Personality Disorders

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Personality Personality DisordersDisorders

Personality DisordersGeneral characteristics of PD’sGeneral characteristics of PD’s

Cluster Cluster AA Disorders Disorders

Paranoid, Schizoid, SchizotypalParanoid, Schizoid, Schizotypal

Cluster Cluster BB Disorders Disorders

Antisocial, Borderline, Histrionic, Antisocial, Borderline, Histrionic, NarcissisticNarcissistic

Cluster Cluster CC Disorders Disorders

Avoidant, Obsessive-Compulsive, DependentAvoidant, Obsessive-Compulsive, Dependent

Personality Disorder

- Inflexible, maladaptive patterns of Inflexible, maladaptive patterns of personality personality

- Results in social, occupational Results in social, occupational problems or distressproblems or distress

Facts About Personality Disorders

Onset usually late childhood, early Onset usually late childhood, early adolescenceadolescence

Causes Causes othersothers distress distress

Affects behavior in many situationsAffects behavior in many situations

Poor insightPoor insight

Little behavior change Little behavior change

Coded on Axis IICoded on Axis II

General Diagnostic Criteria for PD’sEnduring pattern of inner experience or Enduring pattern of inner experience or

behavior that deviates from expectations behavior that deviates from expectations of culture, manifested in of culture, manifested in two (2) or more two (2) or more of the followingof the following:: >>COGNITION COGNITION (perception of self, others)(perception of self, others)>>AFFECTIVITYAFFECTIVITY

(intensity, range of emotions) (intensity, range of emotions)> > INTERPERSONAL functioningINTERPERSONAL functioning> > IMPULSE CONTROLIMPULSE CONTROL

Enduring pattern is inflexible, pervasive in Enduring pattern is inflexible, pervasive in many situationsmany situations

General DiagnosticGeneral Diagnostic Criteria for PD’s

Enduring pattern leads to distress, impairment in Enduring pattern leads to distress, impairment in important areas of functioningimportant areas of functioning

Pattern is stable and of long duration, can be Pattern is stable and of long duration, can be traced back to childhoodtraced back to childhood

Pattern not better explained by another disorderPattern not better explained by another disorder

Pattern not due to substance abuse or medical Pattern not due to substance abuse or medical conditioncondition

Personality Disorders: Why Axis 2?

Axis II disorders:Axis II disorders: * Long-lasting, chronic patterns of interactions * Long-lasting, chronic patterns of interactions

Not discreet episodesNot discreet episodes

* Begin by adolescence * Begin by adolescence

* Frequently co-occur with Axis I diagnoses* Frequently co-occur with Axis I diagnoses

* Complete recovery not possible* Complete recovery not possible

Types of Personality Disorders

Paranoid personality

Schizoid personality Cluster ACluster ASchizotypal personality

Antisocial personalityBorderline personality

Histrionic personality Cluster BCluster BNarcissistic personality

Avoidant personality

Dependent personality Cluster CCluster CObsessive-compulsive personality

Cluster ACluster A Personality Disorders ParanoidParanoid

SchizoidSchizoidSchizotypalSchizotypal

Marked by Marked by EccentricityEccentricity, ,

Odd behaviorOdd behavior notnot psychosis psychosis

Share a superficial similarity with schizophrenia Share a superficial similarity with schizophrenia (a milder version)(a milder version)

Cluster BCluster B Personality DisordersAntisocial Antisocial

Borderline Borderline HistrionicHistrionic

NarcissisticNarcissistic

Being Being Self-Self-absorbed, absorbed, Prone to Prone to Exaggerate Importance of EventsExaggerate Importance of Events

Having difficulty maintaining close relationshipsHaving difficulty maintaining close relationships

Cluster CCluster C Personality Disorders

Avoidant Avoidant Obsessive-compulsive Obsessive-compulsive DependentDependent

People are often People are often Anxious, Fearful and DepressedAnxious, Fearful and Depressed

Cluster ACluster A

ParanoidParanoid Personality Disorder

Lack of trust in othersLack of trust in others

Fear that friends may be disloyal, unfaithful Fear that friends may be disloyal, unfaithful

Being hypersensitive, overly suspicious, Being hypersensitive, overly suspicious, perceived as hostileperceived as hostile

DSM-IV Criteria for ParanoidParanoid PDPervasive distrust, suspicion of others, and four

or more of the following:– suspects, without basis, that others are

exploiting, harming, deceiving– is preoccupied with unjustified doubts of loyalty

or trustworthiness of people– is reluctant to confide in others– reads hidden, demeaning, threatening meaning

into benign actions– persistently bears grudges– perceives attacks on reputation– has unjustified suspicions about fidelity of others

Facts About ParanoidParanoid Personality Disorder

Affects 0.5–2.5 percent of population

Sometimes several individuals band together into groups that share paranoid beliefs (i.e. cults, etc.)

More common in males

SchizoidSchizoid Personality Disorder

Enduring pattern of thinking and behavior characterized by – pervasive indifference to others

– diminished range of emotional experiences, expressions

– Socially isolated, lacking in social relationships

DSM-IV Criteria for SchizoidSchizoid PD

Detachment from social relationships, restricted emotions, as indicated by four or four or more of the followingmore of the following::– neither desires nor enjoys social relationshipsneither desires nor enjoys social relationships– prefers solitary activitiesprefers solitary activities– has little interest in sexual experienceshas little interest in sexual experiences– gets pleasure from few activitiesgets pleasure from few activities– lacks close friendslacks close friends– appears indifferent to praise or criticismappears indifferent to praise or criticism– shows emotional coldness, detachment, flat affectshows emotional coldness, detachment, flat affect

SchizotypalSchizotypal Personality Disorder

Enduring pattern of discomfort with others and odd, peculiar thinking and behavior

Shares symptoms with both paranoid and schizoid personality disorders

Most closely linked to schizophrenia

DSM-IV Criteria for Schizotypal PDAcute discomfort with social relationships,

eccentric behavior, and five or more of the following:– ideas of referenceideas of reference– odd beliefsodd beliefs– unusual perceptual experiencesunusual perceptual experiences– odd speechodd speech– suspiciousnesssuspiciousness– inappropriate or constricted affectinappropriate or constricted affect– odd or eccentric appearance and behaviorodd or eccentric appearance and behavior– lack of close friendslack of close friends– excessive social anxietyexcessive social anxiety

Cluster BCluster B

Cluster BCluster B Personality Disorders

Antisocial, borderline, histrionic, and narcissistic personality disorders

Being self-absorbed, prone to exaggerate importance of events

Having difficulty maintaining close relationships

AntisocialAntisocial Personality Disorder

Pervasive, persistent disregard for or Pervasive, persistent disregard for or violation of rights of other peopleviolation of rights of other people

DSM-IV Criteria for AntisocialAntisocial PDPattern of disregard for rights of others since age 15, as Pattern of disregard for rights of others since age 15, as

indicated by three or more of the following:indicated by three or more of the following:– failure to conform to social norms, respect lawful failure to conform to social norms, respect lawful

behaviorbehavior– deceitfulness, lying, conning others for profit or deceitfulness, lying, conning others for profit or

pleasurepleasure– impulsivity, failure to plan aheadimpulsivity, failure to plan ahead– irritability, aggressiveness, repeated fightsirritability, aggressiveness, repeated fights– reckless disregard for safety of othersreckless disregard for safety of others– consistent irresponsibility, failure to honor consistent irresponsibility, failure to honor

obligationsobligations– lack of remorselack of remorse

Individual is at least 18 years oldIndividual is at least 18 years oldEvidence of conduct disorder before age 15Evidence of conduct disorder before age 15

Facts About Antisocial PD

*Affects 2.5–3.5 percent of population*Affects 2.5–3.5 percent of population

*More common in men*More common in men

*Highest prevalence among men 25–44 yr old*Highest prevalence among men 25–44 yr old

*40 % of affected men and 24 percent of *40 % of affected men and 24 percent of affected women were diagnosed with affected women were diagnosed with conduct disorder as childrenconduct disorder as children

Causes of AntisocialAntisocial PDGeneticsGenetics

Birth traumaBirth trauma

Sensation-seekingSensation-seeking

Family dynamicsFamily dynamics

Modeling and mediaModeling and media

The The SOCIOPATHSOCIOPATH

Not in DSMNot in DSM

Largest subgroup of APDLargest subgroup of APD

Often the products of illegitimacy, broken homes, and Often the products of illegitimacy, broken homes, and lack of any bonding with male or societal authoritylack of any bonding with male or societal authority

70% of sociopaths come from fatherless homes. 70% of sociopaths come from fatherless homes.

Early, precocious sexuality; antagonistic, deprecating Early, precocious sexuality; antagonistic, deprecating attitude toward the opposite sex; lack of interest in attitude toward the opposite sex; lack of interest in bonding with a durable, stable mate; aggressive acting-bonding with a durable, stable mate; aggressive acting-out; excessive boasting; and risk-taking behavior. out; excessive boasting; and risk-taking behavior.

SOCIOPATHSOCIOPATH

Most are males, but femalesMost are males, but females

Some Sociopaths are aggressive, fearless Some Sociopaths are aggressive, fearless sensation seekers – while others are sensation seekers – while others are Machiavellian manipulatorsMachiavellian manipulators

>Cross between an antisocial >Cross between an antisocial personality and a narcissist: personality and a narcissist: someone who also has an extremely someone who also has an extremely high sense of entitlement.high sense of entitlement.

SOCIOPATHSOCIOPATH

1. Superficial charm and good “intelligence”1. Superficial charm and good “intelligence”- seems well-adjusted; doesn’t look like a con man- seems well-adjusted; doesn’t look like a con man- seems to have high intellectual abilities and no social or - seems to have high intellectual abilities and no social or emotional problemsemotional problems

2. Absence of delusions and other signs of irrational 2. Absence of delusions and other signs of irrational thinkingthinking- he’s not psychotic- he’s not psychotic

3. Absence of “nervousness” or psychoneurotic 3. Absence of “nervousness” or psychoneurotic manifestationsmanifestations- almost incapable of anxiety; reactions are usually calm- almost incapable of anxiety; reactions are usually calm

4. Unreliability4. Unreliability- no sense of responsibility; unpredictable- no sense of responsibility; unpredictable

SOCIOPATHSOCIOPATH Some Additional CharacteristicsSome Additional Characteristics

5. Untruthfulness and insincerity5. Untruthfulness and insincerity-Remarkable disregard for the truth; -Remarkable disregard for the truth; -Comfortable lying in any situation -Comfortable lying in any situation

6. Lack of remorse or shame6. Lack of remorse or shame- Cannot accept blame for misfortune he brings on others - Cannot accept blame for misfortune he brings on others -No sense of shame -No sense of shame

7. Inadequately motivated antisocial behavior7. Inadequately motivated antisocial behavior- No motive for antisociality- No motive for antisociality

8. Poor judgment and failure to learn by experience8. Poor judgment and failure to learn by experience- Reasoning ability seems intact, but fails to use it. - Reasoning ability seems intact, but fails to use it. - Decisions and behavior not modified by experience - Decisions and behavior not modified by experience

(e.g. doesn’t want to be in jail, but keeps ending up there)(e.g. doesn’t want to be in jail, but keeps ending up there)

SOCIOPATHSOCIOPATH Some Additional CharacteristicsSome Additional Characteristics

COMMON SOCIOPATHS COMMON SOCIOPATHS Largest subtypeLargest subtypeWeak or unelaborated conscience. Weak or unelaborated conscience. Enjoy--take pride in--bending or breaking the rules. Enjoy--take pride in--bending or breaking the rules. As teenagers, they are often runaways. As teenagers, they are often runaways. As adults, often geographically mobile, living in As adults, often geographically mobile, living in shelters, or taking advantage of welfare systems. shelters, or taking advantage of welfare systems. Experienced shopliftersExperienced shoplifters. .

SOCIOPATHSOCIOPATH TYPE TYPE

COMMON SOCIOPATHS COMMON SOCIOPATHS Active sex lives. Active sex lives. Usually > average intelligence. Usually > average intelligence. Struggle in school.Struggle in school.Cycle of low-paying, dead-end jobs. Cycle of low-paying, dead-end jobs. Seem genuinely happy with their lives: Seem genuinely happy with their lives: ~unburdened by any sense of negative self-worth ~unburdened by any sense of negative self-worth or the fact that they have not been a functional, or the fact that they have not been a functional, contributing member of societycontributing member of society.

1 1 cont.cont.

ALIENATED SOCIOPATHS

Never develop ability to love, empathize or affiliate Never develop ability to love, empathize or affiliate with another person. with another person. Will show more emotion toward pet or an artifact.Will show more emotion toward pet or an artifact.Dating/marital relationships barren and empty.Dating/marital relationships barren and empty.Don't get along with the neighbors. Don't get along with the neighbors. Live in a shell. Live in a shell. Cold, callous.Cold, callous.Believe they are justified -- cheated by societyBelieve they are justified -- cheated by societyChronic complainers.Chronic complainers.

AGGRESSIVE SOCIOPATHS AGGRESSIVE SOCIOPATHS

Strong, gratification from harming others Strong, gratification from harming others Like to hurt, frighten, tyrannize, bully & manipulate Like to hurt, frighten, tyrannize, bully & manipulate Polished aggressive, domineering manner. Polished aggressive, domineering manner. Seek positions of power.Seek positions of power.Passive aggression--systematically sabotage others Passive aggression--systematically sabotage others Occasionally sadistic e.g. mutilate stray animals.Occasionally sadistic e.g. mutilate stray animals.Effective getting their way.Effective getting their way.Vindictive.Vindictive.Don't follow social norm of Don't follow social norm of reciprocityreciprocity

DYSSOCIAL SOCIOPATHSDYSSOCIAL SOCIOPATHS Identify/hold allegiance with an dyssocial, outcast or Identify/hold allegiance with an dyssocial, outcast or predatory subculture.predatory subculture.Capable of intense loyalty, and even a feeling of guilt Capable of intense loyalty, and even a feeling of guilt and shame, within such limited circlesand shame, within such limited circlesSeem to continually have bad luck & companions.Seem to continually have bad luck & companions.Constantly complain that nothing is their fault. Constantly complain that nothing is their fault. Self-defeating mechanism: poor choices. Self-defeating mechanism: poor choices.

Psychopath?Psychopath?Sociopath? Sociopath? OROR

SEE SEE SOCIOPATH…SOCIOPATH…huh?huh?That’s the point —That’s the point —historically, the two historically, the two classifications have been classifications have been used interchangeably; used interchangeably; however…however…

PSYCHOPATHPSYCHOPATH

Vague, argued distinctionsMore OrganizedMore highly intelligent3 C’s

*C*Cold, CCunning, CCalculatedStable proportionSociopaths vary

*E*Environmental influences, stressors, events

Psychopath: more stable profileDr. Robert Hare-Psychopathy Checklist

DISTEMPERED CHARISMATIC

PRIMARY

SECONDARY

PSYCHOPATHPSYCHOPATHFour SubtypesFour Subtypes

PSYCHOPATHPSYCHOPATHTYPE TYPE

11DISTEMPERED

Fly into a rage or frenzy.

Usually men with powerful cravings i.e. drug addiction, kleptomania, pedophilia, any illicit or illegal indulgence. Like the endorphin "high" or "rush" from risk-taking.

22CHARISMATIC

*Charming, attractive liars. *Usually gifted *They are usually fast-talkers*Ability to persuade others.

e.g.Leaders of religious cults*Often believe in their own fictions. *They are irresistible.

33PRIMARY

*Do not respond to punishment, apprehension, stress, or disapproval.

*Seem able to inhibit their antisocial impulses most of the time—suits purpose/mission.*“Semantic aphasia" *Do not follow any life plan*Seem incapable of experiencing any genuine emotion

44SECONDARY

*Risk-takers*Also, stress-reactive, worriers, and guilt-prone *Expose themselves to more stress*Daring, adventurous, unconventional people*Play by their own rules early in life *Strongly driven by a desire to escape or avoid pain *Unable to resist temptation *As their anxiety increases toward some forbidden object,

so does their attraction to it*Live their lives by the lure of temptation

1.1. Glib and superficial charm Glib and superficial charm 2.2. Grandiose (exaggeratedly high) estimation of Grandiose (exaggeratedly high) estimation of

self self 3.3. Need for stimulation Need for stimulation 4.4. Pathological lying Pathological lying 5.5. Cunning and manipulation Cunning and manipulation 6.6. Lack of remorse or guilt Lack of remorse or guilt 7.7. Shallow affect (superficial emotional Shallow affect (superficial emotional

responsiveness) responsiveness) 8.8. Callousness and lack of empathy Callousness and lack of empathy 9.9. Parasitic lifestyle Parasitic lifestyle 10.10. Poor behavioral controls Poor behavioral controls

Dr. Robert Hare’s Psychopathy Checklist

11. Sexual promiscuity 11. Sexual promiscuity 12. Early behavior problems 12. Early behavior problems 13. Lack of realistic long-term goals 13. Lack of realistic long-term goals 14. Impulsivity 14. Impulsivity 15. Irresponsibility 15. Irresponsibility 16. Failure to accept responsibility for own 16. Failure to accept responsibility for own

actions actions 17. Many short-term marital relationships 17. Many short-term marital relationships 18. Juvenile delinquency 18. Juvenile delinquency 19. Revocation of conditional release 19. Revocation of conditional release 20. Criminal versatility 20. Criminal versatility

Interview portion of the evaluation covers the Interview portion of the evaluation covers the subject's background, including such items as: subject's background, including such items as:

*work and educational history *work and educational history *marital and family status *marital and family status *criminal background *criminal background

Because psychopaths lie frequently and easily, the Because psychopaths lie frequently and easily, the information they provide must be confirmed:information they provide must be confirmed:

*review of the documents in the *review of the documents in the subject's subject's case history case history

Results

PCL-R provides a total score that indicates how PCL-R provides a total score that indicates how closely the test subject matches the "perfect" score closely the test subject matches the "perfect" score that a classic or prototypical psychopath would that a classic or prototypical psychopath would rate. rate.

Each of the twenty items is given a score of Each of the twenty items is given a score of 0, 1, or 2 based on how well it applies to the subject 0, 1, or 2 based on how well it applies to the subject being tested. being tested.

Results

A prototypical psychopath would receive a A prototypical psychopath would receive a maximum score of 40, while someone with maximum score of 40, while someone with absolutely no psychopathic traits or tendencies absolutely no psychopathic traits or tendencies would receive a score of zero. would receive a score of zero.

A score of 30+ = a diagnosis of psychopathy. A score of 30+ = a diagnosis of psychopathy.

People with no criminal backgrounds normally People with no criminal backgrounds normally score around 5. score around 5.

Many non-psychopathic criminal offenders score Many non-psychopathic criminal offenders score around 22. around 22.

VIDEOVIDEO

BackgroundBackground•ASPD vs. criminalityASPD vs. criminality

–““criminal” is a legal term criminal” is a legal term denoting conviction for denoting conviction for breaking a law:breaking a law:•Not all people with ASPD are Not all people with ASPD are criminals (or in jails)criminals (or in jails)

•Not all people in jail or Not all people in jail or considered criminal have ASPDconsidered criminal have ASPD

•Not all people with ASPD are Not all people with ASPD are psychopathspsychopaths

2. Statistics and course 2. Statistics and course (cont.)(cont.)

• Course of all PDs is chronic, but overt antisocial behavior seems to age out after 40- could still show ASPD features (e.g., lying;

poor work habits)

Criteria and features of ASPDCriteria and features of ASPD

Causal influences- twin, family and adoption data show strong genetic influence- CD also appears to have shared environment influence- poor socialization due to low fearfulness may account for some cases

TreatmentTreatment

• Most don’t seek treatment for ASPD (usually substance abuse)

• No treatment shown to be efficacious• More likely to end up in jail than in

treatment• Focus is on prevention – target antisocial

children

SummarySummary

• PDs are enduring, maladaptive patterns of relating to the world and to others

• General criteria for PD, then specific PD

• DSM-IV arranges PDs in 3 clusters according to shared characteristics

• Lack of insight – usually do not seek treatment for the PD; PD can impact treatment of other disorders

• ASPD

Borderline Borderline Personality DisorderEnduring pattern of thinking, behavior that

involves:Instability of mood, self-image,

interpersonal relationships Frantic efforts to avoid real or imagined

abandonmentUnrealistically positive or negative opinions Unrealistically positive or negative opinions

about othersabout others (intense relationships or nonexistance)

DSM-IV Criteria for Borderline Borderline PD

Instability in relationships, self-image, marked impulsivity, and five (5) or more of the following:five (5) or more of the following: Frantic efforts to avoid real or imagined abandonmentFrantic efforts to avoid real or imagined abandonment Pattern of unstable, intense relationshipsPattern of unstable, intense relationships Identity disturbanceIdentity disturbance Impulsivity in two or more areas that are self-damaging Impulsivity in two or more areas that are self-damaging Recurrent suicidal behavior, gestures, threatsRecurrent suicidal behavior, gestures, threats Affective instabilityAffective instability Chronic feelings of emptinessChronic feelings of emptiness Inappropriate intense angerInappropriate intense anger Transient, stress-related paranoid ideasTransient, stress-related paranoid ideas

Facts About Facts About Borderline Borderline Personality DisorderPersonality Disorder

2% of populationMore common in womenThreats/actions of self-harm are commonAttributed to parental loss or abuse in

childhoodTreatment mostly unsuccessful – often use

dialectical behavior therapy

Histrionic Histrionic Personality Disorder

Enduring pattern of thinking, behavior characterized by:

Excessive emotionalityAttention-seeking behaviorTypically self-centered, vain, demanding

2–3% percent of the population

Mainly diagnosed in women

Person dresses eccentrically, seductively

DSM-IV Criteria for HistrionicHistrionic PD

Excessive emotionality, attention-seeking, Excessive emotionality, attention-seeking, and and five (5) or more of the following:five (5) or more of the following:Uncomfortable when not center of attentionUncomfortable when not center of attentionRapidly shifting moodsRapidly shifting moodsUses physical appearance to draw attentionUses physical appearance to draw attention Interactions characterized by provocative, Interactions characterized by provocative,

seductive behaviorseductive behaviorExaggerates in dramatic mannerExaggerates in dramatic mannerSuggestible, easily influencedSuggestible, easily influencedConsiders relationships more intimate than they Considers relationships more intimate than they

areare

Narcissistic Narcissistic Personality Disorder

Enduring pattern of thinking, behavior Enduring pattern of thinking, behavior characterized by: characterized by:

Grandiosity Grandiosity Preoccupation with own Preoccupation with own achievements and abilitiesachievements and abilities

DSM-IV Criteria for NarcissisticNarcissistic PDGrandiosity in fantasy and behavior, need for admiration,

lack of empathy, and five (5) or more of the following:five (5) or more of the following:Grandiose sense of self-importanceGrandiose sense of self-importancePreoccupied with fantasies of power, success, lovePreoccupied with fantasies of power, success, loveBelieves he or she is special or uniqueBelieves he or she is special or uniqueRequires excessive admirationRequires excessive admirationSense of entitlementSense of entitlementTakes advantage of others to achieve own needsTakes advantage of others to achieve own needsLacks empathyLacks empathyOften envious of othersOften envious of othersArrogant, haughtyArrogant, haughty

Cluster CCluster C

Cluster CCluster C Personality Disorders

Avoidant Obsessive-Compulsive

Dependent

People are often Anxious Fearful

Depressed

AvoidantAvoidant Personality Disorder

Enduring pattern of thinking, behavior characterized by – pervasive social discomfort pervasive social discomfort – fear of negative evaluation fear of negative evaluation – social isolation social isolation – being easily hurt being easily hurt – fear of disapprovalfear of disapproval

Shy and socially uncomfortable but desire social contact

Avoid it because of fear of embarrassment or criticism

Obsessive-CompulsiveObsessive-Compulsive Personality Disorder

Enduring pattern of thinking, behaviorcharacterized by perfectionism, perfectionism,

inflexibilityinflexibilityPreoccupied with rules, excessively rules, excessively

moralistic, judgmentalmoralistic, judgmental

DependentDependent Personality Disorder

Enduring pattern of Enduring pattern of submissive, dependentsubmissive, dependent behaviorbehavior

Exceedingly dependentExceedingly dependent on others for on others for advice, reassuranceadvice, reassurance

Feelings of Feelings of anxiety and helplessness when anxiety and helplessness when alonealone

Personality Disorders

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