Chapter 11 - Personality Disorders

 

I.  Common Feature:  Long-standing, pervasive, inflexible patterns of behaving, feeling, and thinking.

        A.  “Persistent, pervasive, pathological”

B.  State vs trait vs disorder

C.  Categorical vs dimensional approach to personality disorders?

 

II.  Cluster A:  Odd/Eccentric

        A.  Paranoid

        B.  Schizoid

        C.  Schizotypal

 

III.  Cluster B:  Dramatic/Erratic

        A.  Borderline

        B.  Histrionic

        C.  Narcissistic

        D.  Antisocial

 

IV.  Cluster C:  Anxious/Fearful

        A.  Avoidant

        B.  Dependent

        C.  Obsessive-Compulsive

 

V.  Detailed Example #1:  Borderline Personality Disorder

        A.  Characterized by

                1.  impulsivity

                2.  emotional dysregulation

                3.  instability

 

        B.  Etiological Theories and Factors

                1.  Neurobiological factors: 

a.  emotional dysregulation and impulsivity related to genetic component (eg, temperament differences)

b.  serotonin insensitivity

c.  structural abnormalities (eg, in the amygdala)?

                2.  BPD as extreme form of PTSD?

                3.  Object-relations (psychodynamic) theory (Kernberg):  inconsistent parenting, lack of bonding with caregivers, leads to insecure egos due to introjects of such inconsistent caregivers.  Defense mechanism of splitting protects this insecure ego. 

                4.  Diathesis-Stress theory (Linehan):  invalidating environment (esp abusive one) interacts with biological dysregulation.

        C.  Treatments

                1.  Linehan’s Dialectical Behavior Therapy

                        a.  includes indiv tx and skills-building group

                        b.  role of acceptance, and of learning new skills

                                i.  Skills include distress tolerance, emotional regulation, more

                        c.  includes hierarchy of targets

                2.  Kernberg’s Object-Relations Therapy

                        a.  interpreting defensive behavior

                        b.  provide ways to behave more adaptively

                        c.  analyze transference to identify current distortions

                3.  Medication (antidepressants, mood stabilizers, antipsychotics)?

 

VI.  Detailed Example #2:  Antisocial Personality Disorder

    (aka Psychopathy, Sociopathy)

        A.  Characterized by

                1.  criminal or irresponsible behavior

                2.  lack of remorse

                3.  manipulation

 

        B.  Cleckley’s “Mask of Sanity” vs. DSM approach (and vs criminality)

 

        C.  Etiological Theories and Factors

                1.  Biological Predisposition

                        a.  genetic component, as in borderline PD

                        b.  low anxiety/arousal (tune out aversive stimuli?)

                        c.  inhibition or learning differences

                2.  Poor parenting (to be discussed in more detail when we get to Conduct Disorder)

                        a.  uninvolved or inconsistent parenting

                        b.  abuse

                        c.  poor supervision (role of delinquent peer groups)

                        d.  modeling of antisocial behavior

 

        D.  Treatments

                1.  General view is that treatment is ineffective

                2.  Recent meta-analysis indicated treatment may be somewhat helpful if very intensive, esp for younger patients

                3.  Focus on intervening in childhood, pre-ASPD

                4.  Getting older