PERSONALITY DISORDERS

 

1.  Enduring patterns of perceiving, relating to, and thinking about the                   environment and oneself
2.  These are persistent across time and situations, i.e., trait-like
3.  They are inflexible and maladaptive

Three Clusters:
Cluster A:
Odd/eccentric		 1.  Paranoid Personality Disorder
2.  Schizoid Personality Disorder
3.  Schizotypal Personality Disorder
Cluster B:
Dramatic/emotional or erratic		 1.  Antisocial Personality Disorder
2.  Borderline Personality Disorder
3.  Histrionic Personality Disorder
4.  Narcissistic Personality Disorder
Cluster C:
Anxious/fearful		 1.  Avoidant Personality Disorder
2.  Dependent Personality Disorder
3.  Obsessive/compulsive Personality Disorder

GENDER BIASES IN DIAGNOSIS
Ford & Widiger -Provided clinical descriptions of clear (DSM criteria) cases of:    Antisocial; Histrionic
-Half of each set described the person as male, the other half as female

PERSONALITY DISORDERS
 

Prevalence

Gender
Cluster A    
 

 

 Paranoid
Schizoid
Schizotypal

2%
<1%
4%

 More males
More males
More males
Cluster B     
 

 

 Antisocial
Borderline
Histrionic
Narcissistic

3% males; <1% females
2.5%
2%
<1%

 Far more males
Far more females
Equal
More males
Cluster C       
 

 

 Avoidant
Dependent
Obsessive/
compulsive

 <1%
2%
4%

 Equal
Equal
More males 

ESSENTIAL FEATURES OF CLUSTER A PERSONALITY DISORDERS
Diagnosis Pervasive Pattern
Paranoid Distrust and suspiciousness of others
Interpretation of others’ motives as malevolent
 Schizoid Detachment from social relationships
Restricted range of expression of emotions in interpersonal settings
Schizotypal Social and interpersonal deficits marked by:
       · acute discomfort with close relationships
       · reduced capacity for close relationships
Cognitive or perceptual distortions
Eccentricities of behavior

PARANOID PERSONALITY DISORDER
Turkat et al. (1990) Had subjects role-play unstructured interactions where stooge (i.e., the supposed other subject) would make ambiguous responses.
Paranoid subjects more likely to interpret these as hostile and more likely to respond with anger.
Thompson et al. (1988) Found paranoid subjects responded to ambiguous stimuli by accusing experimenter of misleading them.

SCHIZOID PERSONALITY DISORDER
Slater & Roth (1969) Claimed schizoid was simply part of schizophrenia - occurs prior to full blown disorder
Wolff & Chick (1980) Follow-up study of schizoid children - only 9% developed schizophrenia
Livesley (1987) Had 473 psychiatrists identify prototypic features:
Resultant Dimensions:
Low affiliation - e.g.
  1. crosses street to avoid acquaintances
  2. declines invitations
  3. watches rather than participates
  4. does not initiate conversations
Defective social skills, e.g.,
  1. can’t generate topics of conversation
  2. avoids eye contact
  3. awkward body movements and gestures
Self-absorption, e.g.,
  1. lives in own world
  2. inattentive to what others say
  3. perceives thoughts as more real than external events

SCHIZOTYPAL PERSONALITY DISORDER
Have difficulty in experiments focusing their attention on task at hand. This has been taken to explain their digressive speech.

Consistent with this it has been found that schizotypals make more loose associations in their speech and yet they respond only to concrete aspects of others’ speech.

 

ESSENTIAL FEATURES OF CLUSTER B
PERSONALITY DISORDERS
Diagnosis Pervasive Pattern
Antisocial Disregard for the rights of others
Violation of the rights of overs
Borderline Instability of interpersonal relationships
Instability of self-image
Instability of affects (emotions)
Marked impulsivity
Histrionic Excessive emotionality
Attention seeking
Narcissistic Grandiosity in fantasy or behavior
Need for admiration
Lack of empathy

 

ANTISOCIAL PERSONALITY DISORDER
Features: 1.  Failure to conform to social norms
2.  Deceitful
3.  Impulsive, reckless, thrill-seeking
4.  Irritable/aggressive
5.  Irresponsible
6.  Lack of remorse, shame, embarrassment

Underlying lack of emotionality (Eysenck and others)

Leads to failure to learn via emotional feedback
(i.e., unresponsive to rewards or punishers)
Consistent with the "fearlessness" hypothesis,
i.e., APDs have higher threshold for fear (Lykken)

BIOLOGICAL VIEW
INHERITED/INFORM LOW AROUSAL
Evidence: 1. Induce expectation of stress: Norms show increased arousal; psychopaths show little change
2. EEG studies reveal greater frequency of slow wave brain activity in psychopaths
3. Adoptee studies - higher rates of psychopathy and criminality in biological than in adoptive family
Effects: 1. Emotional feedback will not be strong enough to affect them
2. Low arousal induces boredom which leads to stimulus seeking - take risks, seek thrills, choose novel stimuli

ANTISOCIAL PERSONALITY DISORDER
XYY Syndrome - supposedly extra maleness should increase aggression
Research: Jacobs et al. (1965) found more criminals had XYY
But: XYY also more common
Also: Most XYY are peaceful and retarded
  • Only 2% of criminals are XYY although higher than in noncriminals
  • Most XYY convicted of property not violent offenses
    (Although higher convictions than nonXYY)

EYSENCK’S THEORY

High Neuroticism 
///
Introvert///////Extravert
///
Low Neuroticism
 

Neuroticism = Strength of emotional response
Introversion/Extraversion = Speed of conditioning
Psychopaths = Low Neuroticism/high extraversion i.e., little emotional responding and slow to condition (i.e., needs more trials)
Thus psychopaths do not learn from emotional feedback so don’t acquire social rules

LYKKEN’S STUDY
Many previous studies have shown that psychopaths were unresponsive to punishment in studies of aversive learning.
Questions: 1. Are psychopaths deficient in all learning or just emotional learning?
2. Do psychopaths score poorly on these studies simply because they are not cooperative?
 Study 1. Had all subjects (psychopaths and normals) complete a serial learning      task
2. Two aspects: manifest task; hidden task
         · Manifest task = Correct responses by lever pressing
         · Hidden task = Avoidance of levers that produced shocks
  LYKKEN’S APPARATUS
 

 

  1   2 3 4
Red lights  •  •  • •
Green lights m m m m
Levers n n n n
For example,
Manifest sequence 1 4 2 3, 3 2 4 1, 1 4 2 3
Hidden/shocked sequence 3 2 4 1, 1 4 2 3, 3 2 4 1
TRIAL 1 Press 1 = Green light
         3 = Red light plus shock
   2 + 4 = Red light alone
TRIAL 2 Press 4 = Green light
         2 = Red light plus shock
   3 + 1 = Red light alone

SCHACHTER & LATANE
Repeated Lykken’s study but subjects received an injection of either
(a) saline or
(b) adrenalin to increase anxiety

SCHMAUK’S STUDY
Same procedure as Lykken but varied type of punisher:
a) Physical punisher (electric shock)
b) Tangible punisher (took back 25 cents for every error)
c) Social punisher (experimenter reprimands)

SOCIAL LEARNING
1. Inconsistent/harsh punishment by parents
2. Unloved
3. Psychopathic/violent parents - modeling
Learn to be: -Indifferent to physical/verbal punishment
-Oppositional in response to physical or verbal punishment
-Model psychopathic and violent behavior

STEWART’S STUDY
Psychopaths vs. nonpsychopaths on sentence completion
Task - fill in verb.
Task structured so that can use either (a) aggressive verb or (b) passive verb
Subject groups divided in half One half punished for selecting aggressive meaning
Other half punished for selecting passive meaning
Responses  Nonpsychopaths Low - punished meaning
                            High - unpunished meaning
 Psychopaths High - punished meaning
                     Low - unpunished meaning

 

BORDERLINE PERSONALITY DISORDER
Suicide rate of 8.5%
Females more likely to also have mood disorder and be self-destructive
Males more likely to also have Attention-deficit disorder or Antisocial Personality
Many problems in childhood; attachment with parents
Common for them to have been victims of incest or other sexual abuse as children
Close relatives 5x more likely to be borderline than general population

 

BIOLOGICAL BASES TO BORDERLINE PERSONALITY DISORDER
Genetics Relatives 5x more likely to be BPD than among norms
Serotonin Impulsivity negatively related to serotonin
Greater impulsivity - lower serotonin activity
Sleep Significant abnormalities in REM sleep
- more rapid onset
- more intense
Many features similar to depression:
1. High suicide rates
2. Low levels of serotonin
3. REM sleep abnormalities
4. Commonly also diagnosed as mood disorder
Self-destructive acts of Borderlines:
Suicide threats
Overdoes
Self-mutilation
Drug abuse
Promiscuity
Accidents (reckless driving)		 20%
19%
17%
18%
17%
7%

 

 HISTRIONIC PERSONALITY DISORDER
Overlap with Borderline is significant e.g., Morey (1988) found this overlap in criteria               interpretations was 54%
Also often hard to distinguish Histrionic from Depression and from Anxiety Disorders

NARCISSISTIC PERSONALITY DISORDER
They typically react negatively to criticism:
With rage, shame or humiliation (Gramzow, 1992)
Pessimistic, futility, and depression (Svrakic, 1990)
Cold indifference (Messer, 1985)

ESSENTIAL FEATURES OF CLUSTER C PERSONALITY DISORDERS
Diagnosis  Pervasive Pattern
Avoidant Social inhibition
Feelings of inadequacy
Hypersensitivity to negative evaluation
Dependent Excessive need to be taken care of
Submissive and clinging behaviors
Fears of separation
Obsessive-compulsive Preoccupation with orderliness and perfectionism
Preoccupation with mental and interpersonal control
Restricted flexibility, openness, and efficiency

DIFFERENCES BETWEEN:

Avoidant Personality Disorder

Social Phobia
Fears social relations Fears social circumstances
More likely to be depressed Less likely to be depressed
Fear of rejection Fear of negative evaluation

DIFFERENCES BETWEEN:

Obsessive/compulsive Personality Disorder

O/C Disorder
Preoccupied with order/rules

Ego-syntonic

 Fears some consequences of failing to complete O or C
Ego-dystonic

IMPULSE DISORDERS
Persistent failure to resist temptation or an impulse to act in a harmful way to self or others

Increasing tension ® commit the act ® feel relief ® then feel guilt or regret

IMPULSE DISORDERS:
Explosive Episodes of assault
· unassertive
Kleptomania Cannot resist temptation to steal
· not profit-driven
· unassertive
Pyromania Firesetting accompanied by pleasure, relief, or gratification
· Mixed: psychotic; unassertive; powerless
Trichotillomania Hair pulling; body picking
· negative body image
· lonely
· unassertive

 

PATHOLOGICAL GAMBLERS
 
  1. response to stress
  2. sees life as boring
  3. do not believe they can control themselves
  4. whole life revolves around gambling
  5. excitement more important than winning
4 million plus in USA - Bet $286 million in 1991 and increasing
Commonly low income/low educated males
Increasing with legalization: More casinos, more pathological gamblers
Course:

 

 Early wins followed by losses so ups ante with increasing desperation
Family and social life neglected
Work disrupted
Suicide common
Only seek treatment when hit rock bottom
Avenues: Horse races, cards, casino games, lotteries, bingos
More casinos, more pathological gamblers
Stages:

 
  1. Recreational
  2. Winning
  3. Losing
  4. Desperation
Reinforcement Schedule:
        Continuous ® Accelerates acquisition
        Intermittent ® Retards extinction
Animals will bar-press several thousand times in absence of reward after behavior is established under intermittent reinforcement
Pathological gamblers tend to be:
· self-centered; anxious; frustrated; impulsive
· Gambling associated with "high" and "withdrawal"
All these features are same as substance abusers

RELAPSE PREVENTION WITH GAMBLERS
1. Identify preceding factors
(e.g., depression, anxiety, low self-esteem, stress, relationship problems)
2. Identify behavioral chain
(e.g., depressed ® feels entitled to gamble ® excuses/rationalizations ® goes to track just to look around ® more excuses/rationalizations ® has a drink ® more excuses (e.g., one bet won’t hurt ® gambles)
3. Develop plans to deal with preceding factors and strategies to avoid risky situations
4. Generate warning signs

PYROMANIA
Firesetting - Generic term
Arson - Legal term
Pyromania - For relief/pleasure
Firesetters 30% profit motive
30% revenge/jealousy
28% relief
12% pleasure/excitement
1-2% sexual pleasure
Research:
Less than 3% firesetters meet criteria for pyromania
In Ontario, Fire Marshall’s data: 0.1% pyromaniacs