Transcript Slide 1

Personality disorders
DSM-IV: “A Personality Disorder is an enduring pattern of inner experience
and behavior that deviates markedly from the expectations of the individual’s
culture, is pervasive and inflexible, has an onset in adolescence or early
adulthood, is stable over time, and leads to distress or impairment.”
Cluster A
odd/eccentric
Cluster B
dramatic/erratic
Cluster C
anxious/fearful
Paranoid
Schizoid
Schizotypal
Antisocial
Borderline
Histrionic
Narcissistic
Avoidant
Dependent
Obsessive-compulsive
Personality disorders: Diagnostic criteria for Narcissistic PD
A pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack
of empathy, beginning by early adulthood and present in a variety of contexts, as
indicated by five (or more) of the following:
1. has a grandiose sense of self-importance (exaggerates achievements and talents,
expects to be recognized as superior without commensurate achievement.)
2. is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal
love
3. believes that he or she is ‘special’ and unique and can only be understood by, or
should associate with, other special or high-status people
4. requires excessive admiration
5. has a sense of entitlement, i.e., unreasonable expectations of especially favorable
treatment or automatic compliance with his or her expectations
6. is interpersonally exploitative, i.e., takes advantage of others to achieve his or her
own ends
7. lacks empathy: is unwilling to recognize or identify with the feelings and needs of
others
8. is often envious of others or believes that others are envious of him or her
9. shows arrogant, haughty behaviors or attitudes
Personality disorders: Diagnostic criteria for Antisocial PD
A. A pervasive pattern of disregard for and violation of the rights of others occurring
since age 15 years, as indicated by 3 or more of the following:
1. failure to conform to social norms with respect to lawful behaviors, as indicated by
repeatedly performing acts that are grounds for arrest (destroying property,
harassing others, stealing).
2. deceitfulness, as indicated by repeated lying, use of aliases, or conning others for
personal profit or pleasure
3. impulsivity or failure to plan ahead (making decisions on the spur of the moment)
4. irritability and aggressiveness, as indicated by repeated physical fights or assaults
5. reckless disregard for the safety of self or others
6. consistent irresponsibility, as indicated by repeated failure to sustain consistent work
behavior or honor financial obligations
7. lack of remorse, as indicated by being indifferent to or rationalizing having hurt,
mistreated, or stolen from another
B/C. At least 18 years old, with conduct disorder before age 15
Personality disorders: Questions and assumptions (Morey, Vanderbilt)
1.
2.
3.
4.
5.
6.
Personality disorders are evident early in life
Personality disorders are relatively stable over time
Personality disorders are relatively stable over situations
Personality disorders are ego-syntonic (i.e., not experienced as alien)
Personality disorders are distinguished by interpersonal disruption
Personality disorders represent extremes of normal personality
Personality disorders: Questions and assumptions
1. Personality disorders are evident early in life
Antisocial PD criterion: There is evidence of Conduct Disorder (aggression,
destruction of property, deceitfulness/theft, rule violations) before age 15
years.
Childhood shyness and withdrawal is characteristic of Schizoid (detachment
from social relationships and restricted range of expression of emotions in
interpersonal settings) and Schizotypal (social and interpersonal deficits as
well as cognitive or perceptual distortions and eccentricities of behavior) PD
patients.
In general, personality is stable over time in rank order, but less stable in
mean levels.
Social Dominance
1
1
0.8
0.8
Cumulative d Value
Cumulative d Value
1.2
0.6
0.4
0.2
0.4
0.2
0
-0.2
-0.2
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Age
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Age
Agreeableness
Conscientiousness
1.2
1.2
1
0.8
0.8
Cumulative d Value
1
0.6
0.4
0.2
0.6
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0
0
-0.2
-0.2
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Age
Emotional Stability
Openness to Experience
1.2
1
1
0.8
0.8
Cumulative d Value
1.2
0.6
0.4
0.2
0
0.6
0.4
0.2
0
-0.2
-0.2
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Age
Roberts & Mroczek, in press
0.6
0
10
Cumulative d Value
. . . pattern of
inner experience
and behavior that
deviates
markedly from
the expectations
of the individual’s
culture
Social Vitality
1.2
Cumulative d Value
People become
more socially
dominant,
agreeable,
conscientious,
and emotionally
stable with age:
principle of
maturity
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70
80
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50
Age
Personality disorders: Questions and assumptions
2. Personality disorders are relatively stable over time
3. Personality disorders are relatively stable over situations
Personality is stable over time, and so are personality disorders: Treatment
studies of Borderline PD (instability of interpersonal relationships, self-image,
and affect, and marked impulsivity) found that 44-67% of patients still met
criteria for the disorder at 7-15 years post-treatment and despite treatment.
Personality is stable over situations when aggregated over many situations but some criteria employ the if-then profile suggested by Mischel:
Histrionic PD (excessive emotionality and attention-seeking): (1) is
uncomfortable in situations in which he or she is not the center of attention
Avoidant PD (social inhibition, feelings of inadequacy, and hypersensitivity to
negative evaluation): (2) is unwilling to get involved with people unless
certain of being liked
Personality disorders: Questions and assumptions
4. Personality disorders are ego-syntonic (i.e., not experienced as alien)
5. Personality disorders are distinguished by interpersonal disruption
“They are often seeking evaluation at someone else’s request. Their
presenting complaints often involve the behavior of other people, rather than
their own experiences.”
Cluster A: distrust and suspiciousness of others (Paranoid PD), detachment
from social relationships (Schizoid PD), discomfort with and reduced capacity
for close relationships (Schizotypal PD)
Cluster B: disregard for and violation of the rights of others (Antisocial PD),
instability of interpersonal relationships (Borderline PD), interaction with others
characterized by inappropriately seductive or provocative behavior (Histrionic
PD), is interpersonally exploitative (Narcissistic PD)
Cluster C: social inhibition, unwilling to get involved with others (Avoidant PD),
submissive clinging and fears of separation (Dependent PD), preoccupation
with interpersonal control (Obsessive-Compulsive PD)
Personality disorders: Questions and assumptions
6. Personality disorders represent extremes of normal personality
Personality “disorder” is based on an arbitrary cut point in a continuous
distribution of normal personality (Widiger, UK).
O:
Schizotypal, Histrionic PD (high)
Obsessive-Compulsive PD (low)
C:
Obsessive-Compulsive PD (high)
Antisocial PD (low)
E:
Histrionic, Narcissistic PD (high)
Schizoid, Schizotypal, Avoidant (low)
A:
Dependent PD (high)
Antisocial, Narcissistic, Paranoid PD (low)
N:
Borderline, Avoidant PD, most others (high)
Antisocial, Narcissistic PD (low)
Antisocial PD and Psychopathy
Psychopaths: “Intraspecies predators who use charm, manipulation,
intimidation, and violence to control others and to satisfy their own selfish
needs.”
Antisocial PD:
Psychopaths:
3% of men, 1% of women
1% of population, 15-25% of prison population
All psychopathy is not created equal:
“Factor 2” or secondary psychopathy overlaps with Antisocial PD
Poor behavioral controls, impulsive, irresponsible
Sexually promiscuous, many short-term relationships
Early behavior problems and juvenile delinquency
Lack of realistic, long-term goals
Criminal versatility
Psychopathy
“Factor 1” or primary psychopathy distinguishes psychopaths
Grandiose self of self-worth
Lack of remorse, guilt, empathy; callous
Needs stimulation, prone to boredom
Pathological liar, conner
Glib, superficially charming
Parasitic lifestyle
Factor 2 associates (negatively) with SES, education, and IQ and
(positively) with substance abuse, but Factor 1 does not
Is there such a thing as a successful psychopath?
No sex diff’s
Age r = -.19
No sex diff’s
Age r = -.12
Action
Cheat
Lend $
Drunk
Steal
Volunteer
Lend notes
Vandalize
Return item
Primary Secondary
.05
.46
-.25
.19
.09
.51
.05
.39
-.02
.07
-.06
.30
.02
.37
-.16
.16