Transcript PERSONALITY DISORDERS - University of Toronto Mississauga

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