Personality Disorders and Psychopathy

Personality Disorder (Axis 2)

• Behaviors similar to Schizophrenia but less severe.
  • Flat affect, odd thought, or speech patterns.
  • Aberrations in understanding reality.
• Three disorders:
  • Paranoid Personality Disorder: Paranoia in one situation.
  • Schizotypal personality disorder: Mild Schizophrenia symptoms (cognitive & behavior).

General Personality Disorder: Criterion A

• An enduring pattern that deviates from cultural expectations in two or more areas:
  • Cognition: Perceiving and interpreting self, others, and events.
  • Affectivity: Range, intensity, lability, and appropriateness of emotional response.
  • Interpersonal function.
  • Impulse control.

General Personality Disorder: Criteria B, C, D

• Criterion B: Inflexible and pervasive across situations; not situation-specific.
• Criterion C: Causes clinically significant distress or impairment.
• Criterion D: Stable pattern since adolescence/early childhood.

Personality Disorder Clusters

• Cluster A: Odd-eccentric.
  • Odd beliefs & Unusual perceptual experiences.
  • Odd speech pattern (no operational definition of "odd").
• Cluster B: Dramatic-emotional.
  • Manipulative/uncaring, low empathy.
  • Emotional Dysregulation: Erratic responses.
  • Inappropriately sexual behavior, extreme focus on appearance.
  • Exaggerated emotionality without depth; rapid shifts.
  • Seeks attention; discomfort if not center of attention.
• Cluster A: schizotypal personality disorder
  • Individuals with odd beliefs and behaviors.
• Cluster B: Dramatic-emotional
  • Histrionic personality disorder

Histrionic Personality Disorder

• Cognitive-Behavioral Models (sense of self)
  • Core Beliefs:
  • Self: "If I can’t entertain people they will abandon me"
  • Other: "If other people don’t respond to me they are rotten"
  • Learning History:
  • Selective interpersonal reinforcement leads to attention-seeking.
• Underlying functions matter; Topography (behavior) vs Underlying Function (why the behavior).
• Emotion shifts for attention, unlike Bipolar Disorder (brain chemistry-related mood changes).
• "Attention-seeking disorder" differs from narcissism (ego boosts; selective attention).
• Low insight into their behavior.

Antisocial Personality Disorder (ASPD)

• Characterized by disregard for and violation of others' rights.
• ASPD focused on criminality.
• Diagnostic criteria:
  • Failure to conform to social norms.
  • Deceitfulness.
  • Impulsivity.
  • Irritability and aggressiveness.
  • Reckless disregard for safety.
  • Consistent irresponsibility.
  • Lack of remorse.
• Early term: Moral insanity (deficient in moral faculties).

Psychopathy

• Similar to ASPD, but includes:
  • Grandiosity, arrogance, superficiality.
  • Inability to form emotional bonds.
  • Lack of anxiety; low baseline arousal.
• Prevalence: Overrepresented in criminal/substance abuse settings.
• Genetic contribution.
• Early learning environment:
  • Passive/neglectful parenting.
  • Harsh parenting styles.

Early Learning Environment & ASPD

• Passive/neglectful parenting:
  • No demands for responsible behavior.
  • Attention for (-) behaviors.
• Harsh parenting styles:
  • Aggression for discipline; modeling conflict.
  • Hostile information processing.

Learning and Performance Deficits in Psychopathy

• Deficits in acquiring learning responses:
  • Incapable of profiting from reward/punishment.
  • Not responsive to shock or social comments.
• Deficits in acquiring fear responses:
  • Slow to develop conditioned fear responses.
  • Less influenced by fear reaction.
• Chronic low levels of arousal:
  • Need to increase arousal levels, ASPD individuals will engage in higher-risk sensation-seeking.

Cluster C: Anxious-Fearful

• Extreme concern of criticism and abandonment leads to impaired relationships.
  • Avoidant personality disorder:
  • Feelings of extreme social inhibition, inadequacy, and sensitivity to negative criticism and rejection
  • Dependent personality disorder:
  • Feelings of helplessness, submissiveness, dependence, reassurance seeking

Narcissistic Personality Disorder

• Lacks a gold standard definition.
• Healthy vs. Pathological Narcissism.
  • Healthy narcissism:
  • Positive self-view.
  • Seeks validation but not excessively.
  • Motivated to grow without harming others.
  • Personal agency, interpersonal dominance, fueling motivational achievement.
• High scores on the narcissistic personality inventory (NPI):
  • Negative associations with traits neuroticism and depression
  • Positive association with achievement motivation and self-esteem
• Adaptive subtype of narcissistic personality:
  • Autonomy subtype correlated with creativity, empathy, achievement orientation and individualism
  • High-funtioning/exhibitionstic; motivated to succeed.

Pathological Narcissism

• Two dimensions:
  • Grandiose: Conceited, domineering.
  • Vulnerable: Insecure.
• Grandiose Narcissism:
  • Externalize negative life events.
  • Can’t profit from mistakes; inflated self without skill.
  • Correlation between grandiose and psychopathy.
  • Represses negative aspects of self and avoids external information
  • Malignant subtypes:
  • Seething anger, manipulativeness, lack of remorse
• Vulnerable Narcissism:
  • Fragile, hypersensitive; prone to injury.
  • Emotional states: shame, anxiety, depression.

Etiological Factors of Narcissism

• Heterogeneity in etiology.
• Lack of inoculation in life.

Borderline Personality Disorder (BPD)

• Instability in emotion, cognition, behavior, self-image, relationships.
• Profound abandonment fears.
• Early learning factors:
  • More maternal and paternal absences, more discord between parents, more experiences of being raised by other relatives or in foster homes, and more physical violence in the family
  • Higher likelihood of early trauma: abuse, neglect.
  • Invalidating early environment.
  • Biological factor: genes play a role but not entirely.
• Inherited Traits that increase risk:
  • High Anxiety, Mood Problem, Poor Impulse Control, Traits linked to antisocial behavior, Emotional Instability, & Thinking Difficulties

BPD Clinical Features

• BPD has been referred to as a disorder of “stable instability”? In what ways are individuals with BPD “unstable”?
• BPD “stable instability”: instability in mood such as intense anger or in periods of rapidly changing negative emotion often in response to interpersonal stress. As well as instability of self image in who they are and/or what they want
• Five or more systems for BPD diagnosis:
  • 1. Profound fears of abandonment
  • 2. Interpersonal relationships that are both intense and unstable
  • 3. Identity disturbance
  • 4. Impulsive behavior in at least two areas
  • 5. Recurrent self-mutilating behavior or suicide threats, gesture, or suicidal behaviors
  • 6. Highly reactive mood
  • 7. Persistent feeling of emptiness
  • 8. Intense or inappropriate anger that is difficult to control
  • 9. Brief periods of paranoid ideation or dissociative symptoms when under stress
• APA-Approximately 75% of patient with BPD are women
• Core features of BPD:
  • Linhean considered “affective instability” or bw the core of BPD
  • Gunderson highlights “fear and intolerance” of aloneness

BPD Main Components

• Linehan’s (1993) biosocial theory:
  • Biological vulnerabilities: High emotional sensitivity (easily triggered), Intense emotional reactions, and Slowly recovery from emotional arousal.
  • Environmental factors: an invalidating family environment, dismiss, ignored, or responded to inappropriately
  • Impact of invalidation: Heightened emotional arousal, and Failure to label emotions.
• Negative life events of those later diagnosed with BPD:
  • Childhood trauma, Parent neglect, and Early family dysfunction
  • Loss or separation from primary caregivers
  • Main problems wit retrospective reports. Patients with BPD recalling their early life experiences.

Attachment Theory and BPD

• Attachment theory-infants develop an internal working model of themselves and others based on their early attachment experiences.
• Link between attachment and BPD
  • People with BPD tend to have poor relationships with stability and extreme emotional reactions to perceived rejection
• Insecure attachment linked to BPD:
  • 1. Disorganized attachment
  • 2. Preoccupied with anxious attachment
  • 3. Avoidant attachment
• Bateman and Fonagay’s notions refers to the term of mentalization

Executive Neurocognition and BPD

• Executive neurocognition-refers to a set of high-level cognitive processes
• 1. Interference control: the ability to suppress dominant
• 2. Cognitive inhibition: the ability to suppress irrelevant
• 3. Behavioral inhibition: the ability to inhibit motor responses
• 4. Motivational or affective inhibition: the ability to regulate behavior

Obsessive-Compulsive Personality Disorder (OCPD)

• Preoccupation with orderliness, perfectionism, and control.
• Symptoms:
  • Preoccupied with details, rules, lists, order, organization, or schedules.
  • Show perfectionism that interferes with task completion
  • Excessively devoted to work and productivity to the exclusion of leisure activities and friendship
  • Over-conscientious, scrupulous, and inflexible about matters of mortality, ethics, or values
  • Unable to discard worn-out clothes or worthless object
  • Reluctant to delegate tasks or to work with others unless they submit to exactly his or her way of doing things
  • Adopts a miserly spending style toward both self and others; money is viewed as something to be hoarded for future catastrophes
  • Shows rigidity and stubbornness
• Most common personality disorder.
• Diagnostic Issues: Lack hallmark diagnostic feature: DSM-V recommends perfectionism as primary feature
• Heterogenous diagnostic category

Sexual Disorders Overview

• Sexual dysfunction: quantitative sexual response problems.
• Paraphilias: qualitative deviations in sexual feelings.
• Paraphilia vs. paraphilic disorder (disorder causes problems).

Paraphilias in the DSM

• Paraphilia-an unusual sexual interest, but doesn’t cause harm, distress, or interfere with life
• Paraphilic disorder- the unusual sexual interest does cause distress, harm or problems in life
• 8 classification according to the DSM
  • 2 sub categories:
    • Involving victim (Non consensual)
    • Victimless (Consensual)

Sexual Disorders Etiology

• Etiological and developmental factors: learning models
  • Classical conditioning: Pairing of a neutral stimulus with sexual arousal
  • Imprinting conditioning and fantasy rehearsal
  • Vicarious learning
    • children exposed to sexual violence may learn that sexual coercion is normative or associated with pleasure/power
      # Sexual Disorders Disposition
• Etiological and Development factors: Disposition
  • Characteristic profile:
    * Offenders are predominantly men
    * Impulsivity, anger, aggression, dominance, etc.
    * Heterosocial deficits (have trouble with opposite sex relationship)
    * Early attachment problems (neglect or inconsistent parenting)
    *Comorbid pathology:
    * Mood disorder (like depression)
    * Anxiety
    * Substance abuse (alcohol or abuse addiction)

Fetishism

• Erotic attraction to non-living objects.
  • Wide variety of behavioral manifestations:
    • Masturbation with objects
    • Incorporation of objects into sexual behavior
    • Theft or collection of objects
• Partialism:
  * A form of fetishistic behavior involving intense erotic attraction to specific parts of the body

Sexual Sadism and Masochism

• Sadism:
  *Involves excitement in response to the infliction of psychological and physical suffering
• Masochism:
  *Involves excitement in response to being humiliated or made to suffer
• A diagnosis of a paraphilic disorder requires (a) a nonconsenting person or (b) cause “clinically significant distress or impairment in social, occupational, or other important areas of functioning:

Pedophilia

• Adults erotically attracted to prepubescent children.
• Subtypes:
  • Opportunisti- (don't usually prefer children, but take advantage of a situation when a child is vulnerable)
  • Pervasive angry -(act of rage or hostility, often using sex to dominate or hurt, use it more as violence or power not attraction)
  • Sexual (sexual preference for children)

Exhibitionism and Frotteurism

• Exhibitionism:
  • Recurrent urge for exposure of the genital to strangers or unsuspecting persons
    * Arousal response to shock, fear, or embarrassment of victims
    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, buttocks, or other body parts of an unsuspecting person
    * Occurs in situations where behavior will go undetected by victim
  • Associated with:
  • Withdrawn, immature or socially avoidant personality style

Voyeurism

• The observation of an unsuspecting person or persons who are nude, disrobing, or engaging in a sexual act
  • Essential feature in the lack awareness of the victim *Often involves masturbation during or immediately following voyeurism Associated with:
    • Sadism, aggression, & sexual assault
    • Little sexual experiences and lack of heterosocial skills
    • Strong feelings of inferiority

Psychopathy

• Criteria from Cleckley's "The Mask of Sanity":
  • Superficial charm and good “intelligence
  • Absence of delusions and other sign of irrational thinking
    *Unreliability
  • Untruthfulness and insincerity
  • Lack of remorse or shame
  • Inadequately motivated antisocial behavior
  • Poor judgement and failure to learn by experience
  • Pathological egocentricity and incapacity for love
  • General poverty in major affective reactions
  • Specific loss of insight
  • Unresponsiveness in general interpersonal relation s
• Six most influential:
  • Charm, lack of remorse, antisocial behavior, poor judgment, egocentricity, shallow emotions.

Gray's BIS/BAS Model

• Explains responses to punishment or reward.
• BAS (behavioral Activation System)
  • Responds to cues of reward or non-punishment
  • Drives approach behavior
  • Associated with impulsivity and reward sensitivity
• BIS (behavioral inhibition system)
  • Responds to cues of punishment
    *Inhibits behavior, especially in situation of goal conflict
  • Element mostly related to psychopathy
  • Most linked to deficit in the BIS, that is low sensitivity to punishment, weak behavioral inhibition behavioral and reduced fear response

Brain Areas & Learning Deficits in Psychopathy

• Amygdala: Key area for learning deficits, especially in aversive conditioning.
• Structural brain differences not limited to amygdala:
  • OFC
  • Anterior cingulate cortex
  • Prefrontal cortex
    • Anterior insula
  • Caudate nucleua
  • Abnormal neural connectivity

Response Modulation Hypothesis (RMH)

• Deficit in shifting attention when cues are peripheral.
  • Attention Bottleneck - once focused on a specific goal or task, psychopathic individual fail to process other important information.
• How is RMH different from the low-fear and punishment learning model
• Evidence from Newman & Baskin Sommers
  • Fear- potentiated startle paradigm: psychopath will show normal fear responses when threat cues are central but reduced responses when threat are peripheral

Genetic and Environmental Contributions to Psychopathy

• The level of psychopathic traits in an adolescent is correlated with the level of psychopathic traits in their close peer group
• The genetic that CU are among the most heritable features of psychopathy: Genetic twin design prove this