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• Schizoid withdrawn, reserved, reclusive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)

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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 - Lykkens (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 - Schmauks (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 - Stewarts (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

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PERSONALITY DISORDERSBig 5 OCEAN (Costa
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