PERSONALITY DISORDERS Alberto L. Choy MD FRCPC Psychology 344 Fall 2003 Forensic Psychology University of Toronto, Erindale

Introduction  Overview of the DSM-IV (credits to)  Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition  Descriptions of personality disorders and application to forensic settings

THE MULTIAXIAL ASSESSMENT  Axis I: clinical disorders - “mental illnesses” and mental disorders  Axis II: personality disorders and mental retardation  psychologists can diagnose with the multiaxial assessment

DIMENSIONAL MODELS  other models to describe personality  maladaptive variants of personality traits -  eg: “five factor model” neuroticism, introversion vs. extroversion, closedness vs. openess (to experience), antagonism vs. agreeableness, conscientiousness

PERSONALITY TESTING  Millon Clinical Multiaxial Inventory (MCMI) no “norms” between patients and normals biased towards “finding” problems  Minnesota Multiphasic Personality Inventory (MMPI-2) most widely used in forensic assessments measures that address test taking attitudes

PERSONALITY TRAITS  an enduring pattern of perceiving, relating to, and thinking about the world and oneself, exhibited in a wide range of social and personal contexts  examples: impulsivity, social anxiety, affective stability

PERSONALITY DISORDER (1/3)  personality traits are maladaptive and inflexible  and  significant functional impairment or subjective distress  “extremes of personality characteristics”

PERSONALITY DISORDER (2/3)  inner experience and behaviour deviates from cultural expectation  impairment in 2 of: cognition affectivity interpersonal functioning impulse control

PERSONALITY DISORDER (3/3)  inflexible and pervasive, broadly  significant distress and/or function(s) disturbance  stable and life-long  NOT due to another mental disorder, substances, medical condition  “traits” vs. personality disorder

Paranoid Personality Disorder  pervasive distrust and suspiciousness  sees other’s motives as malevolent  criteria may include: suspicions that they are being exploited unjustified doubts about loyalty of others closed; fear of information used against reacts angrily to perceived attack suspcious / jealous of spouse not psychotic

Schizoid Personality Disorder  detatchment from social relationships  restricted range of expressed emotions  prefer being alone  criteria may include: no interest in close relationships, including family little interest in sex with others no close confidants emotional flatness

Schizotypal Personality Disorder  discomfort with relationships  odd, eccentric thoughts / behaviour  criteria may include: ideas of reference (not delusions) magical beliefs (not cultural) suspiciousness or odd / constricted affect lack of close friends social anxiety: more paranoid

Antisocial Personality Disorder  disregard for, and violation of, the rights of others  terms: psychopathy, sociopathy, dyssocial  criteria may include: impulsive behaviours (drugs, crime) lacking in remorse deceitful / conning / manipulative irritable / aggressive evidence of Conduct Disorder (before 15)

Borderline Personality Disorder  pervasive instability: self image, relationships, affect - impulsivity  criteria may include: frantic avoidance of abandonment unstable, intense interpersonal relationships impulsive behaviour marked reactivity of mood / rage / emptiness recurrent self-harm/suicide

Histrionic Personality Disorder  excessive emotionality and attention seeking behaviour  criteria include: flamboyant appearance / behaviour superficial, rapidly shifting emotions suggestible believes relationships are deeper than they really are seductive or provocative, socially

Narcissistic Personality Disorder  grandiosity, need for admiration, lacking in empathy  criteria may include: solely self-involved: “no.1”, entitled derogatory to others, for himself grandiose, self important, may exaggerate believes he is “special” / high status associates lacks empathy interpersonally exploitive

Avoidant Personality Disorder  social inhibition / anxiety and feelings of inadequacy  criteria may include: marked social anxiety / avoids contact strong wish for relationships restraint in relationships: fear of shame sees self as inept, unappealing, inferior avoids risk, especially of embarrassment

Dependent Personality Disorder  excessive need to be taken care of  submissive, clingy  criteria may include: fear of separation / abandonment will do unpleasant things to obtain nurturance unable to decide without excessive advice / reassurance will not express disagreement urgent relationship seeker: to be taken care of

Obsessive-Compulsive Personality Disorder  preoccupation with detail, order, control  at the expense of openness, efficiency  criteria may include: excessive: rules, details, lists, organization perfectionism, but too slow / stubborness “workaholic” without friends / leisure inflexible, scrupulous: morals, ethics may not throw things out will not delegate tasks

Personality Disorder Not Otherwise Specified  mixed traits  dysfunction

APPLICATION  CRIME  CIVIL / DISABILITY  ADAPTIVE ASPECTS

CRIME  murder  serial murder / group murder cults  sex mutilation  assaults  fraud / robbery  domestic violence  harrassment

CIVIL  disability  malingering in disability

Comorbidity  Major mental illness  substance use / abuse  psychopathy