PSYC 407 1st Edition Lecture 21 Outline of Last Lecture I. Schizoid Personality DisorderII. Schizotypal Personality DisorderIII. Antisocial Personality DisorderIV. ASPD vs. PsychopathyV. Conduct DisorderOutline of Current Lecture I. Cluster C DisordersCurrent LectureBorderline PD- DSM• Unstable relationships• Efforts to avoid real or imagined abandonment• Relationships characterized by alternating idealization and devaluation• Self-dangerous impulsivity• Suicidal threats, gestures, mutilation• Intense emotional lability from dysphoria to anxiety• Chronic feelings of emptiness• Inappropriate intense anger• Transient paranoid ideation or dissociative symptoms• Clinical Description– Turbulent relationships, fearing abandonment– Lack of emotional regulation– Go from intense anger to deep depression in a short timeThese notes represent a detailed interpretation of the professor’s lecture. GradeBuddy is best used as a supplement to your own notes, not as a substitute.– Cutting, punching, burning self– Drug abuse– Chronically bored, feel empty, no identity– 6% succeed at suicideComorbid diagnoses- 24-74% have major depression- 4 – 20% have bipolar disorder- 67% have some substance abuse- 25% diagnosed w/bulimia have BPDCulture and Gender• Primarily females 75%• A pattern of BPD is seen around the world. Some European countries resisted the dx. ICDcalled it “Emotionally-Unstable Disorder”.Cluster B: Borderline Personality Disorder• The causes– Runs in families and linked w/mood disorders (genetically)– Serotonin dysfunctions linked to emotional instability, suicidality, and impulsivity– Early trauma and abuse seem to play some etiologic role (explains why more females)– Usually physical and sexual abuse– Also rapid cultural changes as immigrants may experience (identity, emptiness, fear of abandonment)Integrative Model for BPDTHE TRIPLE VULNERABILITY THEPRYGeneralized biological vulnerability(like emotional reactivity)Generalized psychological vulnerability(excess reaction to real and perceived threats)Specific psychological vulnerability(abuse or neglect reinforces the sensitivity tothreats)Results in outbursts, lability, suicidalityBPD TreatmentPeople w/BPD seek help for distress they feelAntidepressant medications (SSRIs) provide some short-term relief Complicated by SAMajority achieve remission after txDialectical Behavior TherapyLinehan, 1987, 1993First:Help cope with stressors that trigger suicide attemptsSecond:Attend to the behaviors that interfere with therapyThen:Help with the behaviors that interfere with the patient’s qualityof lifeHelp them trust their own instincts rather than depending on the validation of othersTx and PrognosisCBT with a combination of problem-solving, and behavioral change strategies.Techniques to promote acceptance and empathy.Prognosis better for patients who are intelligent, attractive, have artistic talent, or are described as more likeable.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• Excessive emotionality• Attention-seeking, not comfortable sharing the limelight• sexually seductive• Rapidly shifting, shallow emotions• Impressionistic style of speech• Theatricality, dramatization• Easily influenced by others• Considers relationships to be more intimate than they are• Bias to diagnose women • Relationship with antisocial pd (share underlying dynamics; dx’d by gender)Cognitive Style• Cognition is global, diffuse• Typical schemas: waif, “sexy star”• Beck’s dysfunctions:• Unless I captivate people, I am nothing.• If I can’t entertain people, they will abandon me.• If people don’t respond to me, they are rotten.• Potential caregivers are not to be trusted, so they must be manipulated.Family• Inconsistent patterns of reinforcement• Child must draw attention to self• Family has high control• Treatment options • Focus on attention seeking (and long-term negative consequences).• Targets may also include problematic interpersonal behaviors• Little evidence that treatment is effectiveCluster B: Narcissistic Personality Disorder• Overview and clinical features– Exaggerated and unreasonable sense of self-importance (I am different and need special attention)– Preoccupation with receiving attention– Lack sensitivity and compassion for other people– Highly sensitive to criticism, envious, and arrogant • Grandiosity (fantasies of greatness)• Need for admiration• Lack of empathy• Preoccupation w/fantasies of unlimited success, power, beauty, love• Belief that one is special and can only be understood by other ‘special’ people• Requests excessive admiration; arrogant manner• Attitude of entitlement• Exploits others• Is envious of others and believes others are envious of himClinical Picture• Appear to have superiority complex whereby they are constantly defending against underlying feelings of inferiority. • Appear to have general air of nonchalance and imperturbability.• However, when grandiosity is threatened they react withNarcissistic RageWhich can include cool disdain, anger and/or shame. Depressed moods may result feelings of rejection or neglect.Weiner’s subtypes (1998)• Nice and Naughty• Nice: may show considerable interest in others and can enjoy being with others. Can be entertaining and ingratiating with a motive of an appreciative audience. Not necessarily maladaptiveNaughty– Angry, avoidant individuals incapable of demonstrating sincere interest and caring for others– Personal illusions of grandeur interfere with relating to others, snobby, self-centered– Exploit others through trickery and lies for their own advancement– Causes:– Profound failure in modeling empathy by the parents in early development– Child remains fixated at a grandiose stage of development– Child (and as an adult later) begins an endless and fruitless search for the ideal person who will fulfill these needs– Sociological explanation:– This disorder is increasing in western societies because of greater emphasis on short-term hedonism, individualism, and success– Treatment options– Focus on grandiosity, lack of empathy– unrealistic thinking replaced with goals that are attainable–