1. Personality Disorders and Impulse Control Disorders

2. Personality disorders
Characteristics
Inflexible and maladaptive behaviors
Social difficulties, subjective distress, or dysfunction
5-15% of admissions
10-15% lifetime prevalence

3. Gender Distribution Men Women More paranoid, OCPD and antisocial
More borderline, dependent, and histrionic

4. Diagnostic Challenges
Recorded on Axis II of DSM
Categorical approach e/o
Extreme versions of normal personality traits
Dimensional approach
Concerns
Number of factors
Are personality quirks disorders
High degree of comorbidity
Cross over to Axis I

5. Etiological and treatment considerations
Use – FFM of personality and see disorders as extremes of personality traits
Neuroticism
Extraversion
Openness
Agreeableness
Conscientiousness

6. Causes Genetics Environment Some correlates
Some evidence of differences in neuro-activity
Some evidence of neuro-structural differences
Environment
Family
Society
Damage to brain

7. Treatment Varied approaches
Cognitive behavioral treatments
Drug treatments
Clinicians are somewhat pessimistic about the prognosis
Help is often not sought
Behavior rarely results in involuntary treatment
Research to verify efficacy of treatments is needed

8. Three clusters of personality disorders
Odd or eccentric
Paranoid, schizoid, schizotypal
Dramatic, emotional, or erratic
Histrionic, narcissistic, antisocial, borderline
Anxious or fearful
Avoidant, dependent, obsessive-compulsive

9. Odd or Eccentric

10. Paranoid Suspiciousness, lack of emotion, hypersensitivity
Higher among males
Tend to externalize blame and guilt
Not inclined to seek out treatment
Psychoanalytic view suggests projection: self onto others
Cognitive-behavioral therapy aimed at reducing paranoid tendencies

11. Schizoid Desired social isolation
Defect in the capacity to form social relationships
Does not involve abnormal ideas or perceptions
Treatment focuses on facilitating the development of intimate relationships by fostering the building of networking

12. Schizotypal Oddities of thinking Social isolation
Ideas of reference
Magical thinking
Social isolation
Communication symptoms
Vague, digressive, tangential, overly elaborate
Not incoherent
Schizophrenic like symptoms
Does correlate with onset of schizophrenia
Do not lose contact with reality
Treatment focuses on teaching clients to evaluate their environment objectively

13. Dramatic, Emotional, or Erratic

14. Histrionic Self-dramatizing, attention seeking, exaggerated emotions
Higher among women
Superficially charming,
Viewed by others as insincere and shallow
Egocentric
Flirtatious, seductive, yet non-committed
Strong correlations with APD
May be related to Inconsistent patterns of reinforcement by parents
Treatment should focus on defensiveness of client

15. Narcissistic Exaggerated self-importance
Denial and devaluation of others to prop up self-concept
More prevalent in males
More critical of others than self
Entitlement
Fragile self-esteem and deep seated fear of failure
View dependency as dangerous, relies on self for evaluation
Histrionics depend on others for aproval

16. Antisocial Personality Disorder
No guilt
Little loyalty
Predominantly male
Crossover between
Antisocial personality disorder (behaviors)
Those who score high on psychopathy (personality traits)
Criminality
Criminality aspect of APD spurs research

17. Borderline Personality Disorder
Fluctuations in mood, angry outbursts, identity problems, emptiness, capriciousness
Most commonly diagnosed personality disorder
More common in women
Lack of purposefulness
Etiological theories
Psychodynamic: others are either all good or all bad
Social learning: poor coping skills
Cognitive: mistaken assumptions and attributions
Treatment focuses on motivational issues, skill training, supportive acceptance
High attrition rates
Effectiveness of treatments is difficult to determine

18. Anxious or Fearful Avoidant
Desires attention from others but sensitive to disapproval: fear of appearing foolish
Strong similarity to social phobia
Fantasies of intimacy
Depression and inadequacy
Some evidence of hypersensitivity to sensory stimuli
Behavioral treatments show some success

19. Dependent Characteristics Unwilling to assume responsibility
Low self confidence
Let others decide
Subordinate their needs to the needs of others
Even in the face of abuse
Fundamental beliefs
See selves as inadequate
Solution is to depend on another
More common 7% (culture)
More women
High rate of comorbidity with mood disorders
Associated with overprotective, authoritarian parenting styles
More responsive to therapy than other PDs
Caution regarding drug treatments and therapist/client relationship

20. OCPD
Characteristics
Perfectionism
No expression of warmth
Demanding of others (controlling)
Detail oriented
Rigidity
Indecisive
Impaired functioning at work or in relationships
Twice as common in men
Somewhat responsive to cognitive behavioral therapy

21. Antisocial Personality Disorders
Historical Views
Moral insanity, moral imbecility, moral defect, psychopathic inferiority
Current diagnosis is less oriented on “morals”

22. Cleckley’s Characteristics
Superficial charm
Intelligence
Shallow emotions
Little plan of order
Failure to learn from experience
Unreliability
Dishonesty

23. Three Central Themes Inadequately motivated antisocial behaviror
Absence of a conscience and a sense of responsibility to others
Emotional poverty

24. DSM-IV-TR on APD Characteristics Prevalence
Over 18
History of truancy/delinquency before age 15 (conduct disorder
Egocentricity
Impulsivity
Antisocial behavior
Prevalence
3% of population
Predominately men
Primary type lacks guilt, secondary type some remorse

25. Explanations of APD Psychodynamic
Faulty superego development
Lack of parental identification: Oedipal Complex
Family and socialization perspectives
Divorce and socioeconomic indicators weak predictors
Poor parental involvement and prenatal hostility good predictors
Antisocial father that is manipulative is good predictor

26. Genetic influences
5 times more common among first – degree biologic relatives of males
MS twins’ concordance rates higher than DZ twins
Greater likelihood among adoptees with APD biologic parents, still some environmental factors may be involved

27. Central nervous system abnormality
Diminshed brain wave activity
Similar to the activity of the brain of a child
Limited evidence

28. Autonomic nervous system abnormalities
                                             
Inability to learn from experiences
Reduced ability to learn from shocks: less galvanic skin response to potential shock
Absence of anxiety,
Thrill- seeking behaviors

29. Fearlessness or lack of anxiety
Failure to learn avoidance because of under-arousal
Fewer inhibitions about engaging in antisocial behavior

30. Arousal, sensation seeking, and behavioral perspectives
Big thrill seekers
Constructive: test pilot
Destructive: ASP
Type and certainty of punishment
Ineffective
Physical, social, material
Effective
Loss of memory, certain punishment

31. Treatment of APD Poorly motivated to change themselves
Behavior controls
Behavioral and cognitive approaches are not very effective
Prevention: since treatments are not very effective, work to redirect youth with APD tendencies

32. Disorders of Impulse Control
Characteristics
Failure to resist temptations
Tension before committing act
Release after committing act
Guilt may or may not be felt

33. Types of Impulse Control Disorders
Intermittent explosive disorder: episodes of uncontrolled aggression
Kleptomania: failure to resist impulses to steal
Pathological gambling: inability to resist gambling
More common in males
Manic when winning, depressive after
Cognitive treatment focuses on “chance” aspect of gambling

34. Types of Impulse Control Disorders (Cont.)
Pyromania: deliberate fire setting
Pleasure in observing the fires
Hostile and impulsive
More common in males
Trichotillomania: urge to pull out one’s own hair
More common in women
1% of college students report current or past history

35. Etiology and treatment of ICD
Little information on causes
Similar to OCD, substance abuse, sexual deviance
Psychoanalytic theory stresses sexual symbolism
Behaviorists stress variable reinforcement schedule
Lesieur
Impulse control problems on a continuum
Impulse control disease
Treatments often include behavioral and cognitive methods