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7/27/2019 PS 280 12 Personality Disorders
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PERSONALITY DISORDERS
LECTURE OUTLINE
DSM Axis II What is a personalitydisorder?
Clusters of personality disorders 3 main
types
Prevalence
Historical perspectives
Diagnostic issues
Etiology Theoretical perspectives
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PERSONALITY DISORDERS
Clusters of disorders
Odd and eccentric paranoid, schizoid,
schizotypal
Dramatic, emotional, or erraticantisocial, borderline, histrionic,
narcissistic
Anxious and fearful dependent,obsessive-compulsive
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PERSONALITY DISORDERS
Prevalence
6-9% of population have one or more
personality disorder
prevalence higher among people withother mental disorders
most people with personality disorders
never come to the attention of mentalhealth professionals
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PERSONALITY DISORDERS
Historical perspective
Roots in psychoanalysis narcissism,
masochism, etc.
Karl Abraham first theorist to focus onpersonality disorders
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PERSONALITY DISORDERS
Diagnostic issues
poor understanding of etiology of most
personality disorders
comorbidity and diagnostic overlap
gender and cultural issues
reliability of diagnosis categorical vs. dimensional approach
Big 5 personality traits
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PERSONALITY DISORDERS
Etiology Theoretical perspectives
Psychodynamic theory
Attachment theory particularly for
dramatic, emotional, erratic
Cognitive-behavioural perspectives
Biological particularly for odd, eccentricand dramatic, emotional, erratic
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PERSONALITY DISORDERS
Cluster A Odd and eccentric
Paranoid suspicious, argumentative (no
delusions or hallucinations)
Schizoid withdrawn, reserved, reclusive
Schizotypal eccentricity of thought and
behaviour
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PERSONALITY DISORDERS
Cluster B Dramatic, emotional, erratic
Antisocial personality disorder (APD)
Defining feature is pervasive disregard
for and violation of rights of others Begins in childhood
Must meet 3 of the following criteria
violation of rights of others,
nonconformity, callousness, deceitfulness,
irresponsibility, impulsivity,
aggressiveness, recklessness
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PERSONALITY DISORDERS
Cluster B Dramatic, emotional, erratic
Antisocial personality disorder (APD)
Lifetime prevalence rates for APD 3%
for men, 1% for women, lower rates forpsychopathy
40% of those in Canadian prisons have
APD
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PERSONALITY DISORDERS
Cluster B Dramatic, emotional, erratic
APD vs. Psychopathy
APD focuses more on behaviour
Robert Hare, UBC Psychopathy Checklist
Revised focuses on both personality traits
and behaviour (lifestyle instability)
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Robert Hare, UBC Psychopathy Checklist
Revised
Personality traits Lifestyle instability
lack of remorse
callousness
selfishness
exploitation of others
antisocial (lying,
stealing, cheating) impulsive
social deviant lifestyle
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PERSONALITY DISORDERS
Cluster B Dramatic, emotional, erratic
Etiology of APD
Family and parenting factors disruptive
family life, harsh and inconsistentdiscipline, lack of monitoring
genetics concordance rates for
criminality are 51% for MZ twins, 21% forDZ; runs in families
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PERSONALITY DISORDERS
Cluster B Dramatic, emotional, erratic
Etiology of APD
fearlessness hypothesis deficient
emotional arousal and conditioning isassociated with a lack of empathy, thrill-
seeking
in the face of punishment, psychopathsincrease the frequency of punished
behaviour, rather than decrease it;
defiance/opposition
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PERSONALITY DISORDERS
Cluster B Dramatic, emotional, erratic
Etiology of APD - Lykkens (1957) research
in a lever pressing task, people with
psychopathy did not learn the associationbetween particular lever presses and
shocks
in contrast, people without psychopathylearned this association quickly
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PERSONALITY DISORDERS
Cluster B Dramatic, emotional, erratic
Etiology of APD - Schmauks (1970) research
repeated this experiment, but compared
different types of punishers physical,tangible (loss of money), social (reprimands)
he found, like Lykken, that those with
psychopathy learned poorly when physicaland social punishers were used, but they
learned as well as controls when tangible
punishment was used
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PERSONALITY DISORDERS
Cluster B Dramatic, emotional, erratic
Etiology of APD - Stewarts (1972) research
sentence completion task involving
physical punishment for aggressiveresponses
controls stopped aggressive responses
very quickly, but those with psychopathyincreased aggressive responses; they
acted in opposition to and defiance of the
researcher
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PERSONALITY DISORDERS
Cluster B Dramatic, emotional, erratic
Etiology of APD Implication of this research
Punishment of offenders not likely to be
very effective for rehabilitationPrograms like Scared Straight, boot
camps make kids with APD worse rather
than better
Getting tough with this population not
likely to work
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PERSONALITY DISORDERS
Cluster B Dramatic, emotional, erratic
Course of APD
a progression or career of deviancy -
oppositional defiant disorder, conductdisorder, APD
burnout response as they age, people
with APD become less involved in criminalactivity
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PERSONALITY DISORDERS
Cluster B Dramatic, emotional, erratic
Treatment of APD
difficulty establishing therapeutic alliance
need to focus on specific behaviours,such as anger management
treatment approaches not very
successful
probably more success with prevention
and early intervention
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PERSONALITY DISORDERS
Cluster B Dramatic, emotional, erratic
Histrionic personality attention-seeking,
flirtatious, flamboyant, difficulty with
relationships,
Narcissism grandiosity, egocentricity,
vengeful, but low self-esteem
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PERSONALITY DISORDERS
Cluster C Anxious and fearful disorders
Avoidant personality extreme sensitivity tocriticism and disapproval, avoidance of
intimacy
Dependent personality constantly seeks
reassurance, advice, direction from others
Obsessive-compulsive personalityinflexibility and desire for perfection, absence
of obsessional thoughts and compulsive
behaviours
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PERSONALITY DISORDERS
Treatment
Object relations psychodynamic therapy
Kernberg, Kohut
Cognitive-behavioural
Pharmacological
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PERSONALITY DISORDERS
Big 5 OCEAN (Costa & Mcrea, 1992)
High Personality trait Low
Curious Openness Conventional
Reliable Conscientiousness Unreliable
Sociable Extraversion Shy-quiet
Goodnatured
Agreeableness Uncooperative
Nervous Neuroticism Calm
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PERSONALITY DISORDERS
Dimensional analysis of types
Where would schizoid personality fit on
the 5 dimensions?
How about paranoid?
Antisocial?
Narcissism?
Avoidant or dependent?
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PERSONALITY DISORDERS
SUMMARY
Personality disorders are maladaptivepersonality traits
3 broad clusters
Problem of overlap of categories
Etiology for many personality disorders notwell understood
Treatments have not been very successful
for many of these disorders