Goal: Develop an audio presentation and submit a PowerPoint presentation on a common mental health disorder.
Content Requirements:
Students will be randomly selected to participate in groups of three.
Create a case study of a patient based on your assigned group topic only.
The presentation must provide information:
Introduce a fictitious patient with a disease or disorder based on your assigned group topic. Must specifically address the disease as it relates to one of the following populations: infants, toddlers, school-aged children, adolescents, adults, or the elderly.
Incidence
Pathogenesis
History of the patient’s problems
Treatment recommendations according to the US clinical guidelines.
Personality Disorders
NUR 530 Psychopathology
Week 5
St Thomas University
Outline
• An Overview of Personality Disorders
• Cluster A Personality Disorders
• Paranoid, schizoid, schizotypal
• Cluster B Personality Disorders
• Antisocial, borderline, histrionic, narcissistic
• Cluster C Personality Disorders
• Avoidant, dependent, obsessive-compulsive
Personality
Disorders:
An Overview
• The nature of personality disorders
• Enduring, inflexible predispositions
• Maladaptive, causing distress and/or
impairment
• High comorbidity
• Poorer prognosis
• Ego-syntonic: Unlike other disorders,
often feel consistent with one’s
identity; patients don’t feel that
treatment is necessary
• 10 specific personality disorders organized
into 3 clusters
Personality
Disorders:
An Overview
• DSM-5 personality disorder clusters
• Cluster A—odd or eccentric cluster
• Cluster B—dramatic, emotional, erratic
cluster
• Cluster C—fearful or anxious cluster
Personality
Disorders:
Facts and
Statistics
• Prevalence of personality disorders
• Affects about 1% of the general
population
• Origins and course of personality disorders
• Thought to begin in childhood
• Tend to run a chronic course if
untreated
• May transition into a different
personality disorder
Personality
Disorders:
Facts and
Statistics
• Gender distribution and gender bias in
diagnosis
• Antisocial—more often male
• Histrionic—more often female
• Comorbidity is the rule, not the exception
• Personality disorders under study
• Sadistic: Enjoy inflicting pain
• Passive-aggressive: Defiant, undermine
authority
• Further research is needed
Cluster A:
Paranoid
Personality
Disorder
• Overview and clinical features
• Pervasive and unjustified mistrust and
suspicion
• The causes
• Biological and psychological
contributions are unclear
• Early learning that people and the
world are dangerous
Cluster A:
Paranoid
Personality
Disorder
• Treatment options
• Few seek professional help on their
own
• Treatment focuses on development of
trust
• Cognitive therapy to counter
negativistic thinking
• Lack of good outcome studies
Cluster A:
Schizoid
Personality
Disorder
• Overview and clinical features
• Pervasive pattern of detachment from
social relationships
• Very limited range of emotions in
interpersonal situations
• The causes
• Etiology is unclear
• Childhood shyness
• Preference for social isolation
resembles autism
Cluster A:
Schizoid
Personality
Disorder
• Treatment options
• Few seek professional help on their
own
• Focus on the value of interpersonal
relationships
• Building empathy and social skills
• Lack of good outcome studies
Cluster A:
Schizotypal
Personality
Disorder
• Overview and clinical features
• Behavior and dress is odd and unusual
• Socially isolated and highly suspicious
• Magical thinking, ideas of reference,
and illusions
• Many meet criteria for major
depression
• Some conceptualize this as resembling
a milder form of schizophrenia
Cluster A:
Schizotypal
Personality
Disorder
• The causes
• A phenotype of a schizophrenia
genotype?
• More generalized brain deficits
• Treatment options
• 30–50% meet criteria for major
depressive disorder
• Main focus is on developing social skills
• Address comorbid depression
• Medical treatment is similar to that
used for schizophrenia
• Treatment prognosis is generally poor
Cluster B:
Antisocial
Personality
Disorder
• Overview and clinical features
• Failure to comply with social norms
• Violation of the rights of others
• Irresponsible, impulsive, and deceitful
• Lack of a conscience, empathy, and
remorse
• “Sociopathy” and “psychopathy”
typically refer to this disorder or very
similar traits
• May be very charming, interpersonally
manipulative
Cluster B:
Antisocial
Personality
Disorder (APD)
• Relation with early behavior problems and
conduct disorder
• Early histories of behavioral problems,
including conduct disorder
• “Callous-unemotional” type of
conduct disorder more likely to
evolve into APD
• Families with inconsistent parental
discipline and support
• Families often have histories of
criminal and violent behavior
Neurobiological
Contributions
and Treatment
of Antisocial
Personality
• Prevailing neurobiological theories
• Underarousal hypothesis—cortical
arousal is too low
• Cortical immaturity hypothesis—
cerebral cortex is not fully developed
• Fearlessness hypothesis—fail to
respond to danger cues
• Gray’s model: Inhibition signals are
outweighed by reward signals
Neurobiological
Contributions
and Treatment
of Antisocial
Personality
• Treatment
• Few seek treatment on their own
• Antisocial behavior is predictive of
poor prognosis
• Emphasis is placed on prevention and
rehabilitation
• Often incarceration is the only viable
alternative
• May need to focus on practical (or
selfish) consequences (e.g., if you rob
someone, you’ll have to serve time)
Development
of Antisocial
Personality
• Genetic influences
• More likely to develop antisocial
behavior if parents have a history of
antisocial behavior or criminality
• Developmental influences
• High-conflict childhood increases
likelihood of antisocial personality in
at-risk children
• Neurobiological influences
• Antisocial traits are not well explained
by neuropsychological research
Development
of Antisocial
Personality
• Arousal theory
• People with antisocial personalities are
chronically under-aroused and seek
stimulation from the types of activities
that would be too fearful or aversive
for most
• Psychological and social influences
• In research studies, psychopaths are
less likely to give up when goal
becomes unattainable—may explain
why they persist with behavior (e.g.,
crime) that is punished
Development
of Antisocial
Personality
• An integrated model
• APD is the result of multiple
interacting factors
• Impaired fear conditioning: Children
who develop APD may not adequately
learn to fear aversive consequences of
negative actions (e.g., punishment for
setting fires)
• Mutual biological–environmental
influence
• Early antisocial behavior alienates
peers who would otherwise serve
as corrective role models
• Antisocial behavior and family
stress mutually increase one
another
Development of
Antisocial Personality
© 2019 Cengage. All rights reserved.
Cluster B:
Borderline
Personality
Disorder
• Overview and clinical features
• Unstable moods and relationships
• Impulsivity, fear of abandonment, very
poor self-image
• Self-mutilation and suicidal gestures
• Comorbidity rates are high with other
mental disorders, particularly mood
disorders
Cluster B:
Borderline
Personality
Disorder (BPD)
• The causes
• High emotional reactivity
• Runs in families
• May have impaired functioning of
limbic system
• Early trauma/abuse plays a causal role
for some
Cluster B:
Borderline
Personality
Disorder
• “Triple vulnerability” model of anxiety
applies to BPD too:
• generalized biological vulnerability
(reactivity)
• generalized psychological vulnerability
(lash out when threatened)
• specific psychological vulnerability
(stressors elicit borderline behavior)
Cluster B:
Borderline
Personality
Disorder
• Treatment options—few good outcome
studies
• Antidepressant medications provide
some short-term relief
• Dialectical behavior therapy is most
promising treatment
• Focus on dual reality of
acceptance of difficulties and
need for change
• Focus on interpersonal
effectiveness
• Focus on distress tolerance to
decrease reckless/self-harming
behavior
Cluster B:
Histrionic
Personality
Disorder
• Overview and clinical features
• Overly dramatic, sensational, and
sexually provocative
• Often impulsive and need to be the
center of attention
• Thinking and emotions are perceived
as shallow
• More commonly diagnosed in females
Cluster B:
Histrionic
Personality
Disorder
• The causes
• Failure to learn empathy as a child
• Sociological view—product of the “me”
generation
• Treatment options
• Focus on grandiosity, lack of empathy,
unrealistic thinking
• Little evidence that treatment is
effective
Cluster B:
Narcissistic
Personality
Disorder
• Overview and clinical features
• Exaggerated and unreasonable sense of
self-importance
• Preoccupation with receiving attention
• Lack sensitivity and compassion for
other people
• Highly sensitive to criticism; envious
and arrogant
Cluster B:
Narcissistic
Personality
Disorder
• The causes
• Failure to learn empathy as a child
• Sociological view—product of the “me”
generation
• Treatment options
• Focus on grandiosity, lack of empathy,
unrealistic thinking
• Little evidence that treatment is
effective
Cluster C:
Avoidant
Personality
Disorder
• Overview and clinical features
• Extreme sensitivity to the opinions of
others
• Highly avoidant of most interpersonal
relationships
• Are interpersonally anxious and fearful
of rejection
• Low self esteem
Cluster C:
Avoidant
Personality
Disorder
• The causes
• Numerous factors have been proposed
• Difficult temperament and early
rejection
• Treatment options
• Several well-controlled treatment
outcome studies exist
• Treatment is similar to that used for
social phobia
• Treatment targets include social skills
and anxiety
Cluster C:
Dependent
Personality
Disorder
• Overview and clinical features
• Reliance on others to make major and
minor life decisions
• Unreasonable fear of abandonment
• Clingy and submissive in interpersonal
relationships
Cluster C:
Dependent
Personality
Disorder
• Causes
• Still largely unclear
• Linked to early disruptions in learning
independence
• Treatment options
• Research on treatment efficacy is
lacking
• Therapy typically progresses gradually
• Treatment targets include skills that
foster independence
Cluster C:
ObsessiveCompulsive
Personality
Disorder
• Overview and clinical features
• Excessive and rigid fixation on doing
things the right way
• Highly perfectionistic, orderly, and
emotionally shallow
• Obsessions and compulsions are rare
Cluster C:
ObsessiveCompulsive
Personality
Disorder
• The causes
• Largely unknown
• Weak genetic link
• Treatment options
• Data supporting treatment are limited
• Address fears related to the need for
orderliness
• Rumination, procrastination, and
feelings of inadequacy
Summary of Personality
Disorders
• DSM-5 includes 10 personality disorders
• Fall into cluster A, B, or C
• The causes of personality disorders
• Start in childhood, but are difficult to specify
• Treatment is difficult and prognosis poor
References
• American Psychiatric Association (2013).Diagnostic and Statistical
Manual of Mental Disorders, Fifth Edition (DSM-5).
• American Psychiatric Association (2018). What are Personality Disorders?
Retrieved from: https://www.psychiatry.org/patientsfamilies/personality-disorders/what-are-personality-disorders
Fox, D. (2014). The Clinician’s Guide: Diagnosis and Treatment of
Personality Disorders. Eau Claire, WI: PESI Publishing and Media
Hirata, D. (2016). They Say I Have Borderline Personality Disorder. Self
Published
• Samuels, J. (2011). Personality disorders: epidemiology and public
health issues. International Review of Psychiatry, 23(3), 223-233.
• Sperry, L. (2016). Handbook of Diagnosis and Treatment of DSM-5
Personality Disorders (3rd ed.). New York: Routledge.