PS 280 12 Personality Disorders

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
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
Clusters of disorders
• Odd and eccentric – paranoid, schizoid,
schizotypal
• Dramatic, emotional, or erratic –
antisocial, borderline, histrionic,
narcissistic
• Anxious and fearful – dependent,
obsessive-compulsive
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
Historical perspective
• Roots in psychoanalysis – narcissism,
masochism, etc.
• Karl Abraham – first theorist to focus on
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
Etiology – Theoretical perspectives
• Psychodynamic theory
• Attachment theory – particularly for
dramatic, emotional, erratic
• Cognitive-behavioural perspectives
• Biological – particularly for odd, eccentric
and dramatic, emotional, erratic
Cluster A – Odd and eccentric
• Paranoid – suspicious, argumentative (no
delusions or hallucinations)
• Schizoid – withdrawn, reserved, reclusive
• Schizotypal – eccentricity of thought and
behaviour
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
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
APD vs. Psychopathy
• APD focuses more on behaviour
• Robert Hare, UBC – Psychopathy Checklist
Revised – focuses on both personality traits
and behaviour (lifestyle instability)
Robert Hare, UBC – Psychopathy Checklist
Revised
Personality traits Lifestyle instability
• lack of remorse • antisocial (lying,

• callousness stealing, cheating)
• selfishness • impulsive
• exploitation of others • social deviant lifestyle
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
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
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
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
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
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
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
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
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
• Histrionic personality – attention-seeking,
flirtatious, flamboyant, difficulty with
relationships,
• Narcissism – grandiosity, egocentricity,
vengeful, but low self-esteem
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
Treatment
• Object relations psychodynamic therapy
– Kernberg, Kohut
• Cognitive-behavioural
• Pharmacological
Big 5 – OCEAN (Costa & Mcrea, 1992)
High Personality trait Low
Curious Openness Conventional
Reliable Conscientiousness Unreliable
Sociable Extraversion Shy-quiet
Good natured Agreeableness Uncooperative
Nervous Neuroticism Calm

Dimensional analysis of types
• Where would schizoid personality fit on
the 5 dimensions?
• How about paranoid?
• Antisocial?
• Narcissism?
• Avoidant or dependent?
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
Thank You!

PS 280 12 Personality Disorders

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

PS 280 12 Personality Disorders

Uploaded by

Copyright:

Available Formats

PERSONALITY DISORDERS

Personality traits Lifestyle instability

• lack of remorse • antisocial (lying,

Curious Openness Conventional

Reliable Conscientiousness Unreliable

Sociable Extraversion Shy-quiet

Good natured Agreeableness Uncooperative

Nervous Neuroticism Calm

You might also like