Module II: Theoretical overview of personality disorders

Psychoanalytical Model

Cognitive Model

Interpersonal Model

Neurobiological models of personality disorders and other models of personality disorders

Gender differences in development Manifestation of personality disorders

Socio-cultural correlates of personality disorders

Psychoanalytical model of PD

According to Freud, human personality is complex and has more than a single component.

Personality is composed of 3 elements known as the id, the ego and the superego. The

working of the id, ego, and the superego produce different types of anxiety. This anxiety is

handled by defence mechanisms. Although every individual uses a variety of defences each

personality disorder seems to prefer a particular subset of defences over the others. People with

histrionic PD for eg; use repression to keep their world simple. They are not concerned by

existential riddles of human existence nor they wish to confront their own manipulation of

others.

- HPD are not concerned about their existence

- They are more into impulsive and enjoying life

These defence mechanisms can be used to construct a defensive profile that illustrates how a pd

protects itself from internal and external sources of anxiety, stress and challenge. Eg:

Rationalisation is used by people suffering from Narcissistic personality disorder.

The Levels of Personality

o the preconscious,

o and the unconscious.

The Structure of Personality

- The Id

o The Ego

o The Superego

Reality Anxiety, Neurotic Anxiety, and Moral Anxiety

● Freud proposed three types of anxiety: reality anxiety, neurotic anxiety, and moral

anxiety.

Reality

● The first type of anxiety, the one from which the others are derived, is reality anxiety (or

objective anxiety).

● This involves a fear of tangible dangers in the real world. Most of us justifiably fear

fires, hurricanes, earthquakes, and similar disasters.

● We run from wild animals, speeding cars, and burning buildings.

● Reality anxiety serves the positive purpose of guiding our behavior to escape or

protect ourselves from actual dangers.

● Our fear subsides when the threat is no longer present.

● These reality-based fears can be carried to extremes

● The person who cannot leave home for fear of being hit by a car or who cannot light a

match for fear of fire is carrying reality-based fears beyond the point of normality.
 The other kinds of anxiety, neurotic anxiety and moral anxiety, are more consistently

troublesome to our mental health.

Neurotic anxiety

● Has its basis in childhood, in a conflict between instinctual gratification and reality.

● Children are often punished for overtly expressing sexual or aggressive impulses.

● Therefore, the wish to gratify certain id impulses generates anxiety.

● This neurotic anxiety is an unconscious fear of being punished for impulsively

displaying id-dominated behavior.

● Note that the fear is not of the instincts, but of what may happen as a result of

gratifying the instincts.

● The conflict becomes one between the id and the ego, and its origin has some basis in

reality.

Moral anxiety

● results from a conflict between the id and the superego.

● In essence, it is a fear of one’s conscience.

● When you are motivated to express an instinctual impulse that is contrary to your

moral code,

● your superego retaliates by causing you to feel shame or guilt. In everyday terms, you

might describe yourself as conscience-stricken.

Defenses Mechanism

Strategies the ego uses to defend itself against the anxiety provoked by conflicts of everyday

life. Defense mechanisms involve denials or distortions of reality.

anxiety.

● Denial: Involves denying the existence of an external threat or traumatic event

● Reaction Formation: Involves expressing an id impulse that is the opposite of the one

truly driving the person

● Projection: Involves attributing a disturbing impulse to someone else

● Regression: Involves retreating to an earlier, less frustrating period of life and

displaying the childish and dependent behaviours characteristic of that more secure

time

● Rationalisation: Involves reinterpreting behaviour to make it more acceptable and

less threatening

● Displacement: Involves shifting id impulses from a threatening or unavailable object

to a substitute object that is available

● Sublimation: Involves altering or displacing id impulses by diverting instinctual energy

into socially acceptable behaviours.

Cognitive model of PD

● Cognitive model emphasises the mind is actively and constantly developing

‘construals’ of the world, self, others and the future.

● Some of these have far reaching implications: the belief that ‘I am a worthwhile person’

or ‘ Other person is out to get me’ for example is formed on the basis of repeated

experiences and has long term consequences for psychological functioning.

or of others.

● The stimulus will be same but how we understand and perceive it will be different

The questions then are; What does the individual select as worthy of attention? Why is it

selected? How is the stimulus interpreted?

- Avoidant personalities for eg. believe that self is defective and shameful as such they are

hypersensitive to cues of disapproval and embarrassment. Anything that might be

interpreted as pointing to deficiencies in the self during ongoing communication is taken

as proof of their defects ultimately leading to recoil from almost all social engagement.
Neurobiological models of personality disorders and other models of personality disorders

1. Cloninger’s Neurobiological models of personality disorders

● Cloninger proposed a model based on hypothesised relationship of three genetic

neurobiological traits disposition, each associated with a particular neurotransmitter

system

1. Novelty seeking (low basal activity in the dopaminergic system)

2. Harm avoidance ( high activity in serotonergic system)

3. Reward dependence ( low basal activity in noradrenergic system)

Novelty Seeking
 Novelty seeking is hypothesised to dispose the individual towards acceleration or

excitement in response to novel stimuli which leads to the pursuit of potential rewards as well

as active avoidance of monotony

Harm avoidance

It reflects a disposition to respond strongly to aversive stimuli leading the individual to

inhibit behaviours to avoid punishment and frustrations.

Reward Dependance

This is seen as a tendency to respond to signals of reward such as verbal signals of

social approval and to resist extinction or behaviours previously associated with rewards or

relief from punishment

How did Cloninger define Schizoid Personality Disorder?

● Schizoids are seen as being low in reward dependance reflecting their social

detachment or lack of interest in obtaining reward from others.

● Low in harm avoidance reflecting their self confidence and low in novelty seeking

reflecting their behavioural ability.

● Contemporary accounts of the schizoid personality do not typically emphasise on

narcissistic personality. Their aloof manner is not implying arrogance but instead refers

only to their interpersonal distance because cloninger's schizoid differs from the dsm

conception imperturbable. He suggests the term imperturbable schizoid be used to convey

the more restricted neurobiological definition.

Neurobiology
 ● Research psychiatrist Cloninger (1986. 1987b) proposed an elegant theory based on

hypothesized relationships of three genetic-neurobiologic trait dispositions, each of which

is associated with a particular neurotransmitter system.

● Specifically, novelty seeking is associated with low basal activity in the dopaminergic

system.

● harm avoidance with high activity in the serotonergic system, and

● reward dependence with low basal noradrenergic system activity.

● Novelty seeking is hypothesised to dispose of the individual toward exhilaration or

excitement in response to novel stimuli, which leads to the pursuit of potential rewards as

well as an active avoidance of both monotony and punishment.

● Harm avoidance reflects a disposition to respond strongly to aversive stimuli. leading

the individual to inhibit behaviours to avoid punishment, novelty, and

● Reward dependence is seen as a tendency to respond to signals of reward, verbal signals

of social approval, for example and to resist extinction of behaviors previously associated

with rewards or relief from punishment.

● These three dimensions form the axes of a cube whose corners represent various

personality constructs.

● Thus, antisocial personalities. who are often seen as fearless and sensation seeking. are

seen as low in harm avoidance and high in novelty seeking. whereas the imperturbable

schizoid is seen as low across all dimensions of the model. The personality disorders

generated by Cloninger's model correspond only loosely to those in the DSM V, a

number of personality disorders do not appear in the model at all.

2. Psychobiological Model (Siever & Davis, 1991)

Model

● It consist of four dimensions:

1. Cognitive/ Perceptual organization

2. Impulsivity/ Aggression

3. Affective instability

4. Anxiety/ Inhibition

● This model is based on axis

● Each of these dimensions has both Axis I and Axis II manifestations

● Cognitive/perceptual organization appears on Axis I in the form of schizophrenia and

on Axis II especially as the schizotypal personality disorder but also the paranoid and

the schizoid

● Impulsivity/aggression appears on Axis I in the form of impulse disorders and on Axis

II particularly as the borderline and antisocial personalities

● Affective instability, a tendency toward rapid shifts of emotion, is manifested in the

affective disorders on Axis I and in the borderline, and possibly histrionic, on Axis II

● Anxiety/inhibition, associated with social avoidance, compulsivity, and sensitivity to the

possibility of danger and punishment, is manifested in the anxiety disorders on Axis I

and particularly in the avoidant personality on Axis II, but also in the compulsive and

dependent