ANTISOCIAL & NARCISSTIC PERSONALITY DISORDERS Tela Wilson, Psy.D., Psych II

Objectives  Identify specific personality disorders  Identify common characteristics of the psychopath

 As a youth, he fought with other boys, stabbed animals with red hot irons, became a thief, spent time in a juvenile detention center. Became an assassin at 23, exiled to Syria and Egypt, before his rise to power. Reported that he shot and killed a member of his cabinet during a meeting. Caused the deaths of thousands. Who is he?

Cluster B Personality Disorders  People with Cluster B disorders tend to be dramatic, emotional, and attention-seeking.  They have intense interpersonal conflicts.  Personality disorders are characterized by inflexible long-standing and maladaptive personality traits that cause significant functional impairment or subjective distress.  Temperamental deficiencies  Rigidity in dealing with life problems  Defective perceptions of self and other

Antisocial personality disorder (301.7)  Cluster B personality disorder  Pervasive pattern of disregard for, and violation of, the rights of others that begins in childhood or early adolescents and continues into adulthood.  Also referred to a psychopathy, sociopathy or dyssocial personality disorder  At least 18 years old  History of three or more symptoms of Conduct Disorder before age 15.  At least 4 antisocial symptoms as an adult  Fail to conform to social norms with respect to lawful behavior.

 Irritable and aggressive  Get into fights or commit acts of physical assault.  Lack of empathy  Callous, cynical and contemptous of the feeling, rights and sufferings of others  Excessively opinionated, self-assured and cocky  Glib, superficial charm  Blame victim for being foolish

Psychopaths  Subcategory of APD  more severe  More intense  Cold, callous  Unemotional  White collar psychopaths  Able to control their criminality, but still act out in other ways.

Hare Psychopathy checklist - revised  3 factors  Arrogant & deceitful interpersonal style  Deficient affective experience  Impulsive & irresponsible interpersonal style  Doesn’t believe DSM-IV-TR captures “personality” aspect of the disorder  Overemphasizes behavioral manifestations and criminality

Narcissistic personality disorder (301.81)  Pervasive pattern of grandiosity, need for admiration, lack of empathy that begins by early adulthood and is present in a variety of contexts.  Grandiose sense of self-importance  Often preoccupied with fantasies of unlimited success, power, brilliance, beauty or ideal love  Believe they are superior, special, or unique and expect others to recognize them as such  Require excessive admiration  Sense of entitlement, unreasonable expectation of especially favorable treatment  Unconscious or unwitting exploitation of others  Lack of empathy

HISTORY  Phillipe Pinel  Observed people with explosive & irrational violence. These patients seemed to understand their actions & surroundings, did not display delusions  Manie sans delire – mania without delirium

History continued -  1891 Koch introduced term psychopathic inferiority  attempted to define a physical basis rather than moral condemnation

Statistics  2% US population  More frequent in urban environments  Lower socioeconomic groups  Rates comparable across ethnicities  5x more common among 1st degree biological relatives of males  10x more common among 1 st degree relatives of females

Etiology  APD- brains mature abnormally slow rate  Similarities between the EEGs of adult psychopaths and normal adolescents  Egocentricity  Impulsivity  Selfishness  Unwillingness to delay gratification

 Early brain damage in frontal cortex  Similarities  Poor long term planning  Low frustration tolerance  Shallow affect  Irritability & aggressiveness  Socially inappropriate behavior  impulsivity

Etiology continued -  Prolonged separations from primary caregivers, desertion and divorce (not death)  Father’s antisocial or deviant behavior  Mother’s unaffectionate, neglectful care

Epidemiologic Catchment Area study  Study of psychiatric illnesses  15,000 people in 5 US cities  Did not include individuals in prison  Found:  2 -4% men &.5-1% women antisocial  In the US this would mean approximately 7 million Americans antisocial

Treatment Options  Unfortunately, most APD/NPD don’t think anything is wrong with them, referred because of others.  Typically untreatable  If going to treat, should be highly structured and secure inpatient setting.  Use of psychotherapy  Is there capacity of patient to form attachments?  Can patient form genuine emotional relationship with therapist?

European Description of Dissocial Personality Disorder  ICD-10 Classification of Mental and Behavioral Disorders  Personality disorder, usually coming to attention because of a gross between behavior and the prevailing social norms, characterized by at least 3 of the following:  Callous unconcern for the feelings of others  Gross and persistent attitude of irresponsibility and disregard for social norms, rules and obligations  Incapacity to maintain enduring relationships, though having no difficulty in establishing them  Very low tolerance to frustration and low threshold for discharge of aggression, including violence  Incapacity to experience guilty and to profit from experience, especially punishment  Marked proneness to blame others, offer plausible rationalizations  Persistent irritability  Conduct disorder during childhood not always present

 C – cannot follow the law  O - obligations ignored  R - remorselessness  R - recklessness  U - underhandedness  P - planning deficit  T - Temper

Were they?