PERSONALITY DISORDERS

1. PERSONALITY DISORDERS Alberto L. Choy MD FRCPC Psychology 344 Fall 2003 Forensic Psychology University of Toronto, Erindale

2. Introduction • Overview of the DSM-IV (credits to) • Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition • Descriptions of personality disorders and application to forensic settings

3. THE MULTIAXIAL ASSESSMENT • Axis I: clinical disorders - “mental illnesses” and mental disorders • Axis II: personality disorders and mental retardation • psychologists can diagnose with the multiaxial assessment

4. DIMENSIONAL MODELS • other models to describe personality • maladaptive variants of personality traits - • eg: “five factor model” • neuroticism, introversion vs. extroversion, closedness vs. openess (to experience), antagonism vs. agreeableness, conscientiousness

5. PERSONALITY TESTING • Millon Clinical Multiaxial Inventory (MCMI) • no “norms” between patients and normals • biased towards “finding” problems • Minnesota Multiphasic Personality Inventory (MMPI-2) • most widely used in forensic assessments • measures that address test taking attitudes

6. PERSONALITY TRAITS • an enduring pattern of perceiving, relating to, and thinking about the world and oneself, exhibited in a wide range of social and personal contexts • examples: impulsivity, social anxiety, affective stability

7. PERSONALITY DISORDER (1/3) • personality traits are maladaptive and inflexible • and • significant functional impairment or subjective distress • “extremes of personality characteristics”

8. PERSONALITY DISORDER (2/3) • inner experience and behaviour deviates from cultural expectation • impairment in 2 of: • cognition • affectivity • interpersonal functioning • impulse control

9. PERSONALITY DISORDER (3/3) • inflexible and pervasive, broadly • significant distress and/or function(s) disturbance • stable and life-long • NOT due to another mental disorder, substances, medical condition • “traits” vs. personality disorder

10. Paranoid Personality Disorder • pervasive distrust and suspiciousness • sees other’s motives as malevolent • criteria may include: • suspicions that they are being exploited • unjustified doubts about loyalty of others • closed; fear of information used against • reacts angrily to perceived attack • suspcious / jealous of spouse • not psychotic

11. Schizoid Personality Disorder • detatchment from social relationships • restricted range of expressed emotions • prefer being alone • criteria may include: • no interest in close relationships, including family • little interest in sex with others • no close confidants • emotional flatness

12. Schizotypal Personality Disorder • discomfort with relationships • odd, eccentric thoughts / behaviour • criteria may include: • ideas of reference (not delusions) • magical beliefs (not cultural) • suspiciousness or odd / constricted affect • lack of close friends • social anxiety: more paranoid

13. Antisocial Personality Disorder • disregard for, and violation of, the rights of others • terms: psychopathy, sociopathy, dyssocial • criteria may include: • impulsive behaviours (drugs, crime) • lacking in remorse • deceitful / conning / manipulative • irritable / aggressive • evidence of Conduct Disorder (before 15)

14. Borderline Personality Disorder • pervasive instability: self image, relationships, affect - impulsivity • criteria may include: • frantic avoidance of abandonment • unstable, intense interpersonal relationships • impulsive behaviour • marked reactivity of mood / rage / emptiness • recurrent self-harm/suicide

15. Histrionic Personality Disorder • excessive emotionality and attention seeking behaviour • criteria include: • flamboyant appearance / behaviour • superficial, rapidly shifting emotions • suggestible • believes relationships are deeper than they really are • seductive or provocative, socially

16. Narcissistic Personality Disorder • grandiosity, need for admiration, lacking in empathy • criteria may include: • solely self-involved: “no.1”, entitled • derogatory to others, for himself • grandiose, self important, may exaggerate • believes he is “special” / high status associates • lacks empathy • interpersonally exploitive

17. Avoidant Personality Disorder • social inhibition / anxiety and feelings of inadequacy • criteria may include: • marked social anxiety / avoids contact • strong wish for relationships • restraint in relationships: fear of shame • sees self as inept, unappealing, inferior • avoids risk, especially of embarrassment

18. Dependent Personality Disorder • excessive need to be taken care of • submissive, clingy • criteria may include: • fear of separation / abandonment • will do unpleasant things to obtain nurturance • unable to decide without excessive advice / reassurance • will not express disagreement • urgent relationship seeker: to be taken care of

19. Obsessive-Compulsive Personality Disorder • preoccupation with detail, order, control • at the expense of openness, efficiency • criteria may include: • excessive: rules, details, lists, organization • perfectionism, but too slow / stubborness • “workaholic” without friends / leisure • inflexible, scrupulous: morals, ethics • may not throw things out • will not delegate tasks

20. Personality Disorder Not Otherwise Specified • mixed traits • dysfunction

21. APPLICATION • CRIME • CIVIL / DISABILITY • ADAPTIVE ASPECTS

22. CRIME • murder • serial murder / group murder • cults • sex • mutilation • assaults • fraud / robbery • domestic violence • harrassment

23. CIVIL • disability • malingering in disability

24. Comorbidity • Major mental illness • substance use / abuse • psychopathy