1. Disorders of Personality Chapter 19 1 © 2015 M. Guthrie Yarwood

2. Announcements © 2015 M. Guthrie Yarwood 2 Today’s Class: Personality Disorders Wednesday: Finish up personality disorders Help Josh and Lina with their ASPD scale Undergraduate Research Exhibition Friday Dr. Pincus Guest Lecture on Treatment for PD

3. It’s A Party! 3 © 2015 M. Guthrie Yarwood

4. 4 CharacterPersonality DisorderPathological Personality Trait DonnaHistrionic WilliamSchizotypal SherryBorderline WinstonNarcissistic PeterObsessive-Compulsive DoreenParanoid AlanAntisocial MargieAvoidant HaroldSchizoid CarrieDependent © 2015 M. Guthrie Yarwood

5. What is a personality disorder? 5 Symptoms = maladaptive variations within the domains of traits, emotions, cognitions, motives, and self-concept Stable over time and across situations Extreme scores on Big Five and HEXACO All involve distress and impaired social relationships © 2015 M. Guthrie Yarwood

6. Prevalence: 9 – 13% 6 PDPrevalence Paranoid2 – 4 Schizoid3 – 5 Schizotypal4 Antisocial.2 – 3 Borderline1.6 – 6 Histrionic1.8 Narcissistic0 to 6.2 Avoidant2.4 Dependent.5 to.6 Obsessive-Compulsive2.1 to 7.9 Note. Prevalence statistics from community samples. © 2015 M. Guthrie Yarwood

7. Section II of DSM-V 7 Current System for DSM-V © 2015 M. Guthrie Yarwood

8. Three Clusters 8 A Paranoid Schizoid Schizotypal B Antisocial Borderline Histrionic Narcissistic C Avoidant Dependent Obsessive- Compulsive Odd, Eccentric Dramatic, Emotional, Erratic, Impulsive, Aggressive Anxious, Fearful © 2015 M. Guthrie Yarwood Any problems?

9. APD (B) 3+ Paranoid, Schizoid (A) Avoidant and Obsessive-Compulsive (C) 4+ Schizotypal (A) BPD, Histrionic, Narcissistic (B) Dependent (C) 5+ Problems with categorical system: Number symptoms required for diagnoses 9 © 2015 M. Guthrie Yarwood

10. Problems with categorical system PD share similar symptoms (correlated across disorders) Histrionic and Narcissistic Borderline, Avoidant, and Dependent Comorbidity Symptoms within same disorder appear to be un-correlated Paranoid Schizotypal Borderline 10 © 2015 M. Guthrie Yarwood

11. Problems with categorical system: Gender Differences 11 Cluster A: Paranoid, Schizoid, Schizotypal Cluster B: Antisocial, Borderline, Histrionic, Narcissistic Cluster C: Avoidant, Dependent, OCPD Men A Mostly Women B Varies with disorder C © 2015 M. Guthrie Yarwood

12. Section III of DSM-V 12 Proposed System for DSM-V © 2015 M. Guthrie Yarwood

13. Announcements © 2015 M. Guthrie Yarwood 13 Today’s Class: Personality Disorders Wednesday: Finish up personality disorders Help Josh and Lina with their ASPD scale Undergraduate Research Exhibition Friday Dr. Pincus Guest Lecture on Treatment for PD

14. 14 2 Features of PD Impaired Personality Functioning Presence of Pathological Personality Traits © 2015 M. Guthrie Yarwood

15. Proposed System 15 This model includes 6 PD and 1 “Other”: Antisocial Avoidant Borderline Narcissistic Obsessive-Compulsive Schizotypal Personality Disorder –Trait Specified Does not include: Paranoid, Schizoid, Histrionic, Dependent © 2015 M. Guthrie Yarwood

16. Proposed System: Impaired Personality Functioning © 2015 M. Guthrie Yarwood 16 Self-Problems Identity Problems Self-Direction Problems Interpersonal Problems Empathy Problems Intimacy Problems 0 – Healthy, Adaptive Functioning 1 –Some Impairment 2–Moderate Impairment 3 – Severe Impairment 4 –Extreme Impairment

17. Proposed System: Impaired Personality Functioning 17 Self-Problems Identity Problems: No sense of self, unstable (fragile) self-esteem, inability to regulate emotions, emotions inappropriate for context Self-Direction Problems Inability to set realistic or purposeful goals, inability to reflect on outcomes of behaviors, lack internal “meter” for behavior © 2015 M. Guthrie Yarwood

18. Proposed System: Impaired Personality Functioning 18 Interpersonal Problems Empathy Problems Inability to understand other people’s experiences/motivations Inability to engage in perspective-taking Does not understand how his/her behavior affects others Intimacy Problems Lacks positive, long-term relationships; instead, negative interactions View relationships in terms of pleasure or pain to the self Social behavior not reciprocal; focuses on own basic needs © 2015 M. Guthrie Yarwood

19. Impaired Personality Functioning © 2015 M. Guthrie Yarwood 19 Self-Problems: Identity Self-Direction Interpersonal Problems: Empathy Intimacy Antisocial Avoidant Borderline Narcissistic Obsessive-Compulsive Schizotypal Paranoid Schizoid Histrionic Dependent

20. 20 2 Features of PD Impaired Personality Functioning Presence of Pathological Personality Traits © 2015 M. Guthrie Yarwood

21. Pathological Personality Trait Domain Traits Negative Affectivity Emotional Lability; Anxiousness, Separation Insecurity, Submissiveness, Hostility, Depressivity, Suspiciousness Detachment Withdrawal; Anhedonia, Intimacy Avoidance, Depressivity, Suspiciousness; Restricted Affectivity Antagonism Manipulativeness; Deceitfulness; Grandiosity, Attention Seeking; Callousness; Hostility Disinhibition Irresponsibility; Impulsivity; Distractibility; Risk Taking;(Lack of) Rigid Perfectionism Psychoticism Unusual Beliefs and Experiences; Eccentricity; Cognitive and Perceptual Dysregulation 21 © 2015 M. Guthrie Yarwood

22. Pathological Personality Trait Domains 22 Negative Affectivity (v. Emotional Stability) Detachment (v. Extraversion) Antagonism (v. Agreeableness) Disinhibition (v. Conscientiousness) Psychoticism (v. Lucidity) © 2015 M. Guthrie Yarwood

23. 23 CharacterPersonality DisorderPathological Personality Trait DonnaHistrionic WilliamSchizotypal SherryBorderline WinstonNarcissistic PeterObsessive-Compulsive DoreenParanoid AlanAntisocial MargieAvoidant HaroldSchizoid CarrieDependent © 2015 M. Guthrie Yarwood

24. 24 CharacterPersonality DisorderPathological Personality Trait DonnaHistrionicDisinhibition; Antagonism; NA; Detachment WilliamSchizotypalPsychoticism; Detachment SherryBorderlineNA; Disinhibition WinstonNarcissisticAntagonism PeterObsessive-CompulsiveDisinhibition (High C); NA; Detachment DoreenParanoidDetachment; NA; Antagonism AlanAntisocialAntagonism, Disinhibition MargieAvoidantNA; Detachment HaroldSchizoidDetachment CarrieDependentNA © 2015 M. Guthrie Yarwood

25. 25 Dark Tetrad MachiavellianismNarcissismSadismPsychopathy (Paulhus et al., 2014)

26. Some Important Distinctions… © 2015 M. Guthrie Yarwood 26 Narcissistic v. Antisocial OCPD v. OCD Schizoid v. Schizotypal v. Paranoid Histrionic v. Antisocial v. Narcissistic v. Dependent Dependent v. Borderline Dependent v. Avoidant

27. 27 CharacterPersonality DisorderPathological Personality Trait DonnaHistrionicDisinhibition; Antagonism; NA; Detachment WilliamSchizotypalPsychoticism; Detachment SherryBorderlineNA; Disinhibition WinstonNarcissisticAntagonism PeterObsessive-CompulsiveDisinhibition (High C); NA; Detachment DoreenParanoidDetachment; NA; Antagonism AlanAntisocialAntagonism, Disinhibition MargieAvoidantNA; Detachment HaroldSchizoidDetachment CarrieDependentNA © 2015 M. Guthrie Yarwood

28. 28 Causes of PD

29. What do you think causes personality disorders? 29 Environment Genetics Biology Interaction b/w Environment, Genes, and Biology © 2015 M. Guthrie Yarwood

30. Some Environmental Factors 30 Childhood Trauma: number and type of childhood traumas 73% report abuse and 82% report neglect Verbal Abuse (Johnson et al., 2001) Children 3x more likely to receive PD diagnosis in adulthood. High Reactivity: Sensitivity to stimuli (light, noise, texture) As children, more likely to develop shy, anxious, timid personality High quality relationships as protective factor © 2015 M. Guthrie Yarwood

31. Cluster A: Genetics! 31 Paranoid: Relatives diagnosed w/ schizophrenia Schizoid: Relatives diagnosed w/ schizophrenia & schizotypal Schizotypal: First-degree biological relatives diagnosed w/ schizophrenia Dopamine © 2015 M. Guthrie Yarwood

32. Cluster B: Antisocial and Borderline PD 32 Environmental Stressors Genetics: First-degree biological relatives with diagnosis Brain Abnormalities Both Borderline and Antisocial: ↓ levels of 5-HT (serotonin) – associated with impulsivity and aggression Genetics x Environment: ASPD: Interaction between testosterone and childhood sexual abuse © 2015 M. Guthrie Yarwood

33. Cluster B: Narcissistic and Histrionic 33 Narcissistic: Extremes in parenting Extreme pampering (noncontingent rewards) OR Parental neglect/abuse Histrionic??? We don’t know yet! © 2015 M. Guthrie Yarwood

34. Cluster C: Dependent and Avoidant PD 34 Dependent: Environment: Authoritarian or overprotective parenting style Avoidant: Biology: Lower levels of adrenaline Environment: Stressors that trigger genetic vulnerability Anxiety may impair social relationships and participation in activities No history of childhood abuse © 2015 M. Guthrie Yarwood

35. Cluster C: OCPD - Genetics © 2015 M. Guthrie Yarwood 35 Genetics – relatives with OCD Biology: Malfunctioning Gene contributed to OCPD and OCD SERT mutation, Ile425Val Of 7 family members with this mutation, 5 diagnosed w/ OCD and 1 diagnosed with OCPD Mutation seems to lock serotonin transporter in overactive state **More research needed (Ozaki and colleagues, 2003)

36. Coming Up! © 2015 M. Guthrie Yarwood 36 How do we treat personality disorders?