PERSONALITY DISORDERS LECTURE OUTLINE DSM Axis II – What is a personality disorder?

1. PERSONALITY DISORDERS • LECTURE OUTLINE • DSM Axis II – What is a personality disorder? • Clusters of personality disorders – 3 main types • Prevalence • Historical perspectives • Diagnostic issues • Etiology – Theoretical perspectives

2. PERSONALITY DISORDERS • What is a personality disorder? • maladaptive personality traits • traits are relatively enduring features of a person that are persistent over time and situations • people with personality disorders tend to be: rigid and inflexible, show a restricted range of traits, have a dominant single trait • personality disorders are egosyntonic, more than egodystonic

3. PERSONALITY DISORDERS • Clusters of disorders • Odd and eccentric – paranoid, schizoid, schizotypal • Dramatic, emotional, or erratic – antisocial, borderline, histrionic, narcissistic • Anxious and fearful – dependent, obsessive-compulsive

4. PERSONALITY DISORDERS • Prevalence • 6-9% of population have one or more personality disorder • prevalence higher among people with other mental disorders • most people with personality disorders never come to the attention of mental health professionals

5. PERSONALITY DISORDERS • Historical perspective • Roots in psychoanalysis – narcissism, masochism, etc. • Karl Abraham – first theorist to focus on personality disorders

6. PERSONALITY DISORDERS • Diagnostic issues • poor understanding of etiology of most personality disorders • comorbidity and diagnostic overlap • gender and cultural issues • reliability of diagnosis • categorical vs. dimensional approach – Big 5 personality traits

7. PERSONALITY DISORDERS • Etiology – Theoretical perspectives • Psychodynamic theory • Attachment theory – particularly for dramatic, emotional, erratic • Cognitive-behavioural perspectives • Biological – particularly for odd, eccentric and dramatic, emotional, erratic

8. PERSONALITY DISORDERS • Cluster A – Odd and eccentric • Paranoid – suspicious, argumentative (no delusions or hallucinations) • Schizoid – withdrawn, reserved, reclusive • Schizotypal – eccentricity of thought and behaviour

9. PERSONALITY DISORDERS • Cluster B – Dramatic, emotional, erratic • Antisocial personality disorder (APD) • Defining feature is pervasive disregard for and violation of rights of others • Begins in childhood • Must meet 3 of the following criteria – violation of rights of others, nonconformity, callousness, deceitfulness, irresponsibility, impulsivity, aggressiveness, recklessness

10. PERSONALITY DISORDERS • Cluster B – Dramatic, emotional, erratic • Antisocial personality disorder (APD) • Lifetime prevalence rates for APD – 3% for men, 1% for women, lower rates for psychopathy • 40% of those in Canadian prisons have APD

11. PERSONALITY DISORDERS • Cluster B – Dramatic, emotional, erratic • APD vs. Psychopathy • APD focuses more on behaviour • Robert Hare, UBC – Psychopathy Checklist Revised – focuses on both personality traits and behaviour (lifestyle instability)

12. Robert Hare, UBC – Psychopathy Checklist Revised

13. PERSONALITY DISORDERS • Cluster B – Dramatic, emotional, erratic • Etiology of APD • Family and parenting factors – disruptive family life, harsh and inconsistent discipline, lack of monitoring • genetics – concordance rates for criminality are 51% for MZ twins, 21% for DZ; runs in families

14. PERSONALITY DISORDERS • Cluster B – Dramatic, emotional, erratic • Etiology of APD • fearlessness hypothesis – deficient emotional arousal and conditioning is associated with a lack of empathy, thrill-seeking • in the face of punishment, psychopaths increase the frequency of punished behaviour, rather than decrease it; defiance/opposition

15. PERSONALITY DISORDERS • Cluster B – Dramatic, emotional, erratic • Etiology of APD - Lykken’s (1957) research • in a lever pressing task, people with psychopathy did not learn the association between particular lever presses and shocks • in contrast, people without psychopathy learned this association quickly

16. PERSONALITY DISORDERS • Cluster B – Dramatic, emotional, erratic • Etiology of APD - Schmauk’s (1970) research • repeated this experiment, but compared different types of punishers – physical, tangible (loss of money), social (reprimands) • he found, like Lykken, that those with psychopathy learned poorly when physical and social punishers were used, but they learned as well as controls when tangible punishment was used

17. PERSONALITY DISORDERS • Cluster B – Dramatic, emotional, erratic • Etiology of APD - Stewart’s (1972) research • sentence completion task involving physical punishment for aggressive responses • controls stopped aggressive responses very quickly, but those with psychopathy increased aggressive responses; they acted in opposition to and defiance of the researcher

18. PERSONALITY DISORDERS • Cluster B – Dramatic, emotional, erratic • Etiology of APD – Implication of this research • Punishment of offenders not likely to be very effective for rehabilitation • Programs like “Scared Straight,” boot camps make kids with APD worse rather than better • “Getting tough” with this population not likely to work

19. PERSONALITY DISORDERS • Cluster B – Dramatic, emotional, erratic • Course of APD • a progression or career of deviancy - oppositional defiant disorder, conduct disorder, APD • burnout response – as they age, people with APD become less involved in criminal activity

20. PERSONALITY DISORDERS • Cluster B – Dramatic, emotional, erratic • Treatment of APD • difficulty establishing therapeutic alliance • need to focus on specific behaviours, such as anger management • treatment approaches not very successful • probably more success with prevention and early intervention

21. PERSONALITY DISORDERS • Cluster B – Dramatic, emotional, erratic • Borderline personality • fragile identity and instability in relationships • unpredictability, impulsiveness, irritability, argumentative • more prevalent in women • low reliability of this diagnosis • experience of child abuse and neglect

22. PERSONALITY DISORDERS • Cluster B – Dramatic, emotional, erratic • Histrionic personality – attention-seeking, flirtatious, flamboyant, difficulty with relationships, • Narcissism – grandiosity, egocentricity, vengeful, but low self-esteem

23. PERSONALITY DISORDERS • Cluster C – Anxious and fearful disorders • Avoidant personality – extreme sensitivity to criticism and disapproval, avoidance of intimacy • Dependent personality – constantly seeks reassurance, advice, direction from others • Obsessive-compulsive personality – inflexibility and desire for perfection, absence of obsessional thoughts and compulsive behaviours

24. PERSONALITY DISORDERS • Treatment • Object relations psychodynamic therapy – Kernberg, Kohut • Cognitive-behavioural • Pharmacological

25. PERSONALITY DISORDERSBig 5 – OCEAN (Costa & Mcrea, 1992)

26. PERSONALITY DISORDERS • Dimensional analysis of types • Where would schizoid personality fit on the 5 dimensions? • How about paranoid? • Antisocial? • Narcissism? • Avoidant or dependent?

27. PERSONALITY DISORDERS • SUMMARY • Personality disorders are maladaptive personality traits • 3 broad clusters • Problem of overlap of categories • Etiology for many personality disorders not well understood • Treatments have not been very successful for many of these disorders