Personality Disorders and Psychopathy

1
Personality Disorders and Psychopathy

• Big Five Trait Theory
• DSM-IV Personality Disorders
• Anti-Social Personality Disorder vs. Psychopathy

2
Personality Traits

• Patterns of perceiving, relating to and thinking
  about the world, other people, and oneself that
  are exhibited in a wide range of contexts
• When do personality traits become problematic?

3
Trait Approach
TRAIT Consistent patterns of thoughts, feelings,
or actions that distinguish people.

• ASSUMPTION 1 traits are stable over time
• ASSUMPTION 2 traits are stable across situations
• people differ on continuous variables or
  dimensions
• traits exist on a continuum
• basic differences between people are quantitative
• traits are used to understand and predict
  behaviour
• emphasizes measurement of traits through tests

4
Trait Continuum
of people
Low
High
Average
TRAIT
5
The Big Five

• Openness imaginative, novelty seeking and
  independent vs. realistic, routine seeking and
  conforming
• Conscientiousness organized , careful and
  self-disciplined vs. disorganized, careless and
  weak willed
• Extraversion sociable, fun-loving and
  affectionate vs. retiring, sober and reserved
• Agreeableness softhearted, trusting and
  helpful vs. ruthless suspicious and uncooperative
• Neuroticism worried, insecure and self-pitying
  vs. calm, secure and self-satisfied

6
DSM-IV Personality DisordersGeneral Criteria

• A pattern of inner experience behaviour that
  deviates markedly from expectations of the
  individuals culture in 2 or more of the
  following areas
• -cognition
• -affect
• -interpersonal functioning
• -impulse control

7
DSM-IV Personality DisordersGeneral Criteria

• The pattern is inflexible and pervasive across a
  broad range of personal and social situations.
• Clinically significant distress or impairment
  (occupational, social).
• The pattern is stable and of long duration and
  its onset can be traced back at least to
  adolescence or early adulthood.

8
Cluster A Odd or Eccentric Personality Disorders

• Paranoid Is characterized by a pervasive
  tendency to be inappropriately suspicious of
  other peoples motives and behaviours.
• -constantly on guard
• -take extraordinary precautions
• -lack of trust
• -interpret hidden meaning
• -overact, aggression

9
Cluster A Odd or Eccentric Personality Disorders

• Schizoid A pattern of detachment from social
  relationships and a restricted range of affect.
• -loners
• -prefer social isolation
• -little pleasure
• -restricted range of affect
• -cold, aloof

10
Cluster A Odd or Eccentric Personality Disorders

• Schizotypal A pattern of acute discomfort in
  close relationships, cognitive or perceptual
  distortions, and eccentricities of behaviour.
• -odd perceptual experiences, behaviour
• -odd, vague or disjointed speech
• -constricted or inappropriate affect
• -excessive social anxiety
• -not psychotic or out of touch with reality

11
Cluster B Dramatic, Emotional, or Erratic
Personality Disorders

• Antisocial A pattern of disregard for, and
  violation of, the rights of others.
• -begins during childhood (conduct disorder)
• -18 years old
• -deceitfulness, lying, conning, aliases
• -impulsivity
• -breaking the law
• -lack of remorse

12
Cluster B Dramatic, Emotional, or Erratic
Personality Disorders

• Borderline A pattern of instability in,
  self-image, interpersonal relationships, and
  affect, and marked impulsivity.
• -identity disturbance
• -intense, unstable relationships
• -frantic attempts to avoid abandonment
• -emotional lability
• -intense anger, impulsive
• -chronic feelings of emptiness, boredom
• -manipulative

13
Cluster B Dramatic, Emotional, or Erratic
Personality Disorders

• 3. Histrionic A pattern of excessive
  emotionality and attention seeking.
• -center of attention
• -inappropriately seductive or provocative
• -self-centered, vain, demanding
• -seeking approval, considers relationships more
  intimate than they are
• -emotions are shallow and shift rapidly
• -react to situations with inappropriate
  exaggeration

14
Cluster B Dramatic, Emotional, or Erratic
Personality Disorders

• 4. Narcissistic A pattern of grandiosity, need
  for admiration, and lack of empathy.
• -exaggerated sense of their own importance
• -preoccupied with achievements, abilities
• -believes special status
• -arrogant, unable to empathize

15
Cluster C Anxious or Fearful Personality
Disorders

• Avoidant A pattern of social inhibition,
  feelings of inadequacy, and hypersensitivity to
  negative evaluation.
• -views self as socially inept, personally
  unappealing or inferior to others
• -isolate due to fears of criticism
• -desire social relationships

16
Cluster C Anxious or Fearful Personality
Disorders

• 2. Dependent A pattern of submissive and
  clinging behaviour related to an excessive need
  to be taken care of.
• -unable to make decisions
• -anxious and fearful when alone
• -easily hurt by criticism

17
Cluster C Anxious or Fearful Personality
Disorders

• 3. Obsessive-Compulsive A pattern of
  preoccupation with orderliness, perfectionism,
  and control.
• -devoted to work
• -preoccupied with details and rules,
  perfectionism
• -lack of tolerance for uncertainty
• -excessively conscientious, moralistic, and
  judgemental
• -unable to discard worthless objects, miserly

18
Issues Related to Assessment and Diagnosis

• Patterns need to be assessed over time and across
  different situations
• Include information from significant others
• Ego-syntonic
• High levels of overlap
• High levels of co-morbidity
• Sex biases
• Stigmatization

19
Issues related to treatment

• Ego-syntonic
• Difficulty with establishing therapeutic
  relationship
• Premature termination
• Type of therapy
• Individual vs. group
• Medication
• Efficacy

20
Relationship between the 5-factor model of
personality and DSM-IV PDs

• N E O A C
• Paranoid low low low
• Schizoid low
• Schizotypal hi low hi
• Borderline hi hi low low
• Narcissistic hi hi low hi
• Histrionic hi hi hi low
• Antisocial low low low
• Dependent hi hi hi
• Avoidant hi low
• OC hi low low hi

21
Anti-Social Personality Disorder

• A. Pervasive pattern of disregard for, and
  violation of, the rights of others occurring
  since age 15 years and extending to adulthood. (3
  or more below)
• Non conformity to social norms (arrest)
• Deceitfulness, lying, conning
• Impulsivity or failure to plan ahead
• Aggressiveness and irritability
• Reckless disregard for safety of others
• Consistent irresponsibility (job, finances)
• Lack of remorse

22
Anti-Social Personality Disorder

• B. The individual is at least 18 years
• C. There is evidence of Conduct Disorder with
  onset before age 15 years
• D. The occurrence of antisocial behavior is not
  exclusively during the course of Schizophrenia or
  a Manic Episode

23
Anti-Social Personality Disorder

• Associated Features Anxiety Disorders,
  Depressive Disorders, Substance-Related
  Disorders, Somatization Disorder, Pathological
  Gambling, other disorders of impulse control
• PDs Borderline, Histrionic, Narcissistic
• Culture, Age, and Gender low SES, not before 18
  and not without Conduct Disorder
• Prevalence 3 males, 1 females, higher in
  clinical settings (3-30), prisons, and substance
  abuse treatment settings (83 comorbid substance
  abuse)

24
Anti-Social Personality Disorder

• Course chronic, remits with age (40 )
• Familial Pattern more common in 1st degree blood
  relatives than in general population
• biological relatives of females with ASPD are at
  higher risk than males (SD, S-RD)
• Male blood relatives more ASPD S-RD, females
  more SD
• Biological and adopted children of ASPD parents
  are at higher risk for ASPD, SD, and S-RD

25
Conduct Disorder

• Aggression to people and animals
• Destruction of property
• Deceitfulness or theft
• Serious violations of rules
• Onset before or after age 10
• Mild, moderate or severe
• (3 or more of 15 symptoms in past 12 months)

26
Psychopathy

• Continuous variable - Hares Psychopathy
  Checklist (PCL)
• Based on personality traits more than observable
  behavior
• Violence of psychopaths is distinguishable
• Retribution and revenge violence
• High density offenders
• Recidivate with highest frequency

27
Causes of Psychopathy

• Biological
• adoption studies show genetic and environmental
  factors play a role
• Twin studies show similar results (MZ 55 vs. DZ
  13 concordance for criminality)
• Neurobiological influences
• The underarousal hypothesis (cortical immaturity)
• The fearlessness hypothesis (Lykken studies)

28
Causes of Psychopathy

• Psychological and Social influences
• Fixated on goals beyond logic
• Inconsistent parental discipline
• Low Socio-Economic Status

29
Treatment of Psychopathy

• Treatment has little efficacy among psychopaths
• Early intervention (childhood)
• Remits with age
• Is IQ a mediator for psychopathy incarceration?
  (successful psychopaths)