PSYO3280 Antisocial and Borderline Personality Disorder

Antisocial behaviour

Form of criminal deviance

Subclinical psychopathy

Psychopathy in everyday life, undetected in clinics and prisons

Neugebauer et al (1999) - Prenatal effects

Antisocial traits born out of adversity, particularly during prenatal exposure

Caspi et al (2002) - MAOA

Antisocial behaviour may come from childhood maltreatment ESPECIALLY if they have problems with low levels of MAOA activity

Diathesis-stress model

Pre-existing vulnerability interacts with stressful experience to trigger a certain outcome

Glenn et al (2011) - Psychos held responsible

Psychopathic tendencies are linked to reduced emotional reactions to causing harm to others

Caspi et al (2000)- APD in childhood

Under controlled personality functioning as young as 3 years old is predictor for higher rate of developing APD by 21 years old

Raine et al (2003) - Societal failure

Failure to provide children with basic needs can produce increased conduct disorder which is a precursor for APD

Antisociality in Children

Conducts problems and callous-unemotional traits are predictors of APD later in life

Marsh et al (2008) - Callous-unemotional traits

Callous-unemotional traits are associated with reduced amygdala response to distress based social cues

Walsh et al (2004) - Psychopathy and IQ

When psychopathy collides with low IQ, likely to get violent offenders

Psychopaths describing motives

Narrated in terms of basic motives (primitive level)

Disordered Interpersonal Interactions

Disturbed interactions in interpersonal relationships is the biggest red flag for personality disorders

Problems with APD DSM Diagonsis

Focus on behaviour, excludes adult onset, reduce the need for interference, emphasize reliability over validity

Is comorbidity common?

Yes - paranoid, borderline, and narcissistic traits

Model of Prototypical Psychopath

Selfish, callous, and remorseless use of others; chronically unstable, antisocial, and socially deviant lifestyle

Instrumental Murders

93.3% of psychopathic murderers commit instrumental murder; 48.4% of nonpsychopathic murderers commit instrumental murder (more likely crime of passion)

Media vs Data

Media says: 10% of people on Wall Street are psychopathic; Data says: 3.9% had a score of 30 or higher on PCL-R tests

Vitacco et al (2008) - verbal IQ

If you are glib, charming, and grandiose in your interpersonal functioning, the higher the level of psychopathic traits, and verbal IQ

Blanco et al (2008) - drugs and shoplifting

Greater drug dependence = greater lifetime prevalence of shoplifting

Bye et al (2006)- alcohol and violence

Alcohol consumption associated significantly with violence

Hasin et al (2011) - APD and substances

If you have APD traits, you are more likely to suffer with substance dependency

Third Variable Model

Observed correlation between two variables can actually be explained by a third variable

Spectrum Model

Linkages across degrees of severity

Reciprocal Relations Model

Mutual exchanges from both variables causes the correlation

Fals-Stewart et al (2003) - aggression and substances

Roughly 116 of 179 episodes of severe male-to-female physical aggression occurred within less than 2 hours of drinking alcohol or using cocaine

Williams et al (2007) - subclinical psychopathy

Criminal tendencies, erratic lifestyle, interpersonal manipulation, callous affect, stop short of extreme methods that result in incarceration

Prevalence of BPD in US

0.5-5.9%, most common personality disorder

Rates of BPD

Higher rates in lower income background and younger than 30

Zanarini (2010) - Psychosocial functioning

80% of borderline patients lose psychosocial functioning and do not regain it

Tomko (2014) - interpersonal problems

Lifetime diagnosis of borderline associated with divorce, significant trouble at work, and other serious interpersonal problems

Newhill (2009) - aggressive acts

Those with borderline are more likely to commit seriously violent (35%) and aggressive acts (62%) than those without

Pompili et al (2005) - suicide

6-10% of borderline patients will go on to die by suicide

Wedig et al (2012) - depression and borderline

When borderline goes along with depression, more likely to self-harm and attempt suicide. Loss > depression > suicidal behaviour

Predictor for death by suicide

Self-harm

BPD comorbidity with axis I disorders

80% for anxiety, PTSD, mood and substance disorders

BPD comorbidity with axis II disorders

70% for paranoid, schizoid, antisocial, avoidant, dependent PDs and OCD

Choi-Kain (2010) - arugments overtime

Recurrent arguments wane over 10 years time

Zanarini (2007) - decreasing BPD traits

Self mutilation decreases over time, chronic anger decreases overtime

Zanarini (2007) - stable BPD traits

Manipulative suicide efforts, demandingness, intolerance of aloneness, dependency, some dispositional aspects

Zanarini (2009) - SSDI and BPD

Borderline patients are 4x as likely to be on SSDI and more than 2x as likely to still be receiving disability payments in 10 year follow up

BPD and amygdala

BPD-related pattern of protracted amygdala response is consistent with concept that BPD have long-lasting responses to emotional stimuli (Hazlett 2012)

Twin scores and heritability of BPD

0.65-0.75 heritability from twin score studies - moderate heritability

Treatment of choice for BPD

Psychotherapy (no significant differences found between GPM and dialectical behaviour therapy)

Mentalization-based therapy

Helps with forms of distress and hospitalization

CBTE vs DBT

CBTE can significantly reduce suicide attempts; DBT can reduce but not resolve

Bateman and Fonagy (2003) - treatment investment

Making an investment in evidence-based care can alleviate suffering and financial expense; less money spent between 6 months pre, 18 months of, and 18 months post treatment