PERSONALITY DISORDERS

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PERSONALITY DISORDERS

• Alberto L. Choy MD FRCPC
• Psychology 344
• Fall 2003
• Forensic Psychology
• University of Toronto, Erindale

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Introduction

• Overview of the DSM-IV (credits to)
• Diagnostic and Statistical Manual of Mental
  Disorders, Fourth Edition
• Descriptions of personality disorders and
  application to forensic settings

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THE MULTIAXIAL ASSESSMENT

• Axis I clinical disorders - mental illnesses
  and mental disorders
• Axis II personality disorders and mental
  retardation
• psychologists can diagnose with the multiaxial
  assessment

4
DIMENSIONAL MODELS

• other models to describe personality
• maladaptive variants of personality traits -
• eg five factor model
• neuroticism, introversion vs. extroversion,
  closedness vs. openess (to experience),
  antagonism vs. agreeableness, conscientiousness

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PERSONALITY TESTING

• Millon Clinical Multiaxial Inventory (MCMI)
• no norms between patients and normals
• biased towards finding problems
• Minnesota Multiphasic Personality Inventory
  (MMPI-2)
• most widely used in forensic assessments
• measures that address test taking attitudes

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PERSONALITY TRAITS

• an enduring pattern of perceiving, relating to,
  and thinking about the world and oneself,
  exhibited in a wide range of social and personal
  contexts
• examples impulsivity, social anxiety, affective
  stability

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PERSONALITY DISORDER (1/3)

• personality traits are maladaptive and inflexible
  
• and
• significant functional impairment or subjective
  distress
• extremes of personality characteristics

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PERSONALITY DISORDER (2/3)

• inner experience and behaviour deviates from
  cultural expectation
• impairment in 2 of
• cognition
• affectivity
• interpersonal functioning
• impulse control

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PERSONALITY DISORDER (3/3)

• inflexible and pervasive, broadly
• significant distress and/or function(s)
  disturbance
• stable and life-long
• NOT due to another mental disorder, substances,
  medical condition
• traits vs. personality disorder

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Paranoid Personality Disorder

• pervasive distrust and suspiciousness
• sees others motives as malevolent
• criteria may include
• suspicions that they are being exploited
• unjustified doubts about loyalty of others
• closed fear of information used against
• reacts angrily to perceived attack
• suspcious / jealous of spouse
• not psychotic

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Schizoid Personality Disorder

• detatchment from social relationships
• restricted range of expressed emotions
• prefer being alone
• criteria may include
• no interest in close relationships, including
  family
• little interest in sex with others
• no close confidants
• emotional flatness

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Schizotypal Personality Disorder

• discomfort with relationships
• odd, eccentric thoughts / behaviour
• criteria may include
• ideas of reference (not delusions)
• magical beliefs (not cultural)
• suspiciousness or odd / constricted affect
• lack of close friends
• social anxiety more paranoid

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Antisocial Personality Disorder

• disregard for, and violation of, the rights of
  others
• terms psychopathy, sociopathy, dyssocial
• criteria may include
• impulsive behaviours (drugs, crime)
• lacking in remorse
• deceitful / conning / manipulative
• irritable / aggressive
• evidence of Conduct Disorder (before 15)

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Borderline Personality Disorder

• pervasive instability self image, relationships,
  affect - impulsivity
• criteria may include
• frantic avoidance of abandonment
• unstable, intense interpersonal relationships
• impulsive behaviour
• marked reactivity of mood / rage / emptiness
• recurrent self-harm/suicide

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Histrionic Personality Disorder

• excessive emotionality and attention seeking
  behaviour
• criteria include
• flamboyant appearance / behaviour
• superficial, rapidly shifting emotions
• suggestible
• believes relationships are deeper than they
  really are
• seductive or provocative, socially

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Narcissistic Personality Disorder

• grandiosity, need for admiration, lacking in
  empathy
• criteria may include
• solely self-involved no.1, entitled
• derogatory to others, for himself
• grandiose, self important, may exaggerate
• believes he is special / high status associates
• lacks empathy
• interpersonally exploitive

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Avoidant Personality Disorder

• social inhibition / anxiety and feelings of
  inadequacy
• criteria may include
• marked social anxiety / avoids contact
• strong wish for relationships
• restraint in relationships fear of shame
• sees self as inept, unappealing, inferior
• avoids risk, especially of embarrassment

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Dependent Personality Disorder

• excessive need to be taken care of
• submissive, clingy
• criteria may include
• fear of separation / abandonment
• will do unpleasant things to obtain nurturance
• unable to decide without excessive advice /
  reassurance
• will not express disagreement
• urgent relationship seeker to be taken care of

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Obsessive-Compulsive Personality Disorder

• preoccupation with detail, order, control
• at the expense of openness, efficiency
• criteria may include
• excessive rules, details, lists, organization
• perfectionism, but too slow / stubborness
• workaholic without friends / leisure
• inflexible, scrupulous morals, ethics
• may not throw things out
• will not delegate tasks

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Personality Disorder Not Otherwise Specified

• mixed traits
• dysfunction

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APPLICATION

• CRIME
• CIVIL / DISABILITY
• ADAPTIVE ASPECTS

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CRIME

• murder
• serial murder / group murder
• cults
• sex
• mutilation
• assaults
• fraud / robbery
• domestic violence
• harrassment

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CIVIL

• disability
• malingering in disability

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Comorbidity

• Major mental illness
• substance use / abuse
• psychopathy