Personality Psychology Midterm PDF

**[Introduction to Personality & Personality Disorders ]** What is Personality? - Personality: the more or less *stable and enduring organization* of a person's **character, temperament, intellect and physique**, which determines his unique *adjustment to the environment*. Eysenck - P...

**[Introduction to Personality & Personality Disorders ]** What is Personality? - Personality: the more or less *stable and enduring organization* of a person's **character, temperament, intellect and physique**, which determines his unique *adjustment to the environment*. Eysenck - Personality is a **patterned way** in which an *individual interacts with others and the world* **(interpersonal)** & the way the individual views him/her **self**. - Under various circumstances, how an individual - Thinks (cognition) - Has emotional responses (affective) - Behaves - Personality can be **flexible** or **inflexible** - Flexible: easier time adjusting personality to the situation at hand - Composed of **temperament** & **character** **Personality Traits** - "Relatively enduring characteristics that influence our behavior across many situations" - Introduction to Psychology - Many personality traits: - Shy, defiant, cheerful, optimistic, nervous, dismissive, kind - \>18,000 words in English language that describe individual's personality - Became the task of researchers to categorize personality traits into groups through **factor analysis** Personality is influenced by both **genetic components** including **temperament & environment** influences from **interactions with caregivers**. When an individual's personality is **inflexible**, *leading to internal stress or interpersonal difficulties*, **a personality disorder should be considered**. *Personality Assessments* Three Personality Assessments: - Myers Briggs Type Indicator (MBTI) - Neuroticism -- Extraversion -- Openness -- Personality Index Revised (NEO-PI-R) & The Five Factor Model - Minnesota Multiphasic Personality Inventory 2 (MMPI-2) **Myers Briggs Type Indicator (MBTI)** - Self-administered test to determine individual's personality **PREFERENCES** - This or that questions - It **does not assess personality trait** - **Goal**: to provide individuals with insight, to help with team building & address interpersonal work dynamics - To improve interactions and understanding between different people - Acknowledged variation among individuals, **did not state one side was more or less desirable** - Four Dichotomies or Preference Poles Extraversion (E) **Energy** Introversion (I) ------------------ ----------------- ------------------ Sensing (S) **Perception** Intuition (N) Thinking (T) **Judgement** Feeling (F) Judging (J) **Orientation** Perceiving (P) - **Energy:** how do you direct your energy and how do you, yourself, get energized - **Extraversion** - **Introversion** - **Perception**: How do you gather and process information? - **Sensing**: looking at all of the **OBJECTIVES** (and specific) information acquired through 5 senses - **Intuition**: incorporates unconscious association and ideas from what they gather, think of many possibilities (gut instincts) - **Judgment**: how do you come to conclusions? - **Thinking**: try to make an objective decision (not impacted by feelings, decision is based on information gathered, try to make a decision that is closest to the truth) - **Feeling**: try to make a decision reflecting how they will feel about the situation, might overlook objective details if contradictory to their feelings - **Orientation**: How would you like the world to be? - **Perceiving**: prefers when new information can continually be incorporated into the world, likes flexibility, not into significant planning - **Judging**: prefers when there are conclusions, likes structure, order, planning, decisions made - Research Behind the MBTI - Controversial and not fully accepted in the research community - Based off of theory rather than empirical evidence - Criticism includes: - Personality lies on a spectrum, not a dichotomy - Poor reliability (although studies vary) Are our Personalities Innate to us or Mere Reactions to our Environment? - Can personality be an objective measure? - Cross Observer Rating - Were traits merely congruent over time because individuals answered the questions the same? - If multiple people state "Henry is social", does it mean Henry is **objectively** social? **Neuroticism -- Extraversion -- Openness -- Personality Index Revised (NEO-PI-R) Questionnaire & Five Factor Model** - Looks at **personality trait structure**, 5 personality "domains" (factor analysis) - OCEAN Model - Openness - Conscientiousness - Extroversion - Agreeableness - Neuroticism **Low Score** **Trait** **High Score** ------------------------------------------ ----------------------- ------------------------------------- Practical, Conventional, Prefers routine **Openness** Curios, Interests, Independent Impulsive, Careless, Disorganized **Conscientiousness** Hardworking, Dependable, Organized Quiet, Reserved, Withdrawn **Extroversion** Outgoing, Warm, Adventure Critical, Uncooperative, Suspicious **Agreeableness** Helpful, Trusting, Empathetic Calm, even-tempered, secure **Neuroticism** Anxious, unhappy, negative emotions Neuroticism Extraversion Openness Agreeableness Conscientious ----------------- -------------------- ------------ --------------------- ---------------------- Anxiety Warmth Fantasy Trust Competence Angry hostility Gregariousness Aesthetics Straightforwardness Order Depression Assertiveness Feelings Altruism Dutifulness Self-conscious Excitement-seeking Actions Compliance Achievement striving Impulsiveness Positive emotions Ideas Modesty Self-discipline Vulnerability Activity Values Tender-mindedness Deliberation - The FIVE Domains - **Openness**: openness to new experiences, new thoughts - "a general appreciation for art, emotion, adventure, unusual ideas, imagination, curiosity, and variety of experience" Introduction to Psychology - Those with high levels of openness: - Flexible perspectives so able to make creative connections between ideas - Novelty seeking, inherently curious - High levels of openness lead individuals to have broader and deeper emotional experiences - This does NOT translate to experiencing more positive or negative emotions - At high levels, eccentricity, unusual beliefs, perceptual dysregulation - **Conscientiousness**: - Degree of motivation, control, and organization in goal-directed behavior - Get that done in an efficient and complete way - High consciousness: self-directed, diligent, ambitious, rigid perfectionism, perseveration - Low consciousness: aimless, lazy, unreliable, careless, irresponsibility, distractibility, impulsivity, risk-taking - **Extraversion**: - Engaging with the world over inner thoughts - At high levels, social, warm, need for stimulation from others, attention-seeking - At very low levels, social withdrawn & lack of pleasure from company of others - At low levels, intimacy avoidance, social withdrawal, anhedonia, restricted affectivity - At very high levels, can see sexual promiscuity, thrill seeking behaviors, emotional intrusiveness - **Agreeableness**: - "A tendency to be compassionate and cooperative rather than suspicious and antagonistic toward others; reflects individual differences in general concern for social harmony" Introduction to Psychology - Based on interpersonal relationships - High agreeableness: compassionate, trusting, forgiving, & empathetic, submissiveness - Low agreeableness: antagonistic, cynical, suspicious, rude, grandiosity, callousness, deceitfulness, manipulativeness, - **Neuroticism (Negative Affectivity):** - How an individual responds to "threat, frustration, or loss" - Tendency towards negative feelings include anger, sadness, & fear - Unrealistic ideas - Poor frustration tolerance - If something frustrating happens, they're far more likely to frustrate - Not people who can easily remain calm, cool, and collected - Not doing it on purpose - Higher levels of neuroticism correlated with anxiety, depression, separation insecurity, hostility, emotional lability, and personality disorders - How true is this fact of you? - Some of them healthier to be high score some are low score - The TEST: - 240 questions that are answered on a 5-point Likert Scale - "I make other people feel at ease" - "I am the life of the party" - "I follow a schedule" - Both self-report (Form S) & observer report (Form R) available - **Research** Behind the FFM (Five Factor Model) - A **valid and universal** means to describe personality trait structure - Built on factor analysis - **Robust**: many other personality assessments can be mapped onto the FFM model - **Universal**: found similar *trait co-existence within different populations i*ncluding those that spoke German, Portuguese, Hebrew, Chinese, Korean, and Japanese - Cross observer agreement was high in the NEO-PI-R when comparing Form R (observer) and Form S (self) - **Predictive of Success**: a pattern of **HIGH** *conscientiousness*, **LOW** *neuroticism*, and **HIGH** agreeableness predicts [successful job performance]. - Assesses an individual's personality traits, it's deviance from a "normal" population, and an individual's response pattern to the test - Approximately 560 true or false questions - Examples: - "I feel weak and tired most of the time" - "I believe I am more sensitive than most people I know" - Self-report - Clinical & Validity Scales - The Clinical Scale Abbreviation Description What is Measured No. of Items -------------- ------------------------ --------------------------------------------------------- -------------- Hs Hypochondriasis Concern with bodily symptoms 32 D Depression Depressive symptoms 57 Hy Hysteria Awareness of problems and vulnerabilities 60 Pd Psychopathic deviate Conflict, struggle, anger, respect for society's rules 50 MF Masculinity/femininity Stereotypical masculine or feminine interests/behaviors 56 Pa Paranoia Level of trust, suspiciousness, sensitivity 40 Pt Psychasthenia Worry, anxiety, tension, doubts, obsessiveness 48 Sc Schizophrenia Odd thinking and social alienation 78 Ma Hypomania Level of excitability 46 Si Social introversion People orientation 69 - Look at high scores only - Lot of overlap across different domains - **The Clinical Scales** - **The Neurotic Triad** - If someone is neurotic, they are high on these scales: - Scale 1: **Hypochondriasis (Hs)** - Scale 2: **Depression (D)** - Scale 3: **Hysteria (Hy)** - Scale 4: **Psychopathic Deviate (Pd)** - Disregard for rules, authority, superficial relationships people have - Scale 6: **Paranoia (Pa)** - Suspiciousness of other people - Scale 7: **Psychasthenia (Pt)** - OCD - Scale 8**: Schizophrenia (Sc)** - Peculiar body sensations, functions, and other psychosis - Scale 9: **Mania (Ma)** - Intensely elevated mood without trigger for that mood change, euphoric feeling, etc. - **Clinical Scales: Interest Scales** - Scale 5: **Masculinity / Femininity** - Scale 10: **Social Introversion** - **7-2** - **The Validity Scales** - Scales to assess how a participant answered the inventory - Did the individual attempt to distort themselves through answering the question in a certain manner? - Non-Content Based Validity Scales - Cannot Say Score Scale: - The number of unanswered or doubly answered items - Secondary to confusion, distractibility, depression, antagonistic behavior, intellectualization - Did this happen at all? / is the answer true? - Inconsistency Scale - Answering two items in contradictory fashion - Example: saying true to both "I am almost always happy", and "Most of the time I feel sad" - **Validity Scale: Infrequency Scale (F): Over-Reporting** - 60 items, rarely endorsed by the population (typical to endorse 4/60) - Includes bizarre ideas, antisocial behavior, deviant personal attitudes, physical problems - For someone who endorses many of these items, they exaggerate their problems, paint themselves in an unfavorable manner - Secondary to falsely claiming mental illness (malingering), "plea for help", poor reading level, psychosis, random response - **Validity Scales: Under Reporting** - Lie Scale (L) - Minor flaws that most people will admit to about themselves - Q: "I have never gelt nervous ever" - Questions a bit more extreme in nature compared to Correction Scale questions - Correction Scale (K) - High levels indicate an individual is more defended against disclosing their flaws, more subtle than the L scale - Q: "I feel I am a good person even though I do bad things sometimes" - Superlative Self Presentation Scale (S) - Correlated with individuals who claim extremely positive attributes and more values - Claims to have incredibly high moral values - Do you think someone who is narcissistic would over-report or under-report on the MMPI-2? - Wants to protect themselves and use themselves in a way that is quite positive under-reporting - What about an individual who is on a long waitlist for an outpatient evaluation? - Over-report to get off the list - When we are evaluating results on the MMP-2, we want to look at ALL of the validity scales to not miss anything. - The Research Behind the MMPI-2? - **Empirically created** - **Demonstrated construct validity** - **A highly researched measure** - **Highly respected measure** - **Validity was supported by cross reference partner questionnaires** **[Personality Disorders]** What is a Personality Disorder? - Enduring pattern of inner experience and behavior that deviates significantly from the patient's culture manifested in 2 or more of the following areas: - Cognition - Thinking - Affectivity - Emotional experience - Interpersonal functioning - How society is affecting people engaging with others - Impulse control - Impulse control General Personality Disorder Criteria - Pattern is stable, long-duration, inflexible, pervasive across settings - Onset by adolescence or early adulthood - Leads to significant distress or impairment in social, occupational, or other areas of functioning - The personality disorder is not better explained by something else: - Another mental disorder - Substance intoxication - Medical conditions - Individual's culture - A developmental stage *Categorization of Personality Disorders* **Section II: Categorical Model** - Personality Disorders**: 9-15% prevalence** - **Cluster A: 5.7% prevalence** -- those that are considered unusual behaviors - Schizoid - Schizotypal - Paranoid - **Cluster B: 1.5% prevalence** -- those that have dramatic emotional or erratic behaviors - Histrionic - Borderline - Narcissistic - Mandated to treatment, usually not there to manage the narcissistic traits - Antisocial - **Cluster C: 6.0% prevalence** -- anxious thoughts and behaviors, feels distressed show up for treatment, may also be nervous to show up to treatment - Avoidant - Dependent - Obsessive compulsive - **Making a Decision** - Symptoms involving emotions, cognitions, and behaviors that lead to impairment - In order for a provider to make a diagnosis of a personality disorder, patient must exhibit \# of \# symptoms - **Limitations & Criticism of the Categorical Model** - Comorbidities - Do they actually have 2 or more personality disorders or am I double counting? - Binary model when personality pathology lies on a spectrum - Heterogeneity **Section III: Dimensional (Alternative) Model** - **Type of Impairment** - Self-functioning - Identity - Self-direction -- what to do with your life - Interpersonal Functioning - Empathy - Being able to understand the emotions of others - Caring about the emotions other people are experiencing - Being able to understand motivation of other people - Intimacy - Emotional intimacy - To what extent can you develop deep and meaningful relationships with others? / in what way do you do that? - **Degree of Impairment** - None - Mild -- beginning to identify and kind of qualify as a disorder - Harder for you to do things, symptoms are making it harder, but you are still successful - Moderate - Noticing some significant difficulty doing that and having difficulty building significant relationships - Severe - Extreme - **Pathological Personality Traits** - Negative affectivity (Neuroticism) - Detachment (Low extroversion) - Antagonism (Low agreeableness) - Disinhibition (Low conscientiousness) - Psychoticism Negative Affectivity Detachment Antagonism Disinhibition Psychoticism ---------------------------------- ------------------------ --------------- ---------------------------- -------------------------------------- Emotional liability Withdrawal Manipulatives Irresponsibility Unusual beliefs and experiences Separation insecurity Intimacy avoidance Deceitfulness Impulsivity Eccentricity Submissiveness Anhedonia Grandiosity Distractibility Cognitive & perceptual dysregulation Hostility Depressivity Callousness Risk taking Perseveration Restricted affectivity Hostility Rigid perfection (lack of) Depressivity Suspiciousness suspiciousness Restricted affectivity (lack of) - Making a Diagnosis - Only diagnose 6 of the disorders derived through this model: - Schizotypal - Antisocial - Borderline - Narcissistic - Avoidant - Obsessive-compulsive - Each disorder is characterized by typical types of at least moderate impairments in 2 of the 4 personality functions (identity, self-direction, empathy, intimacy) and a set of pathological personality traits (3 of the 4 traits, and one of them has to be anxiousness) - You can also be diagnosed with a specific trait -- **Trait Specific Diagnosis** - For those individuals who do not nearly fit into 1 of the 6 specific disorders - Criteria: - Must have moderate or greater impairment in 2 of the 4 personality functions - Specify which personality trait domain or facet - For example: personality disorder -- disinhibition trait - Strengths and Weaknesses of the Dimensional Model - Categorical model is looking at specific symptoms and dimensional model is looking at domains of difficulty *Personality Disorders: Temperament, Character, Attachment & Internal Working Models* **Temperament & Character** - **Temperament**: nature -- biological determinants of personality, what is innate to an individual - **Character**: nurture -- learned, psychological influences on personality, based on environment - Environmental influences **The First Attachment & Internal Working Models** - Infant Primary Caregiver - Infant Attachment - Secure - Show some distress when left with a stranger. - They seek and are comfortable with social interaction - Upon reunion, the children are quickly comforted and happy to see the caregiver, often seeking physical closeness and affection. - Easily soothed and return to play or exploring - Insecure: Anxious/Resistant - The parent is not consistent in the way that they are approaching the baby - Child doesn't know what to expect from the caregiver - Children are often clingy and hesitant to explore the environment, staying very close to the caregiver. - Children exhibit ambivalent behavior. - May seek closeness but also resist it, displaying anger or frustration toward the caregiver. - The children are not easily soothed by their parent when their parent returns to the room - Insecure: Avoidant - Appear relatively indifferent to the caregiver's presence. - May explore the environment but do so with little apparent need for reassurance from the caregiver. - When the caregiver leaves, these children often show minimal distress. - Do not actively seek the caregiver when they return. - Tend to ignore or avoid the caregiver - Insecure: Disorganized/Disoriented - Show no clear strategy for interacting with caregiver or exploring the environment - Upon reunion, children display odd or contradictory behaviors - Freezing, running away, or showing fear toward the caregiver. - The Strange Situation - Adult Attachment Interview (AAI) - A collaborative interview - Ex: - Q: "Please provide me one adjective to describe your mother." - "Caring." - Q: "Provide me an example of how your mother was caring." - Q: "How did your father react when you were upset?" - Q: "Tell me about any major losses in your childhood" - Q: "How do you interact with your own children?" - Every word is transcribed and then analyzed - Interview assessed for: - Consistent narrative of self and parental figures - Vagueness/specificity of language used - Grammatical mistakes - Level of reliance on caregivers - **Adult Attachment Styles** - **Secure** - **Preoccupied** (anxious) - **Dismissive** (avoidant) - **Unresolved/ disorganized** - There is a 68-75% concordance with infant attachment styles!! - **Outcome of Attachment** - Children with **Secure** Attachment: - More resilient, self-reliant - Deeper relationships - Do not exaggerate environmental threat - Empathetic to other people's distress - Children with **Disoriented/Disorganized** Attachment - Highest rate of psychological disturbance - **Attachment & Personality Disorders** - Higher rates of insecure adult attachment in patients with PDs than general population. - Patients with avoidant or Borderline PD rarely demonstrate secure attachment - Preoccupied Attachment (Hyperactivation of Attachment): Borderline, Histrionic, Avoidant, Dependent PDs - Dismissive Attachment (Deactivation of Attachment): Narcissistic, Antisocial, Schizoid, Paranoid PDs - **Factors That Mediate & Disrupt Attachment** - **Mentalization**: the impulse & ability to understand and imagine other people's "mental states" - Ex: If mother is good at mentalizing child's inner states (thoughts & feelings) at 1 year, child is securely attached to mother and at 4 years, child is able to mentalize other people's states - Ex: mother's ability to understand her own childhood relationship with her mother is a **PREDICTIVE** of child being securely attached to mom. - Maltreatment disrupts both mentalization and attachment - Theory: if a child is maltreated, it is hard for them to reflect on the internal states of themselves and others, or understand the link between behaviors - Thus, the world is a more scary, unpredictable place & navigating social relationships is especially confusing - **Pedagogy Theory:** - **Universal knowledge vs. Separate Minds, Separate Knowledge** - Learning is a process of sharing knowledge between individuals who have distinct experiences and perspectives. - Caregivers' ability to teach the child about emotions, empathy, and social interaction through both verbal and non-verbal communication plays a vital role in developing secure attachment. - Pedagogy Mediating Attachment: - A caregiver who is skilled in mentalization provides the child with important tools for emotional regulation and empathy. - Teaching the child how to understand their own feelings and those of others - Ex: when a mother can recognize and respond appropriately to her child's emotional needs, the child learns to trust that others can be understanding and supportive. - Pedagogy Disrupting Attachment: - When pedagogy is disrupted, in cases of maltreatment or neglect, the ability to form secure attachments is compromised. child's ability to learn from their caregiver about social and emotional regulation is impaired, leading to insecure attachment. - When a child experiences abuse or neglect, the caregiver fails to provide the pedagogical foundation for understanding emotional states and relationships. - The child is unable to link behaviors with internal states. - In cases where the caregiver is not attuned to the child's emotional needs the pedagogical process is disrupted. - Trauma - Insecure attachment: - Strong correlation with a history of trauma with disorganized attachment in adults - The occurrence of a traumatic event is most predictive of a change in attachment styles - Personality disorders: - Patients with PDs are 4x more likely to experience trauma (abuse or neglect) - Rates of trauma in PD: 73% report abuse 82% report neglect - Trauma is a known risk factor for development of PDs - Begin to be abused from early ages - Secure individuals demonstrate: - A sense of identity and self-efficacy through feeling supported by attachment figures but not overly reliant - Idea that attachment figures are available to meet their needs which allows them to independently explore their surroundings - An understanding of other people's emotions & drives behind behaviors, leading to empathy and the capacity for intimacy through learning & mentalization - Insecure individuals demonstrate: - Lack of sense of self AND - Belief that one's needs will not be met by others OR cannot be met without others LEAD TO: - Diffuse identity and/or inflated/deflated sense of self - Under/overreliance on others: fears of abandonment, inhibited behavior when forming relationships, lack of desire for forming relationships - Paranoid thoughts and behaviors **Bartholomew Adult Attachment Styles** - How do I tend to view myself? - Positive OR Negative: Inadequate - How do I tend to view others? - Positive OR Negative: Inadequate & Not Trustworthy Attachment Styles View Self View Others Associated PDs --------------------- --------------------- --------------------------------------- --------------------------------------------- Secure Positive Positive Preoccupied Inadequate Positive Histrionic, Dependent, Obsessive-Compulsive Fearful Inadequate Inadequate & not trustworthy Paranoid Dismissing Positive Inadequate & not trustworthy Schizoid Preoccupied-Fearful Inadequate Positive/inadequate & not trustworthy Avoidant Fearful-Dismissing Positive/inadequate Inadequate & not trustworthy Narcissistic, Antisocial, Schizotypal Disorganized Positive/inadequate Positive/inadequate & not trustworthy Borderline **Adolescents & Personality Disorders** - There is likely some degree of impairment in functioning or distress caused by an individual's personality during adolescence - Personality disorders are persistent through many developmental stages - Even though PDs typically emerge during this time, clinicians are careful to diagnose in adolescents - "Emerging personality traits" - Diagnosis can be made before age 18 if symptoms are persistent for 1 years - Exception is Antisocial Personality Disorder which exists on a continuum from Oppositional Defiant Disorder & Conduct Disorder, which are diagnoses reserved for patient \< 18 years old. **Is There a way to Predict Which Adolescents will go on to Develop Personality Disorders?** - **The Children in the Community Study (2000)** - A longitudinal research project that explored the development of personality traits and personality disorders from childhood through adulthood - Results: - The study found that while there was some variability in personality traits across time, certain traits remained relatively stable, especially between adolescence and adulthood. - Specifically, between the ages 16 and 22, the results showed three main patterns of change in personality disorder traits: - 74% of participants experienced a decrease in personality disorder traits - 21% of participants showed an increase in personality disorder traits - 4% of participants showed no change in personality disorder traits. - **The Developmental Course of Personality Disorders (2005)** - This study aims to identify factors that influence the onset, stability, and progression of personality disorders across various life stages. - Results: - Between ages 14 and 16: moderate stability - 0.57 for Cluster A - 0.65 for Cluster B - 0.48 for Cluster C - Between ages 16 and 22: moderate stability - 0.49 for Cluster A - 0.50 for Cluster B - 0.42 for Cluster C - Between ages 22 and 33: higher stability - 0.56 for Cluster A - 0.55 for Cluster B - 0.54 for Cluster C - Risk factors: Demographics Parental traits Childhood/adolescent traits Child & Parent Relationship ---------------------- --------------------- ---------------------------------------- -------------------------------- Low family SES Parental sociopathy Behavioral problems Low closeness to mother Single parent family Parental conflict Social isolation Low closeness to father Unwanted pregnancy Low IQ Power assertive punishment Poor school performance Maladaptive parenting behavior Low confidence Parent death High emotionality Diagnosed depressive disorder Diagnosed disruptive behavior disorder **[Schizotypal Personality Disorder]**  DSM-5 Categorical Model Criteria - A *pervasive pattern* of **social and interpersonal deficits** marked by **discomfort and reduced capacity for close relationships** as well as by **cognitive or perceptual distortions and eccentricities of behavior**, beginning by *early adulthood* and as indicated by **5 (or more)** of the following: - Ideas of reference (excluding delusions of reference) - Odd beliefs or magical thinking that influences behavior & inconsistent with subcultural norms - Unusual perceptual disturbances, including bodily illusions - Odd thinking & speech - Suspiciousness or paranoid ideation - Inappropriate or constricted affect - Behavior or appearance that is odd, eccentric, peculiar - Lack of close friends or confidants other than first degree relatives - Excessive social anxiety that does not diminish with familiarity DSM V: Schizotypal PD: Dimensional Model - Moderate or greater impairment in personality functioning, manifested by characteristic difficulties in two or more of the following four areas: - Identity: - Confused boundaries between self and others - Distorted self-concept - Emotional expression often not congruent with context or internal experience. - Self-direction: - Unrealistic or incoherent goals - No clear set of internal standards - Empathy: - Pronounced difficulty understanding impact of own behaviors on others - Frequent misinterpretations of others' motivations and behaviors - Intimacy: - Marked impairments in developing close relationships - Associated with mistrust and anxiety - Four or more of the following six pathological personality traits: - Cognitive and perceptual dysregulation (an aspect of Psychoticism): - Odd or unusual thought processes - Vague, circumstantial, metaphorical, overelaborate, or stereotyped thought or speech - Odd sensations in various sensory modalities - Unusual beliefs and experiences (an aspect of Psychoticism): - Thought content and views of reality that are viewed by others as bizarre or idiosyncratic - Unusual experiences of reality - Eccentricity (an aspect of Psychoticism): - Odd, unusual, or bizarre behavior or appearance - Saying unusual or inappropriate things - Restricted affectivity (an aspect of Detachment): - Little reaction to emotionally arousing situations - Constricted emotional experience and expression - Indifference or coldness - Withdrawal (an aspect of Detachment): - Preference for being alone to being with others - Reticence in social situations - Avoidance of social contacts and activity - Lack of initiation of social contact - Suspiciousness (an aspect of Detachment): - Expectations of -- and heightened sensitivity to -- signs of interpersonal ill-intent or harm - Doubts about loyalty and fidelity of others - Feelings of persecution - Schizotypal individuals are HIGH in openness and LOW in extraversion and agreeableness. - Maps on well with the CATEGORICAL Symptoms: - Unrealistic goals - Difficulty understanding other people's point of view - Misinterpretation of words and behaviors - Difficulty in romantic relationships **Symptoms of Schizotypal Personality Disorder** - Peculiar Thought Content / Magical Thinking - Unique intrapsychic experiences (not congruent with culture) - Clairvoyance - Telepathy - Illusions - Sensation based experiences - Paranoid ideation and suspiciousness - Does not increase as the individual becomes more accustomed to the person or environment - More suspicious are likely to become less suspicious when they get know the environment - Do not reach threshold or psychosis - Ideas of Reference - External events have special meaning to the individual - Unusual connection between unrelated events - Excludes delusions of reference - No delusional conviction - Open to reason - Odd, Eccentric, or Peculiar Appearance - Wearing clothing that is inappropriate to context - Wearing clothing that doesn't match or fit well - Things that they have ideas of reference toward - Social Emotional Functioning - Limited peer relationships outside family members - Intense social anxiety often - Hypersensitive to perceived or real criticism - Harder to understand others - Perceived as cold & aloof with constructed affect - Apprehensive of others 2/2 paranoid ideation, prone to suspiciousness (that does not decrease with familiarity - Also exhibit inappropriate affect Attachment Style of Schizotypal PD Attachment Style View of Self View of Others Personality Disorders -------------------- --------------------- ------------------------------ --------------------------------------- Fearful-Dismissing Positive/Inadequate Inadequate & Not Trustworthy Narcissistic, Antisocial, Schizotypal Cognitive Style - Tend to be scattered - Disorganized in speech, thought patterns - Tend to fixate - Cognitive slippage - Drawing connections between things that are not connected - Ruminative - Fixated on something **Theories of Development of Schizotypal PD** - Cognitive-Behavioral Theory - Core Beliefs: world is uncaring and full of powerful forces that cannot be explained - Conditional beliefs: (if/then) - If I get close to normal people, they will reject me - If others view me as different, they will leave me alone - If I use my special gifts, the powers will protect me - Instrumental beliefs: being different is protective - Challenging magical thinking through tracking of thoughts - Biosocial Theory - Cold and formal family environment - Fragmented parental communication - Fueled by social isolation - Not a lot of support, negative interaction with others - How the caregiver reacts is very important - Seen as a deterioration of Schizoid and Avoidant PDs - An exaggerated form of either types - Avoidant subtype: - A child who is slow to warm - Not going to be that interested in interacting with people - Be particularly apprehensive when they enter an environment - Psychodynamic Theory - Consistent parent contact that was punitive & critical leading to social hypersensitivity - Get used to the idea that they do everything wrong - Get hypersensitive when criticized engage in magical thinking to reduce this hypersensitivity - Magical thinking is a defense to reduce emotional overstimulation - Projection is a defense against anger & fear - Feeling overwhelmed that needs to be reduced - Interpersonal Theory - Parent modeled "mind reading" suggesting that even though not present, the parents might "know" something important about the child - Not picking up on social cues, thinking that you know exactly what another person is feeling - For example, an absent father may severely reprimand a child for not staying home - Ex: the parent knows the child skipped the school but to the child they have no idea how they would know he didn't go to school - The adult consequence is a pattern of "knowing" through special means, such as telepathy, mindreading or 6^th^ sense. - Parents likely instructed against leading home for play with peers or other reasons - This resulted in **the reinforcement of social isolation** along with **fantasy** - Reinforces the idea that the world is dangerous - Creates an environment in which interacting with more fantasies increases. **Demographics & Comorbidities** - Prevalence - 0.6 -- 4.6% in general population - 0.6 -- 9.1% in clinical settings - Not very common - Comorbidities - Cluster A Personality Disorders (33% have Schizoid PD, 66% have Paranoid PD) - Other Personality Disorders (Avoidant PD, Borderline PD) - Major Depressive Disorder (50%) - Psychotic Disorders (Schizophrenia) - Dissociative Disorders - Anxiety & Somatic Symptom Disorders - Culture - Assess the culture of the patient's country of origin, ethnicity, etc. - Eccentric beliefs, appearances, and cognitions are not sufficient in themselves to make a diagnosis of Schizotypal PD **Differential of Schizotypal Personality Disorder** - Schizotypal vs. Schizoid Personality Disorder - Similarities: - Socially isolated - Restricted expression of emotions - Differences: - Paranoid ideation / suspiciousness (STPD) - Isolate due to social anxiety & eccentricity (STPD) - Lack of interest in others (SZPD) - Odd / eccentric behavior (STPD) - Schizotypal vs. Paranoid Personality Disorder - Similarities: - Ideas of reference - Suspicious of others - Prefer social isolation - Differences: - Ideas of reference associated with fear of autonomy (PPD) - Ideas of reference are signs or omens for benefit (STPD) - Feel a sense of separateness from others (STPD) - Could, stubborn, rigid (PPD) - Open to experience (STPD) **Difference Between Schizotypal Personality Disorder & Schizophrenia** - Schizophrenia: a psychotic illness comprised of - Positive symptoms -- hallucinations, delusions - Negative symptoms -- diminished emotional expression, anhedonia, avolition, decreased speech outlet - Disorganized symptoms -- disorganized speech & behavior - Symptoms of Schizotypal PD resemble but do not meet the threshold of the positive symptoms of Schizophrenia - Schizotypal Personality disorder is more common in families with first degree biological relatives who have schizophrenia - Psychotic symptoms: - Delusions of reference, delusions, hallucinations - Schizotypal PD Symptoms: Peculiar Thoughts & Perception - Ideas of reference - Magical thinking - Illusions (resemble hallucinations) - Do those with Schizotypal PD go on to develop Schizophrenia or other Psychotic Illnesses? - Studies indicate that approx., 20-30% of teenagers with schizotypal PD go on to develop a more severe psychotic illness - Life Course: Esterberg et al. (2010), A Personality Disorders (ARTICLE) - Resemblance of the schizotypal personality disorder with the prodromal phase od Schizophrenia  - Screened for comorbidities including other personality disorders - Results: - Not perfect overlap between Schizotypal and Schizophrenia **Personality Style vs. Personality Disorder (Schizotypal PD)** - Schizotypal Personality Style - Tend to be tuned in and sustained by their own feelings and beliefs - Keen observation of others, and are particularly sensitive to how others react to them - Tend to be drawn to abstract and speculative thinking - Receptive and interested in the occult, extrasensory, and supernatural - Tend to be indifferent to social convention, and lead interesting and odd, unusual lifestyle - Usually are self-directed and independent, requiring few close relationships - Schizotypal Personality Disorder - Ideas of reference - Suspiciousness or paranoid ideation - Inappropriate or constricted affect - Excessive society anxiety e.g., extreme discomfort in social situation involving unfamiliar people - Odd beliefs or magical thinking, influencing behavior and inconsistent with subcultural norms - Unusual perceptual experiences e.g., illusions, sensing the presence of a force or person not actually there - Odd or eccentric behavior or appearance - No close friends or confidants (or only one) other than first degree relatives **Assessment & Treatment** - Psychological testing - MMPI-2 - 2-7-8 Pattern Depression -- Psychasthenia -- Schizophrenia (HIGH on all of these) - FFM - High neuroticism, low extraversion - Behavioral techniques - Social skills training - Social appropriateness training - Elocution classes - Dale Carnegie classes - Cognitive techniques - Challenge magical thinking by looking for objective evidence to support or refute these thoughts - Tracking predictions to see if they are accurate - Psychodynamic Techniques - Exploring of: - Internal conflicts - Object relations - Postulated that Schizotypal PD a byproduct of a cold and formal family growing up - Thus, goal should be: "Internalization of the therapeutic relationship" -- a new means of relating to someone else - Silence not seen as resistance to treatment by rather, a means of relating. - Therapists are recommended to respect the silence, which demonstrates honoring the patient's private, non-communicative self - Motivational Interviewing - Evidence that cannabis is associated with more intense and earlier onset of Schizotypal Personality Disorder - Motivational interviewing is a technique used to help a patient change a behavioral habit such as smoking marijuana - Technique used to help a patient change a behavioral habit  - Interpersonal Treatment - Allowing the patient to have control in the treatment (tolerating cancelled sessions) - Role of magical thinking in remaining loyal to the abuser - Need to learn that their efforts to take responsibility for abusive situations when they were helpless to predispose them to magical thinking - Treatment complications - Individuals may view their therapist as dangerous -- Fearful & Dismissive Attachment - Can terminate early if offended - Advised to use more concrete language given the already abstract universe the patient lives in - Medications - No FDA approval specific for Schizotypal PD - Omega-3-fatty acids a potential augmentation - Studies have demonstrated efficacy of low dose antipsychotics on the symptoms of Schizotypal PD - **Risperidone in the Treatment of Schizotypal Personality Disorder (Koenigsberg, et al. 2003)** - This study aimed to evaluate the efficacy of risperidone, an atypical antipsychotic, in reducing symptoms of Schizotypal Personality Disorder. - Study Design: - Double Blind Placebo Controlled Randomized 9 Week Clinical Trial - Study population (n = 25): Adults aged 18-60 with diagnosed Schizotypal PD - Exclusion Criteria: Schizophrenia Diagnosis & Substance Abuse - Experiment Group (n = 15): Received Risperdone (0.25mg -- 2 mg) an antipsychotic medication used to treat schizophrenia - Control Group (n = 10): received a placebo pill - Background on Schizophrenia & Antipsychotic Medication - Positive symptoms (delusions, hallucinations) of Schizophrenia secondary to excessive levels of dopamine in the mesolimbic pathway of the brain - Antipsychotics including Risperdal work by blocking dopamine receptors - Many other pathways outside mesolimbic pathway that utilize dopamine side effects of medications - **The Positive and Negative Syndrome Scale (PANSS)** - Clinician rated scale after an interview - 3 Subcategories: - Positive Scale (7 items) -- delusional thinking, paranoia, hallucinations - Negative Scale (7 items) -- social withdrawal, blunted affect, social withdrawal - General Scale (16 items) -- anxiety, somatic concerns, poor attention, tension - Other Assessments - Clinical Global Impression Scale (CGI) - Schizotypal Personality Questionnaire - Hamilton Depression Rating Scale - Results: - Figure 1: The total PANSS score decreased more significantly in the Risperidone group compared to the placebo group. - The reductions were statistically significant starting at week 3 and continued to be significant at weeks 5, 7, and 9. - This shows that risperidone was effective in reducing the overall symptom severity in patients with schizotypal personality disorder compared to placebo. - Figure 2: The negative symptoms (emotional withdrawal, lack of affect, etc.) were significantly reduced in the Risperidone group compared to the placebo group. - This suggests that risperidone is particularly effective in alleviating the negative symptoms often associated with schizotypal personality disorder. - Figure 3: The general psychopathology symptoms, which include anxiety, depression, and other general mental health symptoms, also showed a significant reduction in the Risperidone group compared to the placebo group. - This indicates that Risperidone is helpful not only for core STPD symptoms but also for broader mental health issues experienced by these patients. - Figure 4: The positive symptoms, symptoms like delusions or magical thinking, decreased more in the Risperidone group, though the reductions became statistically significant later in the study (at weeks 7 and 9). - This suggests that Risperidone may have a slower but still significant effect on positive symptoms compared to its faster on negative symptoms. - No statistically significant differences in Clinical Global Impression Scale, Schizotypal Personality Questionnaire, Hamilton Depressing Rating Scale between the control and experimental group at week 9 - 29% participants dropped out of the study secondary to side effects (equal between the control and experiment group) **[Schizoid Personality Disorder]** DSM V Criteria - A pervasive pattern of detachment from social relationships and restricted range of expression of emotions in interpersonal settings, beginning by early adulthood with 4 of the 7 following symptoms: - Neither desires nor enjoys close relationships, including being part of a family - Almost always chooses solitary activities - Has little, if any, interest in having sexual experiences with another person - Take pleasure in few, if any, activities - Lacks close friends or confidants other than first-degree relatives - Appears indifferent to the praise or criticism of others - Shows emotional coldness, detachment, or flattened affectivity Demographics - 3.1 -- 4.0% in general population - Most infrequently in presenting to treatment with estimates of 0.5 -- 5.1% in clinical settings Common Descriptors - Socially aloof - Cold & distant - Non-spontaneous & boring - Alone - Monotone speech **Characteristics and Symptoms** - Anhedonia: - Derive little pleasure in life - Don't derive joy or have interest in hobbies or activities - Not interested in sexual relationships - Limited Range of Emotions: - Rarely experience strong emotions, either positive or negative - Display flattened affect, meaning they show little to no emotional expression. - Interpersonally - Not interested or experience joy from close relationships (per DSM) - Limited close friends, may feel close to some family members - Prefer solitary activities & drawn to independent occupations - Indifferent to both praise and criticism - Cognitively - Distracted - Disorganized Thought Process answers can be vague & irrelevant to questions being asked - Little ability to be introspective & or reflect on interpersonal relationships Dismissing Attachment Style - Positive view of self views others as inadequate & not trustworthy - Positive view of self: often see themselves as self-sufficient and capable. - Do not rely on others for emotional support - Negative view of others: often view others as unreliable, untrustworthy or even burdensome. - Shows their preference for isolation **Theories of the Development of Schizoid PD** - Psychodynamic Theory - Covert Schizoid - Behind the socially detached or unemotional appearance - Emotionally needy - Sensitive & vulnerable - Acutely vigilant (hyper-aware of their social environment) - Described by psychoanalysts such as Salman, Ahktar - Overt Schizoid (act as a defense mechanism) - What we see at the surface (reflects the visible behaviors and characteristics - Socially detached - Not interested in relationships with others - DSM description of Schizoid PD - Occurs likely secondary to "inadequate mothering" - Because an infant did not receive nurturing as a child, they grow up not expecting to receive nurturing & support from others - Thus, asking for support from others would be dangerous - Fear that if they assert needs, it will drive others away or that others will smother/consume them - External social aloofness is a defense against the internal conflict about their desire for support from others - Biosocial Theory - Biological Features - Excessive parasympathetic response - Proliferation of dopaminergic postsynaptic receptors in limbic and frontal cortical regions - Environmental Features - Come from cold, superficial and emotionally reserved families - Fragmented communication among family members - Cognitive Behavioral Theory - Core beliefs: - Misfits from life - Relationship is not worth the effort - I am happier alone - Conditional Beliefs - If I get too close to others, I will be teased or imposed on by them - Instrumental beliefs - Don't get involved with others - Say no to other's demands - Leave social situations quickly - Thoughts -- ex: "I am better off alone" - Emotions -- ex: "I don't need others", "I am indifferent to what others think" - Behaviors -- ex: choosing solitary activities or social withdrawal this lack of engagement with others can also contribute to anhedonia (the inability to feel pleasure), further reducing their emotional responses. - Interpersonal Theory - Raised in a home that was orderly and formal - Little warmth, play or social & emotional interaction within the family - Parents modeled social isolation and colorless, unemotional functioning - Such identification with withdrawn parents **leads schizoid individuals to expect little and give little** - Although underdeveloped in social awareness skills, they can meet social role expectation as employees or even as parents - They may be married, but do not develop close, intimate relationships with their partners **Differential of Schizoid Personality Disorder** Other Psychiatric Disorders that Resemble Schizoid Personality Disorder ------------------------------------------------------------------------- Avoidant Personality Disorder Schizotypal Personality Disorder Schizophrenia (psychotic disorder) Persistent Depressive Disorder (mood disorder) Autism Spectrum Disorder (neurodevelopmental disorder) Schizoid vs. Avoidant Personality Disorder - Similarities: - Socially hesitant & unresponsive - Interpersonally withdrawn - Anxious in social encounters - Differences: - Experience emotions (APD) - Desire social companionship (APD) - Sensitive to the emotions of other (APD) - Insensitive, aloof, cold, detached (SZPD) Schizoid vs. Schizotypal Personality Disorder - Similarities: - Socially isolated - Restricted expression of emotions - Differences: - paranoid ideation / suspiciousness (STPD) - isolate due to social anxiety & eccentricity (STPD) - lack of interest in others (SZPD) - Odd / eccentric behavior (STPD) Schizophrenia vs. Schizoid PD - Overlap with Schizoid PD: - Negative symptoms -- diminished emotional expression, anhedonia, avolition, decreased speech outlet - Disorganized symptoms -- disorganized speech & behavior - NOT Overlap with Schizoid PD: - Positive symptoms -- hallucinations, delusions **Persistent Depressive Disorder (Dysthymia)** - Mood disorder - Depressed mood for most of the day, for more day than not, as evidence by symptoms (low mood, low energy, difficulty sleeping etc.) for 2 years (for adults) or 1 year (for children and adolescent) without a symptom-free period \> 2 months. - Major Depressive Disorder (MDD) vs. Persistent Depressive Disorder - Major Depressive Disorder: - Recurrent episodes - Sharp drops into depression, followed by periods of full recovery - Full interepisode recovery - In between depressive episodes, individuals can often experience periods where their mood is stable, and they do not meet the criteria for depression. - Severity - More severe than persistent, milder symptoms seen in PDD. - Have trouble with basic functioning, and experience significant impairment during an episode - Persistent Depressive Disorder (PDD) - Chronic, long-lasting symptoms - Consistent low-level depression that lasts for a much longer duration, often two years or more in adults - No full recovery - Remain in a constant state of low mood, with few breaks in symptoms - More prolonged but less intense - Mild but persistent - Symptoms are milder but continuous Persistent Depressive Disorder (Dysthymia) vs. Schizoid PD - Those with dysthymia are unhappy by their chronic low state of mood - Those with schizoid PD, according to the DSM, do not appear bothered by being distant, solitary, and having limited pleasure in life (limited range in emotions both positive \* negative) Autism Spectrum Disorder vs. Schizoid PD - Autism Spectrum Disorder - Neurodevelopmental disorder - Symptoms present early in childhood - Characterized by: - Poor social reciprocity, - Limited peer relationships - Poor nonverbal communication skills - Difficulty creating & maintaining social relationships - Also restricted interests & stereotypes - Schizoid PD - Personality disorder - Diagnosed typically in adulthood - Many similar symptoms of limited social interactions, often engage in solitary activities - **On the Continuity Between Autistic and Schizoid Personality Disorder Trait Burden: A Prospective Study in Adolescence (Cook, Zhang, Constantino) -- ARTICLE** - Study design: - Study population -- N = 72 high functioning verbal males (avg. age 9-12) - 50 diagnosed with Autism Spectrum Disorder (ASD) - 22 controls (some with co-morbidities of ADHD, Mood) - Measures: - *Social Responsivity Scale (SRS) -- baseline and then reassessed approximately 7 years later* - 62 item scale about reciprocal social behavior - Parent and teacher report - Sample items: - "is aware of what others are thinking or feeling" - "avoids eye contact or has unusual eye contact" - "does not join group activities unless told to do so" - *Diagnostic interview for Genetic Studies (DIGS) -- at time of reassessment of SRS* - 7 item scale based on the DSM Criteria of Schizoid PD - Parent and self-report - 4-point Likert scale - For diagnosis of schizoid PD required "almost all of the time" to 4 or more items - **Results**: - Adolescents with ASD are **more likely to exhibit symptoms that resemble Schizoid Personality Disorder as they grow older**. - May shoe increased traits of social withdrawal, emotional detachment, or preference for solitary activities during adolescence characteristics similar to Schizoid PD - There may be some **causal overlap or a developmental relationship** between ASD and SZPD. - Some of the traits seen in individuals with ASD (such as social detachment or difficult forming relationships) might continue to **develop in ways that resembles Schizoid Personality Disorder**. - Developmental continuity refers to the idea that early **ASD traits may evolve into more pronounced schizoid traits over time**, potentially **leading to a diagnosis of SZPD in some cases**. - While people with ASD might struggle with social interactions, they may **still desire close friendships**, whereas people with SZPD generally **do not desire social relationships** and are **content with their isolation**. - Individuals with ASD might **not show as much indifference to criticism or praise compared to people with SDP**, who are often **emotionally detached and indifferent to others' opinions**. - **Constricted affect** (limited emotional expression) is more **commonly associated with SZPD**. While same people with ASD **may show limited emotional expression, they do not typically exhibit the pervasive emotional flatness or coldness**. - So, what's the proposed difference? - Autism spectrum disorder -- struggle with ability to create social relationships - Schizoid personality disorder -- lack the desire for social relationships **Personality Style vs. Personality Disorder** Personality STYLE Personality DISORDER --------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Exhibit little need of companionship and are most comfortable alone. **Neither desire nor enjoy close relationships**, including **being part of a family**; have **one or no close friends or confidants other than first-degree relatives**. Tend to be self-contained, not requiring interaction with others in order to enjoy experiences or live their lives. Nearly always **choose solitary activities**. Even-tempered, dispassionate, calm, unflappable, and rarely sentimental **Rarely**, if ever, claim or **appear to experience strong emotion** such as anger or joy. Little driven by sexual needs, and while they can enjoy sex, do not suffer in its absence. **Little** if any **desire to have sexual experiences** with another person. Tend to be un-swayed by either praise or criticism and can confidently come to terms with their own behavior. **Indifferent** to the **praise and criticism of others**; display **constricted affects**, e.g., is **aloof, cold, and rarely reciprocates gestures or facial expressions**, such as smiles or nods. **Clinical Presentation & Co-morbidities** - Comorbidities - Anxiety disorders - Dissociative disorders - Psychotic disorders (Schizophrenia) - Assessments - Careful clinician interview - Neither open-ended or structured questions nor other interview strategies will change the flow of information or expression of affect - Express little or no emotionality even when talking about anxious or depressed feelings - Long periods of silence are not uncommon. - Psychological testing - Five Factor Model - Strongest correlate on FFM is low levels of extroversion - MMPI-2 - Elevated social introversion, depression, schizophrenia clinical scales - Multiple sources of information - Patient's self-report **Psychotherapy for Schizoid Personality Disorder** - Beginning treatment - Very unlikely to self-present - Typically come to treatment at the urging of a family member or employee - Provide short answers or "I don't know" - Report many concerning symptoms such as limited social connections, lack of enjoyment but at the same time, don't seem bothered by this - Often burdensome to the interviewer - Psychotherapy experience - Prolonged silences, minimal spontaneous speech, short answers - Therapist might find themselves bored, feel like they are wasting their time - However, the patient experience may be very different than the therapists - Silence is a means of relating - Value & benefit from the therapeutic relationship Psychodynamic Techniques - Exploration of: - Internal conflicts - Object relations - Psychodynamic Therapy - "internalization of therapeutic relationship": - Showing the value of a relationship -- addressing the inner desire of patient to have a relationship. - "modification total push" - "productive substitution" - Treatment - Goal: increase social interaction & reduce social isolation - Find concrete reasons for changes in behavior: - Use of though records to help track subtilties in changes in their emotions & prevents overgeneralizations (cognitive distortion) - Termination can lead to relapse recommend booster sessions Group Therapy - Exposure to a social experience - Recommend individual therapy prior to initiation group - Tolerate patient starting In a "non-related position" - Recommend group be heterogenous in personality types, not just those with Schizoid PD. Medication Management - No FDA approved medication for Schizoid PD - Consideration that antipsychotics may be effective in treating symptoms - Unfortunately, studies have not demonstrated antipsychotic efficacy in treating Schizoid PD - Utilize medication for treating co-morbidities of anxiety and psychotic disorders **[Paranoid Personality Disorder]** Paranoia - A general term meaning a collection of odd and mistrustful symptoms that may or may not involve psychosis (a break from reality) **DSM-5 Symptom Criteria** - Pervasive distrust & suspiciousness of others such that their motives are interpreted as malevolent, beginning by early adulthood, present in a variety of contexts, as indicated by four (or more) of the following: - Suspects, w/o sufficient basis, that others are exploiting, harming, or deceiving them - Pre-occupied with unjustified doubts about loyalty or trustworthiness of friends or associates - Reluctant to confide in others because of unwarranted fear that information will be used maliciously against them - Reads hidden demeaning or threating meanings into benign remarks or events - Persistently bears grudges )i.e., unforgiving of insults, injuries or slights) - Perceives attacks on their character or reputation that are not apparent to others & is quick to react angrily or to counterattack - Has recurrent suspicious, without justification, regarding fidelity of spouse or sexual partner **Common descriptors** - Aloof - Cold - Rigid - Litigious - Sensitive **Symptoms & Characteristics** - Suspects without sufficient basis, that others are exploiting, harming, or deceiving them - Interpersonally - Secretive & Isolative providing information to others makes one more vulnerable - Always prepared to counterattack a threat - Primary emotions expressed: anger & jealousy - Cognitive style - Mistrusting preconceptions - Scan the environment for evidence to support their mistrusting preconceptions - "The paranoid person does not deny data; instead, he or she gathers and examines data with 'extraordinary prejudice' " **Fearful Attachment Style** **-- Paranoid PD** - Paranoid PD's attachment style is Fearful Attachment: - Views self as inadequate - Others are inadequate & not trustworthy **Theories of Development of Paranoid PD** - Cognitive Behavioral Theory - Core Beliefs: - Other people can't be trusted - Others have ulterior motives towards me - Others are out to undermine or hurt me - Conditional Beliefs: - If I am not careful, others will abuse or manipulate me - Others are friendly only because they have an ulterior motive - Instrumental Beliefs: - Be in guard - Look for hidden meaning - Trust no one - Psychodynamic Theory - Raised in a family that was highly critical - In order to prevent feelings of shame & inadequacy, they identify themselves with the critical parent - In order to preserve the positive feeling of one's self, must be critical and look down on others - Interpersonal Theory - Parents, typically abused themselves as children, believe their children are evil & bad - Sadistic & controlling parents the child is raised with the expectation that others will attack him/her - The child is punished or humiliated for having needs when sick, injured or upset as adults, they individuals seldom reach out to others when in need and fear intimacy & dependency - Family held grudges & made harsh comparisons among members leading individuals to be hyper sensitive to perceived inequities - Biosocial Theory - Paranoid PD is a continuation of 3 other personality disorders: - **Paranoid PD -- Narcissistic Personality Disorder** - Variant of *both paranoid & narcissistic traits* - Described as **arrogant, pretentious, and expansive** - Exaggerate their own importance, influence, or abilities in various aspects of life. - **Over-indulged & unrestrained by parents** - Parents did not set appropriate boundaries or limits - May have been excessively praised, shielded from criticism, or allowed to behave without accountability - This contributes to their **grandiose self-image** leaving them unprepared to handle criticism or failure in adulthood - **Fail** to learn **interpersonal responsibility, cooperation, skills** - Lack key social skills such as cooperation, responsibility, and interpersonal competence - May not know to take responsibility for actions - Once beyond the protective confines of the household, **image of superiority destroyed by the outside world** - Once these individuals leave the protective environment of their household (where they may have been indulged and never challenged), they often face real-world challenges that contradict their inflated sense of superiority. - Encounters with challenges may threaten their grandiose self-image, leading to frustration, anger, or paranoia. - **Delusions of grandeur** become their primary coping mechanism - when their sense of superiority is challenged, individuals with this variant may retreat into delusions of grandeur as a coping mechanism - these delusions serve to protect their self-image by allowing them to believe they are still superior, even when reality contradicts this view. - Instead of facing criticism, they cling to the belief that they are exceptional or unfairly persecuted further entrenching their paranoid and narcissistic traits - Paranoid PD -- Antisocial Personality Disorder - Variant of both **paranoid & antisocial personalities** - **Impulsive & high energy temperament** - Principal environmental determinant is **harsh parental treatment** - Expect they will be on the **receiving end of others' aggressions** - Strategy is to **dominate others before others dominate them** - **Need to protect themselves against any outside influence** - Paranoid PD -- Obsessive Compulsive Personality Disorder - Variant of both **paranoid & obsessive-compulsive personalities** - Raised in households with **perfectionistic and punitive parents** - **Parents are over controlling with firmness and punishments If expectations are not met** - These individuals' **rebel against external restraints to regain control over others** - However, they **apply a rigid set of standards onto others that is used to demean those around them** - Low excitability thresholds for limbic system stimulation - Deficiencies in the inhibitory centers of the rain - Underlying temperament is characterized as hyperresponsive to the environment **Demographics & Co-morbidities** - Prevalence - 2.3% - 4.4% in general population - Estimates of 4.2 -- 27.6% in clinical setting - Comorbidities - Generalized anxiety disorder - Panic disorder - Delusional disorder - Bipolar disorder - Schizophrenia **Differential of Paranoid Personality Disorder** - Psychotic disorders - Delusional disorders - The presence of one (or more) delusions for 1 month or longer - Apart from the impact of the delusion(s) or its ramifications, functioning is not markedly impaired, and behavior is not obviously bizarre or odd. - Criteria for Schizophrenia has never been met - Cannot be explained by another psychiatric disorder, substance use, or medical condition - Type of delusions - Erotomaniac delusions: belief that another person (often a celebrity) is in love with the individual. - Grandiose delusions: belief of having something great (but unrecognized) talent, being of someone of great importance, or having made some important discovery - Jealous delusions: belief that his or her significant other is unfaithful - Persecutory delusions: belief that one is being conspired against, cheated, spied on, followed, poisoned or drugged, maliciously, maligned, harassed, or obstructed in the pursuit of long-term goals - Somatic delusions: belief involving bodily functions or sensations - Delusional disorders vs. Paranoid PD - Delusional Disorder: - Specific delusion - Aside from specific delusion, functioning is intact - Paranoid PD: - Display paranoid ideation in many different settings that significantly impacts function - Schizophrenia - Schizophrenia vs. Paranoid PD - Schizophrenia -- a psychotic illness - Positive symptoms -- hallucinations, **delusions (overlap with Paranoid PD)** - Negative symptoms -- diminished emotional expression, anhedonia, avolition - Disorganized symptoms -- disorganized speech & behavior - PDD is present more often in families with a history of schizophrenia or delusional disorder - Other Personality Disorders: - Narcissistic - Paranoid vs. Narcissistic PD - Similarities: - Mistrust or suspicion of other motives - Doubts regarding loyalty or trustworthiness of others - Interpret ambiguous or benign remarks as hurtful or threatening - Differences: - Calm & aloof attitude (NPD) - Confrontational, drawing data to support their persecutory delusions (PPD) - Pre-occupied with unlimited success & power (NPD) - Pre-occupied with maintaining their own boundaries to defend their autonomy (PPD) - Antisocial - Paranoid vs. Antisocial Personality Disorder - Similarities: - Hypersensitive - Interpret benign comments as insults - Problems with law or social norms - Read malevolent motives into actions of others - Justify pre-emptive aggression - Differences: - Manipulation for profit, power, material gain (ASPD) - Intrinsically suspicious & hypervigilant - Tense or edgy (PPD) - Fearful & guarded (PPD) - Obsessive & Compulsive - Paranoid vs Obsessive-Compulsive PD - Similarities: - Rigid - Over-controlling - Blame others - Dogmatic moralists - Differences: - Deeply fear making mistakes (OCPD) - Cold, rigidly conforming, emotionally unavailable (OCPD) - Project undesirable traits onto others (PPD) - Revel against authority & defend their self-determination (PPD) - Avoidant - Paranoid vs. Avoidant PD - Similarities: - Tense & mistrustful - Hyperalert to threats - Fearful of being shamed, humiliated or embarrassed - Intensely secretive - Few friends and confidants - Differences: - See themselves as inadequate or defective (APD) - Compensatory illusions of strength (PPD) - Fear information will be used against them (PPD) - Sensitive & have a good sense of humor (APD) **Paranoid Personality Style vs. Paranoid Personality Disorder** Personality STYLE Personality DISORDER ------------------------------------------------------------------------------------------------------------------------ --------------------------------------------------------------------------------------------------------------------------------------- Self-assured & confident in their ability to make decisions and take care of themselves. Reluctant to confide in others due to unwarranted fear that others will use it against them. Good listeners & observers, keenly aware of subtlety, tone, and multiple levels of meaning. Reads hidden meanings or threats into benign remarks or events, i.e., suspects that a neighbor may put out trash early to annoy them. Takes criticism rather seriously without being intimidated. Bears grudges or is unforgiving of insults or slights. Place a high premium on loyalty, fidelity, working hard to earn and maintain loyalty, and never taking it for granted. Questions, without justification, the fidelity of a spouse or sexual partner, friends, or associates. Careful in dealings with other people, preferring to size up individuals before entering relationships with them. Expects, without sufficient basis, to be exploited or harmed by others. Are assertive & can defend themselves without losing control & becoming aggressive. Easily slighted or quick to react with anger to counterattack. **Assessment & Treatment of Paranoid Personality Disorder** - Psychological testing - Five Factor Model - HIGH Neuroticism: high anxiousness, angry hostility, depressiveness, self-consciousness, vulnerability - LOW Extraversion: low warmth, gregariousness & positive emotions - LOW Agreeableness: low trust, straightforwardness, altruism, and compliance - MMPI-2 - Elevated Clinical Scales of Paranoia, Hysteria, and Hypochondriasis - Elevated correction scale (K) - Psychotherapy - Psychodynamic Psychotherapy - Three treatment principles - A meaningful therapeutic alliance - Respect for the patient's fragile sense of autonomy - Conversion from paranoid manifestations into depression - Interpersonal Psychotherapy - Use respectful, caring curiosity & allow the patient for some control over treatment - Goal is for patient to gain insights into how them - Expectations of others attacking them stem from their past experiences - Current behaviors encourage further hostility from others - Balance affirmation with confrontation - Proactive criticism - Anger directed towards earlier life figures frees up space to explore new relationships - Cognitive Behavioral Therapy - In initial sessions of therapy, the patient is expected to self-disclose information - Focus initially on less sensitive topics or discuss concerns in a more generalized manner - Acknowledge and accept that the patient has difficult trusting the therapist - Focus on empowering the patient to behave in different manners - Group Therapy - Typically avoid group therapy - Relative contraindication to group therapy unless higher functioning & more insight into their paranoia - Marital therapy - Jealousy, mistrust of spouse, accusations of infidelity - Often, nonparanoid spouses when accused, are passive & secretive which ca https://d.docs.live.net/1a1358e388cd3469/Documents/Personality%20Psych%20Midterm.docxn further arouse the paranoid's spouse mistrust - Couples with a PPD Partner - Individual with Paranoid PD tend to be authoritarian & controlling in relationships - Spouses are often more passive in nature - Once trust is established between the partners, their relationship is largely co-dependent - Self-fulfilling prophecy - Treatment goals - Assessments of the individual's degree of personality pathology - Stabilize crisis - Re-establishment of commitment to the relationship - Individuals taking responsibility for their own actions, problem solving, and breaking of the cycle of criticism & passivity - Medications - No FDA approved medications for Paranoid PD - Limited evidence to support the efficacy of antipsychotic medications in the treatment of paranoid personality disorder