Personality DisordersDefinition of Personality?Definition of Personality DisorderManifest across many life areasInflexibleMaladaptiveCause either significant impairment or distress to self or others

Personality DisordersDimensions or Categories?DSM-IV Consided as Categories (not dimensions)Axis II of the multiaxial systemNot usually primary diagnosisTen Specific LabelsCluster A: Odd / EccentricCluster B: Dramatic / EmotionalCluster C: Anxious / FearfulHigh Rates of ComorbidityGender Bias in Diagnosis?

Paranoid Personality DisorderExcessively Mistrustful Excessively SuspiciousWithout JustificationTreatment Options Few seek professional help on their ownTreatment focuses on development of trustCognitive therapy to counter negativistic thinkingLack good outcome studies

Schizoid Personality DisorderExtreme Social Detachment (Loner) Appear Aloof, Cold, IndifferentLimited Range of EmotionsTreatment Options Few seek professional help on their ownFocus on the value of interpersonal relationships, empathy, and social skillsTreatment prognosis is generally poorLack good outcome studies

Schizotypal Personality DisorderAlso Socially Isolated BUT Behavior Is More Unusual Often Considered Odd or BizarreIdeas of ReferenceMagical ThinkingIllusionsApparent Connection to Schizophrenia (but be careful!)Treatment Options Developing social skillsTreatment also addresses comorbid depressionMedical treatment is similar to that used for schizophreniaTreatment prognosis is generally poor

Antisocial Personality DisorderLong Histories ofViolating Cultural NormsViolating Rights of OthersImpulsivity & AggressivenessLack of Remorse, Conscience, EmpathyNot Always CriminalRelation Between ASPD, Conduct Disorder, and Early Behavior Problems

Antisocial PersonalityNeurobiological TheoriesUnderarousal, Fearlessness, & Behavioral Inhibition Treatment Few seek treatment on their ownAntisocial behavior is predictive of poor prognosis, even in childrenEmphasis is placed on prevention and rehabilitationOften incarceration is the only viable alternative

Borderline Personality DisorderUnstable RelationshipsLove/Hate BehaviorFear of AbandonmentPoor Self-ImageMood Swings, Feel EmptyImpulsivitySubstance Abuse, Sex, SuicidalitySelf-mutilation

Borderline Personality DisorderRuns in familiesEarly trauma and abuse seem to play some roleTreatment Options Few good treatment outcome studiesAntidepressant medications provide some short-term reliefDialectical behavior therapy is the most promising psychosocial approach

Histrionic Personality DisorderOverly DramaticCenter of AttentionEmphasis on AppearanceEmotions are ShallowSeductive & ProvocativeTreatment Options Few good treatment outcome studiesTreatment focuses on attention seeking and long-term negative consequencesTargets may also include problematic interpersonal behaviorsLittle evidence that treatment is effective

Narcissistic Personality DisorderGrandiose Sense of SelfExaggerated Self-ImportancePreoccupied with AttentionRequires AdmirationLittle EmpathyHighly Sensitive to CriticismTreatment Options Focuses on grandiosity, lack of empathy, unrealistic thinkingTreatment may also address co-occurring depressionLittle evidence that treatment is effective

Avoidant Personality DisorderSensitive to Others OpinionsAvoid Social RelationshipsExtreme Low Self-EsteemTakes Few RisksSocially Inhibited & AnxiousTreatment Options Several well-controlled treatment outcome studies existTreatment is similar to that used for social phobia Treatment targets include social skills and anxiety

Dependent Personality DisorderExcessive Reliance on OthersSubmissive & PassiveRely on Others to Make Even Minor DecisionsFear AbandonmentClingyTreatment Options Research on treatment efficacy is lackingTherapy typically progresses gradually Treatment targets include skills that foster independence

Obsessive-Compulsive Personality DisorderNOT same thing as OCDFixation on Doing Things The Right WayPreoccupation withPerfectionismControlOrderliness, Details, and RulesObsessions and Compulsions Are RareTreatment Options Data supporting treatment are limitedTreatment may address fears related to the need for orderlinessOther targets include rumination, procrastination, and feelings of inadequacy

Problems with Personality DisordersThe Causes of Personality Disorders Are Difficult to Pinpoint Treatment of Personality Disorders Is Often Difficult Often Comorbid IssuesEgosyntonic (vs. Egodystonic)

**FIGURE 11.1Gender bias in diagnosing personality disorders (P.D.). Data are shown for the percentage of cases clinicians rated as antisocial personality disorder or histrionic personality disorder, depending on whether the case was described as a male or a female. (From Ford, M. R., & Widiger, T. A., 1989. Sex bias in the diagnosis of histrionic and antisocial personality disorders. Journal of Consulting and Clinical Psychology, 57, 301305.)

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