Personality Disorders Key Points

Personality Disorders (Axis 2)

  • Behaviors similar to, but less severe than, Schizophrenia.

  • Three disorders:.

    • Paranoid Personality Disorder: Paranoia in one aspect/situation.

    • Schizotypal personality disorder: Mild Schizophrenia symptoms.

General Personality Disorder: Criteria

  • Criterion A: Deviation from cultural expectations in cognition, affectivity, interpersonal function, and impulse control.

  • Criterion B: Inflexible behavior across situations.

  • Criterion C: Clinically significant distress or impairment.

  • Criterion D: Stable pattern since adolescence/early childhood.

Clusters of Personality Disorders

  • Cluster A: Odd-eccentric behaviors, odd beliefs, unusual experiences, odd speech patterns.

  • Cluster B: Dramatic-emotional, manipulative, erratic emotions, attention-seeking, exaggerated emotionality.

  • Cluster C: Anxious-fearful, extreme concern about criticism and abandonment.

Cluster A: Schizoid Personality Disorder

  • Flat affect, discomfort in interpersonal relations, difficulty with independent living.

  • Schizotypal personality disorder: Odd beliefs/behaviors (e.g., believing in fairies).

Cluster B: Histrionic Personality Disorder

  • Attention-seeking behavior, shallow emotions, inappropriately sexual behavior.

  • Cognitive-Behavioral Models:

    • Core Beliefs: "If I can’t entertain people they will abandon me."

    • Selective interpersonal reinforcement leads to attention-seeking.

  • Topography vs. Underlying Functions: Disorders differentiated by underlying function.

  • Differs from Bipolar Disorder; shifts aimed at attention, not brain chemistry.

Antisocial Personality Disorder (ASPD)

  • Disregard for the rights of others.

  • DSM-II: focused on criminality.

  • DSM 3: Diagnosis focused on antisocial behaviors and social deviance

  • Moral Insanity: Constitutionally deficient in moral faculties.

Psychopathy

  • Similar to ASPD but includes grandiosity, arrogance, superficiality, lack of emotional bonds, and lack of anxiety.

ASPD Prevalence

  • Overrepresented in criminal/substance abuse settings.

    • 76% prisoners diagnosed with ASPD, most not psychopathic.

  • Community samples: 8% of men, 3% of women.

  • Genetic Contribution: Strong genetic basis.

  • Early Environment:

    • Passive/neglectful or overly harsh parenting.

ASPD: Early Learning Environment

  • Passive/Neglectful: No demands for responsible behavior.

  • Harsh: Aggression for discipline, modeling conflict

ASPD: Learning and Performance Deficits

  • Incapable of profiting from reward/punishment, no fear responses

  • Chronic low levels of arousal lead to sensation-seeking.

Cluster C: Anxious-Fearful

  • Avoidant: Social inhibition, inadequacy, sensitivity to criticism.

  • Dependent: Helplessness, submissiveness, reassurance-seeking.

Narcissistic Personality Disorder

  • Became official in DSM 3 from the Greek mythology Narcissus

  • Not one "gold standard" definition.

  • Psychologists differ in definition and measurement.

Healthy Narcissism

  • Positive self-view, seeking validation, motivated to grow, but without harming others.

  • Increases personal agency, fuels achievement.

  • Adaptive subtype: autonomy.

  • High-functioning/exhibitionistic uses narcissism as motivation to succeed.

Pathological Narcissism

  • Two dimensions:

    • Grandiose Narcissism: Conceited, domineering, inflated self-image, lacks insight, may have malignant subtypes.

    • Vulnerable Narcissism: Fragile, hypersensitive, prone to narcissistic injury.

Etiological Factors (Narcissism)

  • Heterogeneity makes etiology difficult to define.

  • Lacking inoculation.

  • Borderline Personality Disorder: Characterized by instability in emotion, cognition, behavior, sense of self, and interpersonal relationships.

Borderline Personality Disorder

  • Profound fears of abandonment, early learning factors, invalidating early attachment environment

BPD & Genetics

  • 70% concordance in MZ twins, 35% in DZ twins suggests genetic role.

  • Inherited traits: High anxiety, mood problems, poor impulse control, emotional instability, thinking difficulties.

Borderline Personality Disorder (Textbook)

  • "Stable instability": Instability in mood, self-image, relationships, behavior.

  • Clinical features: Fears of abandonment, unstable relationships, identity disturbance, impulsivity, self-mutilation, affective instability, emptiness, anger, paranoid ideation.
    Rapid mood changes are core of BPD.

BPD Theories

  • Linehan: Affective instability.

  • Gunderson: Fear and intolerance of aloneness.

BPD - Biosocial Theory

  • Biological Vulnerabilities: High emotional sensitivity, intense reactions, slow recovery.

    • Environmental Factors: Invalidating family environment.

    • Impact of Invalidation: Heightened arousal, failure to label emotions, self-invalidation.

BPD - Negative Life Events

  • Childhood trauma, neglect, family dysfunction

  • Main Problem with Studies: Reliance on retrospective reports

BPD- Attachment Theory

  • Insecure attachment linked to BPD: disorganized attachment, preoccupied/anxious attachment, avoidant attachment

  • Bateman & Fonagy: Failure in mentalization.

BPD & Neurocognition

  • Executive neurocognition deficits: Interference control, cognitive inhibition, behavioral inhibition, motivational/affective inhibition.

Obsessive-Compulsive Personality Disorder (OCPD)

  • Preoccupation with orderliness, perfectionism, and control at the expense of flexibility, openness, and efficiency. Four requirements:
    -Preoccupied with details, perfectionism interferes with completion, excessively devoted to work, over-conscientious, unable to discard, reluctant to delegate, stingy, rigid
    Critiqued for lacking key diagnostic feature, heterogeneity impairs studies of etiology and course

Sexual Paraphilias

  • sexual dysfunction = problems how the body responds sexually

  • paraphilias = unusual or non-typical sexual interest

  • Paraphilia vs. Paraphilic Disorder: Disorder causes problems, impacts life.
    8 classifications: consensual vs. non-consensual.

  • Paraphilia, NOS: stimuli that have become associated to release a physiological response of arousal but that do not necessary fit into one of the 8 board categorie
    Early sexual experiences can shape what a person is attracted to later in life
    Control over painful memory through mastery with trauma
    Child exposed to violence = sexual corecion and violence

Etiological and Development factors: Disposition

  • predominantly more men, impulsivity anger aggression

  • heterosocial deficits, ealry attachment problems ( inconsistent parenting)

  • comorbidity- mood/anxiety disorders, addiction

  • Fetishism: Erotic attraction to non-living objects

  • Sexual Sadism and Masochism: Key differences (Sadism vs. Masochism)

Paraphilic disorder diagnosis

  • (a) a nonconsenting person and (b) cause “clinically significant distress or impairment in social, occupational, or other important areas of functioning
    -Pedophilia: Adults for whom prepubescent children are the focus of erotic attraction and interest
    Opportunistic, pervasive angry /Sexual

Paraphillias continued

  • Exhibitionism: Recurrent urge for exposure of the genital to strangers or unsuspecting persons associated with:

    • Acts of sexual aggression

  • Antisocial traits or heterosocial deficits

  • Frotteurism: Characterized by the individual’s touching or rubbing his genitals against the leg
    Associated with: Withdrawn, immature or socially avoidant personality style

  • Voyeurism: Involves the observation of an unsuspecting person or persons who are nude
    sadism, aggression & sexual assault

Psychopathy as Psychopathology (Chapter 15)

  • Cleckley’s Criteria: Superficial charm, lack of remorse, antisocial behavior, poor judgment, egocentricity, shallow emotions.
    Greatest Influence: Charm, lack of remorse, antisocial behavior, poor judgment, egocentricity, poverty in affective reactions.

Gray's BIS/BAS Model

  • BIS (behavioral inhibition system) : Responds to cues of punishment, frustration, or novelty

  • BAS (behavioral Activation System): Responds to cues of reward or non-punishment
    Most Linked to Psychopathy: Deficits in BIS (low sensitivity to punishment).

Brain & Psychopathy

  • Blair: Amygdala deficits in learning Not Limited to Amygdala:

    • OFC, ACC, prefrontal cortex, anterior insula, caudate nucleua
      Abnormal neural connectivity

Response Modulation Hypothesis (RMH)

Deficit in shifting attention peripherally: Attention bottleneck; failure to process threat cues peripherally.

  • Different from Low-Fear Model: RMH is peripheral.
    Newman & Baskin-Sommers Support: Passive avoidance task, fear-potentiated startle paradigm

Psychopathy: Genetic vs. Environmental

Genetic: Consistent findings (22-70% heritability).
Nonshared Environment: Moderate to strong influence.
Peer influence shapes psychopathic tendencies.
Callous-Unemotional Traits: Highly heritable.