Announcements

1. Personality Disorders II(Chapter 12)April 16, 2014PSYC 2340: Abnormal PsychologyBrett Deacon, Ph.D.

2. Announcements • Remaining schedule: • Personality disorders – 2 classes • No class this Friday (Easter break) • 3 classes on psychotic disorders • Exam #4 is coming up soon! April 28th • I will email you your exam grade by 5 PM • You have until Wednesday to let me know if you will be taking the final exam

3. From Last Class • Exam #3 returned • General comments on personality and abnormality • Gender bias in personality disorders • Historical evolution of the personality disorders section of the DSM

4. Personality Disorders • Prevalence • 0.5% to 2.5% in general population • 10% to 30% in inpatient settings • 2% to 10% in outpatient settings • Origins and course • Begin in childhood • Run a chronic course • Comorbidity rates are high

5. 0 Research on Personality Disorders

6. 0 Literature on Personality Disorder Treatments • There are no FDA-approved medications for any personality disorder • # randomized, controlled clinical trials for: • Paranoid PD = 0 • Schizoid PD = 0 • Schizotypal PD= 1 • Histrionic PD = 0 • Narcissistic PD = 0 • Avoidant PD = 3 • Obsessive-Compulsive PD = 0 • All Cluster C PDs combined = 1

7. Back to the Disorder Clusters • Cluster A: Odd or Eccentric • Paranoid • Schizoid • Schizotypal

8. Personality Disorder Clusters • Cluster B: Dramatic, Emotional, Erratic • Antisocial • Borderline • Histrionic • Narcissistic

9. 0 Paranoid Personality Disorder • Defining features • Pervasive and unjustified mistrust and suspicion • Motto: “don’t forgive, get even” • Hypersensitivity, hostility, detachment • Causes • Mostly unclear • Learning that the world is a dangerous place and that others can’t be trusted (?)

10. 0 Paranoid Personality Disorder • Treatment • Few seek professional help • Why would they? • Treatment focuses on development of trust • Cognitive therapy for inaccurate thinking • Very little is known • # clinical trials: 0

11. 0 Schizoid Personality Disorder • Defining features • Pervasive detachment from social relationships • Limited range of emotions around others • Indifferent about relationships (not fearful of them) • Causes • Etiology is unclear • Preference for social isolation resembles autism

12. 0 Schizoid Personality Disorder • Treatment options • Few seek professional help • Focus on the value of interpersonal relationships • Building empathy and social skills • Very little is known • # clinical trials: 0

13. 0 Schizotypal Personality Disorder • Defining features • Odd and unusual behavior and appearance • Most are socially isolated, highly suspicious • Magical thinking, ideas of reference, and illusions – but not of delusional intensity • Idea of reference vs. delusion • Illusion vs. hallucination

14. 0 Schizotypal Personality Disorder • Items from Perceptual Aberration Scale: 1. Sometimes I have had the feeling that I am united with an object near me. 2. I have sometimes felt that some part of my body no longer belongs to me. 3. I have sometimes had the feeling that my body is decaying inside. 4. My hands or feet seem far away. 5. Occasionally it has seemed as if my body had taken on the appearance of another person’s body.

15. 0 A Case Example • 22-year-old college student • Schizotypal symptoms: • Belief that she can spread positive energy to others through dancing • Transient visual hallucinations - threatening faces while she is resting with her eyes closed • Seeing angry faces in the clouds • Thoughts that she has been impregnated by Jesus Christ

16. 0 Schizotypal Personality Disorder • Causes • Relationship with schizophrenia • A phenotype of a schizophrenia genotype? • Treatment • Main focus is on social skills • Prognosis is generally poor • # clinical trials: 1 (antipsychotic meds)

17. 0 Borderline Personality Disorder • Defining features • Patterns of unstable moods and relationships • Impulsivity, fear of abandonment, very poor self-image • Self-mutilation and suicidal gestures are common • Most common PD in clinical settings • Comorbidity rates are high

18. 0 Borderline Personality Disorder • Facts and statistics • Lifetime prevalence = 2%-3% • Women account for 75% of cases • 6% commit suicide

19. 0 Borderline Personality Disorder • Causes • Runs in families • Early trauma and abuse seem to play some role • Emotional reactivity coupled with an invalidating environment

20. 0 Borderline Personality Disorder • Treatment • Few good treatment outcome studies • Antidepressant medications – Some short-term relief • Dialectical behavior therapy – Most promising treatment, considered only evidence-based treatment for BPD • http://www.youtube.com/watch?v=FRFh4OBNWaQ

21. 0 Antisocial Personality Disorder • Defining features • Noncompliance with social norms • Violate rights of others • Irresponsible, impulsive, and deceitful • Lack a conscience, empathy, and remorse

22. 0 Antisocial Personality Disorder • Must be evidence of Conduct Disorder before age 15 • Aggression to people and animals • Destruction of property • Deceitfulness or theft • Serious violation of rules

23. Classifying Antisocial Personality Disorder • Excessive variation within the diagnosis? • 2 people with Antisocial Personality Disorder • Person A: Frequently arrested for assault, cons others for personal pleasure, experiences no remorse when hurts others

24. Classifying Antisocial Personality Disorder • Person B: Recurrently arrested for possession of marijuana, difficulty keeping a job, often acts impulsively and displays poor judgment

25. 0 Psychopathy • Partial list of criteria (Cleckley, Hare): • Superficial charm • Grandiose sense of self-worth • Boredom/need for stimulation • Pathological lying • Conning/manipulative • Lack of remorse • “True psychopaths have diminished capacity for experiencing a wide range of emotions and an inability to understand the emotions of others; they lack the ability to sympathize with the plight of others, they do not experience empathy, and even apparent acts of altruism are actually thinly veiled attempts at selfishness. They do not experience soft emotions such as sadness, are rarely experience fear unless it has to do with the perception that something bad is about to happen to them.” (Jacobsen & Gottman, 1998, p. 37)

26. 0 The Successful Psychopath? • “Such a person…. could climb the business ladder by being able to make hard decisions with little remorse (Ken Lay), gain high political office by being able to lie or manipulate people effectively (Bill Clinton), excel by ignoring fear and anxiety in stressful situations (Chuck Yeager) or be driven to fame by relentless narcissism (Madonna). ” • http://seedmagazine.com/content/print/cocky_athletes_or_successful_psychos2/

27. 0 Psychopathy • Ted Bundy’s final interview • http://www.youtube.com/watch?v=jAHgJFPcOvY&feature=related

28. 0 Overlap between Antisocial PD, Psychopathy, and Criminality

29. 0 Causes of Antisocial PD • Prevailing theories • Gene-environment interaction • Chronically low arousal • Higher threshold for becoming fearful • Effects of time (i.e., immaturity)

30. 0 Treatment of Antisocial PD • Treatment • Few seek treatment on their own • Very poor prognosis • Empathy training? • Nope • Incarceration is often the only viable option

31. 0 Histrionic Personality Disorder • Defining features • Overly dramatic, sensational, and sexually provocative • Impulsive and need to be the center of attention • Thinking and emotions are perceived as shallow • More common diagnosis in women

32. 0 Histrionic Personality Disorder • Causes • Largely unknown • Sex-typed variant of antisocial personality? • Who decided this was a disorder? What would the equivalent disorder be in men? • Treatment • Focus on problematic interpersonal behaviors • Little evidence that any treatment is effective • No clinical trials have ever been conducted

33. 0 Dependent Personality Disorder • Defining features • Reliance on others to make major and minor life decisions • Unreasonable fear of abandonment • Clingy and submissive in interpersonal relationships • Causes and Treatment • Little is known • No clinical trials have ever been conducted • What about Independent Personality Disorder?

34. 0 Narcissistic Personality Disorder • Defining features • Exaggerated / unreasonable sense of self-importance • Preoccupation with receiving attention • Lack sensitivity and compassion for other people • Sensitive to criticism, envious, and arrogant

35. 0 Narcissistic Personality Disorder • Causes • Early failure to learn empathy as a child? • Product of the “me” generation? • Treatment • Focuses on grandiosity, lack of empathy • Little evidence that treatment is effective • No clinical trials have ever been conducted

36. 0 Avoidant Personality Disorder • Defining features • Extreme sensitivity to the opinions of others • Highly avoidant of most interpersonal relationships • Interpersonally anxious and fearful of rejection • Indistinguishable from severe, generalized type of social phobia • “There appears to be a great deal of overlap between Avoidant Personality Disorder and Social Phobia, Generalized Type, so much so that they may be alternative conceptualizations of the same or similar conditions.” DSM-IV, p. 720

37. 0 Avoidant Personality Disorder • Causes • Similar to social phobia • Treatment • 3 randomized, controlled clinical trials have been conducted • Surprise! Cognitive-behavioral treatments used in social phobia work well

38. 0 Obsessive-Compulsive PD • Defining features • Excessive and rigid fixation on doing things the right way • Highly perfectionistic, orderly, and emotionally shallow • True obsessions and compulsions are rare • Relationship to OCD

39. 0 Obsessive-Compulsive PD • Phil Hartman as the anal retentive chef • https://screen.yahoo.com/anal-retentive-chef-mothers-day-000000641.html

40. 0 Obsessive-Compulsive PD • Causes • Largely unknown • Treatment • Little is known • Addresses fears related to the need for orderliness and perfection and procrastination