PERSONALITY PERSONALITY DISORDERSDISORDERSAlberto L. Choy MD FRCPCPsychology 344Fall 2003Forensic Psychology

University of Toronto, Erindale

IntroductionIntroduction 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

THE MULTIAXIAL ASSESSMENTTHE 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

DIMENSIONAL MODELSDIMENSIONAL 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

PERSONALITY TESTINGPERSONALITY 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

PERSONALITY TRAITSPERSONALITY 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

PERSONALITY DISORDER PERSONALITY DISORDER (1/3)(1/3)

personality traits are maladaptive and inflexible

and significant functional impairment or

subjective distress

“extremes of personality characteristics”

PERSONALITY DISORDER PERSONALITY DISORDER (2/3)(2/3)

inner experience and behaviour deviates from cultural expectation

impairment in 2 of: cognition affectivity interpersonal functioning impulse control

PERSONALITY DISORDER PERSONALITY DISORDER (3/3)(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

Paranoid Personality DisorderParanoid 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

Schizoid Personality DisorderSchizoid 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

Schizotypal Personality DisorderSchizotypal 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

Antisocial Personality DisorderAntisocial 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)

Borderline Personality DisorderBorderline 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

Histrionic Personality DisorderHistrionic 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

Narcissistic Personality DisorderNarcissistic 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

Avoidant Personality DisorderAvoidant 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

Dependent Personality DisorderDependent 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

Obsessive-Compulsive Personality DisorderObsessive-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

Personality Disorder Not Otherwise SpecifiedPersonality Disorder Not Otherwise Specified mixed traits dysfunction

APPLICATIONAPPLICATION CRIME CIVIL / DISABILITY ADAPTIVE ASPECTS

CRIMECRIME murder serial murder / group murder

cults sex

mutilation assaults fraud / robbery domestic violence harrassment

CIVILCIVIL

disability malingering in disability

ComorbidityComorbidity

Major mental illness

substance use / abuse

psychopathy