms, while in women, it's linked to PTSD symptoms. 4 Neurological Findings Cognitive assessments and neuroimaging studies have revealed mild-to-moderate decrements in memory and learning abilities, as well as generalized brain abnormalities in individuals with SPD. preencoded.png Treatment Approaches for Schizotypal Personality Disorder Initial Assessment People with Schizotypal PD often seek help due to anxiety or depression. The presence of Schizotypal PD significantly increases the risk of developing major depressive disorder. Medical Interventions Treatment may include medical approaches similar to those used for depression. Some studies have explored the use of antipsychotic medications to manage symptoms. Psychological Therapies Psychological treatments for depression are often employed. Cognitive behavior therapy and social skills training have shown promise in managing SPD symptoms. Integrated Approach A combination of antipsychotic medication, community treatment, and social skills training has been found effective in reducing symptoms or postponing the onset of schizophrenia in some cases. preencoded.png Prevention Strategies and Early Intervention Early Detection Medication Cognitive Therapy Social Skills Training Identifying Schizotypal PD Antipsychotic medications may be Cognitive behavior therapy is Developing social skills is crucial in symptoms in younger individuals is used as part of a preventive strategy employed to help individuals helping individuals with Schizotypal crucial for implementing preventive to manage symptoms and manage their thoughts and PD improve their interpersonal measures. potentially delay the onset of behaviors associated with relationships and overall schizophrenia. Schizotypal PD. functioning. These prevention strategies aim to address Schizotypal PD symptoms early and potentially prevent the onset of more severe conditions like schizophrenia. The combination of medication, therapy, and skills training shows promise in managing Schizotypal PD and improving long-term outcomes for affected individuals. preencoded.png Cluster B Personality Disorders Cluster B personality disorders include antisocial, borderline, histrionic, and narcissistic types. These disorders are characterized by dramatic, emotional, or erratic behaviors. preencoded.png Clinical Description of Antisocial Personality Personality Disorder Individuals with antisocial personality disorder have a long history of violating others' rights. They are often aggressive, indifferent to others' concerns, and show no remorse for their actions. Lying, cheating, and substance abuse are common. The long-term outcome is usually poor, with higher rates of unnatural death. This disorder has been known by various names, including moral insanity, sociopathy, and psychopathy. There is ongoing debate about whether psychopathy and antisocial personality disorder are distinct disorders. Key Traits Aggression, indifference, lack of remorse Common Behaviors Lying, cheating, substance abuse Long-term Outcome Generally poor, higher risk of unnatural death preencoded.png Diagnostic Criteria A. A pervasive pattern of disregard for and violation of the rights of others, occurring since age 15 years, as indicated by three (or more) of the following: 1. Failure to conform to social norms with respect to lawful behaviors, as indicated by repeatedly performing acts that are grounds for arrest. 2. Deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure. 3. Impulsivity or failure to plan ahead. 4. Irritability and aggressiveness, as indicated by repeated physical fights or assaults. 5. Reckless disregard for safety of self or others. 6. Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations. preencoded.png Diagnostic Criteria 7. Lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another. B. The individual is at least age 18 years. C. There is evidence of conduct disorder with onset before age 15 years. D. The occurrence of antisocial behavior is not exclusively during the course of schizophrenia or bipolar disorder. preencoded.png Psychological and Social Dimensions Research on reward processing suggests that individuals with psychopathy are less likely to be deterred from pursuing a goal, even when it becomes unattainable. This may explain their persistent antisocial behaviors despite negative consequences. Antisocial behaviors often change form as individuals age, from childhood truancy to adult criminal activities. However, rates of antisocial behavior tend to decline around age 40 for reasons not yet fully understood. 1 Childhood Conduct problems, truancy 2 Adolescence/Early Adulthood Criminal activities increase 3 Middle Age Decline in antisocial behaviors around 40 preencoded.png Treatment Approaches Treatment of antisocial personality disorder in adults is challenging, as individuals rarely seek help voluntarily and can be manipulative in therapy. Most clinicians are pessimistic about treatment outcomes for adults. Emphasis is placed on early identification and intervention for high-risk children. Cognitive behavior therapy has shown some success in reducing violence among offenders, though effectiveness decreases with higher psychopathy scores. For children, parent training programs are common, teaching parents to recognize and address behavior problems early. Cognitive Behavior Therapy Shows some success in reducing violence Parent Training Common approach for children with conduct problems Treatment Challenges Adults rarely seek help, can be manipulative in therapy preencoded.png Prevention Strategies Prevention efforts focus on children at risk for later antisocial personality disorder. Aggressive behaviors in young children are remarkably stable and can escalate over time. School-based programs emphasize behavioral supports and social competence training. Early intervention, such as parent training for toddlers, shows promise in reducing aggression and improving social skills. Participation in high school sports may weaken the link between childhood conduct disorder and adult antisocial behavior. While long-term impacts are still being assessed, prevention is considered the most promising approach given the challenges of treating adults. 1 Early Intervention 2 School-Based Programs 3 Sports Participation Parent training for toddlers shows Focus on behavioral supports and May weaken link between promise in reducing aggression social competence training childhood conduct disorder and adult antisocial behavior preencoded.png Borderline Personality Disorder Borderline Personality Disorder is a prevalent and complex mental health condition characterized by unstable moods, relationships, and self-image. Affecting 1-2% of the general population across cultures, Borderline PD presents significant challenges for those diagnosed and their loved ones. This disorder is marked by intense emotions, fear of abandonment, and a high risk of self-harm and suicide. preencoded.png Clinical Description and Prevalence 1 Prevalence BPD affects 1-2% of the general population across all cultures. 2 Core Features Instability in emotions, relationships, self-concept, and behavior. 3 Risk Factors High risk of suicide, with nearly 10% dying by suicide. 4 Long-term Outlook Approximately 90% of patients achieve remission within a decade of seeking treatment. preencoded.png  Diagnostic Criteria A. A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following: 1. Frantic efforts to avoid real or imagined abandonment. (Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.) 2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation. 3. Identity disturbance: markedly and persistently unstable self-image or sense of self. 4. Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating). (Note: Do not preencoded.png include suicidal or self-mutilating behavior covered in Criterion 5.) Diagnostic Criteria 5. Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior. 6. Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days). 7. Chronic feelings of emptiness. 8. Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights). 9. Transient, stress-related paranoid ideation or severe dissociative symptoms. preencoded.png Causes and Genetic Factors Genetic Influence Neurochemical Factors Brain Imaging Studies Family and twin studies suggest a Research focuses on the serotonin Neuroimaging points to the limbic genetic component to Borderline PD. system, as dysfunction in this area is network's involvement in Borderline Higher concordance rates are linked to emotional instability, suicidal PD, which is crucial for emotion observed in monozygotic twins behaviors, and impulsivity seen in regulation and serotonin compared to dizygotic twins. Borderline PD. neurotransmission. preencoded.png Treatment Approaches 1 2 3 4 Medication Dialectical Behavior Trauma-Focused Therapy Skill Building Therapy (DBT) Mood stabilizers, Patients learn to identify and anticonvulsants, and Developed by Marsha Linehan, Similar to PTSD treatment, this regulate emotions, develop antipsychotics can be effective DBT is a thoroughly approach helps patients problem-solving skills, and for managing affect researched cognitive- reexperience and process build self-trust. disturbances. behavioral treatment for traumatic events. Borderline PD. preencoded.png Effectiveness of Dialectical Behavior Therapy Reduction in Harmful Behaviors DBT has been shown to reduce suicide attempts, treatment dropouts, and hospitalizations. Improved Social Adjustment Follow-up studies indicate that DBT patients show less suicidal ideation, reduced anger, and better social adjustment. Inpatient Treatment Benefits Even short-term inpatient DBT treatment (about 5 days) can lead to improvements in depression, hopelessness, anger expression, and dissociation. Long-term Effectiveness A growing body of evidence supports the long-term effectiveness of DBT in treating Borderline PD. preencoded.png Histrionic Personality Disorder Histrionic Personality Disorder (HPD) is characterized by overly dramatic and theatrical behavior. Individuals with this disorder tend to express emotions in an exaggerated manner, often seeming as if they are acting. This presentation will explore the clinical description, causes, and treatment approaches for Histrionic PD, as well as the controversies surrounding its diagnosis. preencoded.png Clinical Description of Histrionic Personality Disorder 1 Emotional Expression Individuals with Histrionic PD express emotions in an exaggerated fashion, such as hugging strangers or crying uncontrollably during sad movies. 2 Attention-Seeking Behavior They are often vain, self-centered, and uncomfortable when not in the limelight. They seek constant reassurance and approval. 3 Impulsivity People with Histrionic PD tend to be impulsive and have difficulty delaying gratification. 4 Cognitive Style Their cognitive style is impressionistic, viewing situations in global, black-and-white terms. Speech is often vague and exaggerated. preencoded.png Diagnostic Criteria A pervasive pattern of excessive emotionality and attention seeking, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following: 1. Is uncomfortable in situations in which he or she is not the center of attention. 2. Interaction with others is often characterized by inappropriate sexually seductive or provocative behavior. 3. Displays rapidly shifting and shallow expression of emotions. 4. Consistently uses physical appearance to draw attention to self. 5. Has a style of speech that is excessively impressionistic and lacking in detail. 6. Shows self-dramatization, theatricality, and exaggerated expression of emotion. 7. Is suggestible (i.e., easily influenced by others or circumstances). 8. Considers relationships to be more intimate than they actually are. preencoded.png Treatment Approaches for Histrionic Personality Disorder Behavior Modification Interpersonal Focus Cognitive Restructuring Limited Research Some therapists have attempted Therapy often focuses on Patients are shown how short- Despite various approaches, little to modify attention-seeking problematic interpersonal term gains from manipulative research demonstrates consistent behavior through reward and relationships and teaching more behavior result in long-term costs. success in treating Histrionic PD. punishment systems. appropriate ways of negotiating wants and needs. preencoded.png Narcissistic Personality Disorder Narcissistic Personality Disorder have an unreasonablesense of self-importance and are so preoccupied with themselves that they lack sensitivity and compassion for other people. They aren’t comfortable unless someone is admiring them. Their exaggerated feelings and their fantasies of greatness, called grandiosity, create a number of negative attributes. They require and expect a great deal of special attention. They also tend to use or exploit others for their own interests and show little empathy. When confronted with other successful people, they can be extremely envious and arrogant preencoded.png Diagnostic Criteria A pervasive pattern of grandiosity (in fantasy or behavior), need or admiration, and lack of empathy, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following: 1. Has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements). 2. Is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love. 3. Believes that he or she is “special” and unique and can only be understood by, or should associate with, other special or high-status people (or institutions). 4. Requires excessive admiration. preencoded.png Diagnostic Criteria 5. Has a sense of entitlement (i.e., unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations). 6. Is interpersonally exploitative (i.e., takes advantage of others to achieve his or her own ends). 7. Lacks empathy: is unwilling to recognize or identify with the feelings and needs of others. 8. Is often envious of others or believes that others are envious of him or her. 9. Shows arrogant, haughty behaviors or attitudes. preencoded.png Causes 1 Some writers, including Kohut (1971, 1977), believe that narcissistic personality disorder arises largely from a profound failure by the parents of modeling empathy early in a child’s development. 2 In a sociological view, Christopher Lasch (1978) wrote in his popular book The Culture of Narcissism that this personality disorder is increasing in prevalence in most Western societies, primarily as a consequence of large-scale social changes, including greater emphasis on short-term hedonism, individualism, competitiveness, and success preencoded.png Treatment 1 Cognitive therapy strives to replace their fantasies with a focus on the day-to-day pleasurable experiences that are truly attainable. 2 Coping strategies such as relaxation training are used to help them face and accept criticism. Helping them focus on the feelings of others is also a goal. preencoded.png Cluster C Personality Disorders Cluster C personality disorders include avoidant, dependent, and obsessive-compulsive—share common features with people who have anxiety disorders. preencoded.png Clinical Description of Avoidant Personality Disorder People with avoidant personality disorder are extremely sensitive to the opinions of others and although they desire social relationships, their anxiety leads them to avoid such associations. Extreme low self-esteem coupled with fear of rejection Limited friends Dependent on those they feel comfortable with preencoded.png Diagnostic Criteria A pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following: 1. Avoids occupational activities that involve significant interpersonal contact because of fears of criticism, disapproval, or rejection. 2. Is unwilling to get involved with people unless certain of being liked. preencoded.png Diagnostic Criteria 3. Shows restraint within intimate relationships because of the fear of being shamed or ridiculed. 4. Is preoccupied with being criticized or rejected in social situations. 5. Is inhibited in new interpersonal situations because of feelings of inadequacy. 6. Views self as socially inept, personally unappealing, or inferior to others. 7. Is unusually reluctant to take personal risks or to engage in any new activities because they may prove embarrassing. preencoded.png Causes 1 Biological Influences - individuals may be born with a difficult temperament or personality characteristics. 2 Psychological Influences - Stravynski, Elie, and Franche (1989) questioned a group of people with avoidant personality disorder and a group of control participants about their early treatment by their parents. Those with the disorder remembered their parents as more rejecting, more guilt engendering, and less affectionate than the control group, suggesting parenting may contribute to the development of this disorder. Similarly, research has consistently found that these individuals are more likely to report childhood experiences of neglect, isolation, rejection, and conflict with others preencoded.png Treatment 1 Behavioral intervention techniques for anxiety and social skills problems have had some success 2 Therapeutic alliance—the collaborative connection between therapist and client—appears to be an important predictor for treatment success in this group. preencoded.png Clinical Description of Dependent Personality Disorder Individuals with dependent personality disorder sometimes agree with other people when their own opinion differs so as not to be rejected. Their desire to obtain and maintain supportive and nurturant relationships may lead to their other behavioral characteristics, including submissiveness, timidity, and passivity. Similar to those with avoidant personality disorder in their feelings of inadequacy, sensitivity to criticism, and need for reassurance. Respond to these feelings by avoiding relationships preencoded.png Diagnostic Criteria A pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following: 1. Has difficulty making everyday decisions without an excessive amount of advice and reassurance from others. 2. Needs others to assume responsibility for most major areas of his or her life. 3. Has difficulty expressing disagreement with others because of fear of loss of support or approval. (Note: Do not include realistic fears of retribution.) preencoded.png Diagnostic Criteria 4. Has difficulty initiating projects or doing things on his or her own (because of a lack of self-confidence in judgment or abilities rather than a lack of motivation or energy). 5. Goes to excessive lengths to obtain nurturance and support from others, to the point of volunteering to do things that are unpleasant. 6. Feels uncomfortable or helpless when alone because of exaggerated fears of being unable to care for himself or herself. 7. Urgently seeks another relationship as a source of care and support when a close relationship ends. 8. Is unrealistically preoccupied with fears of being left to take care of himself or herself. preencoded.png Causes 1 It was thought that disruptions as the early death of a parent or neglect or rejection by caregivers could cause people to grow up fearing abandonment. 2 Genetic influences are important in the development of this disorder. preencoded.png Treatment 1 People with dependent personality disorder are ideal patients. They are very submissiveness, however, negates one of the major goals of therapy, which is to make the person more independent and personally responsible. 2 Therapy therefore progresses gradually as the patient develops confidence in his ability to make decisions independently. preencoded.png Clinical Description of Obsessive-Compulsive Personality Disorder Individuals with obsessive-compulsive personality disorder are characterized by a fixation on things being done “the right way”. General rigidity – tend to have poor interpersonal relationship Preoccupation with orderliness, perfectionism, and mental and Interpersonal control, at the expense of flexibility, openness, and efficiency Also common to find obsessive-compulsive personality disorder among Gifted children, whose quest for perfectionism can be quite debilitating preencoded.png Diagnostic Criteria A pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following: 1. Is preoccupied with details, rules, lists, order, organization, or schedules to the extent that the major point of the activity is lost. 2. Shows perfectionism that interferes with task completion (e.g., is unable to complete a project because his or her own overly strict standards are not met). 3. Is excessively devoted to work and productivity to the exclusion of leisure activities and friendships (not accounted for by obvious economic necessity). preencoded.png Diagnostic Criteria 4. Is overconscientious, scrupulous, and inflexible about matters of morality, ethics, or values (not accounted for by cultural or religious identification). 5. Is unable to discard worn-out or worthless objects even when they have no sentimental value. 6. Is reluctant to delegate tasks or to work with others unless they submit to exactly his or her way of doing things. 7. Adopts a miserly spending style toward both self and others; money is viewed as something to be hoarded for future catastrophes. 8. Shows rigidity and stubbornness. preencoded.png Causes 1 Moderate genetic contribution to obsessive-compulsive personality disorder. 2 Some people may be predisposed to favor structure in their lives preencoded.png Treatment 1 Therapists help the individual relax or use cognitive reappraisal techniques to reframe compulsive thoughts. This form of cognitive- behavioral therapy—following along the lines of treatment for obsessive-compulsive disorder—appears to be effective for people with this personality disorder preencoded.png Thank You!!!! preencoded.png