PowerPoint
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Lecture Notes Presentation
Abnormal Psychology, Eleventh Edition by
Ann M. Kring, Gerald C. Davison, John M. Neale,
& Sheri L. Johnson

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Longstanding, pervasive, inflexible patterns of behavior and inner experience
Patterns present in at least 2 areas:
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Cognition
» Emotions
» Relationships
» Impulse control
Coded on Axis II
Often comorbid with Axis I disorders
» More severe symptoms and poorer outcome when comorbid
– 50+% of people diagnosed with a personality disorder meet criteria for another personality disorder
– More than two-thirds meet lifetime criteria for an Axis I disorder
(Lenzenwenger et al., 2007)
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Table 12.2 Rates of DSM-IV Personality
Disorders in the Community and in
Treatment Settings
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DSM-IV-TR categorical approach
Classifies in 3 clusters:
» Cluster A Odd/Eccentric
» Cluster B Dramatic/Erratic
» Cluster C Anxious/Fearful
Diagnostic reliability
» Initially poor; improved since DSM-III
Test-retest reliability (diagnostic stability)
» ½ of those initially diagnosed with PD did not receive same diagnosis 1 year later (Shea et al., 2002)
Gender bias
» Certain diagnoses applied more often to men, others to women
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Figure 12.1 Test –retest stability for personality disorders and major depressive disorder across
6-, 12-, and 24-month follow-up interviews
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Five-factor model (McCrae & Costa, 1990)
» Neuroticism, extraversion/introversion, openness to experience, agreeableness/antagonism, and conscientiousness
» Five factors are heritable
Personality traits form a continuum
» Individuals with PDs endorse the extremes
Dimensional approach involves rating each individual on the five factors
» Avoids applying a categorical label which may not completely fit
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Most personality disorders are characterized by high neuroticism and antagonism.
High extraversion tied to histrionic and narcissistic disorders (involve dramatic behavior)
Low extraversion linked to disorders that involve social isolation, such as schizoid, schizotypal, and avoidant personality disorders
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Table 12.4 Sample Items from the Revised NEO
Personality Inventory assessing Five-Factor
Model
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Suspicious
» Secretive; reluctant to confide in others
Expects to be mistreated/exploited
» Vigilant for hints of abuse
Blames others when things go wrong
Questions loyalty
No hallucinations or full blown delusions
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More common in men than women
Cormorbidity high for
» Schizotypal
» Borderline
» Avoidant
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Avoids close interpersonal relationships
» Few close friends
» Aloof & distant
Loner
» Likes solitary activities
Rarely report strong emotions
Little interest in sex
Experiences anhedonia
 Comorbidity high for
» Schizotypal
» Avoidant
» Paranoid
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Interpersonal difficulties similar to schizoid
Odd beliefs or magical thinking
» Superstitious
» Telepathic
Illusions
» Feels the presence of a force or person not actually present.
Odd/eccentric behavior or appearance
» Wears strange clothes
» Talks to self
Ideas of reference
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 Highly heritable
 Links to schizophrenia
» Relatives of individuals with schizophrenia at greater risk for schizotypal
» Individuals with schizotypal PD show problems similar to those found in schizophrenia
– Cognitive and neuropsychological deficits
– Enlarged ventricles
– Less temporal gray matter
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Dramatic/Erratic Cluster: Borderline
Personality Disorder (BPD)
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 Impulsive, self-damaging behaviors
Unstable, stormy, intense relationships
Emotional reactivity
Frantic efforts to avoid abandonment
Unstable sense of self
Anger control problems
Chronic feelings of emptiness
Recurrent suicidal gestures
Transient psychotic or dissociative symptoms
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Dramatic/Erratic Cluster: Borderline
Personality Disorder (BPD)
 Onset during adolescence or early adulthood
 Prognosis poor within 10 years of diagnosis
» Later in life, most no longer meet diagnostic criteria
(Paris, 2002)
 Cormorbidity high with PTSD, MDD, substance-related, and eating disorders
» Comorbidity predicts symptoms 6 years later
 Suicide rates high
» Self-mutilation also a problem
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Etiology of Borderline Personality Disorder
(BPD): Neurobiological factors
 Genetic component
» Highly heritable
» May play a role in impulsivity and emotional dysregulation
 Decreased functioning of serotonin system
 Frontal lobe dysfunction
 Increased activation of amygdala
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Etiology of Borderline Personality Disorder
(BPD): Social Environmental Factors
 Parental separation
 Verbal and emotional abuse during childhood
 Object-Relations Theory (Kernberg, 1985)
» Introjection
» Object-representation
– BPD involves disturbed object representations, possibly due to inconsistent parenting
» Conflict between introjected values and current needs
– Splitting
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Etiology of Borderline Personality Disorder
(BPD): Social Environmental Factors
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Linehan’s Diathesis-Stress Theory
» Individuals with BPD have difficulty controlling their emotions
– Possible biological diathesis
» Family invalidates or discounts emotional experiences and expression
» Interaction between extreme emotional reactivity and invalidating family → BPD
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Formerly known as hysterical personality
Overly dramatic and attention seeking behavior
Craves attention
» Loves to be in the spotlight
Emotionally shallow despite strong displays of emotion
Easily influenced by others
Overly concerned with physical attractiveness
May be sexually provocative and seductive
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 Psychoanalytic theory
» Emotional displays and seductiveness result from parental seductiveness
– Father’s sexual attention towards daughter
» Conflicting family attitudes towards sexuality
– Negative attitudes towards sex while simultaneously acknowledging titillation
 Theory untested
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Grandiose view of self
» Preoccupied with fantasies of success
Self-centered
» Demands constant attention and adulation
Feelings of entitlement and arrogance
Envious of others
Little concern for needs and well being of others
» Lacks empathy
Sensitive to criticism
Seeks out high-status partners
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Kohut’s Self-Psychology Model
» Characteristics mask low self-esteem
» In childhood, narcissist valued as a means to increase parent’s own self-esteem
– Not valued for his or her own competency and self worth
» People with high levels of narcissism report cold parents who overemphasized child’s achievement
Social cognitive model
» Narcissist has low self esteem
» Sense of self depends on “winning”
» Interpersonal relationships are a way to bolster sagging self esteem rather than increase closeness to others
» Lab studies reveal cognitive biases that maintain narcissism
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Pervasive disregard for the rights of others since age 15
» Lies
» Aggression
» Impulsiveness
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Violates the law
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Irresponsible
» Lacks remorse
Conduct disorder before age 15
» Truancy, running away, lying, theft, arson, destruction of property
Substance abuse most common comorbid disorder
Culture plays a role
» More common in US than Scotland
More common among lower SES groups
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Psychopathy (sociopathy)
(Cleckley, 1941)
Predates DSM-IV-TR category
Focuses on internal thoughts and feelings
» Poverty of emotion
– Negative emotions
 Lacks shame and anxiety
– Positive emotions
 Used to manipulate others
» Impulsivity
– Behave irresponsibly for thrills
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Psychopathy
Checklist – revised
(Hare, 2008)
» Interpersonal symptoms
– Pathological lying, manipulativeness, and charm
» Affective symptoms
– Lack of remorse and empathy, shallow affect
Onset before age 15 not required.
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Genetics
» Antisocial behavior heritable
– Estimates as high as .96
» Genetic risk for APD, psychopathy, conduct disorder, and substance abuse related.
Family environment
» Lack of warmth, negativity, and parental inconsistency predict APD
» Poverty, exposure to violence
» Family environment interacts with genetics
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Emotion and psychopathy
» Lack of fear or anxiety
» Low baseline levels of skin conductance
» Skin conductance reactivity at age 3 predicted APD at age 28
(Glenn et al., 2007)
Makes it difficult for them to avoid behavior that leads to punishment
Also show less SCR to other’s distress
» Lack empathy
Figure 12.3
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Avoids interpersonal situations
» Fears criticism or rejection
Hesitant about involvement with others
» Wants to be certain of acceptance
Restrained and inhibited in interpersonal situations
» Fears ridicule
» Feelings of inadequacy
Avoids taking risks or trying new activities
» Doesn’t want to risk embarrassment
High comorbidity with major depression and generalized social phobia
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Related toJapanese syndrome called taijin kyofusho ( taijin means “interpersonal” and kyofusho means “fear”).
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Lack of self confidence
Excessive reliance on others
Intense need to be cared for
Uncomfortable when alone
Feels helpless to care for self
Behavior focused on maintaining relationships
Quickly initiates new relationship if current one fails
Prevalence higher in India and Japan than US
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Anxious/Fearful Cluster: Obsessive-
Compulsive Personality Disorder
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A perfectionist
Preoccupied with rules, details, & organization
Rigid and inflexible
Overly focused on work
» Little time for leisure, family, & friends
Tendency to hoard
» Difficulty discarding worthless items
Reluctant to delegate
Moral inflexibility
Does not have the obsessions/compulsions of OCD
Most frequently comorbid with Avoidant PD
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Etiology of Personality Disorders in the
Anxious/Fearful Cluster
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Not much available research
Avoidant PD
» Overly protective and authoritarian parents
Obsessive-Compulsive PD
» Fixation at anal stage of development (Freud)
» More recent theorists
– Cope with fears of losing control by overcompensation
Dependent PD
» Disruption of early childhood attachment by death, neglect, rejection, or overprotectiveness
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Axis I disorder usually drives individual to treatment
» Presence of PD, reduces success of treatment for Axis I
Medications
» Avoidant PD
– Antianxiety medication or antidepressants
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Schizotypal PD
– Antipsychotic medications
Psychotherapy
» Psychodynamic
– Seek awareness of early childhood problem
» Cognitive behavioral
– Break personality disorder down into discrete problems
 Treat sensitivity to criticism with social skills training
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Table 12.5 Maladaptive Cognitions Associated with Personality Disorders
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Difficult to treat
» Interpersonal problems play out in therapy
» Attempts to manipulate therapist
Object Relations Therapy (Kernberg et al., 1985)
Dialectical Behavioral Therapy (Linehan, 1987)
» Acceptance and empathy plus CBT, emotion regulation, and social skills
Schema-Focused Cognitive Therapy for BPD
» Identify maladaptive assumptions that underlie cognitions
Medications
» Antidepressants
» Antipsychotics
– Olanzapine
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 Intensive psychoanalytic therapy
 Cognitive behavioral therapy
 Issue remains
» Are therapy successes ‘faking good’ or genuinely improved?
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Copyright 2009 by John Wiley & Sons, New
York, NY. All rights reserved. No part of the material protected by this copyright may be reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording or by any information storage and retrieval system, without written permission of the copyright owner.
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