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  1. Introduction
    1. Personality disorders are conditions that involve stable traits of entire personality
      1. Personality traits are enduring patterns of perceiving, relating to, and thinking about environment and oneself exhibited in wide range of contexts
      2. Personality traits when inflexible and maladaptive and cause significant functional impairment or subjective distress, constitute personality disorder
    2. Debate over diagnostic value of personality disorders
      1. Not particularly reliable
      2. Diagnostic criteria more specific to address diagnostic overlap
      3. Assumes stable personality traits
  2. Odd/Eccentric Personality Disorders (Cluster A)
    1. Paranoid Personality Disorder
      1. Defining characteristic of paranoid personality disorder is suspiciousness
        1. Suspiciousness causes constant scanning environment for evidence to support suspicions
        2. Suspiciousness affects emotional adjustment and social relationships
        3. Individual sees problems originating from others, not themselves
      2. Paranoid personality disorder differs from paranoid schizophrenia or delusional disorder; paranoid personality disorder is less disabling
    2. Schizotypal Personality Disorder
      1. Schizotypal personality disorder characterized by odd speech, behavior, thinking, and/or perception, but not odd enough for schizophrenia
      2. Often have histories of being teased and participating in fringe groups
      3. Disorder added to improve diagnosis of schizophrenia
    3. Schizoid Personality Disorder
      1. Defining characteristic of schizoid personality disorder is severely restricted range of emotions associated with social detachment
      2. Person appears to have little/no interest in relationships; does not seem to experience ordinary emotions such as pleasure, warmth
      3. Appears to take pleasure in solitary activities; may appear to be self-absorbed
      4. Does not show typical patterns of thoughts, behaviors, speech of schizophrenia
      5. There may be biological relationship to schizophrenia
  3. Dramatic/Emotional Personality Disorders (Cluster B)
    1. Borderline Personality Disorder (BPD)
      1. Borderline personality disorder proposed by psychodynamic clinicians
      2. Syndrome has four core elements
        1. Difficulties in establishing secure self-identity
        2. Distrust
        3. Impulsive and self-destructive behavior
        4. Difficulty in controlling anger and other emotions
      3. May be due to abnormalities in limbic system
      4. Some have argued borderline personality disorder related to depression
      5. Is one of most frequently diagnosed personality disorders
    2. Histrionic Personality Disorder (HPD)
      1. Self-dramatization is essential feature of histrionic personality disorder
      2. Emotional displays often manipulative to gain attention and sympathy
      3. Interpersonal relationships are fragile
        1. In relationships, can become demanding
        2. Typically flirtatious and sexually provocative
      4. Most of those diagnosed with histrionic personality disorder are women
    3. Narcissistic Personality Disorder
      1. In narcissistic personality disorder individual has grandiose sense of self-importance, sometimes with feelings of inferiority
      2. Bragging of talent and achievements often accompanied by fragile self-esteem
      3. Individuals are poorly equipped for friendship or love
        1. Demand great deal from others such as affection, favors
        2. Typically have long histories of erratic interpersonal relationships
      4. Resembles histrionic personality disorder
        1. What narcissistic type wants is admiration
        2. What histrionic type wants is concern
      5. Psychoanalytic theory suggests cause is compensation for inadequate affection and approval from parents in early childhood
      6. Social learning theory suggests parents' inflated views of their children's talents leading to unrealistic expectation is cause
  4. Anxious/Fearful Personality Disorders (Cluster C)
    1. Avoidant Personality Disorder
      1. Avoidant personality disorder marked by social withdrawal
      2. Social withdrawal based on fear of rejection
        1. Has hypersensitivity to possibility of rejection, humiliation, or shame
        2. Tends to avoid relationships unless sure of other's uncritical affection
      3. Avoidant personalities have low self-esteem
      4. Difficult to differentiate from social phobia
        1. Social phobia restricted to specific situations
        2. Avoidant personality disorder affects almost every day of person's life
    2. Dependent Personality Disorder
      1. Dependence on others characterizes dependent personality disorder
      2. Fear of abandonment underlies dependency
      3. May grow tolerant of unacceptable behaviors of others leading to a vicious cycle leading to more helpless feelings
      4. Overlap with borderline personalities, borderline personality is more disabling
    3. Obsessive-Compulsive Personality Disorder
      1. Excessive preoccupation with orderliness, perfectionism, and control describe obsessive-compulsive personality disorder
      2. Overly concerned with mechanics of efficiency
      3. Obsessive-compulsive personality disorder differs from obsessive-compulsive disorder
        1. Personality disorder is milder and more pervasive
        2. Personality disorder is more common
      4. While seen as "workaholics," typically perfection prevents them from making decisions and meeting deadlines
      5. Treatment is sought only after personal tragedies like divorces, loneliness, and stress
  5. Groups at Risk
    1. Comorbidity
      1. Personality disorders rare in general population but may be common in clinical populations
      2. People at risk for personality disorders are those who are in psychological treatment for other disorders
        1. Most do not seek treatment for personality disorders
        2. Treatment is sought for more specific problems; in treatment personality disorder is identified
    2. The Dispute over Gender Bias
      1. Men are at higher risk for some personality disorders (i.e., paranoid, schizotypal, schizoid, narcissistic, obsessive-compulsive, antisocial)
      2. Women are at higher risk for some personality disorders (i.e., borderline, dependent)
      3. Diagnosticians view men and women differently
        1. Disorders that involve emotionalism more frequently diagnosed in women
        2. Disorders that involve self-importance or callousness more frequently diagnosed in men
        3. Differences may be due to idiom of distress
      4. DSM-IV and DSM-IV-TR changes reflect recognition of gender bias and need for sex-blind criteria
    3. Cultural Bias
      1. Diagnosis assumes behavior is significantly different from expectations of one's culture
      2. Diagnosticians must know individual's culture but may bend over backward to respect culture
  6. Personality Disorders: Theory and Therapy
    1. The Psychodynamic Perspective
      1. Character Disorders
        1. Personality disorders due to disturbances in parent-child relationship
        2. Severe personality disorders originate in separation, individual process
        3. Results in weakened ego and poor adaptive functioning
        4. Fall between neurotics and psychotics in terms of ego strength
          1. Normal coping behavior has broken down
          2. Replaced by erratic, distorted, or deviant behavior
          3. Breakdown affects broad range of ego functions
        5. Introjection believed to play role in personality disorders
      2. Psychotherapy for Personality Disorders
        1. Individuals generally resistant to treatment
        2. Psychodynamic therapy takes more directive, more parental approach with personality disorders than with other disorders
        3. Insight still believed to be mechanism of change
    2. The Behavioral Perspective
      1. Skills, Acquisition, Modeling, and Reinforcement
        1. Families often expect children to be cheerful; parents do not coddle; child never able to get sympathy for minor upsets
        2. As children, individuals never learn emotional skills that would allow them to take problems to parents
        3. Reinforcement and modeling may play role in personality disorders
      2. New Learning
        1. Patients need social skills training and assertiveness training
        2. Dialectical behavior therapy used with borderline patients combining social skills training and how to regulate emotions and tolerate distress
    3. The Cognitive Perspective
      1. Faulty Schemas
        1. Personality disorders seen as product of distortions or exaggerations in underlying schemas
        2. Schemas are not perceived to be faulty; person will generate perceptions and situations that confirm schemas
        3. Beliefs are acquired by learning and modeling in response to developmental conditions
        4. In personality disorders, schemas, seen as being on continuum, are at end of range
      2. Altering Schemas
        1. Goal of therapy is to alter the schema
        2. Therapists attempt to convince patient to modify, reinterpret, or camouflage schema
          1. Reinterpretation refers to putting it to more functional use
          2. Schematic camouflage refers to helping patient to act in more socially acceptable ways
    4. The Sociocultural Perspective
      1. Personality disorders due to large-scale social processes
      2. Therapy should focus on changing society
    5. The Neuroscience Perspective
      1. Genes and Personality
        1. Genes play influential role in development of normal personality
        2. Studies reveal relationship of personality disorders to Axis I disorders that have genetic component
      2. Drug Treatment
        1. Personality disorders can be alleviated by drugs used for their Axis I counterparts
        2. Some personality disorders have no drug treatments as yet
        3. Drugs and Diagnosis
          1. Evidence raises diagnostic questions about reclassified patients with Axis I disorders
          2. Drugs treat a symptom common to both personality disorders and Axis I disorders





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