Personality Disorders

1
Personality Disorders
2
Three Minute Review

• How do you diagnose mental disorders?
• legal definition
• insanity defense
• Diagnostic and Statistical Manual, version IV
• disorder distress or disability or risk
• historically, neuroses vs. psychoses, but not
  anymore
• criticisms
• social context important (e.g., homosexuality)
• billing dependent (e.g., nicotine addiction)
• too much emphasis on reliability? not enough on
  validity?
• beware of medical students disease
• biopsychosocial approach
• diathesis (predisposing factors) stress
  (precipitating factors) disorder
• maintaining factors may prohibit recovery

3

• STRESS
• stress scales
• Effects of stress
• Impaired task performance
• Burnout
• Selyes General Adaptation Syndrome
• alarm-resistance-exhaustion
• Physical illness
• Beneficial effects?
• Predictability control make stressors less
  stressful
• learned helplessness

4

• ANXIETY DISORDERS
• Generalized Anxiety Disorder
• Hypervigiliance
• Phobias
• beyond normal fears
• classical conditioning vs. preparedness theory
• Obsessive-Compulsive Disorder
• obsessions (thoughts) vs. compulsions (actions)
• Panic Disorder
• vicious circle of attacks and fear of attacks
• Post-Traumatic Stress Disorder
• dissociation, flashbacks

5

• MOOD DISORDERS
• dysthymia -- downs, moderate intensity
• depression -- downs, high intensity
• cyclothymia -- ups downs, moderate intensity
• bipolar disorder (manic depression) -- ups
  downs, high intensity

6
Test Yourself

• Which of the following disorders would be an
  example of a psychosis (as historically
  defined)?
• depression
• arachnophobia (fear of spiders)
• antisocial personality disorder (psychopathy)
• schizophrenia
• drug addiction

7
DSM IV Five Axes
8
Personality Disorders

• DSM-IV Axis II
• may coexist with, predispose to, or result from
  Axis I diagnoses and may affect treatment
• long term, maladaptive and rigid personality
  traits that impair normal functioning and involve
  psychological stress
• by that definition, doesnt everybody have some
  PD?
• PD is highly consistent and more extreme than
  normal personality
• controversial
• big changes between DSM editions
• exaggeration of normal traits
• matter of degree
• much overlap between PDs (especially within
  clusters)
• very difficult to treat

9
Personality Disorder Classification
DRAMATIC/IMPULSIVE BEHAVIOR DRAMATIC/IMPULSIVE BEHAVIOR
Histrionic Seductive behavior needs immediate gratification and constant reassurance rapidly changing moods shallow emotions.
Narcissistic Self-absorbed expects special treatment and adulation envious of attention to others.
Borderline Cannot stand to be alone intense, unstable moods and personal relationships chronic anger drug and alcohol abuse.
Antisocial Manipulative, exploitative and dishonest disloyal lacking in guilt habitually breaks social rules childhood history of such behavior often in trouble with the law.
ANXIOUS/FEARFUL BEHAVIOR ANXIOUS/FEARFUL BEHAVIOR
Avoidant Easily hurt and embarrassed few close friends sticks to routines to avoid new and possibly stressful experiences.
Dependent Wants others to make decisions needs constant advice and reassurance fears being abandoned.
Obsessive-compulsive Perfectionistic overconscientious indecisive preoccupied with details stiff unable to express affection.
ODD/ECCENTRIC BEHAVIOR ODD/ECCENTRIC BEHAVIOR
Paranoid Tense, guarded, suspicious, holds grudges.
Schizoid Socially isolated with restricted emotional expression.
Schizotypal Peculiarities of thought, appearance and behavior that are disconcerting to others emotionally detached and isolated.
10
Dependent PD Example

• Hilary satisfied many of the characteristics of
  dependent personality disorder.
• She had married Stanley at age 18 under strong
  pressure from her parents.
• She depended on Stanley for everything and was
  unable to make any decision, no matter how minor,
  without his direction.
• She required constant support from Stanley, her
  parents, her friends, without which she felt
  unable to function in her day-to-day activities
  as a full-time homemaker.
• After four years of married life, Stanley told
  her that he didnt love her any more and wanted a
  divorce.
• Hillary developed a major depressive disorder and
  made two serious suicide attempts.

(Goldstein, Baker Jamison, Abnormal Psychology)
11
Multiple PDs Example

• Jim Jones and the Jonestown suicides

• Jim Jones
• always a leader, always compelled people to
  listen to him
• hyper-religious, watched charismatic preachers
  who had control over congregations
• started his own church, Peoples Temple
• demanded complete loyalty and had interrogation
  sessions
• asked church members if theyd engaged in
  extramarital hetero- or homosexual activity and,
  if they said no, he ordered them to
• ordered some to break up marriages and sleep with
  him
• applied physical punishment and torture
• became paranoid that press was out to get him and
  became fearful that church members would be
  destroyed in nuclear Armageddon
• decided to leave for Guyana
• hosted practice suicides before the real thing

• Suggested diagnoses?
• narcissistic PD (demanded adoration and
  obedience)
• paranoid PD (suspiciousness)
• towards the end, full-blown psychotic disorder
  (delusions of persecution)

(Goldstein, Baker Jamison, Abnormal Psychology)
12
Portrayal of Psychopaths
Hannibal Lecter Silence of the Lambs

• Charles Manson
• brutally killed 5 people

• Ted Bundy
• killed 16

• Karla Holmolka Paul Bernardo
• killed 3

13
Characteristics of a Psychopath

• glib and charming
• often quite intelligent
• needs a great deal of stimulation
• pathologically untruthful
• cunning and manipulative
• remorseless, feels no guilt
• no superego? id gone wild?
• once called moral imbeciles
• emotionally shallow
• callous and lacking in empathy
• parasitic
• poor behavioral control
• sexually promiscuous
• unconcerned with long term goals
• unable to delay gratification

14
Emotional Bankruptcy

• I can remember the first time in my life when I
  began to suspect I was a little different from
  most people. When I was in high school my best
  friend got leukemia and died and I went to his
  funeral. Everybody else was crying and feeling
  sorry for themselves and as they were praying to
  get him into heaven I suddenly realized that I
  wasnt feeling anything at all. He was a nice
  guy but what the hell. That night I thought
  about it some more and found that I wouldnt miss
  my mother and father if they died and that I
  wasnt too nuts about my brothers and sisters for
  that matter. I figured there wasnt anybody I
  really cared for but, thin, I didnt need any of
  them anyways so I rolled over and went to sleep.
• (McNeil, 1967).

15
A Real-Life Psychopath

• Jenny (not her real name)
• stole 1200 from her best friends bank account
  using an ATM
• framed another roommate for the crime
• police believed her
• audacious, charismatic, easily bored
• had crises whenever anyone else was the centre of
  attention
• good at faking emotion but shallow
• had degree in sociology
• worked at a music store during their highest
  period of shoplifting
• told endless lies
• faux boyfriend
• props
• Psychology thesis on chimp language
• amazing memory for details
• stole money and charged my credit card
• claimed to have police connections and to get
  criminal records
• went to prison for faking returns to clothing
  store where she worked
• claimed to be volunteering for the Bow River
  Correctional Institute

16
Psychopaths in Reality

• Psychopathy is surprisingly common
• 3 of men
• 1 of women
• many psychopaths are highly successful in fields
  like business, law, and politics
• The Corporation, a documentary, claims that
  corporations meet the criteria for psychopathy

The faults of the burglar are the qualities of
the financier. --G. B. Shaw
17
Psychopath vs. Sociopath

• Psychopath vs. Sociopath
• psychopath implies psychological, biological or
  genetic causes
• sociopath implies social forces and early
  experiences as causes
• people sometimes avoid psychopath because its
  easily confused with psychosis

In the book, Silence of the Lambs, Hannibal
Lecter is described as a pure sociopath. In
the movie, he is described as a pure psychopath.
18
Psychopaths vs. ASPD

• traditionally, psychopaths have been defined by
  emotional and interpersonal traits (e.g., lack of
  empathy or guilt)
• DSM-makers thought that personality traits were
  too unreliable and put more emphasis on behaviors
• psychopathy experts say DSM sacrificed validity
  to get reliability
• they use a Psychopathy Checklist (by Robert Hare)
  instead

19
Relationships Between Concepts
Criminals
ASPD
Diagram illustrates conceptual overlap but
proportions may not be accurate
Psychopaths Sociopaths

• 60 of criminals have ASPD
• Most psychopaths have ASPD
• However, most people with ASPD are NOT psychopaths

20
Psycho-, Socio- or Bio-paths?

• ASPD Biology
• higher concordance rates for identical than
  fraternal twins
• adoption studies
• the criminal record in male adoptees is more
  similar to the biological father than the
  adopting father
• record of adopting father still had some effect
  though
• suggests nature is biggest influence, but nurture
  contributes too
• ASPD Psychology and Sociology
• impaired superego?
• contributing factors aggressive parents deviant
  peers, low socioeconomic status, dysfunctional
  families, childhood abuse, malnutrition
• personality factors
• high extroversion, impulsiveness, and sensation
  seeking
• Eysenck General Arousal Theory of Criminality
• argued those with ASPD were underaroused and
  needed extreme external stimulation (similar to
  mechanism for extroversion we discussed)

21
Biological Factors

• psychopaths do not seem to feel fear or anxiety
  to the same degree sensation seekers
• psychopaths do not seem to learn from punishment
• because of low arousal, perhaps punishment is not
  so aversive?

I went in and told the guy to give me the money.
I told him to lay on the floor and then I shot
him. I took the money and threw the cash drawer
in a bush and I tried to push the gun in the
bush, too. But as I was pushing it in the bush,
it went off and thats how come I was shot in the
arm. It seems like things have always gone bad
for me. It seems like Ive always done dumb
things that just caused trouble for me. I
remember when I was a boy I would feel like I had
to do things like sit on a railroad track until
just before the train came and then I would dash
off. Or I would put my finger over the end of a
BB gun and pull the trigger to see if a BB was
really in it. Sometimes I would stick my finger
in water and then put my finger in a light socket
to see if it would really shock me. -- executed
murderer Gary Gilmore (in Spitzer et al., 1983)

• Galvanic skin response
• shock person every time digit 8 appears
• psychopaths show less arousal, less anticipation
  of shock, and less of a response to shock

22
Biological Factors

• psychopaths seem to have impaired frontal lobe
  functioning
• lack of forethought and ability to consider
  implications
• less limbic input to frontal cortex

23
Treatment of Psychopathy

• Many writers on the subject have commented that
  the shortest chapter in any book on psychopathy
  should be the one on treatment. -- Robert Hare
• Psychopaths are expert at mimicking the expected
  behaviors to get parole
• often dupe the psychologists into thinking
  theyre cured
• treatment often does more harm than good
• e.g., psychopaths who participated in community
  therapy were 4X more likely to commit a violent
  offense following release than those who didnt
  participate
• As one psychopath put it, These programs are
  like a finishing school. They teach you how to
  put the squeeze on people. -- Robert Hare
• early prevention may help (or not)

24
Evolutionary Biology of Psychopathy

• why are there psychopaths?
• why isnt everybody a psychopath?
• a lion doesnt let its conscience stop it from
  killing
• Machiavellian tendencies in most humans
• Altruism
• Although it is advantageous to cooperate,
  mathematical models of games suggest that there
  will always be a small number of cheaters
• everybody altruistic ? big advantage to cheaters
  ? cheaters ?
• nobody altruistic ? big cost to everyone ?
  cheaters ?
• most people altruistic, a few cheaters ?
  equilibruim
• Personality as a Diversified Portfolio
• benefits to having some sensation seekers to fill
  roles as explorers, warriors, etc.