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

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


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


Clusters of disorders

• Odd and eccentric – paranoid, schizoid, schizotypal

• Dramatic, emotional, or erratic – antisocial, borderline, histrionic, narcissistic

• Anxious and fearful – dependent, obsessive-compulsive


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


Historical perspective

• Roots in psychoanalysis – narcissism, masochism, etc.

• Karl Abraham – first theorist to focus on 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


Etiology – Theoretical perspectives

• Psychodynamic theory

• Attachment theory – particularly for dramatic, emotional, erratic

• Cognitive-behavioural perspectives

• Biological – particularly for odd, eccentric and dramatic, emotional, erratic


Cluster A – Odd and eccentric

• Paranoid – suspicious, argumentative (no delusions or hallucinations)

• Schizoid – withdrawn, reserved, reclusive

• Schizotypal – eccentricity of thought and behaviour


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



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



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

Personality traitsPersonality traits Lifestyle instabilityLifestyle instability

• lack of remorselack of remorse• callousnesscallousness• selfishnessselfishness• exploitation of othersexploitation of others

• antisocial (lying, antisocial (lying, stealing, cheating)stealing, cheating)• impulsiveimpulsive• social deviant lifestylesocial deviant lifestyle



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



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



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



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



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



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



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



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



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



• Histrionic personality – attention-seeking, flirtatious, flamboyant, difficulty with relationships,

• Narcissism – grandiosity, egocentricity, vengeful, but low self-esteem


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


Treatment

• Object relations psychodynamic therapy – Kernberg, Kohut

• Cognitive-behavioural

• Pharmacological

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

HighHigh Personality traitPersonality trait LowLow

CuriousCurious OpennessOpenness ConventionalConventional

ReliableReliable ConscientiousnessConscientiousness UnreliableUnreliable

SociableSociable ExtraversionExtraversion Shy-quietShy-quiet

Good naturedGood natured AgreeablenessAgreeableness UncooperativeUncooperative

NervousNervous NeuroticismNeuroticism CalmCalm


Dimensional analysis of types

• Where would schizoid personality fit on the 5 dimensions?

• How about paranoid?

• Antisocial?

• Narcissism?

• Avoidant or dependent?


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

Documents

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