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Chapter 13
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Personality
Disorders and
Impulse Control
Disorders
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Personality Disorders
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The DSM groups personality disorders into three
clusters:
Cluster A: People who are perceived as odd or
eccentric. This cluster includes paranoid, schizoid, and
schizotypal personality disorders.
Cluster B: People whose behavior is overly dramatic,
emotional, or erratic. This grouping consists of
antisocial, borderline, histrionic, and narcissistic
personality disorders.
Cluster C: People who often appear anxious or fearful.
This cluster includes avoidant, dependent, and
obsessive–compulsive personality disorders.
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Paranoid Personality Disorder
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Paranoid personality disorder - A personality
disorder characterized by undue suspiciousness of
others’ motives, but not to the point of delusion.
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Schizoid personality.
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People who have paranoid personality disorder tend to
be overly sensitive to criticism, whether real or
imagined.
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Overview of Personality Disorders
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Ego dystonic - Referring to behaviors or feelings that
are perceived to be alien to one’s self-identity.
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Ego syntonic - Referring to behaviors or feelings that
are perceived as natural parts of the self.
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Personality disorders - Excessively rigid behavior
patterns, or ways of relating to others, that ultimately
become self-defeating.
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Sheila K. Grant, Ph.D.
Professor
Personality Disorders
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Clinicians need to weigh cultural and sociopolitical
factors when arriving at a diagnosis of paranoid
personality disorder.
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Schizoid Personality Disorder
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Schizoid personality disorder - A personality
disorder characterized by persistent lack of interest in
social relationships, flattened affect, and social
withdrawal.
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Antisocial
Personality Disorder
Antisocial personality disorder - A personality
disorder characterized by antisocial and irresponsible
behavior and lack of remorse for misdeeds.
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Antisocial Personality
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People with antisocial personalities also tend to be
impulsive and fail to live up to their commitments to
others.
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Investigators also find higher rates of the disorder
among African Americans than among Caucasians or
Hispanic Americans.
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Schizotypal personality disorder may be slightly more
common in males than in females and is believed to
affect about 3% of the general population.
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They are not “antisocial” in the colloquial sense of
seeking to avoid people.
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Schizotypal personality disorder - A personality
disorder characterized by eccentricities of thought and
behavior, but without clearly psychotic features.
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The person’s emotions usually appear shallow or
blunted, but not to the degree found in schizophrenia.
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Schizotypal
Personality Disorder
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Often described as a loner or an eccentric, the person
with a schizoid personality lacks interest in social
relationships.
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Antisocial Personality Disorder
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Lifetime prevalences of antisocial
personality disorder by gender.
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Criminality or antisocial
personality disorder?
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The Case of Liz
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Antisocial Behavior and
Criminality
We tend to think of antisocial behavior as synonymous
with criminal behavior.
Although it is the case that antisocial personality
disorder is associated with an increased risk of
criminality, not all criminals have antisocial
personalities nor do all people with antisocial
personality disorder become criminals.
Many people with antisocial personality disorders are
law abiding and successful in their careers, even
though they may
treat others in a callous and insensitive manner.
Borderline
Personality Disorder
Borderline personality disorder (BPD) - A
personality disorder characterized by abrupt shifts in
mood, lack of a coherent sense of self, and
unpredictable, impulsive behavior.
At the core is a pervasive pattern of instability in
relationships, self-image, and mood, along with a lack
of control over impulses.
People with borderline personality disorder tend to be
uncertain about their personal identities—their values,
goals, careers, and perhaps even their sexual
orientations.
Cutting.
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“I have problems with anger management.”
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Borderline
Personality Disorder
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Such acts may be intended to counteract self-reported
feelings of “numbness,” particularly in times of stress.
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Individuals with BPD often have very troubled
relationships with their families and others
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Splitting - An inability to reconcile the positive and
negative aspects of the self and others, resulting in
sudden shifts between positive and negative feelings.
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Histrionic
Personality Disorder
Histrionic personality disorder - A personality
disorder characterized by excessive need for attention,
praise, reassurance, and approval.
The term is derived from the Latin histrio, which
means “actor.”
People with histrionic personality disorder tend to be
dramatic and emotional, but their emotions seem
shallow, exaggerated, and volatile.
The disorder was formerly called hysterical
personality.
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Over the top?
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Self-mutilation is sometimes an expression of anger or
a means of manipulating others.
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Not all people who
dress outrageously or
flamboyantly have
histrionic personalities.
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What other personality
features characterize
people with histrionic
personality disorder?
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Narcissistic
Personality Disorder
Narcissistic personality disorder - A personality
disorder characterized by adoption of an inflated selfimage and demands for attention and admiration.
They expect others to notice their special qualities, even
when their accomplishments are ordinary, and they
enjoy basking in the light of adulation.
They are self-absorbed and lack empathy for others.
Narcissistic
Personality Disorder
Interpersonal relationships are invariably strained by
the demands that people with narcissistic personality
impose on others and by their lack of empathy with,
and concern for, other people.
They seek the company of flatterers and, although they
are often superficially charming and friendly, their
interest in people is one-sided: They seek people who
will serve their interests and nourish their sense of selfimportance.
They have feelings of entitlement that lead them to
exploit others.
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Avoidant Personality Disorder
Avoidant personality disorder - A personality
disorder characterized by avoidance of social
relationships due to fears of rejection.
They may have few close relationships outside their
immediate families.
They also tend to avoid group occupational or
recreational activities for fear of rejection.
They prefer to lunch alone at their desks.
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Obsessive–Compulsive
Personality Disorder
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Obsessive–compulsive personality disorder A personality disorder characterized by rigid ways of
relating to others, perfectionistic tendencies, lack of
spontaneity, and excessive attention to detail.
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Persons with obsessive–compulsive personality
disorder are so preoccupied with the need for
perfection that they cannot complete work on time.
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Their efforts inevitably fall short of their expectations,
so they redo their work.
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Sexist Biases
The construction of certain personality disorders may
have sexist underpinnings.
The diagnostic criteria seem to label stereotypical
feminine behaviors as pathological with greater
frequency than stereotypical masculine behaviors.
Take the example of histrionic personality, which
seems a caricature of the traditional stereotype of the
feminine personality: flighty, emotional, shallow,
seductive, attention-seeking.
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Dependent
Personality Disorder
Dependent personality disorder - A personality
disorder characterized by difficulty making independent
decisions and overly dependent behavior.
Dependent personality disorder has been linked to other
psychological disorders, including major depression,
bipolar disorder, and social phobia, and to physical
problems, such as hypertension, cancer, and
gastrointestinal disorders like ulcers and colitis.
There also appears to be a link between dependent
personality and what psychodynamic theorists refer to
as “oral” behavior problems, such as smoking, eating
disorders, and alcoholism.
Problems with the
Classification of Personality
Disorders
Problems Distinguishing Personality Disorders from
Anxiety and Mood Disorders
Overlap Among Disorders
Difficulty in Distinguishing Between Normal and
Abnormal Behavior
Confusing Labels with Explanations
Are there sexist biases in the
conception of personality disorders?
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Psychodynamic Perspectives
Traditional Freudian theory focused on problems
arising from the Oedipus complex as the foundation
for abnormal behaviors, including personality
disorders.
Freud believed that children normally resolve the
Oedipus complex by forsaking incestuous wishes for
the parent of the opposite gender and identifying with
the parent of the same gender.
As a result, they incorporate the parent’s moral
principles in the form of a personality structure called
the superego.
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Hans Kohut
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To Kohut, early childhood involves a normal stage of
healthy narcissism.
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Infants also normally perceive their parents as
idealized towers of strength and wish to be one with
them and to share their power.
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Empathic parents reflect their children’s inflated
perceptions by making them feel that anything is
possible and by nourishing their self-esteem (e.g.,
telling them how terrific and precious they are).
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Infants feel powerful, as though the world revolves
around them.
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Margaret Mahler
Margaret Mahler, another influential modern
psychodynamic theorist, explained borderline
personality disorder in terms of childhood separation
from the mother figure.
Mahler and her colleagues believed that during the first
year infants develop a symbiotic attachment to their
mothers.
Symbiosis, or interdependence, is a biological term
derived from Greek roots meaning “to live together.”
In psychology, symbiosis is a state of oneness in which
the child’s identity is fused with the mother’s.
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Hans Kohut
One of the principal shapers of modern
psychodynamic concepts is Hans Kohut, whose theory
is labeled self psychology because of its emphasis on
processes in the development of a cohesive sense of
self.
Freud believed that the resolution of the Oedipus
complex was central to the development of adult
personality.
Kohut disagreed, arguing that what matters most is
how the self develops—whether the person is able to
develop self-esteem, values, and a cohesive and
realistic sense of self as opposed to an inflated,
narcissistic personality
Otto Kernberg
Otto Kernberg (1975), a leading psychodynamic
theorist, views borderline personality in terms of a
failure in early childhood to develop a sense of
constancy and unity in one’s image of oneself and
others.
From this perspective, borderline individuals cannot
synthesize contradictory (positive and negative)
elements of themselves and others into complete,
stable wholes.
Rather than viewing important people in their lives as
sometimes loving and sometimes rejecting, they shift
back and forth between pure idealization and utter
hatred.
Learning Perspectives
Learning theorists focus on maladaptive behaviors
rather than disorders of personality.
They are interested in identifying the learning
histories and environmental factors that give rise to
maladaptive behaviors associated with diagnoses of
personality disorders and the reinforcers that
maintain them.
Learning theorists suggest that childhood experiences
shape the pattern of maladaptive habits of relating to
others that constitute personality disorders.
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What are the origins of
antisocial personality disorder?
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Biological Perspectives
Much remains to be learned about the biological
underpinnings of personality disorders.
Most of the attention in the research community has
centered on antisocial personality disorder and the
personality traits that underlie the disorder, which is
the focus of much of our discussion.
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Lack of Emotional
Responsiveness
When people get anxious, their palms tend to sweat.
This skin response, called the galvanic skin response
(GSR), is a sign of activation of the sympathetic branch
of the autonomic nervous system (ANS).
In an early study, Hare (1965) showed that people with
antisocial personalities had lower GSR levels when they
were expecting painful stimuli than did normal
controls.
Apparently, the people with antisocial personalities
experienced little anxiety in anticipation of impending
pain.
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Family Perspectives
Many theorists have argued that disturbances in family
relationships underlie the development of personality
disorders.
Consistent with psychodynamic formulations,
researchers find that people with borderline
personality disorder (BPD) remember their parents as
having been more controlling and less caring than do
reference subjects with other psychological disorders.
When people with BPD recall their earliest memories,
they are more likely than other people to paint
significant others as malevolent or evil.
Genetic Factors
We have learned that first-degree biological relatives
(parents and siblings) of people with certain
personality disorders, especially antisocial, schizotypal,
and borderline types, are more likely to be diagnosed
with these disorders than are members of the general
population.
Genetic factors appear to play a role in the
development of certain psychopathic personality traits,
such as callousness, impulsivity, and irresponsibility.
Investigators find that a variant on a particular gene is
associated with antisocial behavior in adult men, but
only in those who were maltreated in childhood.
The Craving-for-Stimulation
Model
People with antisocial or psychopathic personalities
appear to have exaggerated cravings for stimulation.
Perhaps they require a higher-than-normal threshold
of stimulation to maintain an optimum state of
arousal.
In other words, they may need more stimulation than
other people to maintain interest and function
normally.
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The Brain Abnormalities Model
Brain-imaging techniques link borderline personality
disorder and antisocial personality disorder to
dysfunctions in parts of the brain involved in regulating
emotions and impulsive aggressive behavior, specifically
the prefrontal cortex of the frontal lobes and the deeper
brain structures comprising the limbic system.
The prefrontal cortex is responsible for such functions as
controlling impulsive behavior, weighing consequences
of our actions, and problem solving.
Brain abnormalities could help account for many
features of antisocial personality disorder, including lack
of conscience, failure to inhibit impulsive behavior, low
arousal states, poor problem-solving efforts, and failure
to think about the consequences of one’s behavior
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Treatment Of
Personality Disorders
People with personality disorders usually see their
behaviors, even maladaptive, selfdefeating behaviors,
as natural parts of themselves.
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Despite these obstacles, evidence supports the
effectiveness of both psychodynamic therapy and
cognitive-behavioral therapy in treating personality
disorders
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Sociocultural Perspectives
Social conditions may contribute to the development
of personality disorders.
Because antisocial personality disorder is reported
most frequently among people from lower
socioeconomic classes, the kinds of stressors
encountered by disadvantaged families may contribute
to antisocial behavior patterns.
Many inner-city neighborhoods are beset by social
problems such as alcohol and drug abuse, teenage
pregnancy, and disorganized and disintegrating
families.
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Even when unhappy and distressed, they are unlikely
to perceive their own behavior as causative.
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Behavioral Approaches
Behavior therapists see their task as changing clients’
behaviors rather than their personality structures.
Many behavioral theorists do not think in terms of
clients’ “personalities” at all, but rather in terms of
acquired maladaptive behaviors that are maintained
by reinforcement contingencies.
Behavioral therapists therefore focus on attempting to
replace maladaptive behaviors with adaptive
behaviors through techniques such as extinction,
modeling, and reinforcement.
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Psychodynamic Approaches
Psychodynamic approaches are often used to help
people diagnosed with personality disorders become
aware of the roots of their self-defeating behavior
patterns and learn more adaptive ways of relating to
others.
However, people with personality disorders especially
those with borderline and narcissistic personality
disorders, often present particular challenges to the
therapist.
For example, people with borderline personality
disorder tend to have turbulent relationships with
therapists, sometimes idealizing them, sometimes
denouncing them as uncaring.
Biological Approaches
Drug therapy does not directly treat personality
disorders. Antidepressants or antianxiety drugs are
sometimes used to treat associated depression or
anxiety in people with personality disorders, especially
borderline personality disorder.
Antidepressants of the SSRI class (e.g., Prozac) may
also help temper anger and rage in people with
borderline personality disorder and help them control
anger and impulsive and aggressive behaviors,
including selfmutiliation.
Researchers suspect that impulsive and aggressive
behavior may be related to serotonin deficiencies.
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Impulse Control Disorders
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Impulse control disorders - A category of psychological
disorders characterized by failure to control impulses,
temptations, or drives, resulting in harm to oneself or others.
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Compulsive gambling (called pathological gambling in the
DSM) is a type of impulse control disorder, as is
kleptomania (compulsive stealing), pyromania
(compulsive fire setting), trichotillomania (compulsive
hair-pulling resulting in noticeable bald patches), and
intermittent explosive disorder (failure to resist
aggressive impulses, leading to serious assault or property
destruction).
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Other impulse control problems, such as compulsive Internet
use and compulsive shopping, are presently under
consideration for inclusion in the diagnostic manual.
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Pathological Gambling
Pathological gambling - A type of impulse control
disorder characterized by a pattern of habitual
gambling and impaired control over the behavior.
Pathological gamblers often report they had
experienced a big win, or a series of winnings, early in
their gambling careers.
Eventually, however, their losses begin to mount, and
they feel driven to bet with increasing desperation to
reverse their luck and recoup their losses.
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Gambling and other
Nonchemical Addictions
We can think of pathological gambling as a kind of
nonchemical addiction.
It shares with chemical dependence (addiction) a loss of
control over the behavior, a state of high arousal or
pleasurable excitement experienced when the behavior
is performed, and withdrawal symptoms, such as
headaches, insomnia, and loss of appetite, when the
person cuts back or stops the compulsive behavior.
Personality characteristics of pathological gamblers and
chemical abusers also overlap, with psychological test
profiles of both groups showing such traits as selfcenteredness, anxiety, low tolerance for frustration,
impulsivity, and manipulativeness.
Kleptomania
Kleptomania - A type of impulse control disorder
characterized by a pattern of compulsive stealing.
The stolen objects are typically of little value or use to
the person.
The person may give them away, return them secretly,
discard them, or just keep them hidden at home.
In most cases, people with kleptomania can easily
afford the items they steal.
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Treatment of Pathological
Gambling
Many treatment programs involve peer support
programs, like Gamblers Anonymous (GA), which
models itself on Alcoholics Anonymous.
This program emphasizes personal responsibility for
one’s behavior and ensures anonymity of group
members so as to encourage participation and sharing
of experiences.
Within a supportive group setting, members gain
insight into their self-destructive behaviors.
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QUESTIONS?
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