PSYC 2161: Chapter 13: Personality Disorders SLIDES

Three life tasks of Normal Personality

1. To form stable, integrated and coherent representations of self and others

2. To develop capacity for intimacy

3. To engage in pro-social and cooperative behaviours

Alternative Model of Personality Disorder (AMPD): DSM-5

CRITERION A

• Assesses levels of personality functioning according to two themes:

1) Self (identity and self-direction)

2) Interpersonal (empathy and intimacy)

Alternative Model of Personality Disorder (AMPD): DSM-5

CRITERION B

Involves rating a person across five broad trait dimensions:

• Negative affectivity

• Detachment

• Antagonism

• Disinhibition

• Psychoticism

(Sometimes perfectionism)

Clinical Interviews Challenge

Many personality disorders are egosyntonic, person lacks insight

MMPI

PSY-r5 scales. Good prediction of

• Paranoid

• Schizotypal

• Narcissistic

• Antisocial

Personality disorder symptoms

MCMI-IV

Provides subscale measures of 15 clinical personality scales

• Schizoid, avoidant, melancholic, dependent, histronic, turbulent, narcissistic, antisocial, sadistic, compulsive, negativistic, and masochistic)

AND three severe personality pathology scales (schizotypical, borderline, paranoid)

Personality Disorder Cluster A

1) What is it + examples

2) Based upon what

3) Could be linked to what

Odd/Eccentric

• Paranoid, Schizoid, Schizotypical

  • Oddness and avoidance of social contact

_________________

2. Family study research

3. History of PTSD and childhood maltreatment

Personality Disorder Cluster B

Dramatic/Erratic

• Antisocial, Borderline, Histronic, Narcissitic

  • Dramatic, emotional, or erratic

  • Extrapunitive and hostile

Personality Disorder Cluster C

Anxious/Fearful

• Avoidant, dependent, Obsessive-Compulsive

  • Fearful

Paranoid Personality Disorder

1) More men or women

2) Comorbid with what

3) What is NOT present

1. Men

2. Schizotypal, avoidant, paranoid personality disorder

3. NO hallucinations and full blown delusions

Schizoid Personality Disorder

1) Characteristics

2) Prevalence

3) Men or women more common

1. Characteristics:

   1. No desire for or enjoyment of social relationships

   2. Appear bland, dull, and aloof

   3. Rarely repot strong emotions

   4. Have no interest in sex

   5. Experience few pleasurable activities

   6. Indifferent to praise and criticism

   7. Loners with solitary interests

2. <1% prevalence

3. More common in men

Schizotypical Personality Disorder

1) KEY features

2) KNOW that its similar to schizoid

3) What kind of behaviour + appearance

4) Prevalence

5) Men vs woman more commion

6) ____ is higher than any other personality disorder

1. KEY features

   1. Eccentric thinking

      1. Odd beliefs or magical thinking

      2. Recurrent illusions

      3. Odd speech

      4. Ideas of reference

      5. Suspiciousness

      6. Paranoid ideations

2. Ok

3. Eccentric

4. 3%

5. Men

6. Comorbidity

Borderline personality disorder

1) Prevalence

2) More common woman vs men

3) Object-relations theory

4) Biological (Linehams diathesis stress theory)

5) Biological —> Dysfunctions in what brain systems

1. 1-2%

2. Women

3. Inconsistent parental love causes insecure ego development

4. Biological —> Runs in families (Linehan’s diathesis stress theory)

5. Biological —> Dysfunctions in dorsolateral, prefrontal, and limbic brain regions

What four factors assess narcissistic grandiosity

1. Entitlement rage

2. Exploitativeness

3. Grandiose fantasy

4. Self entitlement

What three factors assess narcissistic vulnerability

1. Contingent self-esteem

2. Hiding the self

3. Devaluing

Dark Triad of Narcissism (Paulhus and Williams)

1) Narcissism

2) Psychopathy

3) Machiavellianism

(sometimes sadism)

Antisocial Personality Disorder

1. Conduct disorder present before age ___

   1. EX: Truancy, running away from home, theft, arson)

2. Pattern of antisocial behaviour continues into adulthood (NAME EXAMPLES)

3) Comorbid with what

4) Estimates ___ to ___% of general population have APD

1. 15

2. Examples:

   1. Irresponsible and anti-social behavior

   2. Work only inconsistently

   3. Break laws

   4. Physically aggressive

3. Substance use

4. 1-4%

Psychopathy

Related to Antisocial Personality Disorder…. but emphasizes psychological not just behavioural, for example 1)

2) All psychopaths are diagnosed with ____ but not the other way around

1) examples:

• lack of remorse, no shame

• superficially charming

• manipulates others for own personal gain; exploits people

• thrill seeking

2) Antisocial personality disorder

Etiology of APD and Psychopathy

1) ___ distinguishes psychopathic children and youth from those without psychopathy

2) Psychopathic personality in adolescence predicts ______ in adulthood

3) Children with psychopathic traits show abnormal _____ responsiveness

4) Criminality and APD have ____ components

5) ____ concordance for MZ compared to DZ twin pairs

6) Increased parental conflict/decreased parental warmth predicts ______ behaviours

1. PCL-R

2. Antisocial behavior

3. Prefrontal cortex

4. Genetic

5. Increased

6. Antisocial

APD + Psychopathy Continued

1) ____ skin conductance

2) _____ heart rate when anticipating intense stimuli

3) ___ brain waves and spikes in the ___ area

4) Less activity in the ____ and _____ formation

5) ___ prefrontal activity

1. Decreased

2. Increased

3. Slow; temporal

4. Amygdala + Hippocampal

5. Decreased

Dependent Personality Disorders

1) Characteristics

2) Comorbid with what (5)

3) What is culture laden

1. Characteristics:

   1. Lack self-reliance

   2. Overly dependent of others )sense of autonomy)

   3. Intense need to be taken care of

   4. Uncomfortable when alone

   5. Subordinate own needs

2. Comorbid:

   1. Bipolar

   2. Depression

   3. Anxiety

   4. Bulimia

3. Connecting with others is more valued in collectivistic cultures (such as East Asia) compared with North American individualism

Obsessive-Compulsive PD

1) Characteristics

2) Differential diagnosis from OCD

3) Comorbidity

4) Pscyhoanalytic theory

1) CHARACTERISTICS:

• Perfectionistic approach to life

• Preoccupied with details, rules, schedules, etc

• Serious, rigid, formal, and inflexible

• Unable to discard worn out and useless objects

2) OCPD does not have the obsessions and compulsions that define OCD

3) OCD, panic disorder, depression, and avoidant personality disorder

4) OCPD traits due to fixations at anal stage of psychosexual development

Two main therapy approaches used for BPD

1) OBJECT RELATIONS THERAPY

• Strengthening clients weak ego

• Reducing splitting

• Combines client-centered acceptance with a CBT focus

2) DIALECTICAL BEHAVIOUR THERAPY

• Challenges dichotomous (black and white) thinking

• Teach assertiveness and emotion regulation