Personality Disorders

The Concept of Personality: - individuals have personality traits (consistent ways of thinking, perceiving and relating to others) - traits may be genetic (temperament) or learned, but are stable across adulthood - traits result in consistent behavior patterns Abnormal Personality Traits - inflexible patterns - maladaptive behavior - marked distress or dissatisfaction

Personality Disorders
DSM Criteria:
-enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individuals culture - manifest in 2 or more areas: cognition (ways of perceiving either self or others) affectivity (how emotion is felt or expressed) interpersonal (relationships with others) impulse control - pattern is inflexible and pervasive across a broad range of personal and social situations - leads to clinically significant distress or impairment in social, occupational, or other important areas of functioning - pattern is stable and of long duration and its onset can be traced back at least to adolescence or early adulthood - not due to other mental disorders, substance abuse, or medical condition

Personality Disorders
Personality Disorder Clusters: 10 Specified Disorders Cluster A: Odd-Eccentric Personality Disorders characterized by odd ways of thinking or social withdrawal, but no impairment in reality testing. Cluster B: Dramatic-Emotional Disorders characterized by lability of emotion, harmful behavior to self/others, impulsivity, shallow/manipulative/unfeeling conduct Cluster C: Anxious-Fearful Disorders characterized by fearfulness/anxiety, primarily related to interpersonal relationships.

Personality Disorders
Cluster A Disorders Schizoid PD (4 or more characteristics) neither desires nor enjoys close relationships almost always chooses solitary activities little, if any, interest in sexual experiences with others takes pleasure in few, if any, activities lacks close friends or confidants other than relatives appears indifferent to praise/criticism shows emotional coldness, detachment, flat affect

Personality Disorders
Cluster A Disorders Schizotypal PD (5 or more characteristics) ideas of reference odd beliefs, magical thinking that influences behavior and inconsistent with subcultural norms unusual perceptual experiences odd thinking and speech suspiciousness or paranoid ideation inappropriate or constricted affect odd, eccentric or peculiar behavior lack of close friends or confidants, other than relatives excessive social anxiety that does not diminish with familiarity, tends to be paranoid rather than negative about self

Personality Disorders
Cluster A Disorders Paranoid PD (4 or more characteristics)
Suspects, without evidence, others are exploiting, harming or deceiving them. Preoccupied with unjustified doubts about loyalty or trustworthiness of others reluctant to confide due to unwarranted fear that info will be maliciously used against them reads hidden demeaning/threatening meanings into benign remarks or events persistently bears grudges quick to react angrily, counterattack to perceived attacks recurrent suspicions, without justification, about fidelity of partners

Personality Disorders
Cluster B Disorders Antisocial PD (3 or more characteristics, past age 18) failure to conform to social norms/law (repeatedly performing acts that are grounds for arrest) deceitfulness (repeated lying, use of aliases, conning others for personal profit/pleasure) impulsivity or failure to plan ahead irritability and aggressiveness (repeated fights/assaults) consistent irresponsibility (failure to sustain consistent work behavior or honor financial obligations) lack of remorse (indifferent or rationalizes having hurt, mistreated, or stolen from others)

Personality Disorders
Cluster B Disorders Borderline PD (5 or more characteristics)
frantic efforts to avoid real/imagined abandonment pattern of unstable/intense interpersonal relationships (alternating idealization and devaluation) identity disturbance (markedly persistent unstable self-image or sense of self) impulsivity (at least 2 areas: spending, sex, SA, reckless driving, binge eating) recurrent suicidal behavior, gestures or threats, self-mutilating behavior affective instability due to marked reactivity of mood chronic feelings of emptiness inappropriate, intense anger or difficulty controlling anger transient, stress-related paranoid ideation/dissociative sxs

Personality Disorders
Cluster B Disorders Histrionic PD (5 or more characteristics)
uncomfortable in situation in which not center of attention inappropriately sexually seductive or provocative behavior rapidly shifting/shallow expression of emotion uses physical appearance to draw attention to self excessively impressionistic style of speech lacking in detail self-dramatizing, theatrical, exaggerated emotional expression suggestible (easily influenced by others/circumstances) considers relationships more intimate than actually are

Personality Disorders
Cluster B Disorders Narcissistic PD (5 or more characteristics)
grandiose sense of self-importance preoccupied with fantasies of success, power, brilliance, beauty or ideal love belief in specialness only understood by other special, high-status people/institutions. requires excessive admiration sense of entitlement interpersonally exploitative lacks empathy often envious of others, believes others envy them shows arrogant, haughty behaviors/attitudes

Personality Disorders
Cluster C Disorders Avoidant PD (4 or more characteristics)
avoids interpersonal contact due to fears of criticism, disapproval or rejection unwilling to get involved with others unless certain of being liked restrained in intimate relationship due to fear of being shamed or ridiculed preoccupied with being criticized or rejected in social situations inhibited in new interpersonal situations due to feelings of inadequacy views self as socially inept, unappealing or inferior to others unusually reluctant to take risks or try new things due to fear of embarrassment.

Personality Disorders
Cluster C Disorders Dependent PD (5 or more characteristics)
difficulty making decisions without advice or reassurance needs others to assume responsibility for most major areas of their life difficulty expressing disagreement with others due to fear of loss of support or approval difficulty initiating projects or doing things by themselves goes to excessive lengths to obtain nurturance and support from others feels uncomfortable or helpless when alone due to exaggerated fears of being unable to care for themselves urgently seeks another relationship when close relationships end unrealistically preoccupied with fears of being left to care for themselves

Personality Disorders
Cluster C Disorders Obsessive-Compulsive PD (4 or more characteristics)
preoccupied with details, rules, lists, order, organization, or schedules losing major point of activity shows perfectionism that interferes with task completion excessively devoted to work/productivity to exclusion of leisure/friendships overconscientious, scrupulous and inflexible about morality, ethics or values unable to discard worn-out or worthless objects reluctant to delegate tasks or work with others, unless others submit to their way of doing things miserly spending style (hoarding money against future catastrophes) rigidity and stubbornness

Personality Disorders
Critical Issues with DSM PD diagnoses 1) Categorical system of a dimensional construct PDs are extreme variants of normal personality styles 2) Overlap in criteria multiple combinations of sxs to meet dx criteria meeting more than one criteria set having some, but not all, criteria (PD-NOS) 3) Poor diagnostic reliability, imprecise/vague sx descriptions 4) Potential for bias in diagnostic process. 5) Gender bias in diagnoses

Personality Disorders
Proposed Diagnostic Changes in DSM5 1) Dimensional ratings of general personality functioning Self-Functioning: identity and self-direction Interpersonal-Functioning: empathy and intimacy 2) 6 Personality Disorder Types Borderline: - affect; disinhibition, antagonism Antisocial: antagonism; disinhibition Schizotypal: psychoticism; detachment; - affect Avoidant: detachment; - affect Narcissistic: - affect; detachment; antagonism Obsessive-Compulsive: - affect; disinhibition

Personality Disorders
Proposed Diagnostic Changes in DSM5 3) Trait Specifications (Facet dimensions) Negative Affectivity (anxiousness, lability, hostility, perseveration [fixated mood], restricted affect, separation insecurity, submissiveness) Detachment (anhedonia, depressivity, intimacy avoidance, suspiciousness, withdrawal) Antagonism (attention-seeking, callousness, deceitfulness, grandiosity, manipulativeness) Disinhibition (distractibility, impulsivity, irresponsibility, perfectionism, risk-taking) Psychoticism (eccentricity, perceptual dysregulation, unusual beliefs and experiences)

Personality Disorders
Antisocial PD (3 or more characteristics, past age 18) failure to conform to social norms/law (repeatedly performing acts that are grounds for arrest) deceitfulness (repeated lying, use of aliases, conning others for personal profit/pleasure) impulsivity or failure to plan ahead irritability and aggressiveness (repeated fights/assaults) consistent irresponsibility (failure to sustain consistent work behavior or honor financial obligations) lack of remorse (indifferent or rationalizes having hurt, mistreated, or stolen from others)

Personality Disorders
Psychopathy= alternative diagnostic perspective Cluster of personality traits characterized by: superficial charm pathological lying egocentricity lack of remorse callousness to the suffering of others Cleckley (1941) Mask of Sanity David Hare (1991) Psychopathy Checklist-Revised (PCL-R) (1993) Without Conscience

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Epidemiology of Psychopathy 2-3 % of general population 4.5% of males compared to 0.8% of females

5x more prevalent in lower SES

Personality Disorders
PCL-R items fall into two distinct factors: Aggressive Narcissism (Core Psychopathy Characteristics)
Glib/superficial charm Grandiosity Pathological lying Cunning/manipulativeness Lack of remorse/guilt Shallow affect Lack of empathy Promiscuity Failure to accept responsibility for actions

Socially Deviant Lifestyle (Antisocial Characteristics) Parasitic lifestyle Impulsivity Prone to boredom Early behavioral problems Irresponsibility Juvenile delinquency

Personality Disorders
Antisocial PD, Psychopathy and Criminal Behavior Not all criminals Psychopaths, not all Psychopaths criminals DSM=50-80% of forensic setting evaluations PCL-R= 15-30% Successful Psychopaths (non-criminals) tend to be: higher IQ higher SES higher Emotional Intelligence although their emotional experience is abnormal, they have more information about emotions

Personality Disorders
Psychopathic Criminals more likely to be career criminals may diminish with age 3x more likely to commit violence during crimes Less likely to be emotionally aroused prior to crime More likely to commit instrumental violence during crime violence aimed at obtaining goals, establishing status, maintain perceived safety More likely to re-offend after release from prison Serial Killers: psychopathy + sexual sadism
target particular types of victims plan murders carefully use close contact weapons maintain contact with victims after killing

Personality Disorders
Antisocial Criminals if violent during crime, tends to be reactive violence: based on perception of threat to violent person: low threat = freeze response moderate threat = escape response high threat = attack response APD more prone to perceive threat as high and attacking when actual threat is low and more successful response would be escape

Personality Disorders
Etiological Models of Antisocial PD A maladaptive developmental pathway that begins in childhood. Conduct D/O strongest predictor of Adult APD Greater likelihood of Adult APD when greater variety of delinquent behavior in childhood MacDonald Triad (1963) = 3 childhood behaviors that predict Adult Psychopathy: Bed-wetting Abuse of animals Pyromania

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Etiology of Psychopathy Genetic inheritance 56% heritability in twin/adoption studies molecular studies have not identified gene anomalies

Neurocircuitry Abnormalities underactivation of frontal lobes underactivation of limbic system, particularly amygdala

Personality Disorders
Etiological Models of Psychopathy Dysfunctional Fear Hypothesis (Lykken 1957) abnormal fear response in psychopathy Passive Avoidance Learning Hypothesis (Gray 1990) impaired Behavioral Inhibition System (BIS) increased anxiety when punishment cues present lack of anxiety leads to failure to learn to stop behavior to avoid punishment

Personality Disorders
Etiological Models of Psychopathy Impaired Emotional Processing Hypothesis (Patrick 1991) impaired fear/anxiety capacity leads to lack of attention to emotional signals in others resulting in inability to feel empathy for others

Violence Inhibition Failure Hypothesis (Gray 1994) lack of anxiety in response to others distress leads to failure to learn to inhibit violence toward others