Personality Disorders

 Traits vs. States vs. Disorders

 Disorder:  

A)   Marked deviation in at least 2 of the following areas:

• Cognition
• Affectivity
• Interpersonal functioning
• Impulse control

B)  Inflexible, pervasive across broad range of personal/social situations

C)  Enduring pattern leads to clinically significant distress or impairment in social, occupational, or other areas of functioning

D)  Pattern is stable and of long duration, with onset in adolescence or early adulthood

E)  Not better accounted for as part of another mental disorder

F)  Not due to substance or general medical condition

 Debate Over Value of Personality Disorder Categories:

• Not particularly reliable
• Much overlap
• Suggest use of dimensions
• “Big 5” - OCEAN
• Which are?
• Assumption that people have stable personality traits
• e.g., passive-aggressive personality disorder
• Often situational rather than a stable disposition

 3 Categories of Personality Disorders:

• Cluster A (Odd)
• Paranoid
• Schizoid
• Schizotypal
• Cluster B (Dramatic)
• Antisocial
• Borderline
• Histrionic
• Narcissistic
• Cluster C (Anxious)
• Avoidant
• Dependent
• Obsessive-Compulsive

 Paranoid Personality Disorder

• Highest frequency of litigation

 Etiology of Paranoid Personality Disorder

• Limited evidence
• Some relationship to chronic schizophrenia and delusional disorder
• Cognitive distortions
• Cultural factors
• Immigrants
• Prisoners
• Refugees
• Elderly
• People with hearing impairment

 Treatment of Paranoid Personality Disorder

• Rarely seek therapy
• Trigger usually anxiety or depression over some crisis in their lives
• Cognitive therapy
• No Clear-cut Support That Any  Form of Treatment Is Successful
• Recent survey of mental health professionals
• Only 11% of those who would treat them thought that they would continue in therapy long enough to be helped

 Schizoid Personality Disorder

• Social deficiencies
• “Observers rather than participants in the world around them”
• Differs from other 2 in Cluster A
• How?

 Etiology of Schizoid Personality Disorder

• No research re genetics
• Relatives of schizophrenics or schizotypal may have increased prevalence
• Some parallels with autism...

 Treatment of Schizoid Personality Disorder

• Value of social relationships
• Social skills training
• Role playing
• Survey results of 75% who see about 2/year in their practices:
• 1/2 felt they couldn’t provide therapy/untreatable
• Other 1/2 felt patients wouldn’t follow treatment recommendations

 Schizotypal Personality Disorder

• Ideas of reference
• Odd thinking
• Illusions
• But can reality test

 Etiology of Schizotypal Personality Disorder

• One phenotype of a schizophrenia genotype
• Family, twin, adoption studies:
• Increased prevalence among relatives of people with schizophrenia

 Treatment of Schizotypal Personality Disorder

• 30-50% also have major depressive disorder
• Social skills training
• Accept/adjust to solitary life style
• Some improvement with Haldol
• Many stop due to side effects
• Some may develop schizophrenia

Positive/Negative Symptoms and Cluster A

• Paranoid - ?
• Schizoid - ?
• Schizotypal - ?

 Antisocial Personality Disorder

• Used to be called “moral insanity”
• Not all antisocial personalities are criminals
• politicians, businessmen, entertainment
• Not all criminals are antisocial personalities

 Cleckley  Criteria (1941) - 16 Major Characteristics of “Psychopathic Personality”      

• Superficial charm and good intelligence
• Absence of delusions and other signs of irrational thinking
• Absence of “nervousness” and other psychoneurotic manifestation
• Unreliability
• Inadequately motivated antisocial behavior
• Poor judgment and failure to learn by experience
• Pathologic egocentricity and incapacity for love
• General poverty in major affective reactions
• Specific loss of insight
• Unresponsiveness in general interpersonal relations
• Fantastic and uninviting behavior, with and without alcohol
• Suicide rarely carried out
• Sex life impersonal, trivial, and poorly integrated
• Failure to follow any life plan
• Lack of remorse or shame
• Untruthfulness and insincerity

 Psychopathy Checklist-Revised

• 20 items
• From Cleckley criteria
• Focus on personality traits

 Etiology of Antisocial Personality Disorder

• Genetics
• Family, twin, adoption studies 
•  All suggest genetic influence on ASPD and criminality
• Adopted children of maternal felons higher rates of arrest and ASPD
•  More time in interim orphanages than control children or those felon children who did not develop problems
•  Twin studies of criminality 
•  MZ 55%
•  DZ 13%

•   Neurobiology
• Underarousal hypothesis
• Abnormally low levels of cortical arousal
•  Negative affect associated with underarousal
•  Risk taking to reduce boredom
•  “Future criminals” at age 15 had: 
•  Lower GSR
• Lower heart rate during rest
•  More slow-wave frequency brain wave activity
•  Cortical immaturity hypothesis 
• Cerebral cortex at more primitive stage of development 
•  May explain childlike/impulsive behavior
•  Decrease in antisocial behavior after age 40
•  Fearlessness hypothesis 
• Higher threshold for fear

Lykken (1957)  Activity Preference Questionnaire

• Number of items each with 2 options
• Pick preferred activity
• Both most would find unpleasant and not prefer to do
• Boring or demanding
• “Stand in a long line waiting for something”
• “Shovel the long driveway after a snowstorm”
• Frightening or embarrassing
• “Being given an electrical shock as part of a medical experiment”
• “Belching in church during prayer”
• Antisocial vs. Normal - What do you predict?

 Lykken  - Classical Conditioning Paradigm

• Tone (CS) paired with shock (UCS)
• Measured GSR to tone (CS)
• Psychopaths had weak GSR (CR) to the tone
• Rapid extinction

 Lykken - Mental Maze Study

• 4 levers
• Multiple trials
• For each trial:
• 1 right
• 3 wrong
• 1 resulting in shock
• Manifest task
• learning sequence of levers with fewest errors
• Latent task
• learning to avoid the one lever in each set which delivered the shock
• Results?

 Schachter and Latane (1964) – Avoidance Paradigm

• Injected with adrenaline/saline
• Psychopaths with placebo did not avoid shock
• Psychopaths with adrenaline = normals with placebo
• What do you think happened to the normals with adrenaline?

 Anticipatory Fear (Hare, 1965)

• Hear #s 1-12
• Told would be shocked at #8
• Measured GSR
• No anticipatory arousal in psychopaths

 Treatment of Antisocial Personality Disorder

• Rarely believe they need treatment
• Intervention with children and conduct disorder
• Parenting training

 Borderline Personality Disorder

• Lack stability in mood, relationships
• Poor self-image
• Fear of abandonment

 Etiology of Borderline Personality Disorder

• More prevalent in families with the disorder
• Linked with mood disorders
• Early trauma suggested
• Problem with retrospective data and bias of patients

 Dialectical Behavior Therapy - Linehan (1987)

• Helping cope with stressors that lead to suicidal gestures
• Weekly sessions
• Focusing on support and emotion regulation
• Extinguish prior traumas and fears
• May reduce suicide attempts and hospitalizations
• Less anger
• Better social adjustment 6 months post vs. Traditional therapy

 Histrionic Personality Disorder

 Etiology of Histrionic Personality Disorder

• 2/3 also meet criteria for ASPD
• Some suggest sex-typed alternative expressions of the same underlying condition
• 5 times more likely among family members with disorder

 Treatment of Histrionic Personality Disorder

• Little success reported
• Treatment for depression

 Narcissistic Personality Disorder

• Etiology of Narcissistic Personality Disorder
• Increasing in prevalence in most western societies
• Related to social changes
• “Me generation”

 Treatment of Narcissistic Personality Disorder

• Limited success reported
• Often accompanied by depressed mood

 Avoidant Personality Disorder

• Want relationship
• But fear rejection

 Etiology of Avoidant Personality Disorder

• May be born with difficult temperament
• Rejected by parents
• Retrospective memories of parents as rejecting, guilt engendering, and less affectionate than controls’
• Caution re state dependent and retrospective memories

 Treatment of Avoidant Personality Disorder

• Systematic desensitization
• Behavioral rehearsal - acting out situations that cause anxiety

 Dependent Personality Disorder

• Little research

 Obsessive-Compulsive Personality Disorder

 Etiology of Obsessive-Compulsive Personality Disorder

• Some support for genetics

 Treatment of Obsessive-Compulsive Personality Disorder

• Relaxation
• Distraction
• Cognitive restructuring