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Personality Disorders. Abnormal Psychology. Personality Disorders are:. more subtle and less incapacitating than many Axis I disorders rigid, inflexible, maladaptive patterns of relating to oneself and one’s environment most often untreated egosyntonic (as opposed to egodystonic)

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Personality Disorders

Abnormal Psychology

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Personality Disorders are:

  • more subtle and less incapacitating than many Axis I disorders

  • rigid, inflexible, maladaptive patterns of relating to oneself and one’s environment

  • most often untreated

  • egosyntonic (as opposed to egodystonic)

  • best viewed on a continuum (dimensional)

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Are PDs really important problems?

  • disrupt interpersonal relationships

  • make therapy very difficult when they occur together with Axis I disorders

  • may represent predispositions toward, or early manifestations of, other Axis I disorders

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Problems regarding PDs

  • diagnostic reliability is quite low

  • tremendous overlap among categories

  • questions remain about temporal stability

  • not clear that they are “culturally universal”

  • little evidence to show that they can be treated successfully

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PDs are difficult to treat because

  • person does not recognize that he or she has a problem

  • interpersonal difficulties interfere with the therapeutic relationship

  • very little research evidence on treatment efficacy because the PDs overlap so extensively with Axis I disorders

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General Criteria for PDs (DSM-IV)

  • an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s culture

  • manifested in two or more of the following areas:

  • 1. cognition

  • 2. affectivity

  • 3. interpersonal functioning

  • 4. impulse control

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General Criteria for PDs (continued)

  • enduring pattern is inflexible and pervasive across a range of situations

  • enduring pattern leads to clinically significant distress or impairment

  • pattern is stable and of long duration (onset traced at least to adolescence)

  • pattern is not better explained by another type of mental disorder

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PD Clusters in DSM-IV

  • Cluster A: odd, eccentric, socially isolated

  • Cluster B: flamboyant, overly emotional

  • Cluster C: anxious or avoidant

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PDs listed in Cluster A (DSM-IV)

  • PARANOID: distrust and suspicion of others

  • SCHIZOID: detachment from social relationships; little expression of emotion

  • SCHIZOTYPAL: discomfort with close relationships; cognitive and perceptual distortions; eccentricities of behavior

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PDs listed in Cluster B (DSM-IV)

  • ANTISOCIAL: disregard for and frequent violation of the rights of others

  • BORDERLINE: instability of interpersonal relationships, self-image, emotions, and control over impulses

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PDs listed in Cluster B (DSM-IV)

  • HISTRIONIC: excessive emotionality and attention-seeking

  • NARCISSISTIC: grandiosity, need for admiration, lack of empathy

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PDs listed in Cluster C (DSM-IV)

  • AVOIDANT: social inhibition, feelings of inadequacy, hypersensitivity to negative evaluation

  • DEPENDENT: excessive need to be taken care of; submissing, clinging behavior

  • OBSESSIVE-COMPULSIVE: preoccupation with orderliness and perfectionism

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Problems with Categorical Approach

  • tremendous overlap among categories

  • problems of setting thresholds

  • need for 10 diagnoses on Axis II creates unnecessary complexity (making decisions on 8 or 9 criteria for each category)

  • it might be simpler and more accurate descriptively to use a few dimensions

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Personality Dimensions: The Big Five

  • neuroticism

  • extraversion

  • openness

  • agreeableness

  • conscientiousness

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Personality Dimensions: The Big Five

  • neuroticism (expression of negative emotions)

  • extraversion (interest in interacting with other people; positive emotions)

  • openness (willingness to consider and explore unfamiliar ideas, feelings, and activities

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Personality Dimensions: The Big Five

  • agreeableness (willingness to cooperate and empathize with others)

  • conscientiousness (persistence in pursuit of goals; organization; dependability)

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Paranoid PD viewed in terms of dimensions

  • extraversion: low

  • openness: low

  • agreeableness: low

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Histrionic PD viewed in terms of dimensions

  • neuroticism: high

  • extraversion: high

  • agreeableness: low

  • conscientiousness: low

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O-C PD viewed in terms of dimensions

  • neuroticism: high

  • extraversion: low

  • openness: low

  • conscientiousness: high

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DSM Criteria for Schizotypal PD

  • a pervasive pattern of social / interpersonal deficits marked by acute discomfort with, and reduced capacity for, close relationships

  • cognitive or perceptual distortions and eccentricities of behavior

  • plus five (or more) of the following:

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Criteria for Schizotypal PD (5 or more)

  • ideas of reference

  • odd beliefs or magical thinking

  • unusual perceptual experiences

  • odd thinking and speech

  • suspiciousness or paranoid ideation

  • inappropriate or constricted affect

  • behavior or appearance that is odd or peculiar

  • lack of close friends or confidants

  • excessive social anxiety

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Schizotypal Personality Disorder

  • closely tied to the concept of schizophrenia

  • odd or peculiar behaviors frequently seen among the first-degree relatives of schizophrenic patients

  • overlaps primarily with paranoid, schizoid, and avoidant PDs

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Etiology and Treatment of Schizotypal PD

  • mostly focused on genetic factors

  • treatment usually focused on low doses of antipsychotic medication

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Borderline Personality Disorder (BPD)

  • GUNDERSON: identified descriptive features of BPD for DSM-III definition

  • focused on intense, unstable interpersonal relationships

  • unstable emotional reactions, including intense anger

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DSM Criteria for Borderline PD (5 or more)

  • frantic efforts to avoid abandonment

  • unstable and intense interpersonal relationships

  • identity disturbance

  • impulsivity in areas that are self-damaging

  • recurrent suicidal behavior or gestures

  • affective instability / marked reactivity of mood

  • chronic feelings of emptiness

  • inappropriate, intense anger

  • transient, stress-related paranoid ideation

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Borderline Personality Disorder

  • AKISKAL: says BPD is a mix of different things, including mild forms of brain dysfunction, conditions that resemble schizophrenia, and sub-clinical mood disorders

  • when all of that is removed, a “residual” group remains that is difficult to distinguish from many other PDs

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Etiology of Borderline PD

  • Akiskal on etiology of his “residual” group

  • they suffer from the negative consequences of parental loss during childhood

  • infant monkeys separated from their mothers experience persistent attachment problems and high negative affect

  • relationships with peers are disrupted

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Etiology of Borderline PD

  • research studies frequently point to abuse by parents (borderline adolescents)

  • but what is the direction of effect ?

  • note people with other types of mental disorders also report childhood abuse and neglect (e.g., Brown’s work on anxiety disorders)

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Psychopathy and Antisocial PD

  • two different traditions for this disorder

  • both attempting to define same concept

  • Hervey Cleckley (1941) The Mask of Sanity

  • described “the psychopath” as being intelligent and superficially charming

  • but also deceitful, unreliable, and incapable of learning from experience

  • disregard for the truth; lack of remorse

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Psychopathy and Antisocial Personality

  • Lee Robins (1966) Deviant Children Grown Up

  • described (as adults) people who had been treated many years earlier at a child guidance clinic

  • conduct disorder among boys predicted antisocial behavior in adults

  • formed basis for ASP in DSM-III

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DSM Criteria for Antisocial PD

  • a pervasive pattern of disregard for and violation of the rights of others occurring since age 15 years, as indicated by 3 (or more) of the following:

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DSM Criteria for Antisocial PD (3 or more)

  • failure to conform to social norms (re laws)

  • deceitfulness

  • impulsiveness

  • irritability and aggressiveness (e.g., fights)

  • reckless disregard for safety of self or others

  • consistent irresponsibility (e.g., failure to work)

  • lack of remorse

  • plus evidence of conduct disorder before age 15

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Shift to DSM-III definition of ASP

  • improved reliability

  • questionable validity

  • more criminals defined as meeting criteria for ASP (50% meet DSM-III, but only 35% meet Cleckley’s definition of psychopathy)

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Etiology of ASP / Psychopathy

  • adoption studies point to influence of genetic factors

  • Cadoret et al. (1995) found an interaction between genetic factors and rearing environment

  • adverse adoptive home environment increases risk of conduct disorder in offspring of antisocial parents

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Social Factors and the Etiology of ASP

  • inconsistent discipline (or complete lack of discipline) often seen in the prior family history of ASP men (Robins, 1966)

  • kids with a “difficult temperament” are especially irritating to parents

  • parents respond inappropriately (giving up, or becoming severe in punishment)

  • person selects friends who share antisocial interests and problems

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Continuity in Life-Course-Persistent ASP

  • person’s options become narrowed; locked into further antisocial behavior

  • limited range of behavioral skills (can’t pursue more appropriate responses)

  • ensnared by consequences of earlier behaviors (drug addiction, parenthood, school dropout, criminal record)

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Psychological Factors: the Etiology of ASP

  • avoidance learning in the lab (sequences)

  • psychopaths unaffected by anticipation of punishment

  • Hypothesis 1: they can ignore the effects of punishment; they are emotionally impoverished

  • Hypothesis 2: they have trouble shifting their attention; they are impulsive