Personality Disorders Disorders of Personality

Prof Craig Jackson

Head of Psychology Division Birmingham City University

Personality Disorder

Inflexible Pervasive Egosyntonic Maladaptive coping skills Depression Anxiety Distress Adolescent / Childhood trauma Diagnosis rare in children

Do you have…

1. An obvious self-focus in interpersonal exchanges 2. Problems in sustaining satisfying relationships 3. A lack of psychological awareness 4. Difficulty with empathy 5. Problems distinguishing the self from others 6. Hypersensitivity to any insults or imagined slights 7. Vulnerability to shame 8. Haughty body language 9. Flattery towards people who admire and affirm you 10. Detesting those who do not admire you 11. Using other people without considering the cost of doing so 12. Pretending to be more important than you really are 13. Bragging / exaggerating (subtly but persistently) achievements 14. Claiming to be an "expert" at many things 15. Inability to view the world from the perspective of other people 16. Deny remorse Thomas 2012

Personality Disorder

Fixed views and beliefs Faulty schemata / Dysfunctional schemata Inflexible behavioural patterns Social and Personal difficulties 1 in 10 UK population

Personality Disorder – Causes?

Oversensitive temperament at birth Excessive admiration never balanced with reality Excessive praise for good behaviours Excessive criticism for bad behaviours in childhood Overindulgence and overvaluation by parents & others Being praised for exceptional looks / abilities by adults Severe emotional abuse in childhood Unpredictable or unreliable caregiving from parents Valued by parents as way to regulate their self-esteem Groopman & Cooper 2006

Diagnosis

Must satisfy following criteria as well as specific criteria for specific PD under consideration Subjective and contentious Some disagreement between ICD 10 and DSM IV

• Characteristic enduring behaviour and inner experience more deviate markedly from cultural norm than one of the , in following: Cognition + Affectivity + Impulse control + Relating • Inflexible, dysfunctional, maladaptive behaviour across many social situations • Personal distress & Impact on social environment • Deviation is stable & of long duration:onset in adol.

• Exclude other mental disorders • Exclude organic brain / neuropsychological disease

DSM IV -Axis II

Cluster A

Paranoid PD + Schizoid PD + Schizotypal PD

Cluster B

Antisocial PD + Borderline PD Histrionic PD + Narcissistic PD

Cluster C

Avoidant PD + Dependent PD Obsessive Compulsive PD

NoS

PD not otherwise specified

Hotchkiss et al. 2003

7 deadly sins…

SHAMELESSNES:

the inability to process shame in healthy ways.

MAGICAL THOUGHTS:

Narcissists see themselves as perfect, using distortion and illusion known as magical thinking. They also use projection to dump shame onto others.

ARROGANCE:

A narcissist who is feeling deflated may re-inflate by diminishing others

ENVY:

A narcissist may secure a sense of superiority by using contempt to minimize others.

ENTITLEMENT:

Narcissists hold unreasonable expectations of particularly favourable treatment and automatic compliance because they consider themselves special. Failure to comply is considered an attack on their superiority, and the perpetrator is considered an "awkward" or "difficult" person. Defiance of their will is a narcissistic injury that can trigger narcissistic rage.

EXPLOITATION:

Can take many forms but always involves the exploitation of others without regard for their feelings or interests. Often the other is in a subservient position where resistance would be difficult or even impossible.

POOR BOUNDARIES:

Narcissists do not recognize that they have boundaries and that others are separate and are not extensions of themselves. Others either exist to meet their needs or may as well not exist at all. Those who provide “Narcissistic supply” to the narcissist are treated as if they are part of the narcissist and are expected to live up to those expectations.

Paranoid PD

Suspiciousness + Mistrust of others + Paranoid Hyper-sensitive /easily offended Vigilant scanning to confirm their beliefs Guarded + Constricted emotional lives Incapacity for emotional relationships Isolated lifestyle

Subtypes

Fanatic + Malignant + Obdurate Querulous + Insular

Schizoid PD

Tendency to insularity Emotional coldness Secrecy No interest in social relationships Sexually apathetic Avoidant attachment styles

Subtypes

Languid + Remote + Depersonalised + Affectless

Antisocial PD

Disregard for others Violation of others' rights Psychopathy Sociopathy Lack of remorse + Lack of empathy Irresponsible work behaviour Promiscuity Lying / stealing Boundary violations

Subtypes

Covetous + Reputation defending + Risk taking Nomadic + Malevolent

Borderline PD

Variability of mood Unusual instability of mood Idealisation & Devaluation of others Chaotic relationships Disturbed sense of self

Subtypes

Discouraged + Petulant + Self-destructive + Impulsive

Histrionic PD

Excessive emotionality Need for approval Seductiveness Attention-seeking + Exhibtionist Lively, dramatic, flirtatious Manipulative behaviour Successful and high-functioning

Subtypes

Theatrical + Infantile + Vivacious + Appeasing Tempestuous + Disingenuous

Obsessive Compulsive PD

Preoccupation with orderliness Perfectionism Mental and personal control Lack of flexibility, openness, efficiency Routine & rule obsessed Conscientious

Subtypes

Conscientious + Puritanical + Bureaucratic Parsimonious + Bedeviled

Anxious (avoidant) PD

Social inhibition Inadequacy Sensitivity to negative evaluations Avoidance of social interaction Socially inept Shyness + Low self-esteem

Subtypes

Conflicted + Hypersensitive + Phobic Self-deserting

Dependent PD

Pervasive dependence on others Reliant on others to fulfill emotional needs Low view of self Feel inadequate Feel helpless

Subtypes

Disquieted + Accommodating + Immature Ineffectual + Selfless

Other PD

Narcissistic Passive-Aggressive Eccentric Haltlose Psychoneurotic Immature Unspecified Mixed and Other

Narcissistic PD

Unprincipled narcissist

Deficient conscience; unscrupulous, amoral, disloyal, deceptive,

Amorous narcissist

Sexually seductive, enticing, glib and clever; declines real intimacy

Compensatory narcissist

offsets deficits by creating illusion of being superior, exceptional,

Elitist narcissist

Feels privileged and empowered by virtue of special childhood status and pseudo achievements

Fanatic narcissist

heroic or worshipped person with a grandiose mission .

Narcissistic Personality Inventory

Raskin & Terry 1988

Measures 7 factors over 40 items (fixed choice)

Authority Superiority Exhibitionism Entitlement Vanity Exploitativeness Self-sufficiency Raskin, R.; Terry, H. (1988). "A principal-components analysis of the Narcissistic Personality Inventory and further evidence of its construct validity". Journal of Personality and Social Psychology, Vol 54(5), 890-902.

Narcissistic Personality Inventory

Score high on the NPI?

More likely to: Cheat in games and sports Cheat in relationships Take more resources for self Leave fewer resources for others Value material things Obsess about appearance

Narcissistic Personality Inventory

US undergraduate students Twenge et al., 2008

Narcissistic Personality Inventory

Legal Defence

Diagnosis or suspicion of PD not a legal defence May be a mitigating factor Does not prevent individual from knowing law and ethics

Questions about PD

Treatment locations Prison v. Hospital Nicola Edgington case

Ethicality of treatment

Mental Health Act Use to treat individual if harm to themselves or others Long term process What right do we have to change a fundamental?

Questions about PD

Relatively new area Contradictory status Curable / incurable Whose role?

Cultural diversity weakens clarity of diagnosis