Personality

Personality Disorder

enduring pattern of experiences & behaviour that differs greatly from the expectations of *a person's culture* that impacts:-thoughts-emotion-interpersonal relationships-behaviour

Views of Personality Disorders

-categorical - meet criteria for diagnosis or not-dimensional - differ in degree on continuum

Dimensional View of *Personality Disorders*

-traits associated with __ are normally distributed-certain behaviours & certain traits in certain amounts = __ manifestation

Similarity from DSM-IV to DSM-5

no change in any diagnostic criteria for any of the 10 personality disorders, thus any personality disorder diagnosis may still be given

Difference from DSM-IV to DSM-5

-personality disorders formerly conceptualized as separate form of mental illness (now all grouped together)-*optional* "hybrid personality model" for diagnosis due to degree of impairment

Optional DSM-5 Hybrid Personality Model

personality disorders diagnosed based on the *degree* of impairment in:-personality functioning (experience of themselves and others)-level of impairment across different personality traits (i.e. emotionality, impulsivity)

Personality Disorders in Traditional Approach (DSM-IV & 5)

-paranoid PD-schizoid PD-schizotypal PD*-borderline PD*-histrionic PD-narcissistic PD*-anti-social PD*-avoidant PD*-dependent PD-Obsessive-Compulsive PD*

Personality Disorders in Optional DSM-5 Hybrid Model

-schizotypal PD-borderline PD-narcissistic PD-antisocial PD-avoidant PD-obsessive-compulsive PD

PD Cluster A ("mad")

-paranoid PD-schizoid PD-schizotypal PD

PD Cluster B ("bad")

-borderline PD-histrionic PD-narcissistic PD-anti-social PD

PD Cluster C ("sad")

-avoidant PD-dependent PD-obsessive-compulsive PD

Paranoid Personality Disorder (cluster A)

-distrustful of others-misinterprets social events as threatening-harbor resentment toward others (forgiveness difficult)-prone to pathological jealousy-argumentative & hostile

Schizoid Personality Disorder(on schizophrenia spectrum; cluster A)

-detached from/indifferent to social relationships-derives little pleasure out of life; low emotional intensity-poor response to social cues (may appear socially inept; preference not to interact)-passive in the face of unpleasant events; limited emotional response

Schizotypal Personality Disorder (on schizophrenia spectrum; cluster A)

-anxious in social relations and avoids people-appears "different" and does not conform to social norms-suspicious of others-odd or eccentric belief (ESP, magic)-thoughts and speech disorganized

Histrionic Personality Disorder (cluster B)

-excessive attention-seeking & emotionality (in inappropriate contexts)-sexually provocative-exhibitions of emotions in public-excessive *need* for attention-opinions shallow & malleable

Narcissistic Personality Disorder (least common personality disorder; cluster B)

-need to be admired-strong sense of self importance-low insight into other peoples' feelings or needs-sense of entitlement-feelings of superiority-self-esteem appears strong, but is fragile-envious of others-difficult to treat (think they're too good for treatment)

Antisocial Personality Disorder (cluster B)

-lack of concern for social norms-repeated lying/conning-impulsivity-reckless disregard for safety of self or others-easily irritated-irresponsibility-lack of remorse

Psychopathy

-glib, superficial charm-grandiose sense of self-worth-lack or guilt, remorse, empathy-deceitful, manipulative-impulsive-lack of responsibility-callous & shallow emotions-early behaviour problems & enduring anti-social behaviour

Psychopathy and the Legal System

-20% of prison population are psychopaths-\>50% of violent crimes perpetrated by psychopaths

Psychopathy often used to predict

recidivism (likelihood of re-offending)

Psychopathy; Antisocial PD

Most people who meet criteria for ___ also meet criteria for __.

Antisocial PD; Psychopathy

Most people who have __ do *not* meet criteria for __.

Antisocial Personality Disorder (over psychopathy)

-more focus on behaviours that are anti-social in nature-behaviours tend to reduce over the lifespan (as do some traits)-DSM diagnosis

Psychopathy (over antisocial personality disorder)

-includes _, but more emphasis on lack of empathy, callous social attributes, glib, superficial charm-extends across lifespan-not a psychiatric diagnosis

Avoidant Personality Disorder (cluster C)

-feelings of inadequacy-sensitive to criticism-restricts activities to avoid embarrassments-low self-esteem

Dependent Personality Disorder (cluster C)

-excessive need to be taken care of by others-submissive-seeks reassurance from others-rarely takes initiative, rarely disagrees with others-does not work well independently-may tolerate abuse from others to obtain support

Obsessive-Compulsive Personality Disorder (most common PD; cluster C)

-preoccupied with order-strives for perfection-devoted to work, seeks little leisure time or friendship-frequently miserly or stingy-rigid and inflexible and stubborn

Non-suicidal Self-Injury (NSSI)

deliberate (immediate) destruction of body tissue in the absence of suicidal intent and for reasons that are not culturally/socially acceptable

Common NSSI Methods

-cutting (most)-scratching, carving, scraping-hitting, bruising-burning

Typical Age of NSSI Onset

12-15 years

25%

start NSSI before age 12

up to 30%

start NSSI after age 17

11-35%

young adult rates of NSSI (at least once; ~25% of these self-injure multiple times)

NSSI Gender Differences in Youth

-females \> males-females seek help more

NSSI Gender Differences in Young Adults

-none (lifetime)-females may self-injure more frequently

Females

-may cut more-perhaps more injuries on wrists/thighs-more frequent

Males

-may hit/burn more-perhaps more injuries on hands & head

NSSI and Negative Emotionality

__ greater in:currently self-injure \> previously self-injured \> never self-injured-difficulty tolerating negative emotions & want to escape sooner

Experiential Avoidance

attempts to avoid or escape from unwanted internal experience (emotions, thoughts) or their triggers;may include NSSI &/or other behaviours

Experiential Avoidance Model

-stressor-heightened emotional response-high negative emotionality & emotion dysregulation --\>-experiential avoidance --\>-NSSI (provides temporary relief from stressor)

Reasons for NSSI

-emotion dysregulation-self-punishment-anti-suicide-anti-dissociation-interpersonal communication

Most Commonly Reported reason for NSSI

emotion dysregulation

Emotion Dysregulation

to provide relief from unwanted, negative emotional experiences (often perceived as intolerable)

Self-punishment

to express hatred toward oneself, punish oneself and damage one's body (2nd most common reason for NSSI)

Anti-Suicide

to avoid urges to attempt suicide/reduce suicidal thinking

Anti-dissociation

to stop feeling emotionally numb; to feel "real" and thus alleviate dissociative experiences

Interpersonal Communication

telling others that one is in pain, to get help from others, to get back at others, etc.

Subtypes of Impulsivity

-urgency (rash decisions when upset)-perseverance (ability to stay on task)-premeditation (stopping actions to make plan)-sensation seeking

NSSI Group in Study had:

-much higher urgency scores-more sensation seeking-less premeditation

More recent & frequent NSSI associated with

low perseverance

NSSI elevates __ risk

many people who self-injure will think about *SUICIDE*-NSSI escalation-NSSI no longer "works"-longer NSSI history-NSSI in isolation-Multiple NSSI methods-No pain during NSSI-Hopelessness-past suicide attempt

Higher impulsivity in suicide

played more of a role for younger individuals vs older

Suicide occurs IF __, AND __

-one has a desire-the means to do so

Thwarted belongingness

social disconnect from others or to do something larger than oneself

Interpersonal-Psychological Model

-perceived burdensome-thwarted belongingness-fearlessness (from prolonged/enduring psychological pain)*All three = highest risk for suicide

NSSI & Suicide Intervention

-emotional regulation skills-DBT & CBT-motivational interviewing (buy-in to change)

Personality-Illness Link Models

-interaction model-health behaviour model-predisposition model-illness behaviour model-transactional model

Interaction Model

personality *moderates* the stress-illness link; interacts with coping, thus impacting illness susceptibility

Criticism of Interaction Model

unable to identify *stable* coping responses that are always adaptive or maladaptive (i.e. taking a break may be good or bad)

Transactional Model

depicts personality with three potential effects:1. how one copes with events2. how one interprets events3. the events themselves*lead to degree of stress

Health Behaviour Model

personality contributes to health promoting OR degrading behaviour

Predisposition Model (Predisposition)

__ accounts for both personality & illness (i.e. neurotransmitter levels)

Illness-Behaviour Model

personality impacts:-degree of perception & attention to bodily sensations-degree to which a person interprets & labels sensations as illness (leads to Dr.'s visits)

*Greater adherence to treatment regimens (diet & insulin in juvenile Diabetes)

higher conscientiousness

*Less adherence to treatment regimens (juvenile diabetes)

higher neuroticism

Implications of Big 5 & Management of Diabetes in Youth

-understanding personality important for developing management regimens-low conscientiousness & high neuroticism = more assistance / reminders needed

Stress

subjective feeling produced by events perceived as uncontrollable & threatening

Common Attributes of Stressors: (events that cause stress)

-extreme in some manner (& overwhelming)-produce opposing tendencies (fight vs. flight)-perceived as uncontrollable

General Adaptation Syndrome (GAS)

-alarm stage-resistance stage-exhaustion stage

Alarm Stage of GAS

fight or flight (opposing tendency)

Resistance Stage of GAS

body uses resources at high rate; physiological activity such as hormone release

Exhaustion Stage

elevated illness susceptibility; resource depletion = can't defend against illness

Major Life Events

cause stress & require people to make a significant adjustment (do things we wouldn't have had to do previously)

Daily Hassles

provide minor stress for most of us, but sustained minor stress yields more psychological & physical symptoms

Varieties of Stress

-acute-episodic acute-traumatic-chronic

Acute Stress

results from sudden onset of demands

Episodic Acute Stress

repeated acute stress (with serious consequences)

Traumatic Stress

major occurrence of acute stress (can have long-lasting effects, such as PTSD)

Chronic Stress

enduring; can lead to serious disease

Cognitive Events That Must Occur for Stress to Be Evoked

-primary appraisal (event perceived as threat)-secondary appraisal (conclusion that one does not have resources to cope)

Primary Appraisal (evokes stress)

one perceives an event as a threat to goals

Secondary Appraisal (evokes stress)

conclusion that one does not have resources to cope

In PTSD, the person was exposed to a traumatic event where:

-the person experienced actual or threatened danger / injury to self or others, *or*-the person responded with horror / intense fear or helplessness

(Characteristics of) Symptoms of PTSD

-the trauma is persistently re-experienced-persistent avoidance of stimuli associated with trauma-persistent symptoms of increased arousal-symptoms last beyond 1-month & impair functioning

PTSD vulnerability among those who experience a traumatic event and who have:

-high negative emotionality-low positive emotionality-low inhibition

High Negative Emotionality link to __ form of PTSD

more internalizing form (depression, anxiety)

Low Positive Emotionality & Low Inhibition link to __ form of PTSD

more externalizing form (impulsivity, aggression, substance abuse)

Explanatory Styles

-pessimism-optimism

Pessimism

stable, global, & internal explanations for bad events

Optimism

unstable, specific, external explanations for bad events

Coping Strategies & Styles

-dispositional optimism-self-efficacy-optimistic bias

Dispositional Optimism

belief that good future events are plentiful; bad future events are scarce

Self-efficacy

belief that one can do what is necessary to achieve a desired outcome

Optimistic Bias

risks are typically under-estimated; optimists view risk as even lower than average

Emotional Inhibition

-has positive & negative consequences-chronic inhibited emotion may impact health

Emotional expressiveness / communication

may be good for psychological & general adjustment (takes less energy than suppressing)

Disclosure

-telling (or writing) a secret can relieve stress & increase health-leads to relief from / reframing of events / stressors-not talking about traumatic, negative, upsetting events can lead to problems

Type A Personality

-competitive achievement motivation-time urgency (& impatient)-*hostility*-linked to CVD via *hostility*

Hostility

1. increased BP & HR2. wear & tear on artery lining3. fat & cholesterol can accumulate4. *Arteriosclerosis* --\> heart attack

Mental Illness

-behavioural/psychological syndrome experienced by an individual-causes persistent distress / disability (functional impairment)-a diagnosis works to classify disorders (not people!)-1 in 5 will experience __ in their lifetime