Abnormal Personality: Theoretical Perspectives

Introduction to Abnormal Personality

  • Abnormal personality has long been a topic of fascination.
  • It is commonly portrayed in books, films, and television, often associated with extreme violence.
  • The term "psycho" is linked to psychopathology, psychosis, and psychopathy, but in popular culture, it often denotes violence.
  • Dr. Susan Krauss Whitman notes that antisocial and narcissistic personality disorders are frequently depicted in Hollywood films.
  • Defining and classifying abnormal personality remains a challenge, with various theoretical perspectives.
  • Assessment and intervention approaches related to abnormal personality are also subject to debate.

Definitions and Classification of Abnormal Personality

  • Abnormal personality is difficult to define without understanding normal personality.
  • Abnormality can be determined by:
    • Atypical traits.
    • Extreme levels of traits.
    • Unusual combinations of traits.
  • An abnormal personality is heavily influenced by the presence, extremity, or combination of personality traits.
  • Personality becomes abnormally problematic when it interferes with a person's experience and responses to the world.
    • This includes patterns of thoughts, feelings, and behaviors.
  • Examples:
    • Taking pleasure in harming others can cause interpersonal difficulties.
    • Excessive deliberation can hinder appropriate responses to the world.
    • Low agreeableness can interfere with interpersonal relationships.
    • Combining gregariousness and self-consciousness can lead to incongruent experiences and confusing presentations to others.
  • Abnormal personality is a common presentation in psychological practice, often showing maladaptive patterns from late adolescence or earlier.
  • Unlike many psychological disorders, there may not be clear remission or relapse patterns.
  • Some individuals find that their mental disturbance is a result of their personality itself.

Historical Context

  • The concept and classification of personality disorders dates back to ancient Greece (around 300 BC), with 30 types described, mainly based on annoying behaviors.
  • The latest DSM conceptualization also arrives at approximately 25 different types of abnormal personality.
  • The concept of personality disorders broadened in the 19th century, initially centered on psychopathy.
  • Schneider's work on psychopathic personalities in 1923 marked the beginning of modern ideas of abnormal personality.

DSM-5 Definition of Personality Disorder

  • The DSM-5 defines abnormal personality as a personality disorder:
    • An enduring pattern of inner experience and behavior that deviates markedly from cultural expectations.
    • Pervasive and inflexible.
    • Onset in adolescence or early adulthood.
    • Stable over time.
    • Leads to distress or impairment.
  • Manifested in areas such as:
    • Thoughts.
    • Feelings.
    • Interpersonal relationships.
    • Impulse control.
  • The pattern of behavior is rigid and displayed across various situations, leading to distress in areas such as work, relationships, or study.
  • This pattern typically has a long history, often back to adolescence or childhood.
  • Must not be attributable to drug abuse, medication, or other medical conditions.
  • Involves impaired social relationships.

ICD-11 Definition

  • The ICD-11 (International Classification of Diseases) shares similarities with the DSM-5 in defining abnormal personality.
  • Characteristics include:
    • Persistent and enduring characteristics.
    • Emergence early in life.
    • Inflexibility across situations.
    • Significant deviation from expected cultural practices.
    • Stability over time.
    • Causes subjective distress and problems of social performance, but not always.

Symptoms of Personality Disorder

  • Maladaptive variations of traits.
  • Disordered motives around power or intimacy.
  • Distortions in cognitions.
  • Dysregulation of emotions.
  • Impaired sense of self-concept.
  • Impaired social relationships.
  • Personality disorder can be defined as maladaptive variations of normal personality traits.

Classification Systems

  • Classification systems aim to be simple yet sophisticated enough to capture the nuances of human personality.
  • Psychologists are interested in how dysfunctional personalities cause distress and dysfunction.
  • Two main classification systems:
    • Categorical system: Quantitative, where one either has or does not have a personality disorder.
    • Dimensional system: Qualitative, describing characteristics without necessarily diagnosing a disorder.

Categorical System

  • The categorical system conceptualizes personality disorders as distinct clinical syndromes.
  • Modern classification began with the first DSM in 1952, where personality disorders were called disturbances.
  • The third edition of the DSM in 1980 used a criterion-based categorical diagnostic system.
  • This version introduced the multi-axial model, placing personality disorders on axis II, separate from other mental health syndromes on axis I.
  • Three clusters of personality disorders were delineated, totaling 10 disorders, plus a "not otherwise specified" category.
  • The DSM-5 abolished the axial system but retained the clusters and 10 personality disorders.

DSM-5 Clusters

  • Cluster A: Odd or eccentric features.
    • Paranoid personality disorder.
    • Schizoid personality disorder.
    • Schizotypal personality disorder.
  • Cluster B: Dramatic, emotional, or erratic characteristics.
    • Antisocial personality disorder.
    • Borderline personality disorder.
    • Histrionic personality disorder.
    • Narcissistic personality disorder.
  • Cluster C: Anxious or fearful aspects.
    • Avoidant personality disorder.
    • Dependent personality disorder.
    • Obsessive-compulsive personality disorder.

Cluster A: Detailed Examples

  • Schizotypal Personality Disorder
    • Acute discomfort in close relationships.
    • Cognitive or perceptual distortions.
    • Eccentricities of behavior.
    • Odd beliefs or magical thinking.
  • Paranoid Personality Disorder
    • Distrust and suspiciousness of others' motives.
    • Prone to bearing grudges and hostility.
    • Few long-term friends.
    • Cold emotional expression.
  • Schizoid Personality Disorder
    • Detachment from social relationships.
    • Restricted range of emotional expression.
    • Introverted and withdrawn.
    • Poor social skills.

Cluster B: Dramatic/Erratic Disorders

  • This cluster involves other people outside the self to a greater extent than other clusters.
  • These personality disorders are defined by a dramatic or erratic way of relating to others and are often the most visible.
  • Borderline and antisocial personality disorders are considered the most complex and heavily researched.
    • Antisocial: Disruptive to the rights and needs of others.
    • Borderline: Disruptive to their sense of self.
    • Histrionic: Dramatic social attention-seeking, requires social evaluation.
    • Narcissistic: Requires social attention but for self-focused purposes.
  • Antisocial personality disorder: disinterest in others.

Cluster C: Anxious/Inhibited Disorders

  • Subjective distress is more of a feature than disruption to social relationships.
  • Commonalities in experiences of anxiety, but the origin and manifestation differ.
    • Avoidant: Anxiety in the context of too much social attention.
    • Dependent: Anxiety in the context of not enough attention.
  • Social relationships are less relevant to obsessive-compulsive personality disorder.
  • Individuals often present with co-occurring personality disorders.
  • The clustering system has limitations and is not consistently validated, according to the DSM-5.

Dimensional Model

  • The DSM-5 introduced an alternative system of diagnosis based on a dimensional model.
  • This model considers more variability in personality disorder diagnosis.
  • Dimensional approaches capture more information about the degree of thought, feeling, and behavioral distortion.

Dimensional Perspective

  • It's tempting to assume abnormality lies at the tail ends of distributions.
  • Normality is determined by behaviors found most frequently in a social group.
  • Pathology or abnormality are features that are uncommon in that population.
  • However, it's important to distinguish extreme scores from disordered functioning.
  • The DSM-5 alternative model suggests that personality needs to be characterized by inflexibility and pervasiveness, as well as disturbance in the self and interpersonal functioning.

DSM-5 Alternative Model

  • A hybrid of categorical and dimensional approaches.
  • Requirements for contextual pervasiveness and temporal inflexibility remain the same.
  • The alternative model reduces the traditional 10 personality disorders to six:
    • Antisocial.
    • Avoidant.
    • Borderline.
    • Narcissistic.
    • Obsessive-compulsive.
    • Schizotypal.

Assessments in the Hybrid Model

  • Requires two assessments:
    • Evaluation of functional impairments:
      • Disturbances in self and interpersonal functioning.
      • Impairment needs to be present in at least two of the four personality functioning areas.
      • Identity.
      • Self-direction.
      • Intimacy.
      • Empathy.
    • Assessment of pathological traits.

Personality Functioning Areas

  • Identity: Experiences of oneself as unique, stable self-appraisal, and the ability to regulate emotional experiences.
  • Self-Direction: Pursuit of coherent life goals, use of constructive internal standards, and productive self-reflection.
  • Intimacy: Depth and duration of connection with others, desire for closeness, and mutuality of regard.
  • Empathy: Comprehension and appreciation of others' experiences and motivations, tolerance of differing perspectives, and understanding the effects of one's behaviors on others.
  • The extent of each impairment is rated from 0 to 4, with 2 indicating a moderate level of impairment is the minimum for a diagnosis.

Diagnosing Specific Disorders

  • Each of the six personality disorders differs in the nature and extent of impairments.
  • Different combinations of impaired functioning areas and levels of impairment define the six disorders.
  • Examples:
    • Obsessive-Compulsive PD: Significant impairment in identity (excessively derived from work) and intimacy (rigidity and stubbornness affecting relationships).
    • Antisocial PD: Significant impairment in self-direction (goal setting based on personal gratification) and intimacy (use of dominance and intimidation).

Pathological Traits

  • It's important to assess the presence of particular pathological traits.
  • Organized into five broad domains:
    • Negative affectivity (akin to neuroticism).
    • Detachment (opposite of extroversion).
    • Antagonism (opposite of agreeableness).
    • Disinhibition (opposite of conscientiousness).
    • Psychoticism ( opposite of lucidity).
  • Each domain has between three and nine facets or subdomains, measured by interview or with the DSM-5's personality inventory.
  • Examples, Antagonism: manipulativeness, deceitfulness, grandiosity, attention seeking, callousness, and hostility
    *
  • Specific traits for example, antisocial PD, needs six or more out of seven of the pathological facets of manipulativeness, callousness, deceitfulness, hostility, risk taking impulsivity, or irresponsibility
  • To summarize the DSM five alternative model of personality disorder, you must assess both functional impairment and pathological traits to make a diagnosis. This differs from the categorical model where all you need is is the presence of certain categorical aspects of the disorder based on the criteria as defined in the DSM-5.

Initial Explorations and Psychopathy

  • Initial explorations of abnormal personality targeted notable personality types (e.g., psychopathy).
  • Psychopathy is drawing much attention because it engender those primary emotions of fear and disgust, which sparked our interest in exploring what's going on with this particular personality feature.

Psychopathy

  • Psychopathy is defined as having antisocial tendencies, a lack of empathy, impulsive thrill-seeking, erratic behavior, and charm.

Lack of Official Diagnostic Status

  • No officially recognized diagnostic category of psychopathy.
  • Antisocial personality disorder is the closest recognized personality disorder in DSM-5.
  • ICD-11 has similar personality disorders, such as dissocial personality disorder or emotionally unstable personality disorder.
  • Different conceptions of psychopathy have been used throughout history, but they are only partly overlapping and sometimes contradictory.
  • Many of the classic traits of psychopathy were often impossible to measure objectively.

Early Conceptualizations of Psychopathy

  • Lombroso: The Born Criminal (late 1800s)
    • Theorized that some people were born to be criminal in their behaviors.
    • Believed there was a degeneration due to congenital causes, leading to inborn and unvarying characteristics of a deficit in morals, often exacerbated by maternal deprivation or maternal genes.
  • Copeland: Moral Insanity
    • Lack or weakness of those sentiments which counter the ruthless satisfaction of egotism.
  • Craplin: Gamut Low Psychopathy
    • Defined someone who is quite compassionless and without morals, with high levels of criminal behavior, virtually doomed to commit crimes by virtue of their own constitution.
    • Compared this to someone with more of a helpless personality disorder. So similar in having psychopathic traits however, built on shortsighted selfishness and irresponsible hedonism. So more pleasure seeking, an inability to anchor oneself to a past or future. A lack of inhibition, that was more psychopathy without intent, superficial, vagabond, unstable type personality.

Schneider's View of Psychopathic Personalities

  • Schneider criticized Crayplin's labels for appearing to be more realistic behaviors that were just deemed undesirable rather than actual medical conditions.
  • Schneider sought to put psychopathy on a morally neutral and scientific footing.
  • Schneider thought that perhaps very creative or intelligent people had abnormal personalities by definition, but defining feature of a psychopathic personality was somebody who suffered from their abnormal personality or cause suffering to society because of it.
  • Schneider listed 10 types of personal psychopathic personalities.

Partridge: Sociopathy

  • Partridge came up with the term sociopath (1930) which was somewhat less stigmatizing than the term psychopath, at the time.
  • Partridge suggested that groups as a whole could in fact become pathological, also suggested that there were social determinants on the development of this type of personality.
  • Differentiated sociopaths on the basis of the ideology, suggesting there was a delinquent type that was more biological based and found predominantly in males. An an inadequate type that was found in females and determined to be biologibally based and based on the genetic criminal, an emotionally unstable type related to upbringing.

Cleckley: The Mask of Sanity

  • Cleckley based his ideas of psychopathy on clinical interviews done with high security psychiatric patients, as well as interviews done with soldiers who had returned from World War I.
  • He noticed that there was a tendency of some people to appear quite confident, personable, and well adjusted, but nonetheless, they revealed some underlying pathology through their actions over time.
  • Cleckley: The psychopath exhibits normal function according to standard psychiatric criteria but privately engages in destructive behavior, which can often be self-destructive.
  • Cleckley thought that there was potentially normal functioning going on but internally a psychopath did not have the ability to experience genuine emotion, due to a neuropsychiatric defect that went beyond a voluntary intention to put on a mask to disguise something negative

Hare: The Psychopathy Checklist

  • Robert Hare developed a research tool based on Cleckley's conceptualization.
  • Two factors:
    • Interpersonal/affective deficits:
      • Superficial charm.
      • Inflated self-worth.
      • Pathological lying.
      • Cunning and manipulation.
      • Lack of remorse or guilt.
      • Shallow affect.
      • Lack of empathy.
      • Failure to accept responsibility.
    • Social deviance:
      • Need for stimulation and proneness to boredom.
      • Parasitic lifestyle.
      • Lack of realistic long-term goals.
      • Impulsivity.
      • Irresponsibility.
      • Poor behavioral controls.
      • Early behavioral problems.
      • Breach of criminal sanctions.
      • Versatile criminal career.

Hare Checklist Related to Other Traits

  • Hay's checklist makes us think about elements of the other dark traits like Machiavellianism that are characterized typically by cunning manipulativeness. deeceit and flattery.
  • Narcisssim characterized by the belief that one is uniquely special is characterized by the Hare checklist. as having a grandiose sense of self.
  • Sadism is a personality trait where one will engage in exploitative, cruel or demeaning behavior. Hares checklist indicates psychopathy is also characterised by a lack of remorse, guilt, and callousness.
  • Psychopathy also is related to Eysencks trait of psychoticsm typically identified as individuals who are impulsive in engaging in responsibility in social norms, have reduced responsiveness in conditioning, and often will act inappropriately in criminal behaviors.

Criticism of Hare's Conceptualization

  • Concerns about overlapping diagnostic criteria.
  • Half of the Hare Psychopathy Checklist consists of symptoms of mania, hypomania, and frontal lobe dysfunction.
  • Risk of dismissing underlying disorders.
  • Criticism for being reductionist, dismissive, tautological, and ignorant of context.
  • Some call for rejection of the concept due to vagueness, subjectivity, judgment, and the potential for misuse.

Triarchic Model

  • Most notably by Cook.

  • Proposed by Cook in the early 2000s that attempted to address some of the concerns of hare's model of psychopathy'm

  • Three factors:

    • Boldness: Low fear, high stress tolerance, self-confidence, and social assertiveness.
    • Disinhibition: Poor impulse control and planning, lacking affect and urge control, demand for immediate gratification, and poor behavioral constraints.
    • Meanness: Lacking empathy and close attachments, disdain of close attachments, use of cruelty to gain empowerment, exploiting others, defying authority, and destructive excitement seeking.

Triarchic Model in Relation to other Domains

  • This model and those features is recognised in the neurological and biological domains for corresponding differences in the amygdala, a neurological system associated with deficits relating to low levels of fear.
  • The disinhibition model has corresponsing features that have found to relate to correspond with damage to the frontal lobe regarding impulse control planning
  • The meanness feature also relate to an inabilitty connect to others and relate neurologically with a lack of empathy attachments

Triarchic and the biological theories of personality models

  • Perhaps it follows somewhere in the continuum of psychopathy, psychotisism and psychosis. A fear system linked to fear anxiety even sadness has impairements to the flight, flight, freeze system and also, causes an innefective response to punishment as a response to a person feeling the fear normally. This is seen as the boldness part of psychopathy.
  • Some have argued for an over active B.A.S. Which refers to an increased, behaviour activation system which involves rewards seeking behavior, relating to impulsiveness. So, to summarize the fear and BAS system correspond with the features and characteristics identified by researchers and practitioners with psychopaths. It is theorized that the final feature involved impaired behaviour or a anxiety. in this case, the brain does not necessarily understand the way in other cases by not registering anxiety which is an aspect the means portion involved with the trait related to what they know of human trait's

Causal Theories of Psychopathy

  • Biological Causes: neuro-damage, brain trauma.

    • Neurostructural: The location in the brain structure is damaged corresponds with certain symptoms and behaviour.
    • Deficits in the amygdala associated with emotional regulation.
    • Deficits in frontal lobe, impulse control.
    • Neurochemical: High testosterone levels, increased sensitivity to rewards.
      • High testerone, low cortisal, plus impairments in serotonin functions can contribute to the callous nature. arrogant, deceitful traits.
    • Genetic Studies: Genetic code from the genes.
      • 60% heritability of the trait's which causes problems, with the children, who exhibit the same traits as the parents that came. from the genetic trait. A long h t t l p allele are protective against internalizing disorders but is theorized in this research and evidence. shows that emotional regulation is over active that diminishes affected processes of shallow shallow shallow affect.

  • Social Theories: social. or environmental . factors are involved. It's not just genetic

    • Convicted Parent.
    • Low family income, harsh disciplining lack of a mother figure, or depressed Mother the the list goes on, and these are all significantly impact to development in. of psychopathic personality.
    • Evidence show that having a lack of stability from environmental features. The heritability, which is typically social causes is stronger than the biological. But ultimately, the. genetic genes from, genetic makeup's dominates those external features ultimately.

  • Historically, responses to psychopathic personality have been (due to the lack of understanding) harsh:

  • lobotomies, genetic screening for sterilization, removing the child from the house hold to not cause harm. The sentence received in these cases tend to be larger than others by the jury panel of society.

*Social Adaptability.
Why is this trait being expressed through genes
Adulterous and coercive. sexuality May increase reproductive success.
Socially paratisic strategies or putting as little effort in to to extract the resource for more with relative balance and it shows that
Abnormal personality is something you cannot remove from normal traits in a relative context. A personality becomes abnormal when it causes an issue.

Conclusion

  • From early on in history there remains debates on both sides and there continues being a great deal of research and exploration in the area.
    *Personality research is traditionally taken through two routes, exploring individuality to express emotions on traits, or the disorders of traits exploring certain emotions. But modern days we combine the two now for both models and disorders.
    *While abnormal personality may be considered an extreme variation of some traits, a definition, requires inflexibility. subjective distress and there impairments with adapation of someone with this trait.
    *The classification of personality disorders has evolved as a feature.
    In conclusion, exploration and understanding of social and. or evolutionary mechanisms has led to a great deal of theory in psychopathy, which is still researched and explored today.