You are on page 1of 3

PSYCHIATRY

Personality Disorders
Lecturer: Dr. Jerez | September 21, 2017
Transcribed by: KJDP|NBO|RLM|KIM|AWP

OUTLINE
 Dramatic, emotional, or erratic – antisocial, borderline,
1. DSM Axis II – What is a personality disorder?
histrionic, narcissistic
2. Clusters of personality disorders – 3 main types
 Anxious and fearful – dependent, obsessive-
a) Cluster A- Odd, Eccentric
i. Paranoid compulsive (one thing is missing here you probably
ii. Schizoid know why)
iii. Schizotypal
b) Cluster B-Dramatic, Emotional Prevalence
i. Antisocial  6-9% of population have one or more personality
ii. Histrionic disorder
iii. Borderline  prevalence higher among people with other mental
iv. Narcissitic disorders
c) Cluster C-Anxious, Fearful  most people with personality disorders never come to
i. Avoidant the attention of mental health professionals
ii. Dependent Historical perspective
iii. Obsessive-Compulsive  Roots in psychoanalysis – narcissism, masochism, etc.
3. Prevalence  Karl Abraham – first theorist to focus on personality
4. Historical perspectives disorders
5. Diagnostic issues
6. Etiology – Theoretical perspectives 19th century German psychiatrist Krafft-Ebing named
7. Clusters of PD in Detail
sadism for Marquis de Sade the autor of Justine, ou les
8. The Big 5 Personality Traits
Malheurs de la Vertu (Justine, or The Misfortunes of Virtue)
9. Summary
and Leopold von Sacher-Masoch, author of Venus in Furs.
Uniquely important elements in Psychiatric History Taking
 Sensitivity (patients will have different level of Diagnostic issues
sensitivity and that depends on their personality)  poor understanding of etiology of most personality
 Confidentiality (It is utmost important for psychiatric disorders
patients)  comorbidity and diagnostic overlap
 Collaboration (this is done between patient’s friends,  gender and cultural issues
family, records and the physician)  reliability of diagnosis
 categorical vs. dimensional approach – Big 5
Others like rapport and empathy are more general. Though personality traits
these are important especially in hostile situations.
The BIG 5 Personality Traits are: OCEAN or CANOE
What is a personality disorder? The five-factor model was claimed to significantly predict all
 maladaptive personality traits ten personality disorder symptoms. However, most
 traits are relatively enduring features of a person that predictions related to an increase in Neuroticism and a
are persistent over time and situations decrease in Agreeableness, and therefore did not
 people with personality disorders tend to be: rigid and differentiate between the disorders very
inflexible, show a restricted range of traits, have a well.
dominant single trait
 personality disorders are egosyntonic, more than
egodystonic

Patients with PD are egosyntonic even up to the point they


try to cover up or deny that do not have the condition or
disorder. When it is egosyntonic and it brings anxiety (not to
the point it brings significant distress and affect normal
functioning) to the person, it is more of just a trait.

Clusters of Disorders
 Odd and eccentric – paranoid, schizoid, schizotypal

1
PSYCHIATRY- Personality Disorders

Etiology- Theoretical Perspectives  Lykken’s (1957) research- In a lever pressing task,


 Psychodynamic theory (id, ego, superego) people with psychopathy did not learn the association
 Attachment theory – particularly for dramatic, between particular lever presses and shocks; in
emotional, erratic contrast, people without psychopathy learned this
 Cognitive-behavioural perspectives association quickly.
 Biological – particularly for odd, eccentric and  Schmauk’s (1970) research- repeated this experiment,
dramatic, emotional, erratic but compared different types of punishers – physical,
tangible (loss of money), social (reprimands); He found,
Cluster A: Odd and Eccentric like Lykken, that those with psychopathy learned
 Paranoid – suspicious, argumentative (no delusions or poorly when physical and social punishers were used,
hallucinations) but they learned as well as controls when tangible
 Schizoid – withdrawn, reserved, reclusive punishment was used.
 Schizotypal – eccentricity of thought and behaviour  Stewart’s (1972) research- sentence completion task
involving physical punishment for aggressive
Schizoid are the loners and do not like or enjoy sex. responses; Controls stopped aggressive responses
Schizotypal likes magical thinking and have perceptual very quickly, but those with psychopathy increased
disturbances. aggressive responses; They acted in opposition to and
defiance of the researcher
Cluster B: Dramatic, Emotional, Erratic  Implication of this research
Antisocial, Histrionic, Borderline, Narcissitic  Punishment of offenders not likely to be
very effective for rehabilitation
Antisocial Personality  Programs like “Scared Straight,” boot camps
 Defining feature is pervasive disregard for and make kids with APD worse rather than
violation of rights of others better
 Begins in childhood  “Getting tough” with this population not
 Must meet 3 of the following criteria – violation of likely to work
rights of others, nonconformity, callousness,
deceitfulness, irresponsibility, impulsivity, APD Course
aggressiveness, recklessness  A progression or career of deviancy - oppositional
 Lifetime prevalence rates for APD – 3% for men, 1% defiant disorder, conduct disorder, APD
for women, lower rates for psychopathy  Burnout response – as they age, people with APD
 40% of those in Canadian prisons have APD become less involved in criminal activity

APD vs. Psychopathy APD Treatment


 Defining feature is APD focuses more on  difficulty establishing therapeutic alliance
behaviour  need to focus on specific behaviours, such as anger
 Robert Hare, UBC – Psychopathy Checklist management
Revised – focuses on both personality traits and  treatment approaches not very successful
behaviour (lifestyle instability)  probably more success with prevention and early
Personality traits Lifestyle instability intervention
lack of remorse antisocial (lying, stealing, cheating)
callousness impulsive
selfishness social deviant lifestyle
Borderline Personality
exploitation of others  fragile identity and instability in relationships
 unpredictability, impulsiveness, irritability,
argumentative
APD Etiology
 more prevalent in women
 Family and parenting factors – disruptive family life,
 low reliability of this diagnosis
harsh and inconsistent discipline, lack of monitoring
 experience of child abuse and neglect
 Genetics – concordance rates for criminality are 51%
for MZ twins, 21% for DZ; runs in families
Histrionic Personality
 Fearlessness hypothesis – deficient emotional arousal
 attention-seeking, flirtatious, flamboyant, difficulty
and conditioning is associated with a lack of empathy,
with relationships
thrill-seeking; In the face of punishment, psychopaths
Reminds us of Sharon Stone on her movie “Basic Instinct.”
increase the frequency of punished behavior, rather
than decrease it; defiance/opposition (the juvenile
form of APD is conduct disorder)

2
PSYCHIATRY- Personality Disorders

Narcissism Personality
 grandiosity, egocentricity, vengeful, but low self-
esteem

Cluster C: Anxious and Fearful Disorders


 Avoidant personality – extreme sensitivity to criticism
and disapproval, avoidance of intimacy
 Dependent personality – constantly seeks reassurance,
advice, direction from others
 Obsessive-compulsive personality – inflexibility and
desire for perfection, absence of obsessional thoughts
and compulsive behaviours

Treatment of PD
 Object relations psychodynamic therapy – Kernberg,
Kohut
 Cognitive-behavioural
 Pharmacological (more on symptoms and comordities)
Kernberg and Kohut are for narcissitic PD: Kernberg
recommends challenging the patient’s defense; while Kohut
recommends exploration of therapist’s empathic failure
BIG 5- OCEAN (Costa and McRea, 1992)
High Personality trait Low
Curious Openness Conventional
Reliable Conscientiousness Unreliable
Sociable Extraversion Shy-quiet
Good natured Agreeableness Uncooperative
Nervous Neuroticism Calm

 Dimensional analysis of types: Where would (Schizoid


/Paranoid /Antisocial /Narcissism /Avoidant
/Dependent) personality fit on the 5 dimensions?

Summary
 Personality disorders are maladaptive personality
traits
 3 broad clusters
 Problem of overlap of categories
 Etiology for many personality disorders not well
understood
 Treatments have not been very successful for many of
these disorders.