Personality Disorders

1. Personality Disorders

2. Personality Disorders General characteristics of PD’s Cluster A Disorders Paranoid, Schizoid, Schizotypal Cluster B Disorders Antisocial, Borderline, Histrionic, Narcissistic Cluster C Disorders Avoidant, Obsessive-Compulsive, Dependent

4. Personality Disorder • Inflexible, maladaptive patterns of personality • Results in social, occupational problems or distress

5. Facts About Personality Disorders Onset usually late childhood, early adolescence Causes others distress Affects behavior in many situations Poor insight Little behavior change Coded on Axis II

6. General Diagnostic Criteria for PD’s Enduring pattern of inner experience or behavior that deviates from expectations of culture, manifested in two (2) or more of the following: >COGNITION (perception of self, others) >AFFECTIVITY (intensity, range of emotions) > INTERPERSONAL functioning > IMPULSE CONTROL Enduring pattern is inflexible, pervasive in many situations

7. General Diagnostic Criteria for PD’s Enduring pattern leads to distress, impairment in important areas of functioning Pattern is stable and of long duration, can be traced back to childhood Pattern not better explained by another disorder Pattern not due to substance abuse or medical condition

8. Personality Disorders: Why Axis 2? Axis II disorders: * Long-lasting, chronic patterns of interactions Not discreet episodes * Begin by adolescence * Frequently co-occur with Axis I diagnoses * Complete recovery not possible

9. Types of Personality Disorders Paranoid personality Schizoid personality Cluster A Schizotypal personality Antisocial personality Borderline personality Histrionic personality Cluster B Narcissistic personality Avoidant personality Dependent personality Cluster C Obsessive-compulsive personality

10. Cluster A Personality Disorders Paranoid Schizoid Schizotypal Marked by Eccentricity, Odd behaviornot psychosis Share a superficial similarity with schizophrenia (a milder version)

11. Cluster B Personality Disorders Antisocial Borderline Histrionic Narcissistic Being Self-absorbed, Prone to Exaggerate Importance of Events Having difficulty maintaining close relationships

12. Cluster C Personality Disorders Avoidant Obsessive-compulsive Dependent People are often Anxious, Fearful and Depressed

13. Cluster A

14. ParanoidPersonality Disorder Lack of trust in others Fear that friends may be disloyal, unfaithful Being hypersensitive, overly suspicious, perceived as hostile

16. DSM-IV Criteria for ParanoidPD Pervasive 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

17. Facts About ParanoidPersonality 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

19. Schizoid 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

20. DSM-IV Criteria for SchizoidPD Detachment from social relationships, restricted emotions, as indicated by four or more of the following: • neither desires nor enjoys social relationships • prefers solitary activities • has little interest in sexual experiences • gets pleasure from few activities • lacks close friends • appears indifferent to praise or criticism • shows emotional coldness, detachment, flat affect

22. SchizotypalPersonality 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

24. DSM-IV Criteria for Schizotypal PD Acute discomfort with social relationships, eccentric behavior, and five or more of the following: • ideas of reference • odd beliefs • unusual perceptual experiences • odd speech • suspiciousness • inappropriate or constricted affect • odd or eccentric appearance and behavior • lack of close friends • excessive social anxiety

25. Cluster B

26. Cluster B Personality Disorders Antisocial,borderline,histrionic, andnarcissistic personality disorders Being self-absorbed, prone to exaggerate importance of events Having difficulty maintaining close relationships

27. Antisocial Personality Disorder Pervasive, persistent disregard for or violation of rights of other people

29. DSM-IV Criteria for Antisocial PD Pattern of disregard for rights of others since age 15, as indicated by three or more of the following: • failure to conform to social norms, respect lawful behavior • deceitfulness, lying, conning others for profit or pleasure • impulsivity, failure to plan ahead • irritability, aggressiveness, repeated fights • reckless disregard for safety of others • consistent irresponsibility, failure to honor obligations • lack of remorse Individual is at least 18 years old Evidence of conduct disorder before age 15

30. Facts About Antisocial PD *Affects 2.5–3.5 percent of population *More common in men *Highest prevalence among men 25–44 yr old *40 % of affected men and 24 percent of affected women were diagnosed with conduct disorder as children

31. Causes of Antisocial PD • Genetics • Birth trauma • Sensation-seeking • Family dynamics • Modeling and media

32. The SOCIOPATH

33. SOCIOPATH Not in DSM Largest subgroup of APD Often the products of illegitimacy, broken homes, and lack of any bonding with male or societal authority 70% of sociopaths come from fatherless homes. Early, precocious sexuality; antagonistic, deprecating attitude toward the opposite sex; lack of interest in bonding with a durable, stable mate; aggressive acting-out; excessive boasting; and risk-taking behavior.

34. SOCIOPATH • Most are males, but females • Some Sociopaths are aggressive, fearless sensation seekers – while others are Machiavellian manipulators • >Cross between an antisocial personality and a narcissist: someone who also has an extremely high sense of entitlement.

35. SOCIOPATH Some Additional Characteristics 1. Superficial charm and good “intelligence” - seems well-adjusted; doesn’t look like a con man - seems to have high intellectual abilities and no social or emotional problems 2. Absence of delusions and other signs of irrational thinking - he’s not psychotic 3. Absence of “nervousness” or psychoneurotic manifestations - almost incapable of anxiety; reactions are usually calm 4. Unreliability - no sense of responsibility; unpredictable

36. SOCIOPATH Some Additional Characteristics 5. Untruthfulness and insincerity -Remarkable disregard for the truth; -Comfortable lying in any situation 6. Lack of remorse or shame - Cannot accept blame for misfortune he brings on others -No sense of shame 7. Inadequately motivated antisocial behavior - No motive for antisociality 8. Poor judgment and failure to learn by experience - Reasoning ability seems intact, but fails to use it. - Decisions and behavior not modified by experience (e.g. doesn’t want to be in jail, but keeps ending up there)

37. SOCIOPATH TYPE 1 • COMMON SOCIOPATHS • Largest subtype • Weak or unelaborated conscience. • Enjoy--take pride in--bending or breaking the rules. • As teenagers, they are often runaways. • As adults, often geographically mobile, living in shelters, or taking advantage of welfare systems. • Experienced shoplifters.

38. SOCIOPATH TYPE 1 cont. • COMMON SOCIOPATHS • Active sex lives. • Usually > average intelligence. • Struggle in school. • Cycle of low-paying, dead-end jobs. • Seem genuinely happy with their lives: ~unburdened by any sense of negative self-worth or the fact that they have not been a functional, contributing member of society.

39. SOCIOPATH TYPE 2 • ALIENATED SOCIOPATHS • Never develop ability to love, empathize or affiliate with another person. • Will show more emotion toward pet or an artifact. • Dating/marital relationships barren and empty. • Don't get along with the neighbors. • Live in a shell. • Cold, callous. • Believe they are justified -- cheated by society • Chronic complainers.

40. SOCIOPATH TYPE 4 • AGGRESSIVE SOCIOPATHS • Strong, gratification from harming others • Like to hurt, frighten, tyrannize, bully & manipulate • Polished aggressive, domineering manner. • Seek positions of power. • Passive aggression--systematically sabotage others • Occasionally sadistic e.g. mutilate stray animals. • Effective getting their way. • Vindictive. • Don't follow social norm of reciprocity

41. SOCIOPATH TYPE 5 • DYSSOCIAL SOCIOPATHS • Identify/hold allegiance with an dyssocial, outcast or predatory subculture. • Capable of intense loyalty, and even a feeling of guilt and shame, within such limited circles • Seem to continually have bad luck & companions. • Constantly complain that nothing is their fault. • Self-defeating mechanism: poor choices.

42. OR Sociopath? Psychopath?

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

45. PSYCHOPATH • Vague, argued distinctions • More Organized • More highly intelligent • 3 C’s • *Cold, Cunning, Calculated • Stable proportion • Sociopaths vary • *Environmental influences, stressors, events • Psychopath: more stable profile • Dr. Robert Hare-Psychopathy Checklist

47. PSYCHOPATH Four Subtypes • DISTEMPERED • CHARISMATIC • PRIMARY • SECONDARY

48. TYPE 1 PSYCHOPATH DISTEMPERED 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.

49. TYPE 2 PSYCHOPATH CHARISMATIC *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.

50. TYPE 3 PSYCHOPATH PRIMARY *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