Is he mentally ill?

Cognitive

• Less and less interested in knowing about the world because they are so self-focused; must rely on other people or hunches to get direction in life

Sociocultural

• Society encourages girls to be vain, dramatic and selfish—histrionic is just this to an extreme degree

Biological

• Possible genetic link with APD

Grandiose view of their own uniqueness and abilities

• Grandiose view of their own uniqueness and abilities

• Self-centered is an understatement

• Require constant attention and admiration

• Believe only high status people will understand them

• Lack of empathy

• Envious

• Arrogant; take advantage of others

•  <1% prevalence

• Males>females (up to 75 % male)

Psychodynamic—cold rejecting parents lead to children spending lives defending against feeling unsatisfied, rejected, unworthy

• Psychodynamic—cold rejecting parents lead to children spending lives defending against feeling unsatisfied, rejected, unworthy

• Support for this—research says that kids who are abused or who lost parents through adoption, divorce, or death are at increased risk

• Behavioral and cognitive types say just the opposite—people develop this when they are treated too positively early in life. Admiring doting parents teach them to overvalue self worth.

• Support for this—onlies and firstborns are at increased risk.

• Sociocultural theorists—link between disorder and eras of narcissism in society.

One of the most difficult patterns to treat

• One of the most difficult patterns to treat

• If they seek, it is because of other disorders, generally depression
• May try to manipulate therapist into supporting their sense of superiority

• Psychodynamic—recognize and work through basic insecurities and defenses

• Cognitive—focus on self-centered thinking, try to redirect onto the opinions of others, to interpret criticism more rationally

• No approach has had a lot of success

2% females>males (about 3:1)

• 2% females>males (about 3:1)

• Males with the disorder tend to be more aggressive, disruptive

• Instability in relationships, mood and self-image

• Erratic emotions

• Argumentative, irritable, sarcastic

• Unpredictable, and impulsive behavior—spending sex

• No clear sense of self—values, career, loyalty

• Intense relationships—stormy and transient

• Emptiness

• Manipulative attempts at suicide

• Paranoid ideation and dissociative symptoms (75% show short or transient psychotic-like symptoms)

• This PD affects job performance more than other PDs

High frequency of physical and sexual abuse

• High frequency of physical and sexual abuse

• Comorbidity with other Axis I disorders

• Disorders ranging from mood and anxiety disorders to substance abuse and eating disorders

• Comorbidity with other personality disorders, esp. histrionic, dependent, antisocial and schizotypal

•  Self-destructive—self-injurious or self-mutilation behaviors

• Suicidal behaviors—at last 70% of BPD attempt suicide at least once and 6-10% actually commit suicide

• Pain to feel alive

Genetic factors play a significant role

• Genetic factors play a significant role

• Biological

• Lowered functioning of serotonin may explain impulsivity and aggression
• Disturbances in regulation of noradrenergic transmitters may explain their hypersensitivity to environmental changes

• Psychosocial—negative, traumatic childhood events

• Diathesis stress model—who are abused are 4x more likely to develop BPD than general pop

• Biosocial theory—Marcia Linehan—combination of internal forces and external forces

• If children have intrinsic difficulties identifying and controlling emotions and if parents teach them to ignore emotions, children never learn how to recognize and control emotional arousal, how to tolerate distress, when to trust emotional responses.

Psychotherapy can eventually lead to some improvement

• Psychotherapy can eventually lead to some improvement

• Tough balance to strike

• Relational psychoanalytic therapy—fairly effective

• Dialectical behavior therapy—Marcia Linehan—an integrative treatment approach—considered by many to be treatment of choice.

• Antidepressants, mood stabilizers, antianxiety, and antipsychotics are controversial, but can help reduce aggression and emotionality.

AKA psychopaths or sociopaths

• AKA psychopaths or sociopaths

• 2 components to antisocial pd

• Conduct disorder before age 15 and
• Antisocial behavior in adulthood—not working consistently, breaking laws, lying, being irritable, physically aggressive, defaulting on debts, being reckless, impulsive, not planning ahead, no regard for truth, no remorse
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