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1

Personality Disorders
- signs
- prevalence
- Diagnostic criteria

Behavior patterns involving overly rigid and maladaptive expression of personality traits; reflect extreme variations on underlying personality traits such as undue suspiciousness, excessive emotionality, and impulsivity.
−Warning signs of P disorder may emerge in childhood with behaviors involving disturbed conduct, depression, anxiety, and immaturity
−Estimated 6 to 10% of population affected
- 18 and older

2

Personality

describes the set of distinct traits and behaviors that make us unique and help account for consistency in behavior.

3

Ego syntonic

(psychodynamic term) describes how most with P disorder tend to perceive their traits as a natural part of themselves

4

Ego dysntonic

describes those with mood and anxiety disorders who do not see their behaviors as parts of their identities.

5

Personality Disorder Clusters

1.Cluster A: Those who are perceived as odd or eccentric; includes paranoid, schizoid, and schizotypal p disorders
2.Cluster B: Those who are perceived as overly dramatic, emotional, or erratic; consists of antisocial, borderline, histrionic, narcissistic p disorders.
3.Cluster C: Those who appear anxious; includes avoidant; dependent, and OCD p disorders

6

Personality disorders characterized by odd or eccentric behavior
- common characteristics

Includes paranoid, schizoid, and schizotypal disorders
•Often have difficulty relating to others or show little or no interest in developing social relationships

7

Paranoid Personality Disorder
- Prevalence/gender
- Cultural diffs

pervasive suspiciousness, tendency to interpret other’s behavior as threatening or demeaning; excessive mistrust in others; overly sensitive to critiscism; readily angered and hold grudges; Tend to remain hyperviligent; deny blame for misdeeds; Not delusional (unlike paranoid schizo)
- Perceived by others as: Aloof, cold, scheming, devious, and humorless, arguementative
- 2.3-4.4% more in men
- immigrants of minorities may seem guarded and defensive but this may reflect unfamiliarity with the language or customs.

8

Schizoid Personality Disorder
- Prevalence/Gender

persistent lack of interest in social relationships, flattened affect, and social withdrawal. Social isolation the cardinal feature
• Emotions appear blunt but not to the degree found in schizo
• They rarely experience joy, anger, or sadness; rarely smile
• May seem indifferent to criticism
• Seem to be wrapped up in abstract ideas
- 3.1- 4.9%
- may still have curiosities about ppl and wishes for love they cannot express
In some cases sensitivity is expressed in deep feelings for animals rather than ppl

9

Schizotypal Personality Disorder
- Prevalence/Gender
- Culture
- Spectrum

- persistent difficulties in forming close relationships with others and display behaviors, mannersims and thought patterns that seem odd but not disturbed enough to merit schizo.
• Lack of coherent sense of self; distorted self-concept or lack of self-direction.
• Lack the capacity for empathy, lack of understanding how their behavior affects others or misinterprets other’s behaviors.
• Anxious in social situations; Social anxiety often linked to paranoid thinking ( fears that others mean them harm) rather than to concerns about being rejected by others.
- 4.6% higher in males
- Higher rates in Blacks than whites or Mex’s
- Appears to share same genetic base as schizo; similar brain abnormalities
however Relatively few of those with this p disorder develop schizo

10

Schizotypal behaviors
-5

1. May have unusual perceptions or illusions such as feeling precscence of dead family member. (they know person isn’t acutally there)
2. May develop ideas of reference such as beleiveing that others are talking about them behind their back
3. May engage in magical thinking such as believing they have a sixth sense (can tell future) or that others can sense their feelings.
4. they may attach unusal meaning to words and speech may become unusally abstract or vague; thought processes appear odd and marked by metaphorical thinking (but without loose assocs in schizo)
5. They may appear unkept and talk to themselves; show little emotion or laugh at wrong times

11

Personality disorders characterized by dramatic emotional or erratic behavior
- common characteristics

Antisocial, BPD, Histrionic, Narcisstic
• Exhibit behaviors that are excessive, unpredictable, or self-centered
• Difficulty maintaining relationships and show antisocial behavior

12

Antisocial Personality Disorder
- Diagnostic criteria
- Prevalence/Gender
- Research
- Sociocultural factor
-Key features of antisocial behavior (7)

antisocial and irresponsible behavior and a lack of remorse for misdeeds; violate rights of others; disregard social norms; break the law; Use others However, They don’t seek to avoid people; Tend to be impulsive and fail to live up to commitments to others; Often show a superficial charm and posses average intelligence; Have little anxiety when faced with threating situations;Punishments do nothing
- 3+ symptoms
- 6% in men, 1% women
- Most researched p disorder
-Disorder is most common in lower SES groups; one explanation is that ppl with this disorder drift downward occupationally; those with lower SES levels may also be more likely to have parents who modeled antisocial behavior
- 1. Failure to adhere to social rules, norms, laws
2. Aggressive behavior
3. Lack of responsibility- failure to maintain job due to abscences/ pay debts/ maintain relationships
4. impulsive behavior
5. Lack of truthfulness (using ppl)
6. Reckless behabior
7. Lack of remorse for misdeeds

13

Psychopath and sociopath (2)

•Clinicians once used terms such as pscyopath and sociopath to refer to those who are classified as antisocial
•Roots of the word psychopath focus on the idea that there is something amiss pathologically in the person’s functioning; roots of sociopath center on their social deviance

14

Course of Antisocial disorder (2)

1. emerge before the age of 15 in form of conduct disorder; These early forms of adolescent behavior may include truancy, running away, initiating physical fights, use of weapons, sexual activities, cruelty to people or animals, destruction of property, lying, stealing, robbery
2. Overtime antisocial behavior assoc with the disorder tends to decline with age and may disappear by age 40 but no so for the underlying traits assoc with the disorder (egocentric, manipulativeness, lack of empathy, guilt, remorse, callousness towards others) these may even increase with age

15

Antisocial behavior and criminality (5)

1. Antisocial behavior is assoc with an increase risk of criminality but not all criminal have this personality; many actually law abiding ppl
2. Investigators view on two dimensions:
I.Personality dimension- consists of traits such as superficial charm, selfishness, lack of empathy callous, and remorseless use of other (applies to those who have these traits but aren’t law breakers)
II. Behavioral dimension- adoption of unstable and antisocial lifestyle including freq problems with the law, poor employment history, unstable relationships
3. Many antisocial individuals show both sets of traits
4. Only about half of all inmates could be diagnosed with this disorder
5. Only a minority of those with the disorder are afoul of the law

16

Profile of antisocial person
- traits
- Hervey Cleckly
- psychopathic traits
- common trait

failure to conform to social norms, irresponsibility, aimlessness, lack of long-term goals, impulsivity, outright lawlessness, violence, unemployment, marial problems, sub abuse, disregard for the truth
- argued that the characteristics used to define psychopathic antisocial personality (self-centeredness, irresponsibility, impulsivity, and insensitivity to needs of others) exist not only among criminals but politicians, lawyers, docs and business executives as well.
•Psychopathic traits can be grouped in four basic dimensions:
1.interpersonal factor – grandiosity, superficiality, deceitfulness
2.affective factor – lack of remorse and empathy and failure to accept responsibility
3.antisocial factor- poor behavioral control and antisocial behavior
4.lifestyle factor- characterized by impulsivity and lack of goals
•Irresponsibility, a common trait among antisocial ppl may be seen in a personal history dotted by repeated unexplained absences from work, abandonment of jobs; often extends to financial matters with failure to repay debts

17

Borderline Personality Disorder
- Prevalence/Gender
- Gender behaviors diffs
- Onset
- Culture diffs
- Famous ppl

deeps sense of emptiness, unstable self-image, history of unstable relationships, dramatic mood changes, impulsivity, difficulty regulating negative emotions, self-injurious behavior, recurred suicidal behaviors. Often uncertain about values, goals, and even sex orientation. Cannot tolerate being along; Fear of abandonment leads them to be clinging and demanding in relationships. Feelings towards others are intense and shifting
-1.6-5.9% more in women
-Women tend to show more inwardly directed aggression in forms of self-mutilation; Men tend to show outward expressions
-Usually diagnosed in early adulthood although signs of disorder may be seen in adolescence
-More common among Lat’s than whites and Blacks
-Marilyn Monroe, Lawrence of Arabia, Adolf Hitler, and the philosopher Soren Kierkegaard all had this.

18

"Borderline Personality"

Term BP originally used to refer to individuals who’s behavior appeared to be on the border between neuroses and psychoses

19

Central features of BPD
- maladaptive behaviors
- suicide rates (2)

difficulty regulating emotions; mood changes from anger to depression
-cutting, substance abuse, and lashing out in anger may be attempts at controlling negative emotions; suicide attempt to escape emotions. Self mutilation may also be attempt to manipulate others
-Three out of four make suicide attempts and about 1 in 10 commits suicide

20

Splitting

abrupt shifts in feelings are signs of inability to reconcile the positive and negative aspects of ones experience of oneself and others.

21

BPD symptoms course of development (2)

•Many features of BPD tend to improve over period of years
•Impulsivity tends to burn out with increasing age

22

Histrionic personality disorder
- old term
- Prevalence

excessive emotionality and overwhelming need to be center of attention; approval; appraise. Tend to be dramatic and emotional but there emotions seem shallow and exaggerated and volatile. • Self-centered and intolerant of delays of gratification Grow restless quickly and crave novelty stimulation; drawn to fads. May have a certain charm; flirty and deducing but too wrapped up for intimate relationships or to have deep feelings.Use physical appearance as means of drawing attention to themselves
- Formerly called hysterical personality ; replacement allowed professionals to distance themselves from the notion that the disorder is intractely bound up with females. (hyster-uterus) However, the disorder is diagnosed more in women
- 1.8%

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Narcissistic Personality Disorder
- compared to histrionic
- compared to BPD
- Prevalence/Gender
- healthy
- rejection

inflated self-image and extreme need for attention and admiration; brag and expect others to praise; self-absorbed and lack empathy for others; insatiable ambition not for money but for adulation that comes with success
• Share features with histrionics such as demanding attention however they have more inflated views of themselves and are less melodramatic
- more organized in thoughts and actions and better relationships
- Affects 1 - 6.2% more than half are men
- A certain degree of narcissism may represent a healthful adjustment to insecurity; shield from criticism; motive for achievement
- Narcissistic injuries is being extremely sensitive to slightest hint of rejection or criticism; hurt deeply because they reopen old psych wounds

24

Personality Disorders Characterized by Anxious or Fearful Behavior

Avoidant, dependent, OCP

25

Avoidant Personality Disorder
- Prevalence/Gender
- Comorbidity

avoidance of social relationships due to fear of rejection; only enter relationships with ardent acceptance. Unlike schizoid qualities with whom they share the feature of social withdrawal they do have interest in other and warmth towards people. Fear public embarrassment; stick to routines and exaggerate risks of trying new things
- Affects 2.4%; equally common in genders
- Often comorbid with social anxiety disorder; suggests they may share common genetic factors
May turn out that avoidant p disorder is just severe form of social anxiety disorder

26

Dependent Personality Disorder
- Prevalence/Gender
- Culture
- Controversy
- Other disorder link

difficulty making independent decisions and overly dependent behavior; overly submissive and clinging in relationships; difficulty making independent decisions and overly dependent behavior; overly submissive and clinging in relationships. Overly sensitive to criticism and fear rejection. They may do degrading things to please others
- Less than 1% more in women
• May differ among cultures (arranged marriages/ patriarchal societies)
• Applying diagnosis to women may seem controversial and seem to be blaming the victim bc women in our society are often socialized to dependent roles
- linked to mood disorders and social phobia; also to hypertension, CVD, and gastro disorders like ulcers and colitis

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Psychodynamic theory of dependent disorder -3

1. Link between this disorder and oral behavior problems like smoking, eating disorders, and alcoholism
2. Psychodynamic theorists trace dependent behaviors to utter dependence of the new born baby and baby’s seeking of nourishment through oral means (food may symbolize love)
3. Those with this disorder often attribute problems to physical rather than emotional causes and seek help from doctors instead of psychologists

28

Obsessive -Compulsive personality disorder
- Prevalence/Gender

rigid ways of relating to others, perfectionistic tendencies, lack of spontaneity, excessive attention to detail; excessive orderliness; difficulty coping with ambiguity, difficutly expressing feelings and meticulous work habits; often leads them unable to complete work in time
-Affects 2.1-7.9% of the population Twice as common in men as women

29

Problems with the classification of personality disorders -6

1. Categories or dimensions?
2. Problems distinguishing personality disorders form other clinical syndromes
3. Overlap among disorders
4. Difficulty in distinguishing between normal and abnormal behavior
5. Confusing labels with explanations
6. Sexist Biases

30

Personality disorders – Categories or Dimensions? (3)
- Dimensional model of p disorders (2)
- Antisocial on dimensional model

1. are they distinct categories marked by particular symptoms or behavioral OR variations of common personality dimensions found in general population?
2. DSM is categorical and may rely too much on arbitrary cutoffs
3. Many of features assoc with disorders found in general pop
- an alternative to the traditional categorical model of the DSM; depicts p disorders as maladaptive and extreme variations along a continuum of traits in general pop
- Thomas Widiger; p disorders can be represented as exreme varaitions of the following five basic traits of personality that comprise the five-factor model: 1. Neuroticism (or emotional instability) 2. Extraversion 3. Openness to experience 4. Agreeableness (friendliness) 5. Conscientiousness
- low levels of conscientiousness and agreeableness