1. Personality Psychopathology
Chapter Fourteen
Personality Psychopathology

2. Personality Psychopathology
Concept of “personality” in psychology means three things:
Refers to individual’s recognizable behaviors in which pattern, order, and regularity can be identified
Personality is a psychological construct
Personality influences how we respond but also causes us to act in certain ways
Can personalities be pathological?

3. Personality Psychopathology (cont’d.)
Personality disorder:
Characterized by impairment in self and interpersonal functioning and presence of inflexible, long-standing, pathological personality traits
Many individuals with personality disorders are never diagnosed
5-15% of hospital admissions and outpatient clinics
Lifetime prevalence: 9-13%

4. Diagnosing Personality Psychopathology
Can be diagnosed through two routes:
Being categorized as showing characteristics from one of the six specific personality disorder types
Possessing certain specific personality traits that impair functioning

5. Diagnosing Personality Psychopathology (cont’d.)
Figure 14-1 Diagnosing Personality Disorders: Two Paths

6. Levels of Personality Functioning
According to the DSM-5:
Impairments in self functioning and in interpersonal functioning, meeting all criteria:
Degree of impairment is measured on five-point “Levels of Personality Functioning” scale
From no impairment to extreme impairment

7. Sociocultural Considerations
DSM-5 recognizes importance of cultural, ethnic, and social background
“Impairment or adaptive” implies within the individual’s contextual norms and expectations
Gender implications:
Borderline personality disorder in women
Antisocial personality disorder in men
Gender bias plays a role

8. Personality Disorder Types and Trait Specified: A Hybrid Approach
Less emphasis on Axis I versus Axis II
Personality disorders are chronic, developmental, and relatively inflexible patterns of responding that are less likely to be changed in treatment
Personality disorders can coexist with one or more clinical disorders
Hybrid approach: difference between categorical disorders and those described on continuum of traits

9. Personality Disorder Types
Six personality disorder types:
Schizotypal
Borderline
Avoidant
Narcissistic
Obsessive-compulsive
Antisocial
Diagnosis involves “matching” individual with DSM-5 description of disorder

10. Schizotypal Type
Characterized by peculiar thoughts and behaviors and by poor interpersonal relationships
Many with disorder believe they have magical abilities or special powers; some are subject to recurrent illusions
Primarily cognitive distortions; affective and interpersonal problems are secondary

11. Schizotypal Type (cont’d.)
Characteristics resemble a less serious form of schizophrenia
Possible genetic link
Treatment:
Dynamic, supportive, cognitive-behavioral, and group psychotherapy
Small doses of anxiolytics can be used for anxiety

12. Borderline Type
Characterized by intense fluctuations in mood, self-image, and interpersonal relationships
Those with disorder are impulsive, have chronic feelings of emptiness, and form unstable relationships
May be friendly one day and hostile the next
Probability of suicide higher

13. Borderline Type (cont’d.)
Most commonly diagnosed personality disorder
May exhibit transient psychotic symptoms such as auditory hallucinations, but they know these are unacceptable
May best be viewed on a continuum

14. Borderline Type (cont’d.)
Diverse models used to conceptualize:
Psychodynamic perspective
Stress in early childhood experiences
Contemporary explanations
Mood regulation as central to disorder
Biological factors including abnormal prefrontal cortex structures and amygdala activation pattern
Cognitive-oriented approaches
Distorted or inaccurate attributions
Dialectical behavioral therapy (DBT)
Smaller drop-out rate and suicidal behaviors

15. Avoidant Type
Characterized by a fear of rejection and humiliation and a reluctance to enter into social relationships
Want social interactions but fear them
Disagreements over diagnostic category
Treatment:
Cognitive-behavioral, psychodynamic, interpersonal, and psychopharmacological

16. Narcissistic Type
Characterized by exaggerated sense of self-importance, exploitative attitude, and lack of empathy
Symptoms may present in adolescents who are later diagnosed as adults
Individual psychotherapy and group therapy are recommended
Little treatment success

17. Obsessive-Compulsive Type
Characterized by perfectionism, a tendency to be interpersonally controlling, devotion to details, and rigidity
Differs from OCD:
Pervasive character disturbance
Individuals see their way of functioning as correct
Treatment:
Cognitive-behavioral and supportive forms of psychotherapy; no medications are currently available

18. Antisocial Type
Characterized by a failure to conform to social and legal codes, a lack of anxiety and guilt, and irresponsible behaviors
Composed of three factors:
Arrogant and deceitful interpersonal style
Deficient affective experience
Impulsive and irresponsible behavioral style

19. Antisocial Type (cont’d.)
Antisocial Personality Disorder (George), Part 1 George describes the symptoms of his antisocial personality disorder.

20. Antisocial Type (cont’d.)
Antisocial Personality Disorder (George), Part 2 George describes the symptoms of his antisocial personality disorder.

21. Antisocial Type (cont’d.)
Problems with self-identity integration
Much more frequent in urban environments and in lower SES
Distinct from impulse control problems
Difficult population to study
Only one out of seven seek treatment

22. Former Personality Disorders
Originally 10 disorders identified in DSM-IV-TR; clinical evidence did not support four of these:
Paranoid, schizoid, histrionic, and dependent personality disorders
Justification for removal:
Absence of research
Excessive co-occurrence
Arbitrary diagnostic thresholds
DSM-5: continuum of personality traits

23. Multipath Analysis of One Personality Disorder: Antisocial Type
Figure 14-2 Multipath Model of Antisocial Personality Disorder The dimensions interact with one another and combine in different ways to result in antisocial personality disorder.

24. Biological Dimension Genetic influences Heredity looks to be a factor
Twin studies
Evidence supports for genetic basis does not preclude environmental factors; undoubtedly caused by both
Difficult to determine causal relationship
Genetic studies do not show how antisocial type is inherited

25. Biological Dimension (cont’d.)
Autonomic nervous system abnormalities
Genetic predisposition to fearlessness or lack of anxiety
Arousal, sensation-seeking, and behavioral perspectives

26. Psychological Dimension
Psychodynamic perspective:
Faulty superego development
Cognitive perspective:
Core unconscious beliefs that influence behavior
Learning perspective:
Inherent neurobiological characteristics that delay or impede learning
Lack of positive role models
Presence of poor role models

27. Psychological Dimension (cont’d.)
Figure 14-3 Effect of Type of Punishment on Psychopaths and Others The effects of three different types of punishment on an avoidance learning task are shown for three groups of participants. Although physical or social punishment had little impact on psychopaths’ learning, monetary punishment was quite effective.
Source: Schmauk (1970).

28. Social Dimension Family and socialization: Impoverished backgrounds
Poor parental supervision and involvement
Neglect, hostility, maltreatment, abuse
Parental rejection/deprivation
Dysfunctional family structure
Parental separation or absence
Do not learn to pay attention to social stimuli

29. Sociocultural Dimension
Gender:
Males more likely to exhibit both conduct disorders and antisocial personality disorder than females; possibly different pathways
Relational aggression in women
Cultural values:
“Rugged individualism” in U.S.
Competitive environment bred by U.S. values could fuel aggressive and violent behavior

30. Treatment of Antisocial Personality Disorder
Individuals feel little anxiety and as a result, lack motivation for treatment
Approaches that require cooperation of client may be ineffective
Programs may need enough control to force confrontation of relationships and affect behavior
Behavior modification:
Most useful is skill-based and behavioral treatment using material rewards, but not long-lasting

31. Treatment of Antisocial Personality Disorder (cont’d.)
Cognitive approaches:
Therapist must build rapport and guide client away from thinking in terms of self-interest and immediate gratification, and toward higher levels of thinking regarding self and others
Current treatments not effective
Need to focus on antisocial youths who appear amenable to treatment and involve families and peers
Individuals may respond to programs involving physical and mental stimulation

32. Personality Disorder Trait Specified
Personality disorders viewed as extremes of underlying dimensions of normal personality traits (assessed on scaled continuum)
DSM-5 uses five-point degree of match between description of disorder type and client

33. Personality Disorder Trait Specified (cont’d.)
Five-domain trait dimensional diagnostic system for assessing personality disorders
Trait: specific personality characteristic possessed by individual; may be organized around a domain
Existence of one or more domain traits that impair interpersonal functioning is sufficient to indicate personality disorder

34. Personality Disorder Trait Specified (cont’d.)