Personality Disorders

Personality Disorders Long-standing patterns of thought, behavior, and emotions that are maladaptive for the individual or for people around him or her.

DSM-IV-TR Personality Disorders Cluster A: Odd-Eccentric Personality Disorders Symptoms similar to those for schizophrenia, including inappropriate or flat affect, odd thought and speech patterns, paranoia. People with these disorders maintain their grasp on reality, however. Cluster B: Dramatic Emotional Personality Disorders Manipulative, volatile, and uncaring in social relationships. Impulsive, sometimes violent behavior that show little regard for their own safety or the safety or needs of others Cluster C: Anxious-Fearful Personality Disorders Extremely concerned about being criticized or abandoned by others and thus have dysfunctional relationships with them.

Problems with the DSM-IV-TR Categories Symptoms described are often only extreme versions of otherwise “normal” traits. Overlap in the diagnostic criteria and the majority of people who are diagnosed with one disorder tend to meet the diagnostic criteria for at least one other personality disorder. Diagnosing a personality disorder often requires information that is hard for a clinician to obtain. Conceptualized as stable characteristics, yet they vary, so individuals go in and out of the diagnosis

Cluster A: The Odd-Eccentric Personality Disorders Paranoid personality disorder Chronic and pervasive mistrust and suspicion of other people that is unwarranted and maladaptive. Schizoid personality disorder Chronic lack of interest in and avoidance of interpersonal relationships, emotional coldness toward others. Schizotypal personality disorder Chronic pattern of inhibited or inappropriate emotion and social behavior, aberrant cognitions, disorganized speech. Weak Strong Relationship to Schizophrenia

Cluster B: Dramatic Emotional Personality Disorders Antisocial personality disorder Pervasive pattern of criminal, impulsive, callous, or ruthless behavior; disregard for rights of others; no respect for social norms. One of the most common of the personality disorders and one of the most difficult to treat. Borderline personality disorder Rapidly shifting and unstable mood, self-concept, and interpersonal relationships; impulsive. Histrionic personality disorder Rapidly shifting moods, unstable relationships, and intense need for attention and approval; dramatic, seductive behavior. Narcissistic personality disorder Grandiose thoughts and feelings of one’s own worth; obliviousness to others’ needs.

Cluster B: Dramatic Emotional Personality Disorders Borderline Personality Disorder: Clips from Marsha Linehan’s DVD Clips from Fatal Attraction

Antisocial Personality Disorder Video clips (World of Ab Psych video – Program 5, 18:45 – 37:00) Pervasive pattern of disregard for and violation of the rights of others, as indicated by three or more of: Failure to conform to social norms re: lawful behavior Deceitfulness Impulsivity / failure to plan ahead Aggressiveness / irritability Reckless disregard for safety of self or others Consistent irresponsibility Lack of remorse

Contributors to Antisocial Personality Disorder Interactive model (biological – environmental) Biological Genetic predisposition (only a modest contribution) Testosterone (evidence?) Serotonin (low levels associated with impulsivity and aggression) ADHD? (correlation vs. causation) Executive functions (deficits in planful behavior) – structural hypofrontality? Arousability (low): fearlessness and/or stimulation-seeking Environmental factors (next slide)

Contributors to Antisocial Personality Disorder and Violence Environmental factors (Patterson, 2008) Patterson, G., (2008) in Perspectives on Psychological Science

Contributors to Violence Violent behavior is controlled by its consequences. Extensive training precedes the violent act. In the societal model (i.e., war), the training is planned, whereas in the individual model the training by parents and peers is inadvertent.

Contributors to Violence In both domains, the training is such that the overlearned violent act becomes automatic. For example, the violent individual who physically assaults his wife has a prior history of thousands of reinforcers for a wide variety of antisocial behaviors. Peers are thought to play a key role in providing reinforcers for violence related behaviors.

Prevention Reducing the relative rate of reinforcement would be associated with reductions in violence. To date, there is empirical support for this assertion as it applies to individual acts. Behavioral approaches to classroom management Improving parenting skills/practices

Treatment of ASPD and/or violent offenders Difficult… Why? Most don’t seek treatment Those that do have a long history of antisocial acts to “unlearn” Victim empathy training

Cluster C: The Anxious-Fearful Personality Disorders Avoidant personality disorder Pervasive anxiety, a sense of inadequacy, and a fear of being criticized, which leads to the avoidance of social interactions and nervousness. Dependent personality disorder: Pervasive selflessness, need to be cared for, fear of rejection, leading to total dependence on and submission to others. . Obsessive-compulsive personality disorder Pervasive rigidity in one’s activities and interpersonal relationships, including emotional construction, extreme perfectionism, and anxiety about even minor disruptions in one’s routine.