abnormal PSYCHOLOGY Third Canadian Edition Prepared by: Tracy Vaillancourt, Ph.D. Chapter 13 Personality Disorders

Heterogeneous group of disorders coded on Axis II of the DSM Regarded as… –long-standing, pervasive, and inflexible patterns of behaviour and inner experience that… –deviate from cultural expectations –causes impairment in social and occupational –can cause emotional distress

Reliability

Personality Disorder Clusters Cluster A –paranoid, schizoid, and schizotypal oddness and avoidance of social contact Cluster B –anti-social, borderline, histrionic, and narcissistic dramatic, emotional, or erratic extrapunitive and hostile Cluster C –avoidant, dependent, and obsessive-compulsive appear fearful

Personality Disorder Clusters Personality Disorders Axis II Cluster A paranoid Schizoid schizotypal Cluster B anti-social borderline histrionic narcissistic Cluster C avoidant dependent obsessive-compulsive

Cluster A: Odd/Eccentric Cluster

Paranoid Personality Disorder Characteristics –suspicious of others –expect to be mistreated or exploited by others –reluctant to confide in others –tend to blame others –can be extremely jealous Prevalence and Comorbidity –Prevalence about 1% –Occurs most frequently in men –Comorbid with schizotypal, borderline, and avoidant personality disorders

Schizoid Personality Disorder Characteristics –no desire for or enjoyment of social relationships –appear dull, bland, and aloof –rarely report strong emotions –have no interest in sex –experience few pleasurable activities –indifferent to praise and criticism Prevalence and Comorbidity –Prevalence < 1% –Slightly more common in men –Comorbid with schizotypal, avoidant, and paranoid personality disorders

Schizotypal Personality Disorder Characteristics –interpersonal difficulties of schizoid personality –  social anxiety –eccentric symptoms identical to prodromal and residual phases of schizophrenia odd beliefs or magical thinking recurrent illusions odd speech ideas of reference suspiciousness, paranoid ideation –eccentric behaviour and appearance Prevalence and Comorbidity –Prevalence about 3% –Slightly more frequent among men than women –Comorbid with borderline, avoidant and paranoid personality disorders

Etiology of Cluster A Genetically linked to schizophrenia Perhaps less severe variants of this Axis I disorder

Cluster B: Dramatic/Erratic Cluster

Borderline Personality Disorder Characteristics –core features are impulsivity and instability in relationships, mood, and self-image –attitudes and feelings toward others vary dramatically –emotions are erratic and can shift abruptly –argumentative, irritable, sarcastic, quick to take offence, etc. Prevalence and Comorbidity –Prevalence 1 to 2% –More common in women than in men –Comorbid with mood disorder, substance abuse, PTSD, eating disorders, and cluster B PDs

Etiology of BPD Object-relations theory Biological evidence –runs in families –poor functioning of the frontal lobes Linehan’s diathesis- stress theory

Histrionic Personality Disorder Characteristics –overly dramatic and attention-seeking –use physical appearance to draw attention –display emotion extravagantly –self-centred –overly concerned with their attractiveness –inappropriately sexually provocative and seductive –speech may be impressionistic and lacking in detail Prevalence and Comorbidity –Prevalence 2 to 3% –More common among women than among men –Comorbid with depression and BPD Etiology –Unknown

Narcissistic Personality Disorder Characteristics –grandiose view of own uniqueness and abilities –preoccupied with fantasies of great success –require almost constant attention and excessive admiration –lack empathy –envious of others –arrogant, exploitive, entitled Prevalence and Comorbidity –Prevalence < 1% –Comorbid with BPD Etiology –product of our times and system of values?

Antisocial Personality Disorder Characteristics –Two major components: 1) Conduct disorder present before 15 and 2) Pattern of anti-social behaviour continues in adulthood irresponsible and anti-social behaviour work only inconsistently break laws irritable physically aggressive impulsive and fail to plan ahead Prevalence and Comorbidity –Prevalence 3% of adult men and 1% of women (US stats) –3% in Canada –Comorbid with substance abuse

Psychopathy Key characteristic— poverty of emotions both positive and negative –lack of remorse –no sense of shame –superficially charming –manipulates others for personal gain –lack of anxiety

APD and Psychopathy APD and psychopathy— related but not identical –20% of people with APD score  on the Hare PCL-R –all psychopaths are diagnosed with APD but many people APD do not meet the criteria for psychopathy –75 to 80% of convicted felons meet criteria for APD but only 15 to 25% of convicted felons meet criteria for psychopathy

Etiology of APD and Psychopathy Role of the Family Since –Lack of affection –Severe parental rejection –Physical abuse –Inconsistencies in disciplining –failure to teach child responsibility toward others Limitations –1. harsh or inconsistent disciplinary practices could be reactions child’s anti-social behaviour –2. many individuals who come from disturbed backgrounds do not become psychopaths Genetic Correlates –Criminality and APD have heritable components –  concordance for MZ than DZ pairs –adoption studies also provide support

Etiology cont. Emotion and Psychopathy –unresponsive to punishments / no conditioned fear responses –have  than normal levels of skin conductance in resting situations –skin conductance is < reactive when confronted or anticipate intense or aversive stimuli –heart rate normal under resting conditions but in when anticipating intense or aversive stimuli heart rate  than norms Response Modulation, Impulsivity, and Psychopathy –slow brain waves and spikes in the temporal area –< activity in the amygdala/hippocampal formation

Cluster C: Anxious/Fearful Cluster

Avoidant Personality Disorder Characteristics –fearful in social situations –keenly sensitive to possibility of criticism, rejection, or disapproval –reluctant to enter relationships unless sure will be liked Prevalence and Comorbidity –Prevalence 1% –Comorbid with dependent personality disorder, depression and generalized social phobia

Dependent Personality Disorder Characteristics –lack self-reliance –overly dependent on others (sense of autonomy) –intense need to be taken care of –uncomfortable when alone –subordinate own needs Prevalence and Comorbidity –Prevalence 1.5% –More common in women than men –Comorbid with bipolar disorder, depression, anxiety disorders,and bulimia

Obsessive-Compulsive PD Characteristics –perfectionistic approach to life –preoccupied with details, rules, schedules, etc. –serious, rigid, formal, and inflexible –unable to discard worn out and useless objects –does not include the obsessions and compulsions that define OCD Prevalence and Comorbidity –Prevalence 1% –Comorbid with OCD, panic disorder, depression, and avoidant personality disorder

Etiology of Cluster C Unknown –Little data exist Speculation about causes has focused on parent-child relationships

Therapies for PDs Note. Not much research-based information on treating personality disorders –Object-relations psychotherapy –Dialectical behaviour therapy for borderline personality disorder combines client-centred acceptance with a cognitive-behavioural focus

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