ps 280 12 personality disorders

7/27/2019 PS 280 12 Personality Disorders

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PERSONALITY DISORDERS

LECTURE OUTLINE

DSM Axis II What is a personalitydisorder?

Clusters of personality disorders 3 main

types

Prevalence

Historical perspectives

Diagnostic issues

Etiology Theoretical perspectives


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Clusters of disorders

Odd and eccentric paranoid, schizoid,

schizotypal

Dramatic, emotional, or erraticantisocial, borderline, histrionic,

narcissistic

Anxious and fearful dependent,obsessive-compulsive


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Prevalence

6-9% of population have one or more

personality disorder

prevalence higher among people withother mental disorders

most people with personality disorders

never come to the attention of mentalhealth professionals


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Historical perspective

Roots in psychoanalysis narcissism,

masochism, etc.

Karl Abraham first theorist to focus onpersonality disorders


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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


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Etiology Theoretical perspectives

Psychodynamic theory

Attachment theory particularly for

dramatic, emotional, erratic

Cognitive-behavioural perspectives

Biological particularly for odd, eccentricand dramatic, emotional, erratic


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Cluster A Odd and eccentric

Paranoid suspicious, argumentative (no

delusions or hallucinations)

Schizoid withdrawn, reserved, reclusive

Schizotypal eccentricity of thought and

behaviour


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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


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Antisocial personality disorder (APD)

Lifetime prevalence rates for APD 3%

for men, 1% for women, lower rates forpsychopathy

40% of those in Canadian prisons have

APD


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APD vs. Psychopathy

APD focuses more on behaviour

Robert Hare, UBC Psychopathy Checklist

Revised focuses on both personality traits

and behaviour (lifestyle instability)


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Robert Hare, UBC Psychopathy Checklist

Revised

Personality traits Lifestyle instability

lack of remorse

callousness

selfishness

exploitation of others

antisocial (lying,

stealing, cheating) impulsive

social deviant lifestyle


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Etiology of APD

Family and parenting factors disruptive

family life, harsh and inconsistentdiscipline, lack of monitoring

genetics concordance rates for

criminality are 51% for MZ twins, 21% forDZ; runs in families


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Etiology of APD

fearlessness hypothesis deficient

emotional arousal and conditioning isassociated with a lack of empathy, thrill-

seeking

in the face of punishment, psychopathsincrease the frequency of punished

behaviour, rather than decrease it;

defiance/opposition


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Etiology of APD - Lykkens (1957) research

in a lever pressing task, people with

psychopathy did not learn the associationbetween particular lever presses and

shocks

in contrast, people without psychopathylearned this association quickly


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Etiology of APD - Schmauks (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 physicaland social punishers were used, but they

learned as well as controls when tangible

punishment was used


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Etiology of APD - Stewarts (1972) research

sentence completion task involving

physical punishment for aggressiveresponses

controls stopped aggressive responses

very quickly, but those with psychopathyincreased aggressive responses; they

acted in opposition to and defiance of the

researcher


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Etiology of APD Implication of this research

Punishment of offenders not likely to be

very effective for rehabilitationPrograms like Scared Straight, boot

camps make kids with APD worse rather

than better

Getting tough with this population not

likely to work


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Course of APD

a progression or career of deviancy -

oppositional defiant disorder, conductdisorder, APD

burnout response as they age, people

with APD become less involved in criminalactivity


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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


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Histrionic personality attention-seeking,

flirtatious, flamboyant, difficulty with

relationships,

Narcissism grandiosity, egocentricity,

vengeful, but low self-esteem


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Cluster C Anxious and fearful disorders

Avoidant personality extreme sensitivity tocriticism and disapproval, avoidance of

intimacy

Dependent personality constantly seeks

reassurance, advice, direction from others

Obsessive-compulsive personalityinflexibility and desire for perfection, absence

of obsessional thoughts and compulsive

behaviours


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Treatment

Object relations psychodynamic therapy

Kernberg, Kohut

Cognitive-behavioural

Pharmacological


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Big 5 OCEAN (Costa & Mcrea, 1992)

High Personality trait Low

Curious Openness Conventional

Reliable Conscientiousness Unreliable

Sociable Extraversion Shy-quiet

Goodnatured

Agreeableness Uncooperative

Nervous Neuroticism Calm


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Dimensional analysis of types

Where would schizoid personality fit on

the 5 dimensions?

How about paranoid?

Antisocial?

Narcissism?

Avoidant or dependent?


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SUMMARY

Personality disorders are maladaptivepersonality traits

3 broad clusters

Problem of overlap of categories

Etiology for many personality disorders notwell understood

Treatments have not been very successful

for many of these disorders

ps 280 12 personality disorders

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