Personality Disorders

1. Personality Disorders

2. Upcoming Lectures Thursday: Course evaluation, Treatment • evaluate the second semester only (you’ve already evaluated Dr. Nurse and the first semester) • constructive feedback in written comments please Tuesday: Positive Psychology • we’ll end on a more upbeat note Thurs Apr 8: Review • Final exam will cover Winter semester material only • List of “focus questions” for lectures will be provided • Do you want Q&A only or a “Sixty Minute Review”? YET ANOTHER REMINDER… DON’T FORGET YOUR RESERCH PARTICIPATION REQUIREMENT!

3. Happiness Survey On a sheet of paper (scrap paper available), answer the following two questions and turn it in. Do NOT put your name or ID or identifying information on the paper. • Write down the number that corresponds to the face which represents how you feel about your life as a whole -3 -2 -1 0 1 2 3 • What changes in your life do you think would make you happier? Group results will be discussed in a week.

4. Three Minute Review SUBSTANCE ABUSE: ALCOHOLISM • contributing factors: expectations, drinking to cope, genes, culture, sex (male/female), context • steady alcoholics vs. binge drinkers • sex differences: different ways of coping DISSOCIATIVE IDENTITY DISORDER • Sybil & Eve • childhood abuse & trauma • Is it a real disorder or treatment-induced (iatrogenic)?

5. SCHIZOPHRENIA • Positive symptoms • disorganized thoughts • delusions (persecution, grandeur, control) • hallucinations • esp. auditory hallucinations • Negative symptoms • flattened affect • apathy, avolition (lack of motivation), poverty of speech • anhedonia • catatonia • Types • paranoid • catatonic • disorganized • undifferentiated

6. Test Yourself • Hilda suffers from a form of schizophrenia in which she spends most of her day sitting in her bedroom chair without speaking or moving. Her symptoms are characteristic of ________ schizophrenia. • paranoid • negative • psychotic • catatonic • disorganized • undifferentiated • positive

7. 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, doesn’t everybody have some PD? • PD is highly consistent and more extreme than normal personality • controversial • seem to change a lot between editions • exaggeration of normal traits • matter of degree • much overlap between PDs (especially within clusters) • very difficult to treat

8. Personality Disorder Classification

9. 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 didn’t 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)

10. Remember 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, People’s Temple demanded complete loyalty and had interrogation sessions asked church members if they’d 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 Multiple PDs: Example • 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)

11. Psychopath vs. Sociopath vs. Antisocial Personality Disorder psychopath implies psychological, biological or genetic causes sociopath implies social forces and early experiences as causes people sometimes avoid “psychopath” because it’s easily confused with psychosis antisocial personality disorder is an official DSM-IV diagnosis antisocial ≠ asocial Antisocial Personality Disorder 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.”

12. Criteria for APD

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 wasn’t 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 wouldn’t miss my mother and father if they died and that I wasn’t too nuts about my brothers and sisters for that matter. I figured there wasn’t anybody I really cared for but, thin, I didn’t need any of them anyways so I rolled over and went to sleep.” (McNeil, 1967).

15. Criminality • majority of criminals (~40-75%) meet criteria for Antisocial Personality Disorder • APD found more commonly in prisons than psychiatric facilities

16. Famous Psychopaths • Karla Holmolka & Paul Bernardo • killed 3 • Ted Bundy • killed 16+ • Charles Manson • brutally killed 5 people

17. BUT… Most criminals are psychopaths BUT… not all psychopaths are criminals • Most studies of psychopathy are done on prison population, but others have tried other creative ways of recruiting them (Widom, 1978) • ad in Boston newspaper “Wanted: charming, aggressive, carefree people who are impulsively irresponsible but are good at handling people and looking after number one. Send name, address, phone and short biography proving how interesting you are to…” • 73 people responded, 1/3 met APD criteria but had not been imprisoned • can be charismatic and successful politicians, businesspeople and religious leaders • “The faults of the burglar are the qualities of the financier.” --George Bernard Shaw, Major Barbara

18. A real life psychopath “Jenny” (not her real name) • stole $1200 from her best friend’s bank account using the ATM • framed another roommate • frequently bought gifts for friends • was easily bored, audacious, charismatic • had crises whenever anyone else was the centre of attention • good at faking emotion but shallow • had degree in sociology • went to prison for faking returns to clothing store where she worked • claimed to be “volunteering for the Bow River Correctional Institute” • worked at a music store during their highest period of shoplifting • told endless lies • faux boyfriend • Psychology thesis on chimp language • Yale golf scholarship • stole money from me and charged my credit card • claimed to have police connections and to get criminal records

19. Causes of Psychopathy • 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? • psychopaths seem to have impaired frontal lobe functioning • lack of forethought and ability to consider implications • less limbic input to frontal cortex • genetic component • also affected by low SES, dysfunctional families (esp. alcohol abuse), childhood abuse • 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

20. 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 they’re 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 didn’t 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)