Chapter 9  Personality Disorders

Slide 1: Time to think...

Slide 2: Sometimes it's not the environment that is the problem...

Slide 3: What are personality disorders?

Slide 4: Different than personality in...

Slide 5: Different than Axis I disorders in that they...

Slide 6: Why pay attention to Axis II?

Slide 7: Problems with Axis II

Slide 8: One solution: Personality as dimensions

Slide 9: Comorbidity

Slide 10: Prevalence and gender differences (APA, 1994)

Paranoid                                  .5-2.5%  MM > FF
Schizoid                                  .2-.3%  MM > FF
Schizotypal                              2.5-3%  MM > FF
Histrionic                                .7-3%  None
Narcissistic                             .3 - 1% MM > FF
Antisocial                                2%  MM > FF
Borderline                               1-2% FF > MM
Avoidant                                 .3-1% None
Dependent                              1.9-2.5% ???
Obsessive-compulsive            1-1.9% MM > FF

Slide 10: Interpersonal Circumplex Model of Personality (Wiggins & Pincus, 1994)

Slide 11: Gender differences???

Slide 12: What do you see?

James is a rather immature 35-year-old man with poor social skills.  Others especially note his problems with social situations in that he prefers to be the center of attention, and will engage in a variety of behaviors to get it (especially sexualizing relationships and overdramatic descriptions of his life and experiences).  Initially others see him as charming, but they are often put off by the shallowness of his experience and expression of emotions.  Despite this, he believes that his relationships are truly intimate: last week he reported that "he had just found his one true love," while today he believes that relationship was "nothing."  He has had no close, long-term sexual relationships.  His lack of real affection for others had been demonstrated by a history of selfish and self-centered behavior.
                                                                                                                                (After Ford & Widiger, 1989)

Slide 13: What do you see?

Marilynn, 25, has a series of confrontations with others over the last several years, several of which have resulted in her arrest and brief jail terms.  Despite this, she fails to see a problem in her behavior: She sees herself as a "victim" who has been "taken advantage of."  Although frequently described as "charming," she says others often lose patience with her.  They are upset by such things as her tendency to lie to them, to behave impulsively, and to "drop into their lives" at the drop of a hat, then disappear.  She has rarely held a job for even as long as a year and has had a series of shallow relationships.
                                                                                                                                (After Ford & Widiger, 1989)

Slide 14: Gender differences???

Slide 15: Antisocial Personality Disorder (APA, 1994)

pervasive pattern of disregard for & violation of rights of others (3+):
(1) failure to conform to social norms with respect to   lawful behaviors;
(2) deceitfulness;
(3) impulsivity or failure to plan ahead;
(4) irritability & aggressiveness;
(5) reckless disregard for safety of self and others;
(6) consistent irresponsibility;
(7) lack of remorse
                                   p. 384

Slide 16: Histrionic Personality Disorder (APA, 1994)

Pervasive pattern of excessive emotionality & attention seeking (5+):
(1) uncomfortable if not center of attention;
(2) interactions with others is often inappropriately   sexually provocative or seductive;
(3) rapidly shifting & shallow expression of emotions;
(4) uses physical appearance to draw attention to self;
(5) impressionistic speech lacking in detail;
(6) exaggerated expression of emotion & theatricality;
(7) very suggestible;
(8) overestimates the intimacy of their relationships.
                                    p. 398

Slide 17: Gender differences???

Slide 18: Time to think...

Some people attribute Antisocial Personality Disorder to chaotic home environments during childhood characterized by strife and discord.  Given this, what would you want to do to reduce the probability of Antisocial Personality Disorder?  Why?

Slide 19: Psychopathy (a negative view)

People with antisocial personality disorder can be described as "social predators who charm, manipulate, and ruthlessly plow their way through life, leaving a broad trail of broken hearts, shattered expectations, and empty wallets.  Completely lacking in conscience and in feelings for others, they selfishly take what they want and do as they please, violating social norms and expectations without the slightest sense of guilt or regret."  (Hare, 1993, p. xi)

Slide 20: Psychopathy Checklist -- Revised

Slide 21: Psychopathy (a more positive view)

Wanted: charming, aggressive, carefree people who are impulsively irresponsible but good at handling people and at looking after number one.  (Widom, 1977)

Slide 22: Who we're most likely to see...

Slide 23: Who we're not going to see...

Slide 24: Antisocial Personality Disorder (APA, 1994)

pervasive pattern of disregard for & violation of rights of others (3+):
(1) failure to conform to social norms with respect to   lawful behaviors;
(2) deceitfulness;
(3) impulsivity or failure to plan ahead;
(4) irritability & aggressiveness;
(5) reckless disregard for safety of self and others;
(6) consistent irresponsibility;
(7) lack of remorse
                                     p. 384

Slide 25: Causes of antisocial personality disorder: Genetic

Slide 26: Influences on adoptees’ behavior (Ge et al., 1996)

Slide 27: Causes of antisocial personality disorder: Underarousal

Slide 28: Causes of antisocial personality disorder: Home environment

Slide 29: Time to think...

One of the defining features of Borderline Personality Disorder is a fear of abandonment combined with almost frantic attempts to avoid it (and sometimes a way to bring it on).  Are there times when you feel this way?  What about a situation makes you feel this way?  What might this tell you about a person who tends to respond this way?

Slide 30: Borderline Personality Disorder (APA, 1994)

Pervasive pattern of instability of interpersonal relationships, self-image, affect, marked impulsivity (5+):
(1) frantic efforts to avoid abandonment,
(2) pattern of unstable & intense interpersonal    relationships alternating between extremes of
      idealization & devaluation,
(3) identity disturbance,
(4) impulsivity that is potentially self-damaging (e.g.,   spending, sex, substance abuse, reckless
      driving, binge eating),
(5) recurrent suicidal behavior, gestures, self-mutilation;
(6) affective instability due to marked reactivity of mood;
(7) chronic feelings of emptiness;
(8) inappropriate intense anger or difficulty controlling   anger; transient stress-related paranoid
      ideation or  severe dissociation.
                                                                                p. 403

Slide 31: Some facts...


Slide 32: Bryan (23 years old)

He was active in student government and was viewed as charismatic, articulate, and sociable. When he met other students for the first time, he could often convince them to participate in campus activities that interested him. Women were quite attracted to him because of his charm and self-disclosing nature. They described him as being exciting, intense, and different from other men. Bryan could form close relationships with others very quickly.

Bryan could not, however, maintain his social relationships. Sometimes he would have a brief but intense affair with a woman and then abruptly and angrily ask himself what he ever saw in her. At other times, the woman would reject him after a few dates, because she thought Bryan was moody, self-centered, and demanding. He often called his friends after midnight because he felt lonesome, empty, bored, and wanted to talk. Several times he threatened to commit suicide... (Sue, Sue, & Sue, 1997, p. 228)

Slide 33: Instability in...

  • Interpersonal relationships
    • Vacillates between intense love and hate
    • Often feel ÒabandonedÓ
  • Emotionally
    • Rapid shifts in moods
  • Identity
    • Have difficulty knowing who they are
    • Often describe themselves as ÒemptyÓ
  • Behaviorally
    • Unsafe sex, gambling, binge eating, drugs, spending, driving
    • Suicidal behaviors
    • Self-mutilation

Slide 34: Typical cognitive distortions
  1. The world is a dangerous place.
  2. I am powerless and vulnerable.
  3. I am inherently unacceptable.

    Slide 35: Therapeutic issues

    • Very poor sense of self-worth
    • Poor coping skills
    • Difficult relationships with others
    • Extreme difficulty trusting others, expects rejection

    Slide 36: Treatment of choice

    • Dialectical behavior therapy
        • 1. Reduces most dysfuntional and out of control aspects of behavior
        2. Explore past traumas associated with current problems
        3. Encourage clients to value selves and gain self-confidence
    • Outcomes:
        • Less likely to drop out than with other treatments.
        About 65% show at least moderate improvement
        Less likely to make threats of suicide.
        Therapy tends to be slow and difficult.

      Often supplemented by antidepressants and antipsychotics


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    Last modified November 1, 2001.

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