Personality Psychopathology - Dr. Saadia McLeod

Personality Characterological Psychopathology Cengage Learning 2016 Introduction to Personality Personality is a psychological characteristic Influenced by biological factors Temperament: differences in infancy Different levels of reactivity to outside stimulation Personality trait Tendency to feel, perceive, behave and think in a relatively consistent manner Cengage Learning 2016 Personality Psychopathology Healthy Personality:

flexibility in responding to life situations Shy people are not necessarily shy in all situations Individuals with personality psychopathology Rigid, inflexible patterns of responding Patterns are long-standing and enduring Present in nearly all situations Cengage Learning 2016 Prevalence of Personality Disorders People with personality psychopathology often function well enough

Cengage Learning 2016 Not aware they have a problem Many individuals do not seek help or come to the attention of mental health professionals Prevalence is difficult to determine Estimated to be 9-13 percent of general population DSM-5 Methods of Diagnosing and Classifying Personality Psychopathology Categorical diagnostic model

Ten specific personality disorder types Each a distinct clinical syndrome Alternative model Has components of both dimensional and categorical assessment Cengage Learning 2016 Personality Disorders Specific disorders grouped into three behavior clusters Odd or eccentric (cluster A)

Dramatic, emotional, or erratic (cluster B) Anxious or fearful (cluster C) Cengage Learning 2016 Cluster A Disorders Characterized by Odd or Eccentric Behaviors Paranoid personality disorder Pervasive distrust and suspiciousness of others Motives interpreted as malevolent

Tend to be rigid in thinking May seem aloof and lacking emotion Use projection as a defense mechanism I am not hostile, they are Prevalence ranges from 2.3 to 4.4 percent Cengage Learning 2016 Schizoid Personality Disorder Characteristics

Pervasive detachment from social relationships Restricted range of emotions Individuals have a long history of impairment in social functioning Neither desire nor enjoy close relationships May be associated with cold, emotionally impoverished childhood See Patient Video

Cengage Learning 2016 Schizotypal Personality Disorder Characterized Characterized by by odd, odd, eccentric, or paranoid eccentric, or paranoid thoughts thoughts and and behaviors behaviors and and poor poor interpersonal interpersonal relationships relationships Abnormalities

Abnormalities in in cognitive cognitive processing processing Many with disorder believe they have magical abilities or special powers Many characteristics resemble schizophrenia Some are subject to recurrent illusions Cengage Learning 2016 Few

Few individuals individuals seek seek therapy therapy Cluster B Disorders Characterized by Dramatic, or Erratic Behaviors Antisocial personality disorder Pervasive pattern of disregard for and violation of the rights of others Must have occurred since age 15 Lack of remorse

Individuals seek power over others Diagnosis applies to individuals age 18 or older Prevalence: 0.6 to 4.5 percent See Scene from American Psycho Cengage Learning 2016 Borderline Personality Disorder Characterized by enduring pattern of volatile emotional reactions

Unstable interpersonal relationships Poor-self image/ Hollow identity Impulsive / Reactive Intense mood fluctuations May engage in behaviors with negative consequences Poor coping skills Cengage Learning 2016

BPD (contd.) Most commonly diagnosed personality disorder Prevalence ranges from 1.6 to 5.9 percent More common in women Up to ten percent of those with BPD die by suicide Many show remission of symptoms over a course of six or more years Cengage Learning 2016 BPD (contd.) Three basic assumptions of individuals with BPD The world is dangerous (be guarded) I am powerless and

vulnerable (I am a victim) I am inherently unacceptable (self loath) Cengage Learning 2016 Early childhood trauma/abuse CBT and DBT have shown to be effective Accountability Acceptance Histrionic Personality Disorder 1 Characterized by pervasive pattern of excessive emotionality and attentionseeking Intensely dramatic

emotions and behaviors Superficially charming and warm Shallow and self-centered Cengage Learning 2016 2 Prevalence may be 0.4 to 1.8 percent 3 Diagnosed more often in females In clinical settings Narcissistic Personality Disorder Individuals with this disorder have a sense of entitlement, exaggerated self-importance, and superiority Grandiosity Talk

Lack mainly about themselves of empathy Little research on causes Treatment recommendations frequently based on clinical experience Cengage Learning 2016 Cluster C Disorders Characterized by Anxious or Fearful Behaviors Avoidant personality disorder Characterized Characterized by by pervasive pervasive pattern pattern of

of social social inhibition, inhibition, feelings feelings of of inadequacy, inadequacy, and and hypersensitivity to negative evaluation hypersensitivity to negative evaluation Individuals Individuals with with disorder disorder crave crave affection affection and and an an active active social social life life Prevalence ranges from 1.4 to 5.2

percent May be a characterological version of social anxiety disorder Cengage Learning 2016 Dependent Personality Disorder Pervasive, excessive need to be taken care of Leads to submissive and clinging behavior Individuals have fear of separation High risk for becoming a victim of relationship violence Cengage Learning 2016 Associated with

overprotective, authoritarian parenting Relatively rare disorder Obsessive-Compulsive Personality Disorder (OCPD) Preoccupation with orderliness, perfectionism, and mental and interpersonal control NOT Obsessive Compulsive Disorder OCD involves unwanted, intrusive thoughts and urges

Individuals with OCPD see their way of functioning as correct Genetic or early childhood environmental factors (overly perfectionistic demands) Cengage Learning 2016 Analysis of A Personality Disorder: Antisocial Personality Individuals with APD often involved with criminal justice system Results in relatively more information on this disorder

The Biopsychosocial model explains the factors leading to the development of APD Cengage Learning 2016 Model of Antisocial Personality Disorder Cengage Learning 2016 Biological Dimension of APD Genetic influences Genetic factors are Strong Includes behavioral characteristics observed during childhood and adolescence

Risk taking, impulsivity Supported by twin studies and adoptive child studies Cengage Learning 2016 Lack of Fear Conditioning and Emotional Responsiveness Biological abnormalities make people with APD less susceptible to fear and anxiety Less Less likely likely to to learn learn from from experiences experiences involving involving punishment punishment

Youth exhibiting antisocial behaviors showed diminished reactivity in the amygdala when shown pictures depicting fearful facial expressions Cengage Learning 2016 Arousal and Sensation Seeking Another hypothesis: Stimulation Seeking People with APD have lower levels of physiological reactivity Generally underaroused May require more stimulation to reach optimal level of arousal Thrill

seeking behavior without concern for conventional behavior standards Cengage Learning 2016 Psychoanalytic perspective Faulty superego development Psychological Dimension of APD Cengage Learning 2016 Learning perspective Lack of positive role models Type of punishment may influence learning See next chart responsive to monetary loss Effect of Punishment Type on Psychopaths and Others

Cengage Learning 2016 Social Dimension of APD Family relationships Poor parental supervision and involvement Rejection or neglect Parental separation or absence

Parents engaging in antisocial behavior Especially if exhibiting hostility or abuse Cengage Learning 2016 Sociocultural Dimension of APD Gender Men more likely to exhibit characteristics of APD Traditional gender-role training accepts or encourages aggression in boys but not girls Cultural Values in the U.S. Individualism and independence viewed as aspects of healthy function Idea that people can and should control their own lives Q: Does that lead to underdx of Antisocial pd? Cengage Learning 2016

Treatment of APD NO MOTIVATION Legal Requirement for Tx Treatment must provide enough control to force confronting inability to form close relationships Incarceration or psychiatric hospitalization may offer setting for treatment Cengage Learning 2016 Material rewards for behavior

modification Treatment (contd.) Family and peer involvement necessary Creates motivation to stay in Tx Cognitive approaches Away from thinking in terms of self-interest and immediate gratification toward Relationship Fulfillment

Cengage Learning 2016 Prevalence of APD diminishes with age Recent study showed promising results with clozapine An Antipsychotic Medication Problems with Diagnosing Personality Disorders Poor inter-rater reliability for personality disorder categories Comorbidity is high, reducing diagnostic accuracy Arbitrary decisions about Sx

Exclusive categorical approach has limitations Cengage Learning 2016 All-or-none method does not take into account continuous nature of personality traits (e.g., degrees of avoidance, callousness, etc.) DSM-5 Alternative Personality Model Dimensional model assesses personality traits on a continuum Consider significant deviations from normal on five key personality dimensions

Extraversion Agreeableness Neuroticism Conscientiousness Openness to experience Cengage Learning 2016 Alternative Model (contd.) Four personality disorders removed

from the model Paranoid Schizoid Histrionic Dependent New model allows these traits to be considered in noncategorical fashion Cengage Learning 2016 Paths to Personality Disorder Diagnosis Using the DSM-5 Alternative Model Cengage Learning 2016 Example of Alternative

Dx Narcissistic Personality Disorder: Disturbance in domains of Identity: exaggerated self-appraisal; reference others for self-esteem Self-Direction: goals set to impress others Empathy: Insensitivity to others needs Intimacy: superficial Meet following Traits:

Grandiosity; Attention Seeking; Exploitive Cengage Learning 2016 Traditional Categorical Dx Narcissistic Personality Disorder; Pervasive Pattern of Grandiosity (5 or more) Exaggerates achievements Fantasies of success Believe is superiority/special

Requires excessive admiration Sense of Entitlement Exploitive Lacks Empathy Envy Arrogant Cengage Learning 2016 Contemporary Trends and

Future Directions Recent research data: personality disorders appear to remit more often than previously believed Leads to a less pessimistic outlook for individuals with personality psychopathology Clinicians favor the traditional categorical model Use of alternative model in clinical diagnosis unknown Cengage Learning 2016

Can ones personality be pathological? What traits are associated with personality disorders? Review How does an antisocial personality develop and can it be changed? What problems occur with personality assessment? Are there alternative methods of personality assessment? Cengage Learning 2016