Personality Disorder

Personality DisordersPersonality Disorders

 Personality Disorder definition/sPersonality Disorder definition/s
 Clinical features of Personality DisordersClinical features of Personality Disorders
 3 Clusters of Personality Disorders3 Clusters of Personality Disorders
 Difficulties in research and studying the causesDifficulties in research and studying the causes
of Personality Disordersof Personality Disorders
 Treatments/InterventionsTreatments/Interventions
Outline:Outline:

What is a Personality Disorder?What is a Personality Disorder?

 Personality DisorderPersonality Disorder –– an enduring pattern ofan enduring pattern of
inner experience and behavior that deviates markedlyinner experience and behavior that deviates markedly
from the expectations of the individual’s culture, isfrom the expectations of the individual’s culture, is
pervasive and inflexible, has an onset in adolescencepervasive and inflexible, has an onset in adolescence
or early adulthood, is stable overtime, and leads toor early adulthood, is stable overtime, and leads to
distress or impairment.distress or impairment. (DSM-5)(DSM-5)
( formerly known as a( formerly known as a ““character disordercharacter disorder”” ))
Definition:Definition:

 Personality DisorderPersonality Disorder –– A type of mentalA type of mental
disorder in which you have rigid and unhealthydisorder in which you have rigid and unhealthy
pattern of thinking, functioning and behaving.pattern of thinking, functioning and behaving.
Definition:Definition:

 GeneticGenetic
 Childhood TraumaChildhood Trauma
 Verbal AbuseVerbal Abuse
 High ReactivityHigh Reactivity
 PeersPeers
(source:(source: www.apa.orgwww.apa.org – American Psychological Association )– American Psychological Association )
Personality Disorders’ causes:Personality Disorders’ causes:

Clinical Features of PersonalityClinical Features of Personality
DisorderDisorder

chronic interpersonal difficultieschronic interpersonal difficulties
problems with one’s identityproblems with one’s identity (( sense of selfsense of self ))
(Livesly, 2001)(Livesly, 2001)
Clinical Features of PersonalityClinical Features of Personality
Disorder:Disorder:

Must be pervasive and inflexibleMust be pervasive and inflexible
Stable and of long durationStable and of long duration
Causes clinically significant distress or impairmentCauses clinically significant distress or impairment
(cognition, affect, interpersonal, functioning, impulse(cognition, affect, interpersonal, functioning, impulse
control)control)
Diagnosing Personality DisorderDiagnosing Personality Disorder
((criteria summarycriteria summary))

Difficulties Doing Research onDifficulties Doing Research on
Personality DisordersPersonality Disorders

Difficulties in diagnosingDifficulties in diagnosing
Difficulties in studying the causesDifficulties in studying the causes
Two major difficulties:Two major difficulties:

3 Clusters of Personality Disorder3 Clusters of Personality Disorder

ClustersClusters of Personality Disorder:of Personality Disorder:
Cluster ACluster A Cluster BCluster B Cluster CCluster C
ParanoidParanoid
SchizoidSchizoid
SchizotypalSchizotypal
HistrionicHistrionic
NarcissisticNarcissistic
AntisocialAntisocial
BorderlineBorderline
AvoidantAvoidant
DependentDependent
Obsessive-compulsiveObsessive-compulsive

ClustersClusters of Personality Disorder:of Personality Disorder:
Cluster ACluster A Cluster BCluster B Cluster CCluster C
People with these disordersPeople with these disorders
often seem odd oroften seem odd or
eccentric, with unusualeccentric, with unusual
behavior ranging frombehavior ranging from
distrust and suspiciousnessdistrust and suspiciousness
to social detachment.to social detachment.
have a tendency to behave a tendency to be
dramatic, emotional, anddramatic, emotional, and
erratic.erratic.
often show anxiety andoften show anxiety and
fearfulness.fearfulness.

Cluster A Personality DisordersCluster A Personality Disorders ((33))

 Paranoid Personality DisorderParanoid Personality Disorder
 Schizoid Personality DisorderSchizoid Personality Disorder
 Schizotypal Personality DisorderSchizotypal Personality Disorder
Cluster ACluster A ((33))

Paranoid Personality DisorderParanoid Personality Disorder

(Cluster A)(Cluster A)
 Paranoid Personality DisorderParanoid Personality Disorder –– havehave
pervasive suspiciousness and distrust of others.pervasive suspiciousness and distrust of others.
 other characteristics include:other characteristics include: tendency to see self astendency to see self as
blameless; on guard for perceived attacks by others.blameless; on guard for perceived attacks by others.
Prevalence:Prevalence: National Comorbidity Survey Replication -National Comorbidity Survey Replication - 2.3%2.3%
National Epidemiologic Survey on Alcohol and RelatedNational Epidemiologic Survey on Alcohol and Related
Conditions –Conditions – 4.4%4.4%

Prevalence:Prevalence: National Comorbidity Survey Replication -National Comorbidity Survey Replication - 2.3%2.3%
Causes:Causes: Little is known (maybe genetic/heritability)Little is known (maybe genetic/heritability)
Treatment:Treatment: People diagnosed with PPD are hard to treat.People diagnosed with PPD are hard to treat.
If sought:If sought: PsychotherapyPsychotherapy

Case:Case: Paranoid Personality DisorderParanoid Personality Disorder

Case: Paranoid Personality DisorderCase: Paranoid Personality Disorder
Paranoid Construction WorkerParanoid Construction Worker
A 40-year-old construction worker believes that his co-workers doA 40-year-old construction worker believes that his co-workers do
not like him and fears that someone might let his scaffolding slipnot like him and fears that someone might let his scaffolding slip
in order to cause him injury on the job. This concern followed ain order to cause him injury on the job. This concern followed a
recent disagreement on the lunch line when the patient felt that arecent disagreement on the lunch line when the patient felt that a
coworker was sneaking ahead and complained to him. He begancoworker was sneaking ahead and complained to him. He began
noticing his new “enemy” laughing with other men and oftennoticing his new “enemy” laughing with other men and often
wondered if he were the butt of their mockery….wondered if he were the butt of their mockery….

The patient offers little spontaneous information, sits tensely in theThe patient offers little spontaneous information, sits tensely in the
chair, is wide-eyed, and carefully tracks all movements in thechair, is wide-eyed, and carefully tracks all movements in the
room. He reads between the lines of the interviewer is siding hisroom. He reads between the lines of the interviewer is siding his
coworkers…coworkers…
He was a loner boy and felt that other children would form cliquesHe was a loner boy and felt that other children would form cliques
and be mean to him. He did poorly in school but blamed hisand be mean to him. He did poorly in school but blamed his
teachers – he claimed that they preferred girls or boys who wereteachers – he claimed that they preferred girls or boys who were
“sissies”. He dropped out of school and has since been a hard and“sissies”. He dropped out of school and has since been a hard and
effective worker, but he feels he never gets the breaks. He believeseffective worker, but he feels he never gets the breaks. He believes

that he has been discriminated against because of Catholicism butthat he has been discriminated against because of Catholicism but
can offer little convincing evidence. He gets on poorly with bossescan offer little convincing evidence. He gets on poorly with bosses
and coworkers, is unable to appreciate joking around, and doesand coworkers, is unable to appreciate joking around, and does
best in situations where he can work and have lunch alone. He hasbest in situations where he can work and have lunch alone. He has
switched jobs many times because he felt he was being mistreated.switched jobs many times because he felt he was being mistreated.
The patient is distant and demanding with his family. His childrenThe patient is distant and demanding with his family. His children
call him “Sir” and know that it is wise to be “seen but not heard”call him “Sir” and know that it is wise to be “seen but not heard”
when he is around… He prefers not to have people visit his housewhen he is around… He prefers not to have people visit his house
and becomes restless when his wife is away visiting others.and becomes restless when his wife is away visiting others.

Schizoid Personality DisorderSchizoid Personality Disorder

 Schizoid Personality DisorderSchizoid Personality Disorder –– areare
usually unable to form social relationships andusually unable to form social relationships and
usually lack much interest in doing so.usually lack much interest in doing so.
 other characteristics include:other characteristics include: unable to express theirunable to express their
feelings, seen by others as distant and cold. Don’tfeelings, seen by others as distant and cold. Don’t
take pleasure in many activities like sexual activity.take pleasure in many activities like sexual activity.
Rarely marry.Rarely marry.

 Prevalence:Prevalence: National Comorbidity Survey Replication –National Comorbidity Survey Replication – 4.9%4.9%
Conditions (2001-2002) –Conditions (2001-2002) – 3.1%3.1%
 Cause/s:Cause/s: Little is knownLittle is known
 Treatment:Treatment: People diagnosed with Schizoid don’t reallyPeople diagnosed with Schizoid don’t really
come for treatment.come for treatment.

Schizotypal Personality DisorderSchizotypal Personality Disorder

 Schizotypal Personality DisorderSchizotypal Personality Disorder –– areare
excessively introverted and have pervasive social andexcessively introverted and have pervasive social and
interpersonal deficits (like those that occur in schizoidinterpersonal deficits (like those that occur in schizoid
personality disorder), but in addition they havepersonality disorder), but in addition they have
cognitive and perceptual distortions, as well ascognitive and perceptual distortions, as well as
oddities and eccentricities in their communication andoddities and eccentricities in their communication and
behavior.behavior.

other characteristics include:other characteristics include: highly personalized andhighly personalized and
superstitious thinking, experience transient psychoticsuperstitious thinking, experience transient psychotic
symptoms. Often believe they have magical powers andsymptoms. Often believe they have magical powers and
may engage in magical rituals. Odd speech, andmay engage in magical rituals. Odd speech, and
paranoid beliefs.paranoid beliefs.
Prevalence:Prevalence: National Epidemiologic Survey on Alcohol and RelatedNational Epidemiologic Survey on Alcohol and Related

Prevalence:Prevalence: National Epidemiologic Survey on Alcohol and RelatedNational Epidemiologic Survey on Alcohol and Related
Cause/s:Cause/s: Little is known/linked with SchizophreniaLittle is known/linked with Schizophrenia
(genetic/heritability)(genetic/heritability)
Treatment:Treatment: PsychotherapyPsychotherapy

Possible Medications (no specific drugs)Possible Medications (no specific drugs)

Case:Case: Schizotypal Personality DisorderSchizotypal Personality Disorder

Case: Schizotypal Personality DisorderCase: Schizotypal Personality Disorder
The Introverted Computer AnalystThe Introverted Computer Analyst
Bill, a highly intelligent but quiet introverted and withdrawn 33-Bill, a highly intelligent but quiet introverted and withdrawn 33-
year old computer analyst, was referred for psychologicalyear old computer analyst, was referred for psychological
evaluation by his physician, who was concerned that Bill might beevaluation by his physician, who was concerned that Bill might be
depressed and unhappy. Bill had virtually no contact with otherdepressed and unhappy. Bill had virtually no contact with other
people. He lived alone in his apartment, worked in a small officepeople. He lived alone in his apartment, worked in a small office
by himself, and usually saw no one at work except his supervisor,by himself, and usually saw no one at work except his supervisor,
who occasionally visited to give him new work and pick upwho occasionally visited to give him new work and pick up
completed projects.completed projects.

He ate lunch by himself, and about once a week, on nice days,He ate lunch by himself, and about once a week, on nice days,
went to the zoo for lunch break. Bill was a lifelong loner; as awent to the zoo for lunch break. Bill was a lifelong loner; as a
child he had few friends and had always preferred solitarychild he had few friends and had always preferred solitary
activities over family outings (he was the oldest of five children).activities over family outings (he was the oldest of five children).
In high school he had never dated and in college had gone out withIn high school he had never dated and in college had gone out with
a woman only once – and that was with a group of students after aa woman only once – and that was with a group of students after a
game. He had been active in sports, however, and had playedgame. He had been active in sports, however, and had played
varsity football in both high school and college.varsity football in both high school and college.

In college he had spent a lot of time with one relatively closeIn college he had spent a lot of time with one relatively close
friend – mostly drinking. However, this friend now lived infriend – mostly drinking. However, this friend now lived in
another city. Bill reported rather matter-of-factly that he ahd aanother city. Bill reported rather matter-of-factly that he ahd a
hard time making friends; he never knew what to say in ahard time making friends; he never knew what to say in a
conversation. On a number of occasions he had thought ofconversation. On a number of occasions he had thought of
becoming friends with other people but simply couldn’t think ofbecoming friends with other people but simply couldn’t think of
the right words, so “the conversation just died”.the right words, so “the conversation just died”.

He reported that he had given some thought lately to changing hisHe reported that he had given some thought lately to changing his
life in an attempt to be more “positive", but it had never seemedlife in an attempt to be more “positive", but it had never seemed
worth the trouble. It was easier for him not to make effort becauseworth the trouble. It was easier for him not to make effort because
he became embarrassed when someone tried to talk to talk withhe became embarrassed when someone tried to talk to talk with
him. He was happiest when he was alone…him. He was happiest when he was alone…

Cluster B Personality DisordersCluster B Personality Disorders ((44))

1.1. Histrionic Personality DisorderHistrionic Personality Disorder
2.2. Narcissistic Personality DisorderNarcissistic Personality Disorder
3.3. Antisocial Personality DisorderAntisocial Personality Disorder
4.4. Borderline Personality DisorderBorderline Personality Disorder
Cluster BCluster B ((44))

Histrionic Personality DisorderHistrionic Personality Disorder

(Cluster B)(Cluster B)
 Histrionic Personality DisorderHistrionic Personality Disorder ––
includesincludes excessive attention-seeking behavior andexcessive attention-seeking behavior and
emotionality.emotionality.
 other characteristics include:other characteristics include: have lively, dramatic,have lively, dramatic,
and excessively extraverted styles of relationship,and excessively extraverted styles of relationship,
appearance and behavior are often theatrical andappearance and behavior are often theatrical and
emotional. Speech is often vague and impressionistic.emotional. Speech is often vague and impressionistic.

Prevalence:Prevalence: National Epidemiologic Survey on Alcohol and RelatedNational Epidemiologic Survey on Alcohol and Related
Conditions (2001-2002)–Conditions (2001-2002)– 1.84%1.84%
 Cause/s:Cause/s: Little is known/Genetic and EnvironmentalLittle is known/Genetic and Environmental
 Treatment: PsychptherapyTreatment: Psychptherapy

Case:Case: Histrionic Personality DisorderHistrionic Personality Disorder

Case: Histrionic Personality DisorderCase: Histrionic Personality Disorder
A Histrionic WifeA Histrionic Wife
Lulu, a 24-year-old housewife, was seen in an impatient unitLulu, a 24-year-old housewife, was seen in an impatient unit
several days after she had been picked up for “vagrancy” after herseveral days after she had been picked up for “vagrancy” after her
husband had left her at the bus station to return her to her ownhusband had left her at the bus station to return her to her own
family because he was tired of her behavior and of taking care offamily because he was tired of her behavior and of taking care of
her. Lulu showed up for the interview all made-up and in a veryher. Lulu showed up for the interview all made-up and in a very
feminine robe, with her hair done in a very special way.feminine robe, with her hair done in a very special way.

Throughout the interview with a male psychiatrist, she showedThroughout the interview with a male psychiatrist, she showed
flirtatious and somewhat childlike seductive gestures and talked inflirtatious and somewhat childlike seductive gestures and talked in
a rather vague way about her problems and her life. Her chiefa rather vague way about her problems and her life. Her chief
complaints were that her husband had deserted her and that shecomplaints were that her husband had deserted her and that she
couldn’t return to her family because two of her brothers hadcouldn’t return to her family because two of her brothers had
abused her. Moreover, she had no friends to turn to and wasn’tabused her. Moreover, she had no friends to turn to and wasn’t
sure how she was going to get along.sure how she was going to get along.

Indeed, she complained that she had never had female friends,Indeed, she complained that she had never had female friends,
whom she felt just didn’t like her, although she wasn’t quite surewhom she felt just didn’t like her, although she wasn’t quite sure
why, assuring the interviewer that she was a very nice and kindwhy, assuring the interviewer that she was a very nice and kind
person.person.

Recently, she and her husband had been out driving with a coupleRecently, she and her husband had been out driving with a couple
who were friends of her husband’s. The wife had accused Lulu ofwho were friends of her husband’s. The wife had accused Lulu of
being overly seductive toward the wife’s husband, and Lulu hadbeing overly seductive toward the wife’s husband, and Lulu had
been hurt, thinking her behavior was perfectly innocent and notbeen hurt, thinking her behavior was perfectly innocent and not
out of line.out of line.

This incident led to a big argument with her own husband, one in aThis incident led to a big argument with her own husband, one in a
long series over the past six months in which he complained aboutlong series over the past six months in which he complained about
her inappropriate behavior around other men and about how vainher inappropriate behavior around other men and about how vain
and needing of attention she was. These arguments and her failureand needing of attention she was. These arguments and her failure
to change her behavior had ultimately led her husband to desertto change her behavior had ultimately led her husband to desert
her.her.

Narcissistic Personality DisorderNarcissistic Personality Disorder

 Narcissistic Personality DisorderNarcissistic Personality Disorder ––
shows an exaggerated sense of self-importance, ashows an exaggerated sense of self-importance, a
preoccupation with being admired, and a lack ofpreoccupation with being admired, and a lack of
empathy for the feelings of others (Pincus &empathy for the feelings of others (Pincus &
Lukowitsky, 2010; Rnningstam, 2005, 2009, 2012)Lukowitsky, 2010; Rnningstam, 2005, 2009, 2012)

2 subtypes of narcissism:2 subtypes of narcissism: Grandiose and VulnerableGrandiose and Vulnerable
Narcissism.Narcissism.
Grandiose NarcissismGrandiose Narcissism –– is manifested by traits related tois manifested by traits related to
grandiosity, aggression, and dominance.grandiosity, aggression, and dominance.
Vulnerable NarcissismVulnerable Narcissism –– have fragile and unstable sensehave fragile and unstable sense
of self-esteem. Arrogance and condescension is merely aof self-esteem. Arrogance and condescension is merely a
façade for intense shame and hypersensitivity tofaçade for intense shame and hypersensitivity to
rejection.rejection.

Prevalence:Prevalence: 0% - 6.2%0% - 6.2% in community samplesin community samples
Cause/s:Cause/s: Parental overvaluation or Parenting styles,Parental overvaluation or Parenting styles,
Emotional/Physical/Sexual AbuseEmotional/Physical/Sexual Abuse
Treatment: Psychotherapy, MedicationsTreatment: Psychotherapy, Medications

Case:Case: Narcissistic Personality DisorderNarcissistic Personality Disorder

Case: Narcissistic Personality DisorderCase: Narcissistic Personality Disorder
A Narcissistic StudentA Narcissistic Student
A 25-year-old, single graduate student complains to hisA 25-year-old, single graduate student complains to his
psychoanalyst of difficulty completing his Ph.D. in Englishpsychoanalyst of difficulty completing his Ph.D. in English
literature and expresses concerns about his relationships withliterature and expresses concerns about his relationships with
women. He believes that his thesis topic may profoundly increasewomen. He believes that his thesis topic may profoundly increase
the level of understanding in his discipline and make him famous,the level of understanding in his discipline and make him famous,
but so far he has not been able to get past the third chapter.but so far he has not been able to get past the third chapter.

His mentor does not seem sufficiently impressed with his ideas,His mentor does not seem sufficiently impressed with his ideas,
and the patient is furious at him but also self-doubting andand the patient is furious at him but also self-doubting and
ashamed. He blames his mentor for his lack of progress and thinksashamed. He blames his mentor for his lack of progress and thinks
that he deserves more help with his grand idea, and that his mentorthat he deserves more help with his grand idea, and that his mentor
should help him with some of the research.should help him with some of the research.

The patient brags about his creativity and complains that otherThe patient brags about his creativity and complains that other
people are “people are “jealousjealous” of his insight. He is very envious of students” of his insight. He is very envious of students
who were moving along faster than he and regards them as “who were moving along faster than he and regards them as “dulldull
drones and ass-kissersdrones and ass-kissers.” He prides himself on the brilliance of his.” He prides himself on the brilliance of his
class participation and imagines someday becoming a greatclass participation and imagines someday becoming a great
professor.professor.

He becomes rapidly infatuated with women and has powerful andHe becomes rapidly infatuated with women and has powerful and
persistent fantasies about each new woman he meets, but afterpersistent fantasies about each new woman he meets, but after
several sexual experiences feels disappointed and finds themseveral sexual experiences feels disappointed and finds them
dumb, clinging, and physically repugnant. He has many “friends”,dumb, clinging, and physically repugnant. He has many “friends”,
but they turn over quickly, and no one relationship lasts very long.but they turn over quickly, and no one relationship lasts very long.

People get tired of his continual self-promotion and lack ofPeople get tired of his continual self-promotion and lack of
consideration of them. For example, he was lonely at Christmasconsideration of them. For example, he was lonely at Christmas
and insisted that his best friend stay in town rather than visit hisand insisted that his best friend stay in town rather than visit his
family. The friend refused, criticizing the patient’s self-family. The friend refused, criticizing the patient’s self-
centeredness; and the patient, enraged, decided never to see hiscenteredness; and the patient, enraged, decided never to see his
friend again.friend again.

Antisocial Personality DisorderAntisocial Personality Disorder

 Antisocial Personality DisorderAntisocial Personality Disorder –– areare
individuals who continually violate and showindividuals who continually violate and show
disregard for the rights of others through deceitful,disregard for the rights of others through deceitful,
aggressive, or antisocial behavior, typically withoutaggressive, or antisocial behavior, typically without
remorse or loyalty to anyone.remorse or loyalty to anyone.
 other characteristics include:other characteristics include: being impulsive,being impulsive,
irritable and aggressive and to show pattern ofirritable and aggressive and to show pattern of
generally irresponsible behavior.generally irresponsible behavior.

 Prevalence:Prevalence: 70%70% higher in affected adverse socioeconomic orhigher in affected adverse socioeconomic or
sociocultural.sociocultural.
0.2% - 3.3%0.2% - 3.3% in criteria of previous DSMsin criteria of previous DSMs
 Cause/s:Cause/s: Genetic, Temperament/Deficiencies in fear andGenetic, Temperament/Deficiencies in fear and
anxiety, Emotional Deficits (e.g., rejection, parental loss)anxiety, Emotional Deficits (e.g., rejection, parental loss)
 Treatment:Treatment: Only if sought -Only if sought - PsychotherapyPsychotherapy

Case:Case: Antisocial Personality DisorderAntisocial Personality Disorder

Case: Antisocial Personality DisorderCase: Antisocial Personality Disorder
A Thief with Antisocial Personality DisorderA Thief with Antisocial Personality Disorder
Mark, a 22-year-old, was awaiting trial for car theft and armedMark, a 22-year-old, was awaiting trial for car theft and armed
robbery. His case records included a long history of arrestsrobbery. His case records included a long history of arrests
beginning at age 9, when he had been picked up for vandalism. Hebeginning at age 9, when he had been picked up for vandalism. He
had been expelled from high school for truancy and disruptivehad been expelled from high school for truancy and disruptive
behavior. On a number of occasions he had run away from homebehavior. On a number of occasions he had run away from home
for days or weeks at a time – always returning in a disheveled andfor days or weeks at a time – always returning in a disheveled and
“rundown” condition.“rundown” condition.

Case: Antisocial Personality DisorderCase: Antisocial Personality Disorder
A Thief with Antisocial Personality DisorderA Thief with Antisocial Personality Disorder
To date he had not held a job for more than a few days at a timeTo date he had not held a job for more than a few days at a time
even though his generally charming manner enabled him to obtaineven though his generally charming manner enabled him to obtain
work readily. He was described as a loner with few friends.work readily. He was described as a loner with few friends.
Although initially charming, Mark usually soon antagonized thoseAlthough initially charming, Mark usually soon antagonized those
he met with his aggressive, self-oriented behavior. Shortly after hishe met with his aggressive, self-oriented behavior. Shortly after his
first therapy session, he skipped bail and presumably left town tofirst therapy session, he skipped bail and presumably left town to
avoid his trial.avoid his trial.

Borderline Personality DisorderBorderline Personality Disorder

 Borderline Personality DisorderBorderline Personality Disorder –– show ashow a
pattern of behavior characterized by impulsivity andpattern of behavior characterized by impulsivity and
instability in interpersonal relationships, self-image,instability in interpersonal relationships, self-image,
and moods.and moods.
 other characteristics include:other characteristics include: affective instability,affective instability,
highly unstable self image, impulsivity, selfhighly unstable self image, impulsivity, self
mutilation.mutilation.

Prevalence:Prevalence: 6%6% in primary care settings.in primary care settings.
10%10% among individuals seen in outpatient mental healthamong individuals seen in outpatient mental health
clinics.clinics.
20%20% among psychiatric inpatients.among psychiatric inpatients.
May decrease in older age group.May decrease in older age group.
 Cause/s:Cause/s: Malfunctioned gene/Abnormalities in brainMalfunctioned gene/Abnormalities in brain
 TreatmentTreatment: Biological and Psychological Treatments: Biological and Psychological Treatments

Case:Case: Borderline Personality DisorderBorderline Personality Disorder

Case: Borderline Personality DisorderCase: Borderline Personality Disorder
Self-Mutilation in Borderline Personality DisorderSelf-Mutilation in Borderline Personality Disorder
A 26-year-old unemployed woman was referred for admission to aA 26-year-old unemployed woman was referred for admission to a
hospital by her therapist because of intense suicidal preoccupationhospital by her therapist because of intense suicidal preoccupation
and urges to mutilate herself with a razor. The patient wasand urges to mutilate herself with a razor. The patient was
apparently well until her junior year in high school, when sheapparently well until her junior year in high school, when she
became preoccupied with religion and philosophy, avoidedbecame preoccupied with religion and philosophy, avoided
friends, and was filled with doubt about who she was.friends, and was filled with doubt about who she was.

Academically she did well, but later, during college, herAcademically she did well, but later, during college, her
performance declined. In college she began to use variety of drugs,performance declined. In college she began to use variety of drugs,
abandoned the religion of her family, and seemed to be searchingabandoned the religion of her family, and seemed to be searching
for a charismatic religious figure with whom to identify.for a charismatic religious figure with whom to identify.

At times, massive anxiety swept over her, and she found it wouldAt times, massive anxiety swept over her, and she found it would
suddenly vanish if she cut her forearm with a razor blade. 3 yearssuddenly vanish if she cut her forearm with a razor blade. 3 years
ago she began psychotherapy and initially rapidly idealized herago she began psychotherapy and initially rapidly idealized her
therapist as being incredibly intuitive and empathetic.therapist as being incredibly intuitive and empathetic.
Later she became hostile and demanding of him, requiring moreLater she became hostile and demanding of him, requiring more
and more sessions, sometimes twice in 1 day. Her life centeredand more sessions, sometimes twice in 1 day. Her life centered
therapist, by this time to the exclusion of everyone else.therapist, by this time to the exclusion of everyone else.

Although her hostility toward her therapist was obvious, she couldAlthough her hostility toward her therapist was obvious, she could
neither see it nor control it. Her difficulties with her therapistneither see it nor control it. Her difficulties with her therapist
culminated in many episodes of her forearm cutting suicidalculminated in many episodes of her forearm cutting suicidal
threats, which led to the referral for admission.threats, which led to the referral for admission.

Cluster C Personality DisordersCluster C Personality Disorders ((33))

1.1. Avoidant Personality DisorderAvoidant Personality Disorder
2.2. Dependent Personality DisorderDependent Personality Disorder
3.3. Obsessive-compulsive Personality DisorderObsessive-compulsive Personality Disorder
Cluster CCluster C ((33))

Avoidant Personality DisorderAvoidant Personality Disorder

(Cluster C)(Cluster C)
 Personality DisorderPersonality Disorder –– show extreme socialshow extreme social
inhibition and introversion, leading to lifelonginhibition and introversion, leading to lifelong
patterns of limited social relationships and reluctancepatterns of limited social relationships and reluctance
to enter into social interactions.to enter into social interactions.
 other characteristics include:other characteristics include: do not enjoy theirdo not enjoy their
aloneness, feeling inept and socially inadequate.aloneness, feeling inept and socially inadequate.

 Prevalence:Prevalence: National Epidemiologic Survey on Alcohol and RelatedNational Epidemiologic Survey on Alcohol and Related
Conditions (2001-2002)–Conditions (2001-2002)– 2.4%2.4%
 Cause/s:Cause/s: Inhibited temperament/geneticInhibited temperament/genetic
 TreatmentTreatment: Psychotherapy: Psychotherapy

Case:Case: Avoidant Personality DisorderAvoidant Personality Disorder

Case: Avoidant Personality DisorderCase: Avoidant Personality Disorder
The Avoidant LibrarianThe Avoidant Librarian
Sally, a 35-year-old librarian, lived a relatively isolated life andSally, a 35-year-old librarian, lived a relatively isolated life and
had few acquaintances and no close personal friends. Fromhad few acquaintances and no close personal friends. From
childhood on, she had been very shy and had withdrawn fromchildhood on, she had been very shy and had withdrawn from
close ties with others to keep from being hurt or criticized. Twoclose ties with others to keep from being hurt or criticized. Two
years before she entered therapy, she had had a date to go to ayears before she entered therapy, she had had a date to go to a
party with an acquaintance she had met at the library.party with an acquaintance she had met at the library.

The moment they had arrived at the party, Sally had felt extremelyThe moment they had arrived at the party, Sally had felt extremely
uncomfortable because she had not been “dressed properly”. Sheuncomfortable because she had not been “dressed properly”. She
left in a hurry and refused to see her acquaintance again.left in a hurry and refused to see her acquaintance again.
In the early treatment sessions, she sat silently much of the time,In the early treatment sessions, she sat silently much of the time,
finding it too difficult to talk about herself. After several sessions,finding it too difficult to talk about herself. After several sessions,
she grew to trust the therapist and she related numerous incidentsshe grew to trust the therapist and she related numerous incidents
in her early years in which she had been “devastated” by herin her early years in which she had been “devastated” by her
alcoholic father’s obnoxious behavior in public.alcoholic father’s obnoxious behavior in public.

Although she had tried to keep her school friends from knowingAlthough she had tried to keep her school friends from knowing
about her family problems, when this had become impossible, sheabout her family problems, when this had become impossible, she
instead had limited her friendships, thus protecting herself froinstead had limited her friendships, thus protecting herself fro
possible embarrassment or criticism.possible embarrassment or criticism.

When Sally first began therapy, she avoided meeting people unlessWhen Sally first began therapy, she avoided meeting people unless
she could be assured that they would “like her”. With therapy thatshe could be assured that they would “like her”. With therapy that
focused on enhancing her assertiveness and social skills, she madefocused on enhancing her assertiveness and social skills, she made
some progress in her ability to approach people and talk withsome progress in her ability to approach people and talk with
them.them.

Dependent Personality DisorderDependent Personality Disorder

 Dependent Personality DisorderDependent Personality Disorder ––
extreme need to be taken care of, which leads toextreme need to be taken care of, which leads to
clinging and submissive behavior.clinging and submissive behavior.
 other characteristics include:other characteristics include: lack of self confidencelack of self confidence
and feeling helpless without great deal of advice andand feeling helpless without great deal of advice and
reassurance.reassurance.

 Prevalence:Prevalence: National Epidemiologic Survey on Alcohol and RelatedNational Epidemiologic Survey on Alcohol and Related
Conditions (2001-2002) –Conditions (2001-2002) – 0.49%0.49%
National Comorbidity Survey Replication –National Comorbidity Survey Replication – 0.6%0.6%
 Cause/s:Cause/s: Possible biological/genetic or developmentalPossible biological/genetic or developmental
 TreatmentTreatment: Psychotherapy: Psychotherapy

Medications may be used.Medications may be used.

Case:Case: Dependent Personality DisorderDependent Personality Disorder

Case: Dependent Personality DisorderCase: Dependent Personality Disorder
The Dependent WifeThe Dependent Wife
Sarah, a 32-year-old mother of two and part-time tax accountant,Sarah, a 32-year-old mother of two and part-time tax accountant,
came to a crisis center late one evening after Michael, her husbandcame to a crisis center late one evening after Michael, her husband
of a year and a half, had abused her physically and then left home.of a year and a half, had abused her physically and then left home.
Although he never physically harmed the children, he frequentlyAlthough he never physically harmed the children, he frequently
threatened to do so when he was drunk.threatened to do so when he was drunk.

Sarah appeared acutely anxious and worried about the future andSarah appeared acutely anxious and worried about the future and
“needed to be told what to do”. She wanted her husband to come“needed to be told what to do”. She wanted her husband to come
back and seemed rather unconcerned about his regular pattern ofback and seemed rather unconcerned about his regular pattern of
physical abuse. At the time, Michael was an unemployed residentphysical abuse. At the time, Michael was an unemployed resident
in a day treatment program at a halfway house for paroled drugin a day treatment program at a halfway house for paroled drug
abusers. He was almost always in a surly mood and “ready toabusers. He was almost always in a surly mood and “ready to
explode”.explode”.

Although Sarah had a well-paying job, she voiced great concernAlthough Sarah had a well-paying job, she voiced great concern
about being able to make it on her own. She realized that it wasabout being able to make it on her own. She realized that it was
foolish to be “dependent” on her husband, whom she referred to asfoolish to be “dependent” on her husband, whom she referred to as
a “real loser”. (She had had a similar relationship with her firsta “real loser”. (She had had a similar relationship with her first
husband who had left her and her oldest child when she was 18.)husband who had left her and her oldest child when she was 18.)

Several times in the past few months, Sarah had made up her mindSeveral times in the past few months, Sarah had made up her mind
to get out of the marriage but couldn’t bring herself to break away.to get out of the marriage but couldn’t bring herself to break away.
She would threaten to leave, but when the time came to do so, sheShe would threaten to leave, but when the time came to do so, she
would “freeze in the door” with a numbness in her body and awould “freeze in the door” with a numbness in her body and a
sinking feeling in her stomach at the thought of “not being withsinking feeling in her stomach at the thought of “not being with
Michael”.Michael”.

Obsessive Compulsive Personality DisorderObsessive Compulsive Personality Disorder


Obsessive Compulsive Personality Disorder (OCPD)Obsessive Compulsive Personality Disorder (OCPD) ––
perfectionism and a excessive concern withperfectionism and a excessive concern with
maintaining order and control.maintaining order and control.
 other characteristics include:other characteristics include: excessively devoted toexcessively devoted to
work, inflexible about moral and ethical issues, havework, inflexible about moral and ethical issues, have
difficulty delegating tasks to others. Ungenerous.difficulty delegating tasks to others. Ungenerous.

Prevalence:Prevalence: 2.1% - 7.9%2.1% - 7.9% in general population.in general population.
 Cause/s:Cause/s: Genetic/High level of conscientiousness/assertivenessGenetic/High level of conscientiousness/assertiveness
 TreatmentTreatment: CBT, Medication, Relaxation Training: CBT, Medication, Relaxation Training

Case:Case: Obsessive Compulsive Personality DisorderObsessive Compulsive Personality Disorder

Case: Obsessive Compulsive PersonalityCase: Obsessive Compulsive Personality
DisorderDisorder
The Perfectionist Train DispatcherThe Perfectionist Train Dispatcher
Allan appeared to be well suited to his work as a train dispatcher.Allan appeared to be well suited to his work as a train dispatcher.
He was entious, perfectionistic, and attended to minute details.He was entious, perfectionistic, and attended to minute details.
However, he was not close to his coworkers, and they reportedlyHowever, he was not close to his coworkers, and they reportedly
thought him “off”. He would get quiet upset if even minorthought him “off”. He would get quiet upset if even minor
variations to his daily routine occurred. For example, he wouldvariations to his daily routine occurred. For example, he would
become tense and irritable if coworkers did not follow exactly hisbecome tense and irritable if coworkers did not follow exactly his
elaborately constructed schedules and plans.elaborately constructed schedules and plans.

Case: Obsessive Compulsive PersonalityCase: Obsessive Compulsive Personality
DisorderDisorder
The Perfectionist Train DispatcherThe Perfectionist Train Dispatcher
In short, Alan got little pleasure out of life and worried constantlyIn short, Alan got little pleasure out of life and worried constantly
about minor problems. His rigid routines were impossible toabout minor problems. His rigid routines were impossible to
maintain, and he often developed tension headaches ormaintain, and he often developed tension headaches or
stomachaches when he couldn’t keep his complicated plans instomachaches when he couldn’t keep his complicated plans in
order. His physician, noting the frequency of his physicalorder. His physician, noting the frequency of his physical
complaints and his generally perfectionistic approach to life,complaints and his generally perfectionistic approach to life,
referred him for a psychological evaluation. Psychotherapy wasreferred him for a psychological evaluation. Psychotherapy was
recommended, but he did not follow on the treatmentrecommended, but he did not follow on the treatment
recommendations because he felt that he could not afford the timerecommendations because he felt that he could not afford the time
away from work.away from work.

Treatments and Outcomes for Personality DisordersTreatments and Outcomes for Personality Disorders

Treatment of Borderline Personality DisorderTreatment of Borderline Personality Disorder
Biological TreatmentsBiological Treatments
Antidepressant medicationAntidepressant medication ((most often from the SSRI categorymost often from the SSRI category))
Antipsychotic medicationAntipsychotic medication
Mood-stabilizing medicationsMood-stabilizing medications ((e.g., carbazeminee.g., carbazemine))

Treatment of Borderline Personality DisorderTreatment of Borderline Personality Disorder
Psychological TreatmentsPsychological Treatments
Dialectal Behavior TherapyDialectal Behavior Therapy
Variants of psychodynamic psychotherapyVariants of psychodynamic psychotherapy
MentalizationMentalization

Personality Disorder

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