1) Personality disorders (PD) consist of a loosely-bound cluster of sub-types. Which of the following common features are evident in PD? Show 2) Which of the following is the most well-known of the Personality disorders ? 3) Which of the following is NOT a characteristic of individuals with paranoid personality disorder 4) An Individual with a schizotypal personality disorder will usually exhibit which of the following characteristics? 5) Which of the following is a subtype of Dramatic/Emotional Personality Disorders (Cluster B) 6) The term 'sociopath' or 'psychopath' is sometimes used to describe which type of personality disorder 7) An individual with narcissistic personality disorder will routinely overestimate their abilities and inflate their accomplishments, and this is characterized by which of the following? 8) The apparent lack of empathy and the tendency to exploit others for self-benefit, has lead psychologists to compare narcissistic personality disorder with which one of the following? 9) Which of the following are considered to be the main features of avoidant personality disorder? 10) Some clinicians have come to believe that antisocial personality disorder and social phobia are both components of a broader spectrum called: 11) An Individual with Dependent Personality Disorder will exhibit which of the following? 12) An Individual with Obsessive-Compulsive Personality Disorder will exhibit which of the following characteristics? 13) Which of the following is NOT considered to be a risk factors for personality disorders ? 14) The formalistic similarities between Cluster A disorders and schizophrenia have led researchers to argue that they are part of a broader 15) According to psychodynamic theory which of the following is NOT deemed to be characteristic of the parents of an individual with paranoid personality disorder 16) Antisocial Personality Disorder is closely associated with criminal and antisocial behaviour. Because of this, considerable effort has been invested in attempting which of the following? 17) Personality disorders are an enduring patterns of behaviour that persist from childhood into adulthood and because of this fact, one of the best predictors of APD in adulthood is a diagnosis of 18) Behaviour of individuals with Antisocial Personality Disorder often appears impulsive and unpredictable due to switching quickly and unpredictably between: 19) More recent research has linked Borderline Personality Disoder (BPD) with bipolar disorder, and the two are often comorbid. Some individuals with BPD belong to a broader: 20) Evidence suggests that individuals with Borderline Personality Disorder have a number of brain abnormalities that may give rise to impulsive behaviour. There is evidence for dysfunction in brain: 21) According to psychodynamic theory individuals are sometimes motivated to respond to the world through the perspectives they have learnt from important other people in their developmental past. This is called: 22) Psychodynamic theories of personality disorders that individuals with weak egos engage in a defence mechanism called: 23) Narcissistic personality disorder is also closely associated with antisocial personality disorder (APD),. Which of the following is not a way in narcissistic individuals will regularly act: 24) Which of the following is not usually associated with Avoidant Personality Disorder? 25) Which of the following is a particular example of psychodynamic treatment which attempts to strengthen the individual's weak ego so that they are able to address issues in their life without constantly flipping from one extreme view to another: 26) There is one particular form of therapy that has been successfully used to treat individuals with personality disorders and involves providing them with insight into their dysfunctional ways of thinking, and is designed to provide them with the necessary skills to overcome these problematic ways of thinking and behaving. Which of the following is this therapy ? 27) Cognitive behavioural therapy may be used to treat an individual with obsessive-compulsive personality disorder by challenging: 28) In the treatments of individuals with Borderline Personality Disorder a therapist may change dysfunctional schemata by: 29) Which of the following could be described as a stage of schemata therapy for personality disorder? 30) Which of the following is not a DSM-IV-TR criterion for schizoid personality disorder?
In general, treatment of personality disorders aims to
Reducing subjective distress (eg, anxiety, depression) is the first goal. These symptoms often respond to increased psychosocial support, which often includes moving the patient out of highly stressful situations or relationships. Drug therapy may also help relieve stress. Reduced stress makes treating the underlying personality disorder easier.
An effort to enable patients to see that their problems are internal should be made early. Patients need to understand that their problems with work or relationships are caused by their problematic ways of relating to the world (eg, to tasks, to authority, or in intimate relationships). Achieving such understanding requires a substantial amount of time, patience, and commitment on the part of a clinician. Clinicians also need a basic understanding of the patient’s areas of emotional sensitivity and usual ways of coping. Family members and friends can help identify problems of which patients and clinicians would otherwise be unaware.
Maladaptive and undesirable behaviors (eg, recklessness, social isolation, lack of assertiveness, temper outbursts) should be dealt with quickly to minimize ongoing damage to jobs and relationships. Behavioral change is most important for patients with the following personality disorders:
Behavior can typically be improved within months by group therapy and behavior modification; limits on behavior must often be established and enforced. Sometimes patients are treated in a day hospital or residential setting. Self-help groups or family therapy can also help change socially undesirable behaviors. Because family members and friends can act in ways that either reinforce or diminish the patient’s problematic behavior or thoughts, their involvement is helpful; with coaching, they can be allies in treatment.
Modifying problematic personality traits (eg, dependency, distrust, arrogance, manipulativeness) takes a long time—typically > 1 year. The cornerstone for effecting such change is
During therapy, clinicians try to identify interpersonal problems as they occur in the patient's life. Clinicians then help patients understand how these problems are related to their personality traits and provide skills training to develop new, better ways of interacting. Typically, clinicians must repeatedly point out the undesirable behaviors and their consequences before patients become aware of them. This strategy can help patients change their maladaptive behaviors and mistaken beliefs. Although clinicians should act with sensitivity, they should be aware that kindness and sensible advice by themselves do not change personality disorders. Learning Objectives
To this point in the chapter we have considered the psychological disorders of the Diagnostic and Statistical Manual of Mental Disorders (DSM) categorization system. A personality disorder is a disorder characterized by inflexible patterns of thinking, feeling, or relating to others that cause problems in personal, social, and work situations. Personality disorders tend to emerge during late childhood or adolescence and usually continue throughout adulthood (Widiger, 2006). The disorders can be problematic for the people who have them, but they are less likely to bring people to a therapist for treatment. The personality disorders are summarized in Table 13.5, “Descriptions of the Personality Disorders.” They are categorized into three types: those characterized by odd or eccentric behaviour, those characterized by dramatic or erratic behaviour, and those characterized by anxious or inhibited behaviour. As you consider the personality types described in Table 13.5, I’m sure you’ll think of people that you know who have each of these traits, at least to some degree. Probably you know someone who seems a bit suspicious and paranoid, who feels that other people are always “ganging up on him,” and who really do not trust other people very much. Perhaps you know someone who fits the bill of being overly dramatic — the “drama queen” who is always raising a stir and whose emotions seem to turn everything into a big deal. Or you might have a friend who is overly dependent on others and can’t seem to get a life of her own. The personality traits that make up the personality disorders are common — we see them in the people with whom we interact every day — yet they may become problematic when they are rigid, overused, or interfere with everyday behaviour (Lynam & Widiger, 2001). What is perhaps common to all the disorders is the person’s inability to accurately understand and be sensitive to the motives and needs of the people around them.
The personality disorders create a bit of a problem for diagnosis. For one, it is frequently difficult for the clinician to accurately diagnose which of the many personality disorders a person has, although the friends and colleagues of the person can generally do a good job of it (Oltmanns & Turkheimer, 2006). And the personality disorders are highly comorbid; if a person has one, it’s likely that he or she has others as well. Also, the number of people with personality disorders is estimated to be as high as 15% of the population (Grant et al., 2004), which might make us wonder if these are really disorders in any real sense of the word. Although they are considered as separate disorders, the personality disorders are essentially milder versions of more severe disorders (Huang et al., 2009). For example, obsessive-compulsive personality disorder is a milder version of obsessive-compulsive disorder (OCD), and schizoid and schizotypal personality disorders are characterized by symptoms similar to those of schizophrenia. This overlap in classification causes some confusion, and some theorists have argued that the personality disorders should be eliminated from the DSM. But clinicians normally differentiate Axis I and Axis II disorders, and thus the distinction is useful for them (Krueger, 2005; Phillips, Yen, & Gunderson, 2003; Verheul, 2005). Although it is not possible to consider the characteristics of each of the personality disorders in this book, let’s focus on two that have important implications for behaviour. The first, borderline personality disorder (BPD), is important because it is so often associated with suicide, and the second, antisocial personality disorder (APD), because it is the foundation of criminal behaviour. Borderline and antisocial personality disorders are also good examples to consider because they are so clearly differentiated in terms of their focus. BPD (more frequently found in women than men) is known as an internalizing disorder because the behaviours that it entails (e.g., suicide and self-mutilation) are mostly directed toward the self. APD (mostly found in men), on the other hand, is a type of externalizing disorder in which the problem behaviours (e.g., lying, fighting, vandalism, and other criminal activity) focus primarily on harm to others. Borderline Personality DisorderBorderline personality disorder (BPD) is a psychological disorder characterized by a prolonged disturbance of personality accompanied by mood swings, unstable personal relationships, identity problems, threats of self-destructive behaviour, fears of abandonment, and impulsivity. BPD is widely diagnosed — up to 20% of psychiatric patients are given the diagnosis, and it may occur in up to 2% of the general population (Hyman, 2002). About three-quarters of diagnosed cases of BDP are women. People with BPD fear being abandoned by others. They often show a clinging dependency on the other person and engage in manipulation to try to maintain the relationship. They become angry if the other person limits the relationship, but also deny that they care about the person. As a defence against fear of abandonment, borderline people are compulsively social. But their behaviours, including their intense anger, demands, and suspiciousness, repel people. People with BPD often deal with stress by engaging in self-destructive behaviours, for instance by being sexually promiscuous, getting into fights, binge eating and purging, engaging in self-mutilation or drug abuse, and threatening suicide. These behaviours are designed to call forth a “saving” response from the other person. People with BPD are a continuing burden for police, hospitals, and therapists. Borderline individuals also show disturbance in their concepts of identity: they are uncertain about self-image, gender identity, values, loyalties, and goals. They may have chronic feelings of emptiness or boredom and be unable to tolerate being alone. BPD has both genetic and environmental roots. In terms of genetics, research has found that those with BPD frequently have neurotransmitter imbalances (Zweig-Frank et al., 2006), and the disorder is heritable (Minzenberg, Poole, & Vinogradov, 2008). In terms of environment, many theories about the causes of BPD focus on a disturbed early relationship between the child and his or her parents. Some theories focus on the development of attachment in early childhood, while others point to parents who fail to provide adequate attention to the child’s feelings. Others focus on parental abuse (both sexual and physical) in adolescence, as well as on divorce, alcoholism, and other stressors (Lobbestael & Arntz, 2009). The dangers of BPD are greater when they are associated with childhood sexual abuse, early age of onset, substance abuse, and aggressive behaviours. The problems are amplified when the diagnosis is comorbid (as it often is) with other disorders, such as substance abuse disorder, major depressive disorder, and post-traumatic stress disorder (PTSD) (Skodol et al., 2002).
Posner et al. (2003) hypothesized that the difficulty that individuals with BPD have in regulating their lives (e.g., in developing meaningful relationships with other people) may be due to imbalances in the fast and slow emotional pathways in the brain. Specifically, they hypothesized that the fast emotional pathway through the amygdala is too active, and the slow cognitive-emotional pathway through the prefrontal cortex is not active enough in those with BPD. The participants in their research were 16 patients with BPD and 14 healthy comparison participants. All participants were tested in a functional magnetic resonance imaging (fMRI) machine while they performed a task that required them to read emotional and nonemotional words, and then press a button as quickly as possible whenever a word appeared in a normal font and not press the button whenever the word appeared in an italicized font. The researchers found that while all participants performed the task well, the patients with BPD had more errors than the controls (both in terms of pressing the button when they should not have and not pressing it when they should have). These errors primarily occurred on the negative emotional words. Figure 13.15 shows the comparison of the level of brain activity in the emotional centres in the amygdala (left panel) and the prefrontal cortex (right panel). In comparison to the controls, the BPD patients showed relatively larger affective responses when they were attempting to quickly respond to the negative emotions, and showed less cognitive activity in the prefrontal cortex in the same conditions. This research suggests that excessive affective reactions and lessened cognitive reactions to emotional stimuli may contribute to the emotional and behavioural volatility of borderline patients.  Antisocial Personality Disorder (APD)In contrast to borderline personality disorder, which involves primarily feelings of inadequacy and a fear of abandonment, antisocial personality disorder (APD) is characterized by a disregard of the rights of others, and a tendency to violate those rights without being concerned about doing so. APD is a pervasive pattern of violation of the rights of others that begins in childhood or early adolescence and continues into adulthood. APD is about three times more likely to be diagnosed in men than in women. To be diagnosed with APD the person must be 18 years of age or older and have a documented history of conduct disorder before the age of 15. People having antisocial personality disorder are sometimes referred to as “sociopaths” or “psychopaths.” People with APD feel little distress for the pain they cause others. They lie, engage in violence against animals and people, and frequently have drug and alcohol abuse problems. They are egocentric and frequently impulsive, for instance suddenly changing jobs or relationships. People with APD soon end up with a criminal record and often spend time incarcerated. The intensity of antisocial symptoms tends to peak during the 20s and then may decrease over time. Biological and environmental factors are both implicated in the development of antisocial personality disorder (Rhee & Waldman, 2002). Twin and adoption studies suggest a genetic predisposition (Rhee & Waldman, 2002), and biological abnormalities include low autonomic activity during stress, biochemical imbalances, right hemisphere abnormalities, and reduced gray matter in the frontal lobes (Lyons-Ruth et al., 2007; Raine, Lencz, Bihrle, LaCasse, & Colletti, 2000). Environmental factors include neglectful and abusive parenting styles, such as the use of harsh and inconsistent discipline and inappropriate modelling (Huesmann & Kirwil, 2007). Key Takeaways
Exercises and Critical Thinking
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What type of disorder is characterized by a set of inflexible maladaptive behavior patterns?
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