Fundamentals of Psychological Disorders - 3rd edition Part V Mental Disorders - Block 4 Module 13 Personality Disorders

Fundamentals Disorders Module 13 Personality Disorders edition as of July 2023 Module Overview In Module 13 , we will cover matters related to personality disorders to include their clinical presentation , epidemiology , etiology , and treatment options . Our discussion will include Cluster A disorders of paranoid , schizoid , and Cluster disorders of antisocial , borderline , histrionic , and narcissistic and Cluster personality disorders of , dependent , and compulsive . Be sure you refer Modules for explanations of key terms ( Module ) an overview of the various models to explain psychopathology ( Module ) and descriptions of the therapies ( Module ) Module Outline . Clinical Presentation . Epidemiology . Etiology Module Learning Outcomes Describe how personality disorders present . Describe the epidemiology of personality disorders . Describe in relation to personality disorders . Describe the etiology of personality disorders . Describe treatment options for personality disorders . Clinical Presentation Section Learning Objectives Define personality trait .

Fundamentals Disorders Define personality disorder . List the defining features of personality disorders . Describe the three clusters . Describe how paranoid personality disorder presents . Describe how schizoid personality disorder presents . Describe how personality disorder presents . Describe how antisocial personality disorder presents . Describe how borderline personality disorder presents . Describe how histrionic personality disorder presents . Describe how narcissistic personality disorder presents . Describe how personality disorder presents . Describe how dependent personality disorder presents . Describe how personality disorder presents . Overview of Personality Disorders According to the , personality traits are enduring patterns of perceiving , relating to , and thinking about the environment and oneself that are exhibited in a wide range of social and personality while a personality disorder is an enduring pattern of inner experience and behavior that deviates markedly from the norms and expectations of the individual culture , is pervasive and , and has an onset in adolescence or early adulthood , is stable over time , and leads to distress or impairment ( APA , 2022 , 733 ) Personality disorders have four defining features , which include distorted thinking patterns , problematic emotional responses , or impulse control , and interpersonal difficulties . While these four core features are universal among all ten personality disorders , the divides the personality disorders into three different clusters based on symptom similarities . Cluster A is described as the odd or eccentric cluster and consists of paranoid , schizoid , and personality disorders . The common feature between these three disorders is social awkwardness and social withdrawal . Often these behaviors are similar to those seen in schizophrenia however , they tend to be not as extensive or impactful on daily functioning as seen in schizophrenia . In fact , there is a strong relationship between Cluster A personality disorders among individuals who have a relative diagnosed with schizophrenia ( Siever , 2011 ) Cluster is the dramatic , emotional , or erratic cluster and consists of antisocial , borderline , histrionic , and narcissistic personality disorders . Individuals with these personality disorders often experience problems with impulse control and emotional regulation . Due to the dramatic , emotional , and erratic nature of these disorders , it is nearly impossible for individuals to establish healthy relationships with others . And finally , Cluster is the anxious or fearful cluster and consists of , dependent , and personality disorders . As you read through the descriptions of the disorders , you will see an overlap with symptoms from the anxiety and depressive disorders . Cluster disorders have the most treatment options of all the personality disorders , likely because the overlapping anxiety and depressive disorders have treatment options . To meet the criteria for any personality disorder , the individual must display the pattern of behaviors in 255

Fundamentals Disorders adulthood . Children can not be diagnosed with a personality disorder . Some children may present with similar symptoms , such as poor peer relationships , odd or eccentric behaviors , or peculiar thoughts and language however , a formal personality disorder diagnosis can not be made until the age of 18 . The reports that median prevalence across several countries is for Cluster A disorders , for Cluster , for Cluster , and for any personality disorder . It is also noted that the clustering approach used in the has not been consistently validated and has some serious limitations . As written , An alternative to the categorical approach is the dimensional perspective that personality disorders represent variants of personality traits that merge imperceptibly into normality and into one another ( APA , 2022 , 734 ) Interested readers should consult Section III of the ( beginning on page 881 ) for a full description of the dimensional model for personality disorders and an alternative model for personality disorders that utilizes a hybrid model approach . Paranoid personality disorder . Paranoid personality disorder is characterized by a marked distrust or suspicion of others . Individuals interpret and believe that other motives and interactions are intended to harm them , and therefore , they are skeptical about establishing close relationships outside of family , at times , even family members actions are also believed to be malevolent ( APA , 2022 ) Individuals with paranoid personality disorder often feel as though they have been deeply and irreversibly hurt by others even though they lack evidence to support that these others intended to or did hurt them . Because of these persistent suspicions , they will doubt relationships that show true loyalty or trustworthiness . Compliments are misinterpreted and they may view an offer of help as a criticism that they are not doing a good enough job on their own . Individuals with paranoid personality disorder are also hesitant to share any personal information or in others as they fear the information will be used against them . Additionally , benign remarks or events are often viewed as demeaning or threatening . For example , if an individual with paranoid personality disorder was accidentally bumped into at the store , they would interpret this action as intentional , with the purpose of causing them injury . Because of this , individuals with paranoid personality disorder are quick to hold grudges and unwilling to forgive insults or whether intentional or not . They are known to quickly and angrily counterattack , either verbally or physically , in situations where they feel they were insulted ( APA , 2022 ) Schizoid personality disorder . Individuals with schizoid personality disorder display a persistent pattern of avoidance of social relationships , along with a limited range of emotional expression in interpersonal settings ( APA , 2022 ) Similar to those with paranoid personality disorder , individuals with schizoid personality disorder do not have many close relationships however , unlike paranoid personality disorder , this lack of connection is not due to suspicious feelings , but rather , the lack of desire to engage with others and the preference to engage in solitary behaviors . Individuals with schizoid personality disorder are often viewed as loners and prefer activities where they do not have to engage with others ( APA , 2022 ) Established relationships rarely extend outside that of the family as they make no effort to start or maintain friendships . This lack of establishing social relationships also extends to sexual behaviors , as these individuals report a lack of interest in engaging in sexual experiences with others . 256

Fundamentals Disorders Regarding the limited range of emotion , individuals with schizoid personality disorder are often indifferent to criticisms or praises of others and appear not to be affected by what others think of them . Individuals will rarely show any feelings or expressions of emotion and are often described as having a bland exterior ( APA , 2022 ) In fact , individuals with schizoid personality disorder rarely reciprocate facial expressions or gestures typically displayed in normal conversations such as smiles or nods . Because of this lack of emotion , there is a limited need for attention or acceptance . personality disorder . personality disorder is characterized by a range of impairment in social and interpersonal relationships due to discomfort in relationships , along with odd cognitive or perceptual distortions and eccentric behaviors ( APA , 2022 ) Similar to those with schizoid personality disorder , individuals also seek isolation and have few , if any established relationships outside of family members . One of the most prominent features of personality disorder is ideas of reference , or the belief that unrelated events pertain to them in a particular and unusual way . Ideas of reference also lead to superstitious behaviors or preoccupation with paranormal activities that are not generally accepted in their culture ( APA , 2022 ) The perception of special or magical powers , such as the ability to or control other thoughts , has also been documented in individuals with personality disorder . Similar to schizophrenia , unusual perceptual experiences such as auditory hallucinations , as well as unusual speech patterns of derailment or incoherence , are also present . Like the other personality disorders within cluster A , there is a component of paranoia or suspiciousness of other motives . Additionally , individuals with personality disorder display inappropriate or restricted affect , thus impacting their ability to appropriately interact with others in a social context . Significant social anxiety is often also present in social situations , particularly in those involving unfamiliar people . The combination of limited affect and social anxiety contributes to their inability to establish and maintain personal relationships most individuals with personality disorder prefer to keep to themselves to reduce this anxiety . Cluster . Antisocial personality disorder . The essential feature of antisocial personality disorder is the persistent pattern of disregard for , and violation of , the rights of others . This pattern of behavior begins in late childhood or early adolescence and continues throughout adulthood . While this behavior presents before age 15 , the individual can not be diagnosed with antisocial personality disorder until the age of 18 . Prior to age 18 , the individual would be diagnosed with conduct disorder . Although not discussed in this book as it is a disorder of childhood , conduct disorder involves a repetitive and persistent pattern of behaviors that violate the rights of others or major norms . Common behaviors of individuals with conduct disorder that go on to develop antisocial personality disorder are aggression toward people or animals , destruction of property , deceitfulness or theft , or serious violation of rules ( APA , 2022 ) While commonly referred to as psychopaths or sociopaths , individuals with antisocial personality disorder fail to conform to social norms . This also includes legal rules as individuals with antisocial personality disorder are often repeatedly arrested for property destruction , others , or stealing ( APA , 2022 ) Deceitfulness is another hallmark symptom of antisocial personality disorder as individuals often lie repeatedly , generally to gain profit or pleasure . There is also a pattern of 257

Fundamentals Disorders made in the moment without forethought of personal consequences or consideration for others ( Lang et , 2015 ) This impulsivity also contributes to their inability to hold jobs as they are more likely to impulsively quit their jobs ( et , 2014 ) Employment instability , along with impulsivity , also impacts their ability to manage finances it is not uncommon to see individuals with antisocial personality disorder with large debts that they are unable to pay ( 2016 ) While also likely related to impulsivity , individuals with antisocial personality disorder tend to be extremely irritable and aggressive , repeatedly getting into fights . The marked disregard for their safety , as well as the safety of others , is also observed in reckless behavior such as speeding , driving under the , and engaging in sexual and substance abuse behavior that may put themselves at risk ( APA , 2022 ) Of course , the most known and devastating symptom of antisocial personality disorder is the lack of remorse for the consequences of their actions , regardless of how severe they may be . Individuals often rationalize their actions as the fault of the victim , minimize the harmfulness of the consequences of their behaviors , or display indifference ( APA , 2022 ) Overall , individuals with antisocial personality disorder have limited personal relationships due to their selfish desire and lack of moral conscience . Borderline personality disorder . Individuals with borderline personality disorder display a pervasive pattern of instability in interpersonal relationships , and affect ( APA , 2022 ) The combination of these symptoms causes significant impairment in establishing and maintaining personal relationships . They will often go to great lengths to avoid real or imagined abandonment . Fears related to abandonment can lead to inappropriate anger as they often interpret the abandonment as a reflection of their own behavior . It is not uncommon to experience intense in mood , often observed as volatile interactions with family and friends ( 2014 ) Those with borderline personality disorder may be friendly one day and hostile the next . To prevent abandonment , individuals with borderline personality disorder will often exhibit impulsive behaviors such as and suicidal behavior . In fact , individuals with borderline personality disorder engage in more suicide attempts , and completion of suicide is higher among these individuals than the general public ( et , 2015 ) Other impulsive behaviors , such as injury ( cutting ) and sexual promiscuity , are frequently seen within this population , typically occurring during periods ( 2012 ) They often have chronic feelings of emptiness along with painful feelings of aloneness . Occasionally , hallucinations and delusions are present , particularly of a paranoid nature however , these symptoms are often transient and recognized as unacceptable by the individual ( 2007 ) Histrionic personality disorder . Histrionic personality disorder is the first personality disorder that addresses pervasive and excessive emotionality and . These individuals are usually uncomfortable in social settings unless they are the center of attention . To help gain attention , the individual is often vivacious and dramatic , using physical gestures and mannerisms along with grandiose language . These behaviors are initially very charming to their audience however , they begin to wear due to the constant need for attention to be on them . If the theatrical nature does not gain the attention they desire , they may go to great lengths to draw attention , such as using a fictitious story or creating a dramatic scene . 258

Fundamentals Disorders To ensure they gain the attention they desire , individuals with histrionic personality disorder frequently dress and engage in sexually seductive or provocative ways . These sexually charged behaviors are not only directed at those in which they have a sexual or romantic interest but to the general public as well ( APA , 2022 ) They often spend a amount of time on their physical appearance to gain the attention they desire . Individuals with histrionic personality disorder are easily suggestible . Their opinions and feelings are by not only their friends but also by current fads ( APA , 2022 ) They also tend to exaggerate relationships , considering casual as more intimate than they are . Narcissistic personality disorder . Like histrionic personality disorder , narcissistic personality disorder also centers around the individual however , with narcissistic personality disorder , individuals display a pattern of grandiosity along with a lack of empathy for others ( APA , 2022 ) The grandiose sense of self leads to an overvaluation of their abilities and accomplishments . They often come across as boastful and pretentious , repeatedly proclaiming their superior achievements . These proclamations may also be fantasized to enhance their success or power . Oftentimes they identify themselves as special and will only interact with others of high status . Given the grandiose sense of self , it is not surprising that individuals with narcissistic personality disorder need excessive admiration from others . While it appears that their is hugely , it is very fragile and dependent on how others perceive them ( APA , 2022 ) Because of this , they may constantly seek out compliments and expect favorable treatment from others . When this sense of entitlement is not upheld , they can become irritated or angry that their needs are not met . A lack of empathy is also displayed in individuals with narcissistic personality disorder as they often struggle to ( or choose not to ) recognize the desires or needs of others . This lack of empathy also leads to exploitation of interpersonal relationships , as they are unable to understand other feelings ( et , 2014 ) They often become envious of others who achieve greater success or possessions than them . Conversely , they believe everyone should be envious of their achievements , regardless of how small they may be . Cluster . personality disorder . Individuals with personality disorder display a pervasive pattern of social inhibition due to feelings of inadequacy and increased sensitivity to negative evaluations ( APA , 2022 ) The fear of being rejected drives their reluctance to engage in social situations so that they may prevent others from evaluating them negatively . This fear extends so far that it prevents individuals from maintaining employment due to their intense fear of negative evaluation or rejection . Socially , they have very few if any friends , despite their desire to establish social relationships . They actively avoid social situations in which they can develop new friendships out of the fear of being disliked or ridiculed . Similarly , they are cautious of new activities or relationships as they often exaggerate the potential negative consequences and embarrassment that may occur this is likely a result of their ongoing preoccupation with being criticized or rejected by others . Within intimate relationships , their fear of being shamed or ridiculed leads to restraint , and they view themselves as socially inept ( APA , 2022 ) 259

Fundamentals Disorders Making Sense of the Disorders As you read the clinical description of personality disorder , did you think it sounded a lot like social anxiety disorder ?

You likely did as there is a great deal of overlap between the two disorders . So , how do they differ if they are to be regarded as separate diagnostic categories in the ?

This difference is linked to . How so ?

In social anxiety disorder the negative is unstable and less pervasive and entrenched . In personality disorder , the negative is more stable as an enduring and pervasive pattern , typical of personality traits . Additionally , personality disorder frequently occurs in the absence of social anxiety disorder and some separate risk factors have been identified for the two . Dependent personality disorder . Dependent personality disorder is characterized by pervasive and excessive need to be taken care of by others ( APA , 2022 ) This intense need leads to submissive and clinging behaviors as they fear they will be abandoned or separated from their parent , spouse , or another person with whom they are in a dependent relationship . They are so dependent on this other individual that they can not make even the smallest decisions without first consulting with them and gaining their approval or reassurance . They often allow others to assume complete responsibility for their life , making decisions in nearly all aspects of their lives . Rarely will they challenge these decisions as their fear of losing this relationship greatly outweighs their desire to express their own opinion . Should the relationship end , the individual experiences significant feelings of helplessness and quickly seeks out another relationship to replace the old one ( APA , 2022 ) When they are on their own , individuals with dependent personality disorder express difficulty initiating and engaging in tasks on their own . They lack and feel helpless when they are left to care for themselves or engage in tasks on their own . So that they do not have to engage in tasks alone , individuals will go to great lengths to seek out support of others , often volunteering for unpleasant tasks if it means they will get the reassurance they need ( APA , 2022 ) personality disorder ( is defined by an individual preoccupation with orderliness , perfectionism , and ability to control situations that they lose , openness , and efficiency in everyday life ( APA , 2022 ) One preoccupation with details , rules , lists , order , organization , or schedules overshadows the larger picture of the task or activity . In fact , the need to complete the task or activity is significantly impacted by the individual high standards and need to complete the task perfectly , that the task often does not get completed . The desire to complete the task perfectly often causes the individual to spend an excessive amount of time on the task , occasionally repeating it until it is to their standard . Due to repetition and attention to fine detail , the individual often does not have time to engage in leisure activities or engage in social relationships . Despite the excessive amount of time spent on activities or tasks , individuals with will not seek help from others , as they are convinced that the others are incompetent and will not complete the task up to their standard . Personally , individuals with OCD are rigid and stubborn , particularly with their morals , ethics , and 260

Fundamentals Disorders values . Not only do they hold these standards for themselves , but they also expect others to have similarly high standards , thus causing significant disruption to their social interactions . The rigid and stubborn behaviors are also seen in their financial status , as they are known to live significantly below their means to prepare financially for a potential catastrophe ( APA , 2022 ) Similarly , they may have difficulty discarding or worthless items , despite their lack of sentimental value . Though on the surface it may appear that and OCD are one and the same , there is a distinct difference as the personality disorder lacks definitive obsessions and compulsions ( APA , 2022 ) In fact , most individuals with OCD do not have a pattern of behavior that meets criteria for this personality disorder . Key Takeaways You should have learned the following in this section Personality disorders share the features of distorted thinking patterns , problematic emotional responses , or impulse control , and interpersonal difficulties and divide into three clusters . Cluster A personality disorders are described as the cluster and share as the common feature social awkwardness and social withdrawal . It consists of paranoid , schizoid , and personality disorders . Cluster personality disorders are described as the dramatic , emotional , or erratic cluster and consists of antisocial , borderline , histrionic , and narcissistic personality disorders . Cluster is the cluster and consists of , dependent , and compulsive personality disorders . Paranoid personality disorder is characterized by a marked distrust or suspicion of others . Schizoid personality disorder is characterized by a persistent pattern of avoidance of social relationships , along with a limited range of emotion among social relationships . personality disorder is characterized by a range of impairment in social and interpersonal relationships due to discomfort in relationships , along with odd cognitive or perceptual distortions and eccentric behaviors . Antisocial personality disorder is characterized by a persistent pattern of disregard for , and violation of , the rights of others . They show no remorse for their behavior Borderline personality disorder is characterized by a pervasive pattern of instability in interpersonal relationships , and affect . Histrionic personality disorder is characterized by pervasive and excessive emotionality and . Narcissistic personality disorder is characterized by a pattern of grandiosity along with a lack of empathy for others . personality disorder is characterized by a pervasive pattern of social anxiety due to feelings of inadequacy and increased sensitivity to negative evaluations . Dependent personality disorder is characterized by pervasive and excessive need to be taken care of by others . is characterized by an individual preoccupation with orderliness , perfectionism , and the ability to control situations that they lose , openness , and efficiency in everyday life . 261

Fundamentals Disorders Section Review Questions . What are personality traits and how do they lead to personality disorders ?

What are the three clusters ?

How are disorders grouped into these three clusters ?

Discuss the differences in symptom presentation between the three personality clusters . Create a chart identifying each of the disorders among the three clusters . Be sure to include personality characteristics of each disorder . It is important to find characteristics unique to each personality disorder to aid in their identification . Epidemiology Section Learning Objectives Describe the epidemiology of Cluster A personality disorders . Describe the epidemiology of Cluster personality disorders . Describe the epidemiology of Cluster personality disorders . Disorders within Cluster A have a prevalence rate of around . More , according to Part II of the National Survey Replication , the estimated prevalence of paranoid personality disorder was , schizoid personality disorder was , and personality disorder was . personality disorder has been found to be more common in men while research on schizoid personality disorder leans to no gender difference in prevalence . As for paranoid personality disorder , it appears to be more common in men though the National Survey on Alcohol and Related conditions found it to be more common in women ( APA , 2022 ) Cluster Using Part II of the National Survey Replication , it was found that for Cluster personality disorders prevalence rates were for antisocial , for borderline , for histrionic , and for narcissistic . It should be noted that the prevalence of histrionic personality disorder was and narcissistic was in the National Survey on Alcohol and Related Conditions . As for differences , antisocial personality disorder is three times more common in 262

Fundamentals Disorders men and they present with and reckless disregard for the safety of others more often than women . Borderline personality disorder is more common among women in clinical samples while community samples show no difference in prevalence , likely due to the tendency of women to seek help leading them to clinical settings . Histrionic personality disorder is more predominant in females in clinical settings , though some studies using structured assessments point to no difference in prevalence rates across the genders . Narcissistic personality disorder occurs more in men than women . Cluster Using Part II of the National Survey Replication , it was found that for Cluster personality disorders prevalence rates were for , for dependent , and for . Women are more likely to be diagnosed with and dependent personality disorders while appears to be equally prevalent in women and men . For expanded information on the prevalence of the various personality disorders from the , please see Table 13 . below . 263

Fundamentals Disorders Table . Comparing Prevalence Rates by Data Source Personality Disorder Part II of Paranoid Schizoid Antisocial Borderline Histrionic Narcissistic Dependent Notes All numbers are reported as percentages Part II of the National Survey Replication Survey on Alcohol and Related Conditions Values from reviews of epidemiological studies ( to studies with data sets from the ) Source ( APA , 2022 ) Key Takeaways You should have learned the following in this section Prevalence rates of Cluster A personality disorders range from to with being more common in men and there being no difference in schizoid and evidence for paranoid . Prevalence rates of Cluster personality disorders range from to and antisocial and narcissistic are more common in men with borderline and histrionic being more common in women , in general . Prevalence rates of Cluster personality disorders range from to with women being more likely to be diagnosed with and dependent personality disorders and 264

Fundamentals Disorders appearing to be equally prevalent in women and men . Section Review Questions . What is the difference in prevalence rates across the three clusters ?

Are there any trends among gender ?

Identify the most commonly occurring personality disorder . Which is the least common ?

Section Learning Objectives Describe the of personality disorders . Among the most common diagnoses with personality disorders are mood disorders , anxiety disorders , and substance abuse disorders ( Lane , Kessler , 2007 ) A large exploring the data on the of major depressive disorder and personality disorders indicated a high diagnosis of major depressive disorder , bipolar disorder , and ( Kaiser , 2014 ) Further exploration of major depressive disorder suggested the lowest rate of diagnosis in Cluster A disorders , higher rate in Cluster disorders , and the highest rate in Cluster disorders . While the relationship between bipolar disorder and personality disorders has not been consistently clear , the most recent findings report a high between Cluster personality disorders , with the exception of ( which is in Cluster ) which had the highest rate than any other personality disorder . Overall analysis of suggested that it is the most diagnosed depressive disorder among all personality disorders . A more detailed analysis exploring the prevalence rates of the four main anxiety disorders ( generalized anxiety disorder , specific phobia , social phobia , and panic disorder ) among individuals with various personality disorders found a clear relationship specific to personality disorders and anxiety disorders ( Grant , 2014 ) More specifically , individuals diagnosed with borderline and personality disorders were found to have an additional diagnosis of one of the four main anxiety disorders . Individuals with narcissistic personality disorder were more likely to be diagnosed with generalized anxiety disorder and panic disorder schizoid and personality disorders reported significant rates of generalized anxiety disorder personality disorder had a higher diagnosis rate of social phobia . Substance use disorders occur less frequently across the ten personality disorders but are most common in individuals diagnosed with antisocial , borderline , and personality disorders ( Grant et , 2015 ) personality disorder is also with brief 265

Fundamentals Disorders psychotic disorder , disorder , delusional disorder , and schizophrenia while borderline is additionally with eating disorders , and ( APA , 2022 ) Key Takeaways You should have learned the following in this section Mood disorders , anxiety disorders , and substance abuse disorders have a high with personality disorders . Substance abuse disorders occur less frequently across the ten personality disorders but when they do , are with antisocial , borderline , and personality disorders . Section Review Questions . With what other disorders are personality disorders ?

Etiology Section Learning Objectives Describe the biological causes of personality disorders . Describe the psychological causes of personality disorders . Describe the social causes of personality disorders . Research regarding the development of personality disorders is limited compared to that of other mental health disorders . The following is a general overview of contributing factors to personality disorders . While there is some research lending itself to specific causes of specific personality disorders , the overall contribution of biological , psychological , and social factors will be reviewed . Biological Research across the personality disorders suggests some underlying biological or genetic component 266

Fundamentals Disorders however , of specific mechanisms have not been identified in most disorders , except for those below . Because of this lack of concrete evidence , researchers argue that it is difficult to determine what role genetics plays into the development of these disorders compared to that of environmental . Therefore , while there is likely a biological predisposition to personality disorders , exact causes can not be determined at this time . Research on the development of personality disorder has identified similar biological causes to that of activity of dopamine and enlarged brain ventricles ( et , 2015 ) Similar differences in neuroanatomy may explain the high similarity of behaviors in both schizophrenia and personality disorder . Surprisingly , antisocial personality disorder and borderline personality disorder also have similar neurological changes . More specifically , individuals with both disorders reportedly show deficits in serotonin activity ( Thompson , Ramos , 2014 ) These low levels of serotonin activity in combination with deficient functioning of the frontal the prefrontal cortex which is used in planning , and decision well as an overly reactive amygdala , may explain the impulsive and aggressive nature of both antisocial and borderline personality disorder ( Stone , 2014 ) Psychological Psychodynamic , cognitive , and behavioral theories are among the most common psychological models used to explain the development of personality disorders . Although much is still speculation , the following are general etiological views with regards to each specific theory . Psychodynamic . The psychodynamic theory places a large emphasis on negative early childhood experiences and how these experiences impact an individual inability to establish healthy relationships in adulthood . More specifically , individuals with personality disorders report higher levels of childhood stress , such as living in impoverished environments , exposure to domestic violence , and experiencing repeated maltreatment ( et , 2014 ) Additionally , high levels of childhood neglect and parental rejection are also observed in personality disorder patients , with early parental loss and rejection leading to fears of abandonment throughout an individual life ( 2014 , 2014 , 2010 ) Psychodynamic theorists believe that maltreatment in early childhood has the potential to negatively affect an individual sense of self and their perception of others , leading to the development of a personality disorder . For example , an individual who was neglected as a young child and deprived of love may report a lack of trust in others as an adult , a characteristic of antisocial personality disorder ( 2010 ) Difficulty trusting others or beliefs that they are unable to be loved may also impact one ability or desire to establish social relationships , as seen in many personality disorders , particularly schizoid . Because of these early childhood deficits , individuals may also overcompensate in their relationships to convince themselves that they are worthy of love and affection ( 2014 ) Conversely , individuals may respond to their early childhood experiences by becoming emotionally distant , using relationships as a sense of power and destructiveness . Cognitive . While psychodynamic theory emphasizes early childhood experiences , cognitive theorists focus on the thought patterns and cognitive distortions displayed by 267

Fundamentals Disorders those with personality disorders . Overall deficiencies in thinking can lead individuals with personality disorders to develop inaccurate perceptions of others ( Beck , 2015 ) These dysfunctional beliefs likely originate from the interaction between a biological predisposition and undesirable environmental experiences . thought patterns and strategies are strengthened during aversive life events as a protective mechanism and ultimately come together to form patterns of behavior displayed in personality disorders ( Beck , 2015 ) Cognitive distortions such as dichotomous thinking , also known as thinking , are observed in several personality disorders . More specifically , dichotomous thinking explains rigidity and perfectionism in , and the lack of among individuals with dependent and borderline personality disorders ( Beck , 2006 ) Discounting the positive also explains the underlying mechanisms for personality disorder ( Beck , 2006 ) For example , individuals who have been routinely criticized or rejected during childhood may have difficulty accepting positive feedback from others , expecting only to receive rejection and harsh criticism . In fact , they may employ these to positive feedback to support their ongoing theory that they are constantly rejected and criticized by others . Behavioral . Behavioral theorists apply three major theories to explain the development of personality disorders modeling , reinforcement , and lack of social skills . In modeling , an individual learns social patterns and behaviors by directly observing family members engaging in similar behaviors ( 2007 ) While we can not discredit the biological component of the familial , research does support an additive modeling or imitating component to the development of personality disorders , especially antisocial personality disorder ( APA , 2022 ) Reinforcement , or rewarding of behaviors is also observed in the development of many personality disorders . Parents may unintentionally reward aggressive behaviors by giving in to a desires to cease the situation or prevent escalation of behaviors . When this is done repeatedly over time , children ( and later as adults ) continue with these behaviors as they are effective in gaining their needs and wants . On the other side , there is some speculation that excessive reinforcement or praise during childhood may contribute to the grandiose sense of self observed in individuals with narcissistic personality disorder ( 2011 ) Finally , failure to develop normal social skills may explain the development of some personality disorders , such as personality disorder ( 2010 ) Social . Family dysfunction . High levels of psychological and social dysfunction within families have also been identified as contributing factors to the development of personality disorders . High levels of poverty , unemployment , family separation , and witnessing domestic violence are routinely observed in individuals diagnosed with personality disorders ( Paris , 1996 ) While formalized research has yet to explore the relationship between SES and personality disorders fully , correlational studies suggest a link between poverty , unemployment , and poor academic achievement with increased levels of personality disorder diagnoses ( 2006 ) Childhood maltreatment . Childhood maltreatment is among the most argument for the development of personality disorders in adulthood . Individuals with personality 268

Fundamentals Disorders disorders often struggle with a sense of self and the ability to relate to that is generally developed during the first four to six years of a child life , and it is affected by the emotional environment in which that child was raised . This sense of self is the mechanism in which individuals view themselves within their social context , while also informing attitudes and expectations of others . A child who experiences significant maltreatment , whether it be through neglect or physical , emotional , or sexual abuse , is for an underdeveloped or absent sense of self . Due to the lack of affection , discipline , or autonomy during childhood , these individuals are unable to engage in appropriate relationships as adults as seen across the spectrum of personality disorders . Another way childhood maltreatment contributes to personality disorders is through the emotional bonds or attachments developed with primary caregivers . John thoroughly researched the relationship between attachment and emotional development as he explored the need for affection in Harlow monkeys ( 1998 ) Based on research , four attachment styles have been identified secure , anxious , ambivalent , and disorganized . While securely attached children generally do not develop personality disorders , those with anxious , ambivalent , and disorganized attachment are at an increased risk of developing various disorders . More , those with an anxious attachment are for developing internalizing disorders , ambivalent are for developing externalizing disorders , and disorganized are for dissociative symptoms and disorders ( 2006 ) Key Takeaways You should have learned the following in this section Biological causes of personality disorders have not been identified in most disorders , the exception being which has similar biological causes as schizophrenia and antisocial and borderline personality disorders which have similar neurological changes . Psychological causes of personality disorders include negative early childhood experiences thought patterns and cognitive distortions and modeling , reinforcement , and lack of social skills . Social causes of personality disorders include high levels of psychological and social dysfunction within families and maltreatment . Section Review Questions What personality disorders are most explained by the biological model ?

How does the psychodynamic model explain the development of personality disorders ?

What cognitive distortions are most discussed with respect to personality disorders ?

What are the three behavioral theories used to explain the development of personality disorders ?

Discuss the roll of attachment and how theorists have used it to explain the development of personality disorders . 269 Fundamentals Disorders . Treatment Section Learning Objectives Describe treatment options for personality disorders . Individuals with personality disorders within Cluster A often do not seek out treatment as they do not identify themselves as someone who needs help ( 2011 ) Of those that do seek treatment , the majority do not enter it willingly . Furthermore , due to the nature of these disorders , individuals in treatment often struggle to trust the clinician as they are suspicious of the clinician intentions ( paranoid and personality disorder ) or are emotionally distant from the clinician as they do not have a desire to engage in treatment due to lack of overall emotion ( schizoid personality disorder Hardy , 2014 , 2014 ) Because of this , treatment is known to move very slowly , with many patients dropping out before any resolution of symptoms . When patients are enrolled in treatment , strategies are most commonly used with the primary intention of reducing symptoms . Additionally , attempts at cognitive identifying and changing thought also helpful in addressing the of others words and actions , particularly for individuals with paranoid personality disorder ( Hardy , 2014 ) Schizoid personality disorder patients may engage in techniques to help experience more positive emotions and more satisfying social experiences , whereas the goal of for personality disorder is to evaluate unusual thoughts or perceptions objectively and to ignore the inappropriate thoughts ( Beck , 2011 ) Finally , behavioral techniques such as training may also be implemented to address ongoing interpersonal problems displayed in the disorders . Cluster . Antisocial personality disorder . Treatment options for antisocial personality disorder are limited and generally not effective ( Black , 2015 ) Like Cluster A disorders , many individuals are forced to participate in treatment , thus impacting their ability to engage in and continue with treatment . Cognitive therapists have attempted to address the lack of morality and encourage patients to think about the needs of others ( Beck , 2011 ) Borderline personality disorder . Borderline personality disorder is the one personality disorder with an effective treatment Behavioral Therapy ( is a form of therapy developed by ( Armstrong , Suarez , 270

Fundamentals Disorders Heard , 1991 ) There are four main goals of reduce suicidal behavior , reduce therapy interfering behavior , improve quality of life , and reduce stress symptoms . Within , five main treatment components collectively help to reduce harmful behaviors ( mutilation and suicidal behaviors ) and replace them with practical , behaviors ( 2014 ) The first component is skills training . Generally performed in a group therapy setting , individuals engage in mindfulness , distress tolerance , interpersonal effectiveness , and emotion regulation . Second , individuals focus on enhancing motivation and applying skills learned in the previous component to specific challenges and events in their everyday life . The third , and often the most distinctive aspect of , is the use of telephone and in vivo coaching for patients from the clinical team . It is not uncommon for patients to have the cell phone number of their clinician for availability of moment support . The fourth component , case management , consists of allowing the patient to become their own case manager and effectively use the learned techniques to ongoing issues . Within this component , the clinician will only intervene when absolutely necessary . Finally , the consultation team , is a service for the providing the treatment . Due to the high demands of borderline personality disorder patients , the consultation team offers support to the providers in their work to ensure they remain motivated and competent in principles to provide the best treatment possible . Support for the effectiveness of in borderline personality disorder patients has been implicated in several randomized control trials ( 2014 , Kramer , 2014 ) More , has shown to significantly reduce and behaviors in those with borderline personality disorders . Additionally , the rates for treatment are extremely low , suggesting that patients value the treatment components and find them useful in managing symptoms . Histrionic personality disorder . Individuals with histrionic personality disorder are more likely to seek out treatment than other personality disorder patients . Unfortunately , due to the nature of the disorder , they are very difficult patients to treat as they are quick to employ their demands and seductiveness within the treatment setting . The overall goal for the treatment of histrionic personality disorder is to help the patient identify their dependency and become more . Cognitive therapists utilize techniques to help patients change their helpless beliefs and improve skills ( Beck , 2011 ) Narcissistic personality disorder . Of all the personality disorders , narcissistic personality disorder is among the most difficult to treat ( with maybe the exception of antisocial personality disorder ) Most individuals with narcissistic personality disorder only seek out treatment for those disorders secondary to their personality disorder , such as depression ( APA , 2022 ) The focus of treatment is to address the grandiose , thinking , while also trying to teach patients how to empathize with others ( Beck , 2014 ) Cluster While many individuals within and personality disorders seek out treatment to address their anxiety or depressive symptoms , it is often difficult to keep them in treatment due to distrust or fear of rejection from the clinician . Treatment goals for personality disorder are similar to that of social anxiety disorder . techniques , such as identifying and challenging distressing thoughts , 271

Fundamentals Disorders have been effective in reducing symptoms ( Beck , 2006 ) Specific to , cognitive techniques aimed at changing dichotomous thinking , perfectionism , and chronic worrying help manage symptoms of . Behavioral treatments such as gradual exposure to various social settings , along with a combination of social skills training , have been shown to improve individuals prior to engaging in social outings when treating personality disorder ( Herbert , 2007 ) Antianxiety and antidepressant medications commonly used to treat anxiety disorders have also been used with minimal efficacy furthermore , symptoms resume as soon as the medication is discontinued . Unlike other personality disorders where individuals are skeptical of the clinician , individuals with dependent personality disorder try to place obligations of their treatment on the clinician . Therefore , one of the main treatment goals for dependent personality disorder patients is to teach them to accept responsibility for themselves , both in and outside of treatment ( 2014 ) Cognitive strategies such as challenging and changing thoughts on helplessness and inability to care for oneself have been minimally effective in establishing independence . Additionally , behavioral techniques such as assertiveness training have also shown some promise in teaching individuals how to express themselves within a relationship . Some argue that family or couples therapy would be particularly helpful for those with dependent personality disorder due to the relationship between the patient and another person being the primary issue however , research on this treatment method has not yielded consistently positive results ( Nichols , 2013 ) Key Takeaways You should have learned the following in this section Individuals with a Cluster A personality disorder do not often seek treatment and when they do , struggle to trust the clinician ( paranoid and ) or are emotionally distant from the clinician ( schizoid ) When in treatment , cognitive restructuring and cognitive behavioral strategies are used . In terms of Cluster , treatment options for antisocial are limited and generally not effective , borderline responds well to dialectical behavioral therapy ( histrionic patients seek out help but are difficult to work with , and finally narcissistic are the most difficult to treat . For Cluster , cognitive techniques aid with while gradual exposure to various social settings and social skills training help with . use cognitive strategies to challenge thoughts on helplessness in patients with dependent personality disorder . Section Review Questions . What is the process in Dialectical Behavioral Therapy ( What does the treatment entail ?

What disorders are treated with ?

Given the difference in personality characteristics between the three clusters , how are the suggested treatment options different between cluster A , and ?

272 Fundamentals Disorders Module Recap Module 13 covered three clusters of personality disorders Cluster A , which includes paranoid , schizoid , and Cluster , which includes antisocial , borderline , histrionic , and narcissistic and Cluster which includes , dependent , and . We also covered the clinical description , epidemiology , etiology , and treatment of personality disorders . edition 273