PSYC 238 Cluster B Part 1 (ASPD, BPD)

Cluster B personality disorders

Characterized by overly dramatic, impulsive, emotional, and/or erratic behavior

Antisocial, Borderline, Histrionic, Narcissistic

antisocial personality disorder

Disregard for and violation of the safety/rights of others

3+ of the following:
• Failure to conform to social norms (w/ respect to lawful behaviors)
• Manipulative/Deceitful
• Impulsivity
• Irritability and aggression
• Reckless disregard for safety of self/others
• Unwillingness to take responsibility for one's actions • Lack of remorse

Age 18 or older + History of Conduct Disorder by age 15

Psychological factors of ASPD

Learning Deficits
• Hypothesis 1: Emotional deficits. Lack fear & anxiety, so they can ignore the effects of punishment

• Hypothesis 2: Impulsivity. Trouble shifting attention to consider the negative consequences of their behavior

Biological factors of both ASPD

Abnormal brain structure & function
• Smaller and hypoactive frontal lobes
• Deficits in Executive functioning

Genetically predisposed temperament
• High reward dependence
• Low harm avoidance
• Low persistence: low frustration tolerance

Social factors of both ASPD

*Inconsistent, lack of, or severe discipline* often seen in the prior family history of ASPD men
• Kids with a difficult temperament may be especially irritating to parents
• Parents may then respond inappropriately

*Child selects friends* who reinforce or increase antisocial behaviors

Gene x environment interaction of ASPD risk

Rate of ASPD increases in offspring when bio + adoptive parents have ASPD

ASPD rate didn't change much based off environment if bio parents didn't have ASPD

ASPD prevalence

• General Population: about same as BPD, larger than Histrionic, cluster A, cluster C(minus OCPD)
less than NPD
• Forensic Populations: 60%
• Men 3x more likely to be diagnosed

ASPD course

• Tends to be chronic
• Starts in childhood/adolescence
• Middle age (~40s) "burn out"

What makes us think ASPD could present differently in men and women?

Assessment limitations (e.g. bias)

Socialization & different manifestations
• Physical aggression more common in men
• Relational aggression more common in women

ASPD Treatment

• Little research on treatments
• Antisocial PD has poor prognosis

• Treatments for individuals with antisocial PD who are not psychopathic are more successful

• Most likely to respond if they have a comorbid anxiety disorder

• Treatment that targets behavior change and behavior control (through CBT) is more effective than treatment that targets empathy training

ASPD Five Factor Model

High: open
Low: conscientiousness, agreeableness
Mid: neuroticism
Anywhere: extraversion

borderline personality disorder

A pervasive pattern of *chaotic* interpersonal *relationships*, *unstable* self-image, affective *instability*, and marked *impulsivity* (5+ of the following)

• Frantic efforts to avoid abandonment
• Unstable and intense interpersonal relationships that alternate between extreme idealization and devaluation • Unstable self-image or sense of self
• Impulsivity (e.g., binge eating, spending, sex)
• Marked reactivity of mood
• Chronic feelings of emptiness
• Inappropriate, intense anger
• Recurrent suicidal behavior or self-mutilation
• Stress-related paranoia or severe dissociative symptoms

Psychological etiology of BPD

emotion dysregulation
• Lower threshold for emotional activation
• Experience emotions more intensely • Experience slow return to emotional baseline

Engage in dangerous behaviors to self-soothe (neg reinforcement)
• Substance abuse
• Self-injurious behaviors
• Binge Eating
• Violence toward others

Social etiology of BPD

*Invalidating Environments*
• Early environments where emotional experience is trivialized, criticized, punished, or ignored
• Learn to see themselves and their emotions as bad and punishable

*Childhood Abuse*
• Sexual assault most common
• Physical, emotional abuse, and neglect
• Typically can remember the abuse (unlike in DID)

BPD prevalence

General population: about same as ASPD
greater than histrionic, cluster A, cluster C (minus OCPD)
less than NPD
Treatment-seeking populations:
Inpatient: 20% • Outpatient: 10%

Are women or men diagnosed with BPD more? Why?

75% of those diagnosed are women
• Might only be true for treatment seeking populations
• Clinicians more likely to diagnose men with ASPD and women with BPD

BPD Treatment: medication

• Used to treat comorbid disorders (e.g., depression, anxiety)
• May help with symptoms of emotional instability and impulsivity

BPD Treatment: Dialectical Behavior Therapy (DBT)

• "Dialectics" - synthesizing opposing elements (accept current situation & recognize that change must occur)
• Most well-validated treatment for BPD
• Under umbrella of CBT
• Individual therapy & skills training group

Skills training group involves 4 basic modules:
• *D*istress Tolerance
• *I*nterpersonal Effectiveness
• *C*ore Mindfulness
• *E*motion Regulation

BPD on 5 factor model

Mid: Openness
Low: conscientiousness, extroversion, agreeableness
High: Neuroticism

Neurological etiology of BPD

Hyperactivity in amygdala
Hypoactivity in frontal lobes
Low serotonin levels (depression and impulsivity)

histrionic personality disorder

A pervasive pattern of *excessive emotionality* and *attention seeking*

(5+ of the following)
• Uncomfortable in situations in which they're not the center of attention
• Inappropriately seductive or provocative behavior
• Rapidly shifting and shallow expression of emotions
• Uses physical appearance to draw attention to self
• Impressionistic style of speech (makes big claims) and lacking in detail (can't explain them)
• exaggerated expression of emotion
• Suggestible, easily influenced by others
• Considers relationships more intimate than they really are

Histrionic PD prevalence

General Population: less than cluster A, C(minus dependent), other cluster B
Treatment-Seeking Population: 10-15% (similar to BPD)
Women more likely to get diagnosis

Histrionic PD etiology

~Not enough attention from parents
~High reward dependence for social cues (i.e praise)

Histrionic PD treatment

• CBT
• Get bored easily - continue to see others as the primary problem

Histrionic PD 5 factor model

High: openess, extroverness
Mid: neuroticsm
Low: conscientiousness, agreeableness

Narcissstic personality disorder

A pervasive pattern of *grandiosity, need for admiration*, and lack of *empathy*

(5+ of the following)
• A grandiose sense of self-importance
• Preoccupied with fantasies of unlimited success
• Attempts to only associate with high-status others
• Requires excessive admiration
• Strong sense of entitlement
• Interpersonally exploitative
• Lacks empathy
• Envious of others and/or believes others are envious of them
• Arrogant, haughty behaviors or attitudes

grandiose vs vulnerable narcissism

Grandiose Narcissism
• Inflated self-esteem, exhibitionism

Vulnerable Narcissism
• Feelings of insecurity
• Associated with depression and reactive aggression
~More likely to seek out treatment themself for their insecurity
~Regards themself highly until something happens and it all comes crashing down

NPD etiology

same psychological and social factors that contribute to histrionic PD

NPD prevalence

Most cluster B, higher than cluster A, C, similar OCPD
More men diagnosed than women

Cluster B PDs seem to all be associated with manipulative tendencies in order to achieve some sort of personal gain. What are the differences in reasoning behind these tendencies?

ASPD: power
BPD: nurturance and comfort (told feelings are valid)
Histrionic: attention

NPD treatment

~Develop depression due to poor relationships or wanting others to change
~Focus on dealing with negative feedback, setting appropriate goals, and challenging beliefs on self worth

NPD 5 factor model

High: openess, extrovertness
Mid: Concientiousness, neuroticsm
Low: agreeableness