chapter 10: personality disorders

PERSONALITY 5 FIVE-FACTOR MODEL OF PERSONALITY

- set of unique traits and behaviors that TRAITS:
characterize the individual 1. OPENNESS TO EXPERIENCE
- adult personality is attuned to the demands of 2. CONSCIENTIOUSNESS
society
- propensity to follow socially prescribed norms
for impulse control, to be goal directed, to plan,
• BROADLY CHARACTERISTIC TRAITS, COPING
and to be able to delay gratification.
STYLES, AND WAYS OF INTERACTING IN THE
3. EXTRAVERSION/ INTROVERSION
SOCIAL ENVIRONMENT EMERGE DURING
- 6 facets: warmth, gregariousness,
CHILDHOOD
assertiveness, activity, excitement seeking,
- normally crystallize into established patterns by
and positive emotions
the end of adolescence or early adulthood
4. AGREEABLENESS/ANTAGONISM
the low pole of agreeableness, references 5. NEUROTICISM
a person's ability to put
traits related to immorality, combativeness,
- emotional instability other people's needs above
callousness grandiosity/pretentious, and
their own. e.g. empathy
distrustfulness. - 6 facets: anxiety,
angry-hostility, depression, self-consciousness,
impulsiveness, and vulnerability

PERSONALITY DISORDER

- formerly known as character disorder

- have certain traits that are so inflexible and
maladaptive that they are unable to perform
adequately at least some of the varied roles
expected of them by their society
- do not stem from debilitating reactions to stress
in the recent past as do PTSD or many cases of
major depression but it stems from the gradual
development of inflexible and distorted
personality and behavioral patterns that result in > not caused by another mental disorder
persistently maladaptive ways of perceiving, - can be diagnosed in individuals < 18 years of
thinking about, and relating to the world age if features have been present for ≥ 1 year
- comorbid with anxiety disorders, mood (except antisocial personality disorder
disorders, substance use problems, and sexual > manifested in at least two of the following
deviations areas:
- Age of onset: late childhood or adolescence  COGNITION
- e.g., perceives events, others, or self in an
• SOME OF THESE CONDITIONS OVERLAP WITH inappropriate way
EACH OTHER SO MUCH THAT IT CAN BE  AFFECTIVITY
IMPOSSIBLE TO TEASE THEM APART, AND - the degree of a person's response or
BECAUSE OF THIS MATTER, THE MOST COMMON susceptibility to pleasure, pain, and other
DIAGNOSE IS PERSONALITY DISORDER NOT emotional stimuli.
OTHERWISE SPECIFIED OR PDNOS  IMPULSE CONTROL
- ego syntonic
• GENETIC PROPENSITIES AND TEMPERAMENT
 INTERPERSONAL FUNCTIONING
MAY BE IMPORTANT PREDISPOSING FACTORS
FOR THE DEVELOPMENT OF PARTICULAR
• OTHER PEOPLE TEND TO FIND THE BEHAVIOR
PERSONALITY TRAITS AND DISORDERS
OF INDIVIDUALS WITH PERSONALITY DISORDERS
- parental influences including emotional,
CONFUSING, EXASPERATING, UNPREDICTABLE,
physical, and sexual abuse, may also play a big
AND, TO VARYING DEGREES, UNACCEPTABLE
role in the development of personality disorders.
- these patterns color their reactions to each new
situation and lead to a repetition of the same
2 OF THE GENERAL FEATURES THAT
maladaptive behaviors because they do not learn
CHARACTERIZE MOST PERSONALITY DISORDERS:
from previous mistakes or troubles.
1.) chronic interpersonal difficulties
2.) problems with one’s identity or sense of self
TREATMENTS OF PERSONALITY
DISORDERS:
IN GENERAL DSM-5 CRITERIA FOR o Psychotherapy, dialectical behavior
DIAGNOSING A PERSONALITY therapy, group therapy, and/or
DISORDER/ DIAGNOSTIC CRITERIA: cognitive
live in the therapy
moment, mindfulness, improve
> begins in early adulthood, stable and of long relationship with others, coping strategies for stress

duration o Symptomatic medical therapy

> clinically significant distress & impaired in  Mood stabilizers: valproate, topiramate, and
functioning lamotrigine have been shown to decrease
symptoms, such as affective dysregulation,
impulsivity, and aggression.
 Antipsychotics: especially for symptoms of - people with these disorders often seem to be
delusion odd or eccentric
 Antidepressants: selective serotonin - with unusual behavior ranging from distrust and
reuptake inhibitors (SSRIs) are the drug of suspiciousness to social detachment
choice, especially in depressive episodes,
anxiety disorders, and obsessive-compulsive • CLUSTER A: PARANOID PEOPLE ARE
disorders. ACCUSATORY, SCHIZOID PEOPLE ARE ALOOF,
AND SCHIZOTYPAL PEOPLE ARE AWKWARD
EGO-DYSTONIC
- those who have them are aware they have a CLUSTER A 3 PERSONALITY DISORDERS:
problem and tend to be distressed by their 1.) PARANOID PERSONALITY DISORDER
symptoms
- ex. OCD, bipolar disorder

EGO-SYSTONIC
- the person experiencing them does not
necessarily think they have a problem
- sometimes they think that the problem is - have a pervasive suspiciousness and distrust of

everyone else others, leading to numerous interpersonal

- ex. OCPD and other personality disorders difficulties

- their motives are interpreted as

• ANTISOCIAL AND NARCISSISTIC PERSONALITY malevolent/showing a wish to do evil to others

DISORDERS ARE MORE COMMONLY DIAGNOSED - see themselves as blameless, instead blaming

IN MALES. others for their own mistakes and failures

- are chronically tense and on guard

• HISTRIONIC AND BORDERLINE PERSONALITY - constantly expecting trickery and looking for

DISORDERS ARE MORE COMMONLY DIAGNOSED clues to validate their expectations while

IN FEMALES. disregarding all evidence to the contrary

- often preoccupied with doubts about the

DSM-5 PERSONALITY DISORDERS ARE GROUPED loyalty of friends and hence are reluctant to

INTO THREE CLUSTERS: confide in others

• CLUSTER A #WEIRD - commonly bear grudges, refuse to forgive

perceived insults and slights, and are quick to
react with anger and sometimes violent behavior
- may consist of elements of both suspiciousness
and hostility
- are not usually psychotic and most of the time
they are in clear contact with reality, although
they may experience transient psychotic
symptoms during periods of stress
- paranoid schizophrenia share some symptoms CAUSAL FACTORS OF PPD:
found in paranoid personality, but they have  not strong: partial genetic transmission that
many additional problems including more may link the disorder to schizophrenia
persistent loss of contact with reality, delusions,  modest genetic liability: occur through the
and hallucinations heritability of high levels of antagonism (low
- If criteria are met prior to the onset of agreeableness) and neuroticism (angry-
schizophrenia, add premorbid, (e.g. paranoid hostility)
personality disorder (premorbid).  psychosocial causal including parental
neglect or abuse and exposure to violent
COMORBIDITIES OF PPD: adults
1. SCHIZOTYPAL
2. BORDERLINE 2.) SCHIZOID PERSONALITY DISORDER

CASE STUDY:

- are usually unable to form social

relationships, and seen by others as cold, aloof,
and distant, and usually lack much interest in
doing so
- can be classified as loners or introverts, with
solitary interests and occupations
- tend not to have good friends, with the
possible exception of a close relative; and seen
by others as cold and distant
- unable to express their feelings
- cannot take pleasure in many activities,
including sexual activity, and rarely marry
- are not very emotionally reactive, rarely
experiencing strong positive or negative
emotions, but rather show a generally apathetic
mood/no interest or concern
- show extremely high levels of introversion
(especially low on warmth, gregariousness, and
positive emotions)
- low on openness to feelings (one facet of
openness to experience)
• SIMILAR WITH PPD, SCHIZOID PERSONALITY 3.) SCHIZOTYPAL PERSONALITY
DISORDER HAS NOT BEEN THE FOCUS OF MUCH DISORDER
RESEARCH ATTENTION SINCE PEOPLE WITH
SCHIZOID PERSONALITY DISORDER ARE NOT
EXACTLY THE PEOPLE WE MIGHT EXPECT TO
VOLUNTEER FOR A RESEARCH STUDY

COMORBIDITIES OF SPD:
1. SCHIZOTYPAL PERSONALITY DISORDERS - most stable characteristics: oddities in thinking,
2. PARANOID PERSONALITY DISORDERS speech, and other behaviors are the most stable
3. AVOIDANT PERSONALITY DISORDERS characteristics
- excessively introverted and have pervasive
other aspects related to cognitive and
social and interpersonal
deficits
- they have cognitive and perceptual distortions
CAUSAL FACTORS OF SCHIZOID including believe that they have magical powers
DISORDER and may engage in magical rituals
 not strong evidence: to be a likely precursor - oddities and eccentricities in their
to the development of schizophrenia; communication and behavior
heritability group of people that belief that conversations or gestures of others

needs to be with others have special meaning or personal significance

 severe disruption in sociability may be due - cognitive–perceptual problems include ideas of

to severe impairment in an underlying reference, odd speech, and paranoid beliefs
affiliative system - contact with reality is usually maintained, highly
 exhibit cool and aloof behavior because of personalized and superstitious thinking is
maladaptive underlying schemas that lead characteristic of people with schizotypal
them to view themselves as self-sufficient personality
loners/do not need other people for their - under extreme stress they may experience
basic needs and to view others as intrusive transient psychotic symptoms and an
(causes annoyance; unwelcome) attenuated/less form of schizophrenia
no explanation for these
dysfunctional beliefs
- pathological trait is psychoticism which consists  heritability of schizotypal personality
of three facets: unusual beliefs and experiences, disorder is moderate
eccentricity/strange views, and cognitive and  biological associations of schizotypal
perceptual dysregulation personality disorder with schizophrenia
are remarkable

• SCHIZOTYPAL PERSONALITY WAS THE ONLY  show numerous other mild impairments

CATEGORICAL DISORDER RETAINED FROM in cognitive functioning

CLUSTER A • deficits in their ability to sustain

CASE STUDY OF STPD: attention because of auditory stimuli

- show deficits in their ability to inhibit
attention to a second stimulus that rapidly
follows presentation of a first stimulus
• deficits in working memory
 auditory stimuli
- show language abnormalities that may be
related to abnormalities in their auditory
processing
 childhood abuse and early trauma
 elevated exposure to stressful life events
and low family socioeconomic status in
adolescence

• CLUSTER B #WILD

• SCHIZOID AND SCHIZOTYPAL DIFFERENCE:

- people with schizotypal are introvert but they - individuals with these disorders share a

have interest in socializing while schizoid has no tendency to be dramatic, emotional, and erratic

interest at all. or unpredictable

COMORBIDITIES OF STPD: • CLUSTER B: ANTISOCIAL PEOPLE ARE BAD,

SOME PEOPLE ARE BORDERLINE, HISTRIONIC
1. SCHIZOPHRENIA
PEOPLE ARE FLAMBOYANT, AND NARCISSISTIC
2. SCHIZOPHRENIA-SPECTRUM DISORDERS
PEOPLE MUST BE THE BEST.

CAUSAL FACTORS OF STPD:

CLUSTER B 4 PERSONALITY DISORDERS: #WILD
1.) HISTRIONIC PERSONALIY • MORE ON FEMALE THAN MALE BECAUSE
DISORDER #FLAMBOYANT INVOLVE MALADAPTIVE VARIANTS OF FEMALE-
RELATED TRAITS:
- overdramatization, vanity/narcissism,
seductiveness, and overconcern with physical
appearance
• OTHER PERSONALITY TRAITS PROMINENT IN
HISTRIONIC PERSONALITY DISORDER ARE
ACTUALLY MORE COMMON IN MEN THAN IN
- key characteristics: excessive attention-seeking
WOMEN INCLUDING:
behavior and emotionality
- high excitement seeking and low self-
- tend to feel unappreciated if they are not the
consciousness
center of attention
- their lively but dramatic
CASE STUDY:
- excessively extraverted styles often ensure that
they can charm others into attending to them
- do not lead to stable and satisfying
relationships because others tire of providing this
level of attention
- in craving stimulation and attention, their
appearance and behavior are often quite
theatrical and emotional as well as sexually
provocative and seductive
- may attempt to control their partners through
seductive behavior and emotional manipulation
- show a good deal of dependence
- excessively concerned about the approval of
others, who see them as overly reactive, shallow,
and insincere
- speech is often vague and impressionistic, and
they are usually considered self-centered, vain

HISTRIONIC ARE FLAMBOYANT

• DIFFICULTY RESEARCHERS HAVE HAD IN
- tending to attract attention because of their
DIFFERENTIATING IT FROM OTHER PERSONALITY
exuberance, confidence, and stylishness.
DISORDERS
- many do not believe it is a valid diagnosis
GENDER DIFFERENCES
- one leading theorist and researcher on this
topic has referred to the diagnosis as being dead
- histrionic personality disorder was one of the
four diagnoses that was recommended for
removal in DSM-5

COMORBIDITIES OF HPD:
1. BORDERLINE
2. ANTISOCIAL
3. NARCISSISTIC
- show an exaggerated sense of self-importance
4.DEPENDENT PERSONALITY DISORDER
- preoccupation with being admired
- lack of empathy for the feelings of others
- there are of two subtypes of narcissism which
CAUSAL FACTORS OF HPD: are grandiose and vulnerable narcissism
 genetic link with antisocial personality - narcissistic central trait: they are unwilling or
disorder unable to take the perspective of others and
- there may be some common underlying unable to see things other than through their
predisposition that is more likely to be own eyes
manifested in women as histrionic - they are selfish, make risky, and unethical
personality disorder and in men as antisocial decisions
personality disorder - if they do not receive the validation or
 partial genetic basis may be characterized as assistance they desire, they are inclined to be
involving extreme versions of two common, hypercritical and retaliatory
normal personality traits - they had greater tendencies toward sexual
• high levels of extraversion coercion, more enjoyable, and sexually arousing
- high levels of gregariousness, excitement when they were rejected by the target of their
seeking, and positive emotions sexual desires
• high levels of neuroticism
- depression and self-consciousness facets • THE STRONGEST IMPAIRMENT ASSOCIATED
• they are also high on openness to fantasies WITH NARCISSISTIC PERSONALITY DISORDER IS
 maladaptive schemas or dysfunctional THE DISTRESS OF ‘PAIN AND SUFFERING’
beliefs EXPERIENCED NOT BY THE NARCISSIST BUT BY
- revolving around the need for attention to HIS OR HER SIGNIFICANT OTHERS
validate self-worth - close friends and relatives may be more
- ex. “Unless I captivate people, I am distressed about his or her behavior than the
nothing” and “If I can’t entertain people, narcissist him- or herself
they will abandon me”

2 SUBTYPES OF NARCISSISM:
2.) NARCISSISTIC PERSONALITY 1.) GRANDIOSE NARCISSISM
DISORDER - high extraversion, dominance, and attention seeking
- grandiosity means quality of being impressive and - may avoid interpersonal relationships due to fear of
imposing in appearance or style, especially rejection or criticism
pretentiously so - very high levels of negative affectivity/neuroticism
- manifested by traits related to grandiosity, and being describe by others as bossy, intolerant,
aggression, and dominance cruel, argumentative, dishonest, opportunistic,
- reflected in a strong tendency to overestimate their conceited, arrogant, and demanding
abilities and accomplishments while underestimating - low agreeableness, trust and extraversion
the abilities and accomplishments of others - high on vulnerability were described as worrying,
- sense of entitlement is frequently a source of emotional, defensive, anxious, bitter, tense, and
astonishment to others, although they themselves complaining
seem to regard their lavish expectations as merely
what they deserve
- sense of entitlement is also associated with their • VULNERABLE IS MORE ASSOCIATED WITH
unwillingness to forgive others for perceived slights, BORDERLINE AND AVOIDANT PERSONALITY DISORDER
and they easily take offense
- behave in stereotypical ways (e.g., with constant self- • SOME NARCISSISTIC INDIVIDUALS MAY FLUCTUATE
references and bragging) to gain the acclaim and BETWEEN GRANDIOSITY AND VULNERABILITY
recognition they crave - both subtypes are associated with high levels of
- seek power, status, and attention interpersonal antagonism/low agreeableness (which
- believe they are so special; they often think they can includes traits of low modesty, arrogance, grandiosity,
be understood only by other high-status people and superiority)
- exceptionally low in certain facets of neuroticism but - low altruism (expecting favorable treatment and
high in extraversion exploiting others)
- high on grandiosity were additionally described as - tough-mindedness (lack of empathy)
being aggressive, hardheaded, outspoken, assertive,
and determined CASE STUDY:

• GRANDIOSE IS MORE ASSOCIATED WITH ANTISOCIAL

AND HISTRIONIC PERSONALITY DISORDER

2.) VULNERABLE NARCISSISM

- they can be quiet and reserved
- have a very fragile and unstable sense of self-esteem
- arrogance and condescension/superiority are merely
a façade for intense shame and hypersensitivity to
rejection and criticism
- become completely absorbed and preoccupied with
fantasies of outstanding achievement but at the same
time experience profound shame about their
ambitions
- they have strong sense of entitlement but easily
threatened
CAUSAL FACTORS OF HPD: CASE STUDY:
 grandiose and vulnerable forms of narcissism are
associated with different causal factors
• GRANDIOSE NARCISSISM
- associated with parental overvaluation
• VULNERABLE NARCISSISM
- associated with emotional, physical, and sexual
abuse
- parenting styles characterized as intrusive,
controlling, and cold

 HERITABILITY
PSYCHOPATHY AND ANTISOCIAL
 CULTURE VALUES INDIVIDUALITY
PERSONALITY DISORDER
- psychopathy includes such affective and
1.) ANTISOCIAL PERSONALITY
interpersonal traits as lack of empathy, selfish,
DISORDER
callous/heartless, inflated and arrogant self-
appraisal or grandiose sense of self-worth, and
glib and superficial charm (more explanation on
table)
- diagnosis of psychopathy appears to be the
single best predictor of violence and recidivism
- one review estimated that people with
psychopathy are three times more likely to
- continually violate and show disregard for the reoffend and four times more likely to reoffend
rights of others through deceitful/deceive, violently following prison terms than are people
aggressive, or antisocial behavior without a psychopathy diagnosis
- without remorse or loyalty
- tend to be impulsive, irritable, and aggressive 2 DIMENSIONS OF PSYCHOPATHY:
and to show a pattern of generally irresponsible - Psychopathy Checklist-Revised (PCL-R) shown
behavior especially in work that there are two related but separable
- little regard for safety either their own or that dimensions of psychopathy, each predicting
of others different types of behavior
- repeated conflict with society, and a high  FIRST DIMENSION
proportion become incarcerated - affective and interpersonal core of the
- pattern of behavior must have been occurring disorder and reflects traits such as lack of
since the age of 15 remorse or guilt, callousness/lack of
- before age 15 the person must have had empathy, glibness/ superficial charm,
symptoms of conduct disorder
aggression toward people or animals,
 grandiose sense of self-worth, and severely retarded or
nonexistent, and they behave
pathological lying as though social regulations
- affective and interpersonal dimension is and laws do not apply to them
prone to acting out impulses in
positively related to verbal intelligence remorseless and often
senselessly violent ways
prone to thrill seeking and
 SECOND DIMENSION deviant and unconventional
behavior
- antisocial or impulsive acts, social deviance, seem to have good insight into
other people’s needs and
as well as a need for stimulation, poor weaknesses and are adept at
behavior controls, irresponsibility, and a exploiting them
appears to be the single best
parasitic lifestyle predictor of violence and
recidivism that is more likely to
- antisocial dimension is negatively related to
reoffend 3-4 times in the prison
intelligence

• SECOND DIMENSION IS MUCH MORE CLOSELY CASE STUDY:

RELATED THAN THE FIRST TO THE DSM

DIAGNOSIS OF ASPD

• THE DIFFERENCE OF PSYCHOPATHY AND ASPD

- they are related but differ in significant ways
- have high rates of alcohol abuse and
dependence and other substance abuse
/dependence disorders
- but alcohol abuse is related only to the
antisocial or deviant dimension of the PCL-R
- elevated rates of suicide attempts and
completed suicides, 2nd only
PSYCHOPATH ASPD
selfish, callous/heartless, and antisocial and
exploitative behaviors, aggressive
deceitful and manipulative, behaviors necessary
cannot understand love in for a diagnosis of
others or give it in return ASPD but do not
show enough
selfishness, callous,
and exploitative
behaviors
often charming, spontaneous, charming,
and likable on first impulsive, irritable,
acquaintance that easily get and aggressive,
new friends without remorse or
loyalty
live in a series of present failure to plan
moments without ahead, irresponsible
consideration for the past or and little regard for
future safety
conscience development is
 - family factors are most important in
predicting which children will show the most
antisocial behaviors are poor parental
supervision, harsh or erratic parental
discipline, physical abuse or neglect,
disrupted family life, and a convicted mother
 HISTORY OF ODD/OPPOSITIONAL DEFIANT D.
- age of 6
 HAS CONDUCT SYMPTOMS
- age of 9
- “Travel to CONey (CONduct disorder) island
before age 15 and you will be sent to
ANTarctica (ANTisocial personality disorder)
after age 18”
 ADHD + ODD = ASPD = PSYCHOPATHY

2.) BORDERLINE PERSONALITY

DISORDER

- history: it was related to schizophrenia; it

actually has a term “borderline schizophrenia”
however current diagnosis of BPD is no longer
considered to be biologically related to
schizophrenia.
CAUSAL FACTORS OF APD: - BPD shows a pattern of behavior characterized
 GENETIC INFLUENCES by impulsivity and instability in interpersonal
 LOW-FEAR HYPOTHESIS AND CONDITIONING relationships, self-image, and moods
- deficiencies in fear and anxiety - central characteristic 1: affective instability
 MORE GENERAL EMOTIONAL DEFICITS
manifested by unusually intense emotional
 EARLY PARENTAL LOSS, PARENTAL
responses to environmental triggers, with
REJECTION, AND INCONSISTENCY
delayed recovery to a baseline emotional state;
characterized by drastic and rapid shifts from one • WHY PEOPLE WITH BPD HAVE SELF-
emotion to another DESTUCTIVE BEHAVIOR, SUICIDE ATTEMPTS, AND
- central characteristic 2: highly unstable self- DOING SELF-MULTILATION?
image or sense of self or sense of self, which is - self-injurious behavior is associated with relief
sometimes described as “impoverished/ from anxiety or dysphoria, and it also serves to
exhausted/weakened and/or fragmented” communicate the person’s level of distress to
- affective instability + highly unstable self-image others
= highly unstable interpersonal relationships - BPD is associated with analgesia in as many as
- relationships tend to be intense but stormy, 70 to 80 percent of women with BPD
typically involving over idealizations of friends or absence of the experience of pain in the
presence of a theoretically painful stimulus
lovers that later end in bitter disillusionment,
disappointment, and anger • BPD AND NONSUICIDAL SELF-INJURY DISORDER
- they may make desperate efforts to avoid real IS DIFFERENT DISORDER
or imagined abandonment because their fears of - NSSI involves deliberate damage to body tissue
abandonment are so intense such as might occur with skin cutting, burning,
biting, excessive scratching, and punching but in
the absence of an intent to die
- central characteristic 3: impulsivity which is - seems to be greatest in the adolescent years
characterized by rapid responding to - tension relief is one reason that many people
environmental triggers without thinking or caring with NSSI give
about long-term consequences - people who engage in NSSI tend to have higher
- high levels of impulsivity + affective instability = pain endurances than the rest of us
erratic, self-destructive behaviors such as - have a highly self-critical cognitive style and
gambling sprees or reckless driving “may regard suffering and pain as something
- suicide attempts are present, sometimes they deserve”.
manipulative sometimes may ultimately
complete suicide COMORBIDITIES OF BPD:
- central characteristic 4: self-mutilation such as 1.) UNIPOLAR (depression) and BIPOLAR (mania
repetitive cutting behavior however, many and depression) MOOD
people who engage in self-injury do not have 2.) ANXIETY DISORDERS
BPD - panic and ptsd
- other symptoms: cognitive symptoms including 3.) SUBTSNACE USE DISORDER
short or transient episodes in which they appear 4.) EATING DISORDERS
to be out of contact with reality and experience 5.) CLUSTER A PERSONALITY DISORDER
delusions or other psychotic-like symptoms such - schizotypal personality disorder
as hallucinations, paranoid ideas, or severe 6.) CLUSTER B PERSONALITY DISORDERS
dissociative symptoms - histrionic personality disorder
- antisocial personality disorder
7.) CLUSTER C PERSONALITY DISORDER
- dependent personality disorder

CAUSAL FACTORS OF BPD:

 genetic factors
- affective instability and impulsivity are
partially heritable traits
 5-HTT GENE/SEROTONIN TRANSPORTER
GENE
- lowered functioning of the
neurotransmitter serotonin, which is
involved in inhibiting behavioral
responses so they have low inhibiting
behavior response
- they show impulsive-aggressive
behavior, as in acts of self-mutilation;
that is, their serotonergic activity is too
low to put the brakes on
 traumatic events in childhood CASE STUDY:
- include abuse and neglect, and separation
and loss
 parental failure

• CLUSTER C #WORRIED
 • APD CAN OVERLAP WITH SOCIAL PHOBIA
SOCIAL PHOBIA APD
- specific situations - general situations
like speaking in public make them anxious
or eating in public
make them anxious

- research findings: there are cases of generalized

- people with these disorders often show anxiety social phobia without avoidant personality
and fearfulness disorder but very few cases of avoidant
- more commonly associated with depression personality disorder without generalized social
than is BPD phobia

• CLUSTER C: AVOIDANT PEOPLE ACT CASE STUDY:

COWARDLY, SOME PEOPLE ARE OBSESSIVE-
COMPULSIVE, AND DEPENDENT PEOPLE ARE
CLINGY.

CLUSTER C 3 PERSONALITY DISORDERS:

1.) AVOIDANT PERSONALITY DISORDER
#COWARD
- shy, timid, insecure, low self-esteem such as
“I’m so incapable, undesirable, or inadequate “
- want relationship but has hypersensitivity to
rejection, negative feedback or criticism, rarely
take risk, and avoid social situations
- easily get bored and do not enjoy their
aloneness
- often associated with depression
- 2 most stable features: feeling inept/unskillful/
CAUSAL FACTORS OF APD:
incompetent/clumsy and socially inadequate
 INNATE INHIBITED TEMPERAMENT
- show more generalized timidity/lack of courage
- leaves the infant and child shy and
or confidence and avoidance of many novel
inhibited in novel and ambiguous
situations and emotions including positive
situations
emotions
 GENETIC VULNERABILITY
- deficits in their ability to experience pleasure
- least partially shared with that for
- higher levels of dysfunction and distress
social phobia
 HERITABILITY
- fear of being negatively evaluated
 - introversion and neuroticism COMORBIDITIES OF DPD:
 CHILDHOOD EXPERIENCES 1.) mood disorders
- experience emotional abuse, rejection, 2.) anxiety disorders
or humiliation from parents who are not 3.) eating disorders
particularly affectionate
- rejection would be especially likely to • DPD OVERLAP WITH AVOIDANT PERSONALITY
lead to anxious and fearful attachment D.
patterns in temperamentally inhibited - they both have low self-confidence and fear of
children rejection

2.) DEPENDENT PERSONALITY • DPD OVERLAP WITH BORDERLINE

DISORDER #CLINGY PERSONALITY DISORDER
- both borderline personalities and dependent
personalities fear abandonment
- the borderline personality, who usually has
intense and stormy relationships, reacts with
feelings of emptiness or rage if abandonment
occurs, whereas the dependent personality
- extreme need to be taken care of that leads to reacts initially with submissiveness and
clinging and submissive/compliant behavior appeasement and then finally with an urgent
- overly depend on and cling to relationship seeking of a new relationship
- intense fear of separation and rejection
sometimes simply having to be alone • DPD OVERLAP WITH HISTRIONIC PERSONALITY
- usually build their lives around other people DISORDER
and subordinate their own needs and beliefs to - both have strong needs for reassurance and
keep the people around them approval
- they fail to get angry to not just lose the - histrionic personality is much more gregarious,
support of people flamboyant, and actively demanding of attention,
- often trap in abusive relationship whereas the dependent personality is more
- difficulty on making simple decision docile and self-effacing/not claiming attention for
- lack of self-confidence and feel helpless oneself

• DPD IS MORE COMMON IN WOMEN THAN CAUSAL FACTORS OF DPD:

MEN  GENETIC INFLUENCE ON PERSONALITY
- certain personality traits such as neuroticism TRAITS
and agreeableness, which are prominent in - particularly neuroticism and
dependent personality disorder agreeableness
  PARENTING STYLES 3 MAIN CHARACTERISTICS:
- parents who are authoritarian and • PERFECTIONISM (THAT IS DYSFUNCTIONAL)
overprotective • EXCESSIVE CONCERN WITH MAINTAINING
- or those parents who are not promoting ORDER
autonomy and individuation in their child • EXCESSIVE CONCERN MAINTAINING CONTROL
but instead reinforcing dependent behavior
- lead children to believe that they are 4 MOST PREVALENT AND STABLE
reliant on others for their own well-being FEATURES OF OCPD:
and are incompetent on their own • RIGIDITY
 UNDERLYING MALADAPTIVE SCHEMAS
• STUBBORNNESS
- involving core beliefs about weakness and
• PERFECTIONISM
competence and needing others to survive
• RELUCTANCE TO DELEGATE
- “I am completely helpless” and “I can
- fear of losing power
function only if I have access to somebody
- lack confidence and trust in their subordinates
competent”

OCD VS. OCPD

3.) OBSESSIVE COMPULSIVE
- has similarity
PERSONALIY DISORDER #COMPULSIVE
- some patients with OCD have a comorbid
- obsessed with orderliness, rules, schedule,
diagnosis of OCPD
detail, perfectionism, and complete control
OCD OCPD
- inflexible and have rigid/fixed beliefs and moral
has true obsessions or no true obsessions
issues compulsive rituals only
that are source of overconscientiousness
- perceived as stubborn
extreme anxiety or lifestyles or living
- inefficient because they spend great time in distress more thoughtful
attention to
planning and worrying
something, high
- excessively devoted to work to the exclusion of neuroticism,
inflexibility, and
leisure activities and may have difficulty relaxing
perfectionism
or doing anything just for fun ego dystonic ego syntonic
- have difficulty delegating tasks to others
people have this they don’t think they
- easily stressed
wishes they stop have to change
- are quite rigid, stubborn, and cold, which is how
others tend to view them • OCPD OVERLAP WITH SOME FEATURES OF
- have lifestyles characterized by over NARCISSISTIC
conscientiousness, high neuroticism, inflexibility, - may be because they want to be perfect and
and perfectionism but without the presence of the best
true obsessions or compulsive rituals - individuals with narcissistic and ASPDs may
share the lack of generosity toward others that
characterizes OCPD however OCPD are equally
unwilling to be generous with others and CASE STUDY:
themselves

• OCPD OVERLAP WITH SOME FEATURES OF

ANTISOCIAL
- unwilling to be generous with others
• OCPD OVERLAP WITH SOME FEATURES OF
SCHIZOID PERSONALITY DISORDERS
- may have a certain amount of formality and
social detachment
- however, OCPD has difficulty in interpersonal
relationships because of excessive devotion to
work and great difficulty expressing emotions.

CAUSAL FACTORS OF OCPD:

 HIGH LEVELS OF CONSCIENTIOUSNESS
- this leads to extreme devotion to
work, perfectionism, and excessive
controlling behavior
 HIGH ON ASSERTIVENESS/FORCEFUL
BEHAVIOR
- facet of extraversion
 LOW ON COMPLIANCE
- facet of agreeableness
 INFLUENTIAL BIOLOGICAL
DIMENSIONAL APPROACH
- low levels of novelty seeking or low
seeking of new experiences, they
actually avoid change
- low levels of reward dependence
because they work excessively at the
expense of pleasurable pursuits
- high levels of harm avoidance
 MODEST GENETIC INFLUENCE