Personality Disorders

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Personality Disorders

• I. Background

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A. Definition

• Personality disorder enduring patterns of
  perceiving, relating to, and thinking about the
  environment and oneself that are exhibited in a
  wide range of important social and personal
  contexts that cause significant functional
  impairment or subjective distress

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B. DSM-IV General criteria for personality
disorder

• Enduring pattern of inner experience and behavior
  that deviates markedly from cultural
  expectations. Manifested in two or more of the
  following areas
• Cognition
• Affectivity
• Interpersonal functioning
• Impulse control

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B. General criteria (cont.)

• B. Pattern is inflexible and pervasive across a
  broad range of personal and social situations
• C. Pattern leads to clinically significant
  impairment or distress
• D. Pattern is stable and of long duration and
  onset can be traced to adolescence or early
  childhood

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B. General criteria (cont.)

• E. Pattern not better accounted for as a
  manifestation of another disorder
• F. Not due to substance or GMC (e.g., head trauma)

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B. General criteria (cont.)

• Person must meet the general criteria before a
  specific PD is diagnosed
• Coded on Axis II

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C. Other Features

• Lack insight into PD (seek treatment for Axis I
  problem or relationship problems)
• PD symptoms are ego syntonic feels like a
  normal part of oneself
• Most have interpersonal problems
• Can be difficult to diagnose in initial session
• Intractable, difficult to treat can affect
  treatment of other disorders

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D. Cluster Organization in DSM-IV

• PDs classified within clusters defined by common
  features
• Cluster A
• main feature is odd or eccentric in nature
• 3 PDs in this cluster
• Paranoid PD distrust and suspiciousness
• Schizoid PD detachment from social
  relationships (does not want them)
• Schizotypal PD social deficits and perceptual
  distortions or eccentricities

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D. Clusters (cont.)

• 2) Cluster B
• Main feature is dramatic, emotional, or erratic
• 4 PDs in this cluster
• Antisocial PD disregard for social norms and
  rights of others
• Borderline PD instability in relationships,
  self-image, and mood impulsivity
• Histrionic PD excessive emotionality and
  attention seeking
• Narcissistic PD grandiosity, need for
  admiration, self-centered

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D. Clusters (cont.)

• 3) Cluster C
• Main feature involves anxiety or fearfulness
• 3 PDs in this cluster
• Dependent PD submissive, need to be taken care
  of
• Avoidant PD social inhibition and inadequacy
• Obssessive-compulsive PD orderliness,
  perfectionism, need to control things

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E. Categorical System

• DSM-IV is a categorical classification system
• Personality traits viewed as dimensional
  constructs
• Push toward dimensional approach to classifying
  PDs
• PD research lags behind Axis I research ? PDs are
  least reliable diagnoses ? problems for their
  systematic study

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Personality Disorders

• II. Antisocial Personality Disorder (ASPD)

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A. Background

• ASPD diagnosis stems from Cleckleys description
  of psychopathy
• Superficial charm
• Absence of delusions and irrational thinking
• Absence of nervousness
• Unreliability
• Untruthfulness and insincerity
• Lack of remorse or shame
• Inadequately motivated antisocial behavior
• Poor judgment and failure to learn by experience

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Psychopathy (cont.)

• Pathological 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 drink
• Suicide rarely carried out
• Sex life impersonal, trivial, and poorly
  integrated
• Failure to follow any life plan

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A. Background (cont.)

• ASPD definition based on Cleckleys view appeared
  in DSM-II
• Psychopathy is now a separate construct with an
  antisocial (ASPD-like) component
• Lee Robins work in mid-1960s formed basis of
  current ASPD criteria
• Found that most antisocial adults were antisocial
  in childhood
• Most antisocial children are not antisocial as
  adults

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A. Background (cont.)

• ASPD vs. criminality
• criminal is a legal term denoting conviction
  for breaking a law
• Not all people with ASPD are criminals (or in
  jails)
• Not all people in jail or considered criminal
  have ASPD
• Not all people with ASPD are psychopaths

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B. Criteria and features of ASPD

• Case of George
• DSM-IV criteria (p. 433)
• A. Pattern of disregard for and violation of the
  rights of others occurring since age 15 as
  indicated by 3 or more
• (1) failure to conform to social norms
• (2) repeated lying/conning
• (3) impulsivity or failure to plan ahead

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1. Criteria (cont.)

• (4) irritability and aggressiveness
• (5) reckless disregard for safety
• (6) consistent irresponsibility
• (7) lack of remorse
• B. Individual is at least 18 years old
• C. Evidence of Conduct Disorder before age 15
• D. Occurrence of antisocial behavior not
  exclusively during course of schizophrenia or a
  manic episode

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B. Criteria and features of ASPD (cont.)

• 2. Course and statistics
• - prevalence is 3 in men lower in women
• - sex difference is probably real, but may be
  inflated by clinician bias
• - onset in childhood (by definition)
• - CD portion may start as early as age 3-5

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2. Statistics and course (cont.)

• Course of all PDs is chronic, but overt
  antisocial behavior seems to age out after 40
• - could still show ASPD features (e.g., lying
  poor work habits)

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B. Criteria and features of ASPD (cont.)

• 3. Causal influences
• - twin, family, and adoption data show strong
  genetic influence
• - CD also appears to have shared environment
  influence
• - poor socialization due to low fearfulness may
  account for some cases

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C. Treatment

• Most dont seek treatment for ASPD (usually
  substance abuse)
• No treatment shown to be efficacious
• More likely to end up in jail than in treatment
• Focus is on prevention target antisocial
  children

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Summary

• PDs are enduring, maladaptive patterns of
  relating to the world and to others
• General criteria for PD, then specific PD
• DSM-IV arranges PDs in 3 clusters according to
  shared characteristics
• Lack of insight usually do not seek treatment
  for the PD PD can impact treatment of other
  disorders
• ASPD