Abnormal Psych- Chapt. 13

Dramatic Personality Disorder- BPD Treatments

- It appears that psychotherapy can eventually lead to some degree of improvement for people with borderline personality disorder -But it is extraordinarily difficult for a therapist to strike a balance between empathizing with the borderline client's dependency and anger and challenging his or her way of thinking -The wildly fluctuating interpersonal attitudes of clients with the disorder can also make it difficult for therapists to establish productive working relationships with them ---Clients might also violate the boundaries in a client-therapist relationship. For ex: excessive use of emergency contact for issues that aren't really an emergency -*Dialectical Behavior Therapy*- --This approach grows largely from the cognitive-behavioral treatment model. --Includes a number of the same behavioral and cognitive techniques that are applied to other disorders: homework assignments, psychoeducation, the teaching of social and other skills, therapist modeling, clear goal setting, reinforcements for appropriate behaviors, and collaborative examinations by client and therapist of the client's ways of thinking --Also heavily uses humanistic and contemporary approaches. --Uses meditation techniques to make the client understand their emotions and accept them for what they are --Places client-therapist relationship itself at the center of treatment interactions, making sure that appropriate treatment boundaries are adhered to, and, at the same time, providing acceptance of the client. --DBT has received more research support than any other treatment for borderline personality disorder --People who receive this treatment come to display an increased ability to tolerate stress; develop new, more appropriate, social skills; respond more effectively to life situations; and develop a more stable identity. Also they have lower rates of the suicidal behavior -Finally, antidepressant, mood stabilizing, antianxiety, and antipsychotic drugs have helped calm the emotional and aggressive storms of some people with borderline personality disorder -oday, many professionals believe that psychotropic drug treatment for borderline personality disorder should be used largely as an adjunct to psychotherapy approaches, and in fact many clients seem to benefit from a combination of psychotherapy and drug therapy

Dramatic Personality Disorders- Antisocial Personality Disorder

-*Antisocial personality disorder:* A personality disorder marked by a general pattern of disregard for and violation of other people's rights. -Aside from substance use disorders, this is the disorder most closely linked to adult criminal behavior. -DSM-5 stipulates that a person must be at least 18 years of age to receive this diagnosis; however, most people with antisocial personality disorder displayed some patterns of misbehavior before they were 15, including truancy, running away, cruelty to animals or people, and destroying property. -Many cannot work consistently at a job; they are absent frequently and are likely to quit their jobs altogether. -Usually they are also careless with money and frequently fail to pay their debts. They are often impulsive, taking action without thinking of the consequences -Recklessness is another common trait: people with antisocial personality disorder have little regard for their own safety or for that of others, even their children. -They are self-centered as well, and are likely to have trouble maintaining close relationships. Usually they develop a knack for gaining personal profit at the expense of other people -Because the pain or damage they cause seldom concerns them, clinicians commonly say that they lack a moral conscience -2%-3.5% of people in the US meet the criteria for anti-social personality disorder ---4x more common in men than woman -around 30 percent of people in prison meet the diagnostic criteria for this disorder -For many people with this disorder, criminal behavior declines after the age of 40 -Studies and clinical observations also indicate higher rates of alcoholism and other substance use disorders among people with antisocial personality disorder than in the rest of the population

Anxious Personality Disorders- Avoidant Personality Disorders

-*Avoidant personality disorder:* A personality disorder characterized by consistent discomfort and restraint in social situations, overwhelming feelings of inadequacy, and extreme sensitivity to negative evaluation. -Ppl are timid and hesitant in social situations, afraid of saying something foolish or of embarrassing themselves by blushing or acting nervous. -People with this disorder believe themselves to be unappealing or inferior to others -They usually have few or no close friends, though they actually yearn for intimate relationships, and frequently feel depressed and lonely. As a substitute, some develop an inner world of fantasy and imagination -APD is similar to Social Anxiety Disorder- -The similarities include a fear of humiliation and low confidence. -Some theorists believe that there is a key difference between the two disorders—namely, that people with social anxiety disorder primarily fear social circumstances, while people with the personality disorder tend to fear close social relationships -As many as 1 to 2 percent of adults have avoidant personality disorder, men as frequently as women

Dramatic Personality Disorder- Borderline personality disorder

-*Borderline personality disorder:* A personality disorder characterized by repeated instability in interpersonal relationships, self-image, and mood and by impulsive behavior. -Ppl with borderline personality disorder swing in and out of very depressive, anxious, and irritable states that last anywhere from a few hours to a few days or more. -They are prone to bouts of anger, which sometimes result in physical aggression and violence -Just as often, however, they direct their impulsive anger inward and inflict bodily harm on themselves. Many seem troubled by deep feelings of emptiness. -Ppl lack self control. their impulsive, self-destructive activities may range from alcohol and substance abuse to delinquency, unsafe sex, and reckless driving --- Many engage in self-injurious or self-mutilation behaviors, such as cutting or burning themselves or banging their heads ---The ppl with the disorder like the feeling self inflicted pain causes cuz it feels like a sense of relief ---Many ppl with BPD try to hurt themselves as a way of dealing with their chronic feelings of emptiness, boredom, and identity confusion. -Studies suggest that around 75 percent of people with BPD attempt suicide at least once in their lives; as many as 10 percent actually commit suicide -Ppl w/ BPD frequently form intense, conflict-ridden relationships in which their feelings are not necessarily shared by the other person. ---Ppl with this disorder have recurrent fears of impending abandonment and frequently engage in frantic efforts to avoid real or imagined separations from important people in their lives ---Sometimes they cut themselves or carry out other self-destructive acts to prevent partners from leaving. - Sufferers of borderline personality disorder typically experience dramatic shifts in their identity. An unstable sense of self may produce rapid shifts in goals, aspirations, friends, and even sexual orientation -Between 1 and 2.5 percent of the general population are thought to suffer from borderline personality disorder --- Close to 75 percent of the patients who receive the diagnosis are women -The course of the disorder varies from person to person. ---In the most common pattern, the individual's instability and risk of suicide peak during young adulthood and then gradually wane with advancing age -Not surprising that this disorder interferes with job performance more so than most other personality disorders do

Anxious Personality Disorders-Dependent Personality Disorder

-*Dependent personality disorder:* A personality disorder characterized by a pattern of clinging and obedience, fear of separation, and a persistent, excessive need to be taken care of. - those with dependent personality disorder constantly need assistance with even the simplest matters and demonstrate extreme feelings of inadequacy and helplessness. -people with dependent personality disorder have difficulty with separation -They lack confidence in their own ability and judgement -they so fear rejection, they are overly sensitive to disapproval and keep trying to meet other people's wishes and expectations, even if it means volunteering for unpleasant or demeaning tasks. -Many people with dependent personality disorder feel distressed, lonely, and sad; often they dislike themselves. ---they are at risk for depressive, anxiety, and eating disorders -Studies suggest that over 2 percent of the population may experience dependent personality disorder ---Just as common for both genders

Dramatic Personality Disorders- Histrionic Personality Disorder

-*Histrionic personality disorder*: A personality disorder in which an individual displays a pattern of excessive emotionality and attention seeking. Once called hysterical personality disorder. -Ppl w/ HPD always used over the top and dramatic gestures to describe simple everyday events -Change themselves per situation to attract and impress an audience -Ppl w/ HPD require constant high approval of themselves by others -Some common features the disorder: -Desire to be center of attention -Overly sexually seductive and provocative -Rapidly shifting emotions -Uses physical appearance for attention -Overly theatrical and exaggerated emotions -Believes relationships to be more intimate than they are -Some research suggests that around 2% to 3% of adults have this personality disorder, with males and females equally affected ----*BUT*--- -Very debated topic on whether this just a disorder that is inherently sexist towards women

Odd Personality Disorders- Schizoid Personality Disorder Explanations

-*Many psychodynamic theorists,* particularly object relations theorists, propose that schizoid personality disorder has its roots in an unsatisfied need for human contact -The parents of people with this disorder, like those of people with paranoid personality disorder, are believed to have been unaccepting or even abusive of their children. -Cognitive theorists propose, not surprisingly, that people with schizoid personality disorder suffer from deficiencies in their thinking. -Their thoughts tend to be vague, empty, and without much meaning, and they have trouble scanning the environment to arrive at accurate perceptions -Unable to pick up emotional cues from others, they simply cannot respond to emotions. As this theory might predict, children with schizoid personality disorder develop language and motor skills very slowly, whatever their level of intelligence

Dramatic Personality Disorders- Narcissistic Personality disorder

-*Narcissistic personality disorder*: A personality disorder marked by a broad pattern of grandiosity, need for admiration, and lack of empathy. -People with narcissistic personality disorder exaggerate their achievements and talents, expecting others to recognize them as superior, and often appear arrogant. -They are very choosy about their friends and associates, believing that their problems are unique and can be appreciated only by other "special," high-status people. -Because of their charm, they often make favorable first impressions, yet they can rarely maintain long-term relationships. -Not interested in the feelings of others -Many ppl with NPD take advantage of others to achieve what they want -React to criticism or frustrating with intense rage, humiliation of embitterment -usually ppl become extremely pessimistic and filled with depression -Around 1 percent of adults display narcissistic personality disorder, up to 75 percent of them men

Anxious personality Disorder- OCD

-*Obsessive-compulsive personality disorder*: A personality disorder marked by such an intense focus on orderliness, perfectionism, and control that the individual loses flexibility, openness, and efficiency -People with this personality disorder set unreasonably high standards for themselves and others. -they can never be satisfied with their performance, but they typically refuse to seek help or to work with a team, convinced that others are too careless or incompetent to do the job right. -These individuals also tend to be rigid and stubborn, particularly in their morals, ethics, and values. -They live by a strict personal code and use it as a yardstick for measuring others. -As many as 1 to 2 percent of the population are believed to display obsessive-compulsive personality disorder, with white, educated, married, and employed individuals receiving the diagnosis most often - Men are twice as likely as women to display the disorder. -Many clinicians believe that obsessive-compulsive personality disorder and obsessive-compulsive disorder are closely related. -many people who suffer from one of the disorders meet the diagnostic criteria for the other as well -it is worth noting that people with the personality disorder are more likely to suffer from either major depressive disorder, generalized anxiety disorder, or a substance use disorder than from obsessive-compulsive disorder

Odd Personality Disorders- Paranoid Personality Disorder

-*Paranoid personality disorder:* A personality disorder marked by a pattern of extreme distrust and suspiciousness of others. -They find "hidden" meanings, which are usually belittling or threatening, in everything. -In a study that required individuals to role-play, participants with paranoia were more likely than control participants to read hostile intentions into the actions of others -people with paranoid personality disorder remain cold and distant -*Although inaccurate and inappropriate, their suspicions are not usually delusional; the ideas are not so bizarre or so firmly held as to clearly remove the individuals from reality* -People with this disorder are critical of weakness and fault in others, particularly at work. -hey are unable to recognize their own mistakes, however, and are extremely sensitive to criticism. They often blame others for the things that go wrong in their lives, and they repeatedly bear grudges. Between 0.5 and 3 percent of adults are believed to experience this disorder, apparently more men than women

"Personality Disorder Trait Specified": Another Dimensional Approach

-*Personality disorder trait specified*: A personality disorder, proposed for possible inclusion in future editions of DSM-5, in which an individual displays significant impairment in personality functioning, characterized by at least one severely maladaptive trait. -five groups of problematic traits would be eligible for a diagnosis of PDTS: negative affectivity, detachment, antagonism, disinhibition, and psychoticism. -If a person is impaired significantly by any of the five trait groups, or even by just one of the 25 traits that comprise those groups, he or she would qualify for a diagnosis of personality disorder trait specified. -Many clinicians believe that the proposed changes would give too much latitude to diagnosticians—allowing them to apply diagnoses of personality disorder to an enormous range of personality patterns.

Anxious Personality Disorders- Dependent Personality Disorder Explained

-*Psychodynamic Theorists*-explanations for this personality disorder are very similar to those for depression ---Freudian theorists argue, for example, that unresolved conflicts during the oral stage of development can give rise to a lifelong need for nurturance, thus heightening the likelihood of a dependent personality disorder ---*object relation Theorists*-say that early parental loss or rejection may prevent normal experiences of attachment and separation, leaving some children with fears of abandonment that persist throughout their lives ---other psychodynamic theorists suggest that, to the contrary, many parents of people with this disorder were overinvolved and overprotective, thus increasing their children's dependency, insecurity, and separation anxiety -*Behaviorists*-propose that parents of people with dependent personality disorder unintentionally rewarded their children's clinging and "loyal" behavior, while at the same time punishing acts of independence, perhaps through the withdrawal of love. Alternatively, some parents' own dependent behaviors may have served as models for their children -*Cognitive THeorists*- identify two maladaptive attitudes as helping to produce and maintain this disorder: (1) "I am inadequate and helpless to deal with the world," and (2) "I must find a person to provide protection so I can cope ---Dichotomous (black-and-white) thinking may also play a key role: "If I am to be dependent, I must be completely helpless," or "If I am to be independent, I must be alone." Such thinking prevents sufferers from making efforts to be independent."

Dramatic Personality Disorders- Histrionic Personality Disorder Explained

-*Psychodynamic Therapists* - believe that as children, people with this disorder experienced unhealthy relationships in which cold and controlling parents left them feeling unloved and afraid of abandonment ---To defend against deep-seated fears of loss, the individuals learned to behave dramatically, inventing crises that would require other people to act protectively. -*Cognitive Therapists*- look at the lack of substance and extreme suggestibility found in people with HPD ---They see the individuals as becoming less and less interested in knowing about the world at large because they are so self-focused and emotional. ---also propose that people with this disorder hold a general assumption that they are helpless to care for themselves, and so they constantly seek out others who will meet their needs -*Sociocultural/multicultural therapists*- HPD is produced in part by cultural norms and expectations. ---some clinical observers claim that HPD is diagnosed less often in Asian and other cultures that discourage overt sexualization and more often in Hispanic American and Latin American cultures that are more tolerant of overt sexualization

Dramatic Personality Disorder- BPD explained

-*Psychodynamic theorists* have looked once again to early parental relationships to explain the disorder ---Object relations theorists, for example, propose that an early lack of acceptance by parents may lead to a loss of self-esteem, increased dependence, and an inability to cope with separation ---Research has found that the early childhoods of people with the disorder are often consistent with this view. ---In many cases, the parents of such individuals neglected or rejected them, verbally abused them, or otherwise behaved inappropriately --- their childhoods were often marked by multiple parent substitutes, divorce, death, or traumas such as physical or sexual abuse. ---*At the same time, it is important to recognize that the vast majority of persons with histories of physical, sexual, or psychological abuse do not go on to develop this disorder* -*Biological view*- ---Ppl w/ BPD have overly reactive amygdala, the brain structure so closely tied to fear and other negative emotions, and an underactive prefrontal cortex, the brain region linked to planning, self-control, and decision-making --- individuals who are particularly impulsive—those who attempt suicide or are very aggressive toward others—apparently have lower brain serotonin activity ---close relatives of those with borderline personality disorder are five times more likely than the general population to have the same personality disorder ---*Biosocial Theory*- According to this view, the disorder results from a combination of internal forces (for example, difficulty identifying and controlling one's emotions) and external forces (for example, an environment in which a child's emotions are punished, misinterpreted, or disregarded). ---if children have intrinsic difficulties identifying and controlling their emotions and if their parents further teach them to ignore their intense feelings, the children may never learn how to properly recognize and control their emotional arousal or how to tolerate emotional distress (resulting in risk for development of BPD) ---Biosocial theory is very similar to one of the leading explanations for eating disorders -*Socialcultural theorists* -suggest that cases of borderline personality disorder are particularly likely to emerge in cultures that change rapidly ---As a culture loses its stability, they argue, it inevitably leaves many of its members with problems of identity, a sense of emptiness, high anxiety, and fears of abandonment. ---Changes of this kind in society today may explain growing reports of the disorder

Anxious Personality Disorders- Avoidant Personality Disorders Explanations

-*Psychodynamic theorists*- focus mainly on the general sense of shame felt by people with avoidant personality disorder ---Some trace the shame to childhood experiences such as early bowel and bladder accidents. If parents repeatedly punish or ridicule a child for having such accidents, the child may develop a negative self-image. This may lead to the individual's feeling unlovable throughout life and distrusting the love of others. -*Cognitive Theorists*- believe that harsh criticism and rejection in early childhood may lead certain people to assume that others in their environment will always judge them negatively. ---These individuals come to expect rejection, misinterpret the reactions of others to fit that expectation, discount positive feedback, and generally fear social involvements—setting the stage for avoidant personality disorder -*Behavioral Theorists*- suggest that people with avoidant personality disorder typically fail to develop normal social skills, a failure that helps maintain the disorder. --- Most behaviorists agree, however, that the deficits first develop as a result of the individuals avoiding so many social situations.

Anxious Personality Disorders- OCD explained

-*Psychodynamic theorists*- suggest that people with obsessive-compulsive personality disorder are anal regressive. That is, because of overly harsh toilet training during the anal stage, they become filled with anger, and they remain fixated at this stage -To keep their anger under control, they persistently resist both their anger and their instincts to have bowel movements. In turn, they become extremely orderly and restrained; many become passionate collectors. Other psychodynamic theorists suggest that any early struggles with parents over control and independence may ignite the aggressive impulses at the root of this personality disorder -*Cognitive theorists*- they do propose that illogical thinking processes help keep it going ---They point to dichotomous—"black-and-white"—thinking, which may produce rigidity and perfectionism. ---they note that people with this disorder tend to misread or exaggerate the potential outcomes of mistakes or errors.

Dramatic Personality Disorders- Narcissistic Personality disorder Explained

-*Psychodynamic theorists*- the problem begins with cold, rejecting parents. They argue that some people with this background spend their lives defending against feeling unsatisfied, rejected, unworthy, and wary of the world --- They do so by repeatedly telling themselves that they are actually perfect and desirable, and also by seeking admiration from others. ---*Object relations theorists*- nterpret the grandiose self-image as a way for these people to convince themselves that they are totally self-sufficient and without need of warm relationships with their parents or anyone else ---research has found that children who are abused or who lose parents through adoption, divorce, or death are at particular risk for the later development of narcissistic personality disorder -*Cognitive Behavioral Theorists*- say that NPD may develop when people are treated too positively rather than too negatively in early life. ---certain individuals acquire a superior and grandiose attitude when their "admiring or doting parents" teach them to "overvalue their self worth," repeatedly rewarding them for minor accomplishments or for no accomplishment at all -*Sociocultural Theorists*- see a link between narcissistic personality disorder and "eras of narcissism" in society ---They suggest that family values and social ideals in certain societies periodically break down, producing generations of youth who are self-centered and materialistic and have short attention spans ---Especially in Western Cultures- which encourage self-expression, individualism, and competitiveness, are considered likely to produce such generations of narcissism ---In fact, one worldwide study conducted on the Internet found that respondents from the United States had the highest narcissism scores, followed, in descending order, by individuals from Europe, Canada, Asia, and the Middle East

Odd Personality Disorders- Schizoid Personality Disorder

-*Schizoid personality disorder*: A personality disorder in which a person persistently avoids social relationships and shows little emotional expression. -Like people with paranoid personality disorder, these individuals do not have close ties with other people. The reason they avoid social contact, however, has nothing to do with paranoid feelings of distrust or suspicion; *it is because they genuinely prefer to be alone* -People with schizoid personality disorder focus mainly on themselves and are generally unaffected by praise or criticism. -They rarely show any feelings, expressing neither joy nor anger. - They seem to have no need for attention or acceptance; are typically viewed as cold, humorless, or dull; and generally succeed in being ignored. -This disorder is estimated to be present in fewer than 1 percent of the population -It is slightly more likely to occur in men than in women, and men may also be more impaired

Odd Personality disorders- Schizotypal Personality Disorder

-*Schizotypal personality disorder*: A personality disorder characterized by extreme discomfort in relationships, odd forms of thinking and perceiving, and behavioral eccentricities. -Symptoms may include ideas of reference and bodily illusions ---*ideas of reference*—beliefs that unrelated events pertain to them in some important way ---*bodily illusions*- such as sensing an external "force" or presence. -Examples of schizotypal eccentricities include: repeatedly arranging cans to align their labels, organizing closets extensively, or wearing an odd assortment of clothing. -The emotions of these individuals may be inappropriate, flat, or humorless. -Have problems keeping attention -Their conversation is typically vague and has hints of loose associations -Work undemanding jobs usually below their capacity so they can avoid interacting with others -2%-4% of all ppl- slightly more males than females- have this

Categories vs. Dimensions

-A growing number of theorists believe that personality disorders differ more in degree than in type of dysfunction. - they propose that the disorders should be classified by the severity of key personality traits *or dimensions* rather than by the presence or absence of specific traits ---*DIMENSIONS*- each key trait (for example, disagreeableness, dishonesty, or self-absorption) would be seen as varying along a continuum in which there is no clear boundary between normal and abnormal. -People with a personality disorder would be those who display extreme degrees of several of these key traits—degrees not commonly found in the general population.

Odd Personality disorders- Schizotypal Personality Disorder Explained

-Because the disorders symptoms very vividly reflect schizophrenia, researchers have hypothesized that similar factors are at work in both disorders -They have in fact found that schizotypal symptoms, like schizophrenic ones, are often linked to family conflicts and to psychological disorders in parents -They have also learned that defects in attention and short-term memory may contribute to schizotypal personality disorder, just as they apparently do to schizophrenia -Finally, researchers have begun to link schizotypal personality disorder to some of the same biological factors found in schizophrenia, such as high activity of the neurotransmitter dopamine, enlarged brain ventricles, smaller temporal lobes, and loss of gray matter -Although these findings do suggest a close relationship between schizotypal personality disorder and schizophrenia, the personality disorder also has been linked to disorders of mood -Over 50% of the ppl with personality disorder also suffer from major depressive disorder at some point in their lives -relatives of people with major depressive disorder have a higher than usual rate of schizotypal personality disorder, and vice versa. Thus, at the very least, this personality disorder is not tied exclusively to schizophrenia.

Classifying Personality Disorders

-DSM 5 identifies 10 personality disorders -Often these disorders are separated into three groups, or clusters. -One Cluster: (Marked by odd or eccentric behavior) consist of *paranoid, schizoid, and schizotypal* personality disorders -Second cluster: (features dramatic behavior) consists of *antisocial, borderline, histrionic, and narcissistic* personality disorder -Third and final cluster: (features high degree of anxiety) includes *avoidant, dependent, and obsessive-compulsive* personality disorders. -DSMs listing of 10 distinct personality disorders is called a *categorical approach)- this kind of approach assumes that (1) problematic personality traits are either present or absent in people, (2) a personality disorder is either displayed or not displayed by an individual, and (3) a person who suffers from a personality disorder is not markedly troubled by personality traits outside of that disorder. -*Problems*-the symptoms of the personality disorders listed in DSM-5 overlap so much that clinicians often find it difficult to distinguish one disorder from another resulting in frequent disagreements about which diagnosis is correct for a person with a personality disorder. ---This lack of agreement has raised serious questions about the validity (accuracy) and reliability (consistency) of the 10 DSM-5 categories. -Many clinicians prefer to see Personality disorders as dimensional approaches -*dimensional approach*-each trait is seen as varying along a continuum extending from nonproblematic to extremely problematic. ---People with a personality disorder are those who display extreme degrees of problematic traits—degrees not commonly found in the general population. -as many as 9 to 13 percent of adults have such a disorder. DSM-5 uses a categorical approach that lists 10 distinct personality disorders. In addition, the framers of DSM-5 proposed a dimensional approach to the classification of personality disorders, an approach that they assigned for further study and possible inclusion in a future revision of DSM-5.

Dramatic Personality Disorders- Antisocial Personality Disorder Explanations

-Explanations of antisocial personality disorder come from the psychodynamic, behavioral, cognitive, and biological models. -*Psychodynamic theorists*-propose that this disorder starts with an absence of parental love during infancy, leading to a lack of basic trust ---In this view, some children—the ones who develop antisocial personality disorder—respond to the early inadequacies by becoming emotionally distant, and they bond with others through the use of power and destructiveness. ---In support of the psychodynamic explanation, researchers have found that people with antisocial personality disorder are more likely than others to have had significant stress in their childhoods, particularly in such forms as family poverty, family violence, and parental conflict or divorce -*Behavioral therapists*-have suggested that antisocial symptoms may be learned through modeling, or imitation ---As evidence, they point to the higher rate of antisocial personality disorder found among the parents of people with this disorder ---Other behaviorists have suggested that some parents unintentionally teach antisocial behavior by regularly rewarding a child's aggressive behavior -*Cognitive Therapists*-says that people with antisocial personality disorder hold attitudes that trivialize the importance of other people's needs. ---Cognitive theorists further propose that people with this disorder have genuine difficulty recognizing a point of view other than their own. -*Biological Factors*-Researchers have found that antisocial people, particularly those who are highly impulsive and aggressive, display lower serotonin activity than other individuals --both impulsivity and aggression also have been linked to low serotonin activity in other kinds of studies, so the presence of this biological factor in people with antisocial personality disorder is not surprising. ---Other studies further indicate that individuals with this disorder display deficient functioning in their frontal lobes, and particularly the prefrontal cortex ---mong other duties, this brain region helps individuals to plan and execute realistic strategies and to experience personal characteristics such as sympathy, judgment, and empathy. These are, of course, all qualities absent in people with antisocial personality disorder. ---people with antisocial personality disorder would be more likely than other people to take risks and seek thrills.

Dramatic Personality Disorders- Narcissistic Personality disorder Treatments

-Narcissistic personality disorder is one of the most difficult personality patterns to treat because the clients are unable to acknowledge weaknesses, to appreciate the effect of their behavior on others, or to incorporate feedback from others -The clients who consult therapists usually do so because of a related disorder, most commonly depression -*Psychodynamic therapists* seek to help people with this disorder recognize and work through their basic insecurities and defenses -*Cognitive Therapists*- try to redirect the clients' focus onto the opinions of others, teach them to interpret criticism more rationally, increase their ability to empathize, and change their all-or-nothing notions

Anxious Personality Disorders- Avoidant Personality Disorders Treatments

-People with avoidant personality disorder come to therapy in the hope of finding acceptance and affection. -Keeping them in treatment can be a challenge for many of them because they begin to avoid the sessions. -Beyond building trust, therapists tend to treat people with avoidant personality disorder much as they treat people with social anxiety disorder and other anxiety disorders -*Psychodynamic Therapists*- try to help clients recognize and resolve the unconscious conflicts that may be operating -*Cognitive Therapists*- help them change their distressing beliefs and thoughts and improve their self-image -*Behavioral Therapists*- provide social skills training as well as exposure treatments that require people gradually to increase their social contact - Group therapy formats, especially groups that follow cognitive and behavioral principles, have the added advantage of providing clients with practice in social interactions -Antianxiety and antidepressant drugs are sometimes useful in reducing the social anxiety of people with the disorder, although the symptoms may return when medication is stopped

Dramatic Personality Disorders- Histrionic Personality Disorder Treatment

-People with histrionic personality disorder are more likely than those with most other personality disorders to seek out treatment on their own -Working with them can be difficult because of the demands, tantrums, and seductiveness they are likely to deploy. -Another problem is that these individuals may pretend to have important insights or to experience change during treatment merely to please the therapist. -*Cognitive therapists* have tried to help people with this disorder to change their belief that they are helpless and also to develop better, more deliberate ways of thinking and solving problems -In all these approaches, therapists ultimately aim to help the clients recognize their excessive dependency, find inner satisfaction, and become more self-reliant -Drug therapy appears less successful except as a means of relieving the depressive symptoms experienced by some patients

Anxious Personality disorders: OCD treatments

-People with obsessive-compulsive personality disorder do not usually believe there is anything wrong with them. -They are not likely to seek treatment unless they are also suffering from another disorder or unless someone close to them insists that they get treatment -*Psychodynamic therapy*- typically try to help them recognize, experience, and accept their underlying feelings and insecurities, and perhaps take risks and accept their personal limitations. -*Cognitive therapy*- seek to help clients change their dichotomous thinking, perfectionism, indecisiveness, procrastination, and chronic worrying. -*Biological Treatment* - ppl with OCD respond well to serotonin enhancing anti-depressants

Odd Personality Disorders- Paranoid Personality Disorder Treatments

-People with paranoid personality disorder do not typically see themselves as needing help, and few come to treatment willingly -therapy for this disorder, as for most other personality disorders, has limited success and moves very slowly -*Object relations therapists—the psychodynamic therapists who give center stage to relationships*—try to see past the patient's anger and work on what they view as his or her deep wish for a satisfying relationship -Cognitive and behavioral techniques have also been applied in cases of paranoid personality disorder, often combined into an integrated cognitive-behavioral approach. ---*On the behavioral side*, therapists help the individuals to master anxiety-reduction techniques and to improve their skills at solving interpersonal problems. ---*On the cognitive side*, therapists guide the clients to develop more realistic interpretations of other people's words and actions and to become more aware of other people's points of view *DRUG THERAPY SEEMS TO BE OF LIMITED HELP*

Anxious Personality Disorders

-The cluster of "anxious" personality disorders includes the avoidant, dependent, and obsessive-compulsive personality disorders. -People with these patterns typically display anxious and fearful behavior. -Although many of the symptoms of these disorders are similar to those of the anxiety and depressive disorders, researchers have not found direct links between this cluster and those disorders

Dramatic Personality Disorders

-The cluster of "dramatic" personality disorders includes the antisocial, borderline, histrionic, and narcissistic personality disorders. -The behaviors of people with these problems are so dramatic, emotional, or erratic that it is almost impossible for them to have relationships that are truly giving and satisfying. -These personality disorders are more commonly diagnosed than the others. -. However, only the antisocial and borderline personality disorders have received much study, partly because they create so many problems for other people. -The causes of the disorders, like those of the odd personality disorders, are not well understood. -Treatments range from ineffective to moderately effective.

Odd Personality disorders

-The cluster of "odd" personality disorders consists of the paranoid, schizoid, and schizotypal personality disorders. -People with these disorders typically display odd or eccentric behaviors that are similar to but not as extensive as those seen in schizophrenia, including extreme suspiciousness, social withdrawal, and peculiar ways of thinking and perceiving things. -Such behaviors often leave the person isolated. -Some clinicians believe that these personality disorders are actually related to schizophrenia, and they call them schizophrenia-spectrum disorders.

Odd Personality Disorders- Paranoid Personality Disorder Explanations

-The proposed explanations of paranoid personality disorder, like those of most other personality disorders, have received little systematic research -*Psychodynamic theories* the oldest of the explanations for this disorder, trace the pattern to early interactions with demanding parents, particularly distant, rigid fathers and overcontrolling, rejecting mothers ---According to one psychodynamic view, some individuals come to view their environment as hostile as a result of their parents' persistently unreasonable demands. ---They must always be on the alert because they cannot trust others, and they are likely to develop feelings of extreme anger ---They also project these feelings onto others and, as a result, feel increasingly persecuted ---Similarly, some cognitive theorists suggest that people with paranoid personality disorder generally hold broad maladaptive assumptions, such as "People are evil" and "People will attack you if given the chance" -*Biological Theorists*- propose that paranoid personality disorder has genetic causes

Odd Personality Disorders- Schizoid Personality Disorder Treatment

-Their social withdrawal prevents most people with schizoid personality disorder from entering therapy unless some other disorder, such as alcoholism, makes treatment necessary -These clients are likely to remain emotionally distant from the therapist, seem not to care about their treatment, and make limited progress at best -Cognitive-behavioral therapists have sometimes been able to help people with this disorder experience more positive emotions and more satisfying social interactions ---*On the cognitive end*, their techniques include presenting clients with lists of emotions to think about or having them write down and remember pleasurable experiences. ---*On the behavioral end*, therapists have sometimes had success teaching social skills to such clients, using role-playing, exposure techniques, and homework assignments as tools. *As with paranoid personality disorder, drug therapy seems to offer limited help*

Odd Personality disorders- Schizotypal Personality Disorder Treatments

-Therapy is as difficult in cases of schizotypal personality disorder as it is in cases of paranoid and schizoid personality disorders. -Most therapists agree on the need to help their clients "reconnect" with the world and recognize the limits of their thinking and their powers -The therapists may thus try to set clear limits—for example, by requiring punctuality—and work on helping the clients recognize where their views end and those of the therapist begin. -Other therapy goals are to increase positive social contacts, ease loneliness, reduce overstimulation, and help the individuals become more aware of their personal feelings -Cognitive-behavioral therapists further combine cognitive and behavioral techniques to help people with schizotypal personality disorder function more effectively. ---*Using cognitive interventions*, they try to teach clients to evaluate their unusual thoughts or perceptions objectively and to ignore the inappropriate ones ---*specific behavioral methods*, such as speech lessons, social skills training, and tips on appropriate dress and manners, have sometimes helped clients learn to blend in better with and be more comfortable around others -*Antipsychotic drugs have been given to people with schizotypal personality disorder, again because of the disorder's similarity to schizophrenia. In low doses the drugs appear to have helped some people, usually by reducing certain of their thought problem*

Dramatic Personality Disorders- Antisocial Personality Disorder Treatments

-Treatments for people with antisocial personality disorder are typically ineffective -A major obstacle to treatment is the individuals' lack of conscience or desire to change -Some cognitive therapists try to guide clients with antisocial personality disorder to think about moral issues and about the needs of other people -In a similar vein, a number of hospitals and prisons have tried to create a therapeutic community for people with this disorder, a structured environment that teaches responsibility toward others ---Some patients seem to profit from such approaches, but it appears that most do not. -clinicians have also used psychotropic medications, particularly atypical antipsychotic drugs, to treat people with antisocial personality disorder. ---Some report that these drugs help reduce certain features of the disorder, but systematic studies of this claim are still needed

"Big Five" Theory of Personality

-he basic structure of personality may consist of five "supertraits," or factors—*neuroticism,* *extroversion*, *openness to experiences*, *agreeableness,* and *conscientiousness* -Theoretically, everyone's personality can be summarized by a combination of these supertraits. -Many proponents of the Big Five model have argued further that it would be best to describe all people with personality disorders as being high, low, or in between on the five supertraits and to drop the use of personality disorder categories altogether -

Problems with classifying personality disorders

1. Some of the criteria used to diagnose the DSM-5 personality disorders cannot be observed directly. To separate paranoid from schizoid personality disorder, for example, clinicians must ask not only whether people avoid forming close relationships, but also why. In other words, the diagnoses often rely heavily on the impressions of the individual clinician. 2. Clinicians differ widely in their judgments about when a normal personality style crosses the line and deserves to be called a disorder. Some even believe that it is wrong ever to think of personality styles as mental disorders, however troublesome they may be. 3. The personality disorders often are very similar to one another. Thus it is common for people with personality problems to meet the diagnostic criteria for several DSM-5 personality disorders 4. People with quite different personalities may qualify for the same DSM-5 personality disorder diagnosis.

Anxious Personality Disorder- Dependent Personality Disorder Treatments

- In therapy, people with this personality disorder usually place all responsibility for their treatment and well-being on the clinician ---to counter this, a key task of therapy is to help patients accept responsibility for themselves -Treatment for dependent personality disorder can be at least modestly helpful. -*Psychodynamic therapy*- focuses on many of the same issues as therapy for depressed people, including the transference of dependency needs onto the therapist -*Cognitive-Behavioral therapy*- combines behavioral and cognitive interventions to help the clients take control of their lives. ---*On the behavioral end,* the therapists often provide assertiveness training to help the individuals better express their own wishes in relationships ---*On the cognitive end*, the therapists also try to help the clients challenge and change their assumptions of incompetence and helplessness -Antidepressant drug therapy has been helpful for persons whose personality disorder is accompanied by depression -a group therapy format can be helpful because it provides opportunities for the client to receive support from a number of peers rather than from a single dominant person