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 • Selye’s 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, doesn’t 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

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 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)

11. 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)

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 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. A Real-Life Psychopath “Jenny” (not her real name) • stole $1200 from her best friend’s 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 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 Psychopath vs. Sociopath 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 • ~60% of criminals have ASPD • Most psychopaths have ASPD • However, most people with ASPD are NOT psychopaths Criminals ASPD * Diagram illustrates conceptual overlap but proportions may not be accurate Psychopaths = Sociopaths

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 that’s how come I was shot in the arm. It seems like things have always gone bad for me. It seems like I’ve 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 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)

24. Evolutionary Biology of Psychopathy • why are there psychopaths? • why isn’t everybody a psychopath? • a lion doesn’t 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.