PS 280 12 personality disorders

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PERSONALITY DISORDERS LECTURE OUTLINE DSM Axis II – What is a personality disorder? Clusters of personality disorders – 3 main types Prevalence Historical perspectives Diagnostic issues Etiology – Theoretical perspectives

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PERSONALITY DISORDERS What is a personality disorder? maladaptive personality traits traits are relatively enduring features of a person that are persistent over time and situations people with personality disorders tend to be: rigid and inflexible, show a restricted range of traits, have a dominant single trait personality disorders are egosyntonic, more than egodystonic

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PERSONALITY DISORDERS Clusters of disorders Odd and eccentric – paranoid, schizoid, schizotypal Dramatic, emotional, or erratic – antisocial, borderline, histrionic, narcissistic Anxious and fearful – dependent, obsessive-compulsive

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PERSONALITY DISORDERS Prevalence 6-9% of population have one or more personality disorder prevalence higher among people with other mental disorders most people with personality disorders never come to the attention of mental health professionals

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PERSONALITY DISORDERS Historical perspective Roots in psychoanalysis – narcissism, masochism, etc. Karl Abraham – first theorist to focus on personality disorders

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PERSONALITY DISORDERS Diagnostic issues poor understanding of etiology of most personality disorders comorbidity and diagnostic overlap gender and cultural issues reliability of diagnosis categorical vs. dimensional approach – Big 5 personality traits

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PERSONALITY DISORDERS Etiology – Theoretical perspectives Psychodynamic theory Attachment theory – particularly for dramatic, emotional, erratic Cognitive-behavioural perspectives Biological – particularly for odd, eccentric and dramatic, emotional, erratic

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PERSONALITY DISORDERS Cluster A – Odd and eccentric Paranoid – suspicious, argumentative (no delusions or hallucinations) Schizoid – withdrawn, reserved, reclusive Schizotypal – eccentricity of thought and behaviour

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PERSONALITY DISORDERS Cluster B – Dramatic, emotional, erratic Antisocial personality disorder (APD) Defining feature is pervasive disregard for and violation of rights of others Begins in childhood Must meet 3 of the following criteria – violation of rights of others, nonconformity, callousness, deceitfulness, irresponsibility, impulsivity, aggressiveness, recklessness

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PERSONALITY DISORDERS Cluster B – Dramatic, emotional, erratic Antisocial personality disorder (APD) Lifetime prevalence rates for APD – 3% for men, 1% for women, lower rates for psychopathy 40% of those in Canadian prisons have APD

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PERSONALITY DISORDERS Cluster B – Dramatic, emotional, erratic APD vs. Psychopathy APD focuses more on behaviour Robert Hare, UBC – Psychopathy Checklist Revised – focuses on both personality traits and behaviour (lifestyle instability)

Robert Hare, UBC – Psychopathy Checklist Revised: 

Robert Hare, UBC – Psychopathy Checklist Revised

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PERSONALITY DISORDERS Cluster B – Dramatic, emotional, erratic Etiology of APD Family and parenting factors – disruptive family life, harsh and inconsistent discipline, lack of monitoring genetics – concordance rates for criminality are 51% for MZ twins, 21% for DZ; runs in families

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PERSONALITY DISORDERS Cluster B – Dramatic, emotional, erratic Etiology of APD fearlessness hypothesis – deficient emotional arousal and conditioning is associated with a lack of empathy, thrill-seeking in the face of punishment, psychopaths increase the frequency of punished behaviour, rather than decrease it; defiance/opposition

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PERSONALITY DISORDERS Cluster B – Dramatic, emotional, erratic Etiology of APD - Lykken’s (1957) research in a lever pressing task, people with psychopathy did not learn the association between particular lever presses and shocks in contrast, people without psychopathy learned this association quickly

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PERSONALITY DISORDERS Cluster B – Dramatic, emotional, erratic Etiology of APD - Schmauk’s (1970) research repeated this experiment, but compared different types of punishers – physical, tangible (loss of money), social (reprimands) he found, like Lykken, that those with psychopathy learned poorly when physical and social punishers were used, but they learned as well as controls when tangible punishment was used

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PERSONALITY DISORDERS Cluster B – Dramatic, emotional, erratic Etiology of APD - Stewart’s (1972) research sentence completion task involving physical punishment for aggressive responses controls stopped aggressive responses very quickly, but those with psychopathy increased aggressive responses; they acted in opposition to and defiance of the researcher

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PERSONALITY DISORDERS Cluster B – Dramatic, emotional, erratic Etiology of APD – Implication of this research Punishment of offenders not likely to be very effective for rehabilitation Programs like 'Scared Straight,' boot camps make kids with APD worse rather than better 'Getting tough' with this population not likely to work

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PERSONALITY DISORDERS Cluster B – Dramatic, emotional, erratic Course of APD a progression or career of deviancy - oppositional defiant disorder, conduct disorder, APD burnout response – as they age, people with APD become less involved in criminal activity

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PERSONALITY DISORDERS Cluster B – Dramatic, emotional, erratic Treatment of APD difficulty establishing therapeutic alliance need to focus on specific behaviours, such as anger management treatment approaches not very successful probably more success with prevention and early intervention

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PERSONALITY DISORDERS Cluster B – Dramatic, emotional, erratic Borderline personality fragile identity and instability in relationships unpredictability, impulsiveness, irritability, argumentative more prevalent in women low reliability of this diagnosis experience of child abuse and neglect

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PERSONALITY DISORDERS Cluster B – Dramatic, emotional, erratic Histrionic personality – attention-seeking, flirtatious, flamboyant, difficulty with relationships, Narcissism – grandiosity, egocentricity, vengeful, but low self-esteem

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PERSONALITY DISORDERS Cluster C – Anxious and fearful disorders Avoidant personality – extreme sensitivity to criticism and disapproval, avoidance of intimacy Dependent personality – constantly seeks reassurance, advice, direction from others Obsessive-compulsive personality – inflexibility and desire for perfection, absence of obsessional thoughts and compulsive behaviours

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PERSONALITY DISORDERS Treatment Object relations psychodynamic therapy – Kernberg, Kohut Cognitive-behavioural Pharmacological

PERSONALITY DISORDERSBig 5 – OCEAN (Costa & Mcrea, 1992): 

PERSONALITY DISORDERS Big 5 – OCEAN (Costa andamp; Mcrea, 1992)

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PERSONALITY DISORDERS Dimensional analysis of types Where would schizoid personality fit on the 5 dimensions? How about paranoid? Antisocial? Narcissism? Avoidant or dependent?

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PERSONALITY DISORDERS SUMMARY Personality disorders are maladaptive personality traits 3 broad clusters Problem of overlap of categories Etiology for many personality disorders not well understood Treatments have not been very successful for many of these disorders