Personality Traits

enduring patterns of perceiving, relating to, and thinking about the environment and oneself that are exhibited in a wide range of contexts

When does a personality trait become a disorder?

• When the trait is maladaptive or harmful
• when it deviates from the expectations of the culture
• when it is inflexible
• when it has onset in early adolescence
• when it leads to problems in life
• when it is stable over time

Problems with diagnosis of personality disorders

• lots of changes over time in DSM

• many people fall into "atypical" category that contains combinations of traits from different disorders - sign that categorization isn't that great right now

• it assumes personality traits are stable, which is a debatable concept

Personality disorder clusters

• Odd/Eccentric

• Paranoid
• Shizotypal
• Shizoid

• Dramatic/emotional

• Antisocial
• Histrionic
• Narcissistic
• Borderline

• Anxious/fearful

• Avoidant
• Dependent
• Obsessive-compulsive

Paranoid PD

• • Suspiciousness in almost all situations and with almost all people, usually for no reason (often that people are trying to dupe them)
  • Impairment in cognitive scanning: find confirmatory evidence (they only gather information that confirms their hypotheses)
  • Few interpersonal relationships, isolative
  • Erratic work histories
  • Critical, stubborn, controlling
  • weak relationship to schizophrenia
    

Shizotypal PD

•  
  • Evidence of odd speech, behavior, thinking and/or perception (magical thinking, rambling speech, illusions)
  • they may mishear/misunderstand things but never actually have delusions
  • Tend to be isolative and have little interest in interpersonal relationships (they don’t have a lot of conflict, just uninterested. Negative symptom)
  • May be biologically related to schizophrenia (more common in first degree relatives who have schizophrenia)

Prevalence of schizotypal PD

• • •   .6 – 5.2% lifetime prevalence
    • Some believe more prevalent in groups of color due to tendency to misinterpret cultural beliefs
    • More prevalent in men (true for all odd/eccentric PDs)

Schizoid PD

• (Ted Kaczynski-unibomber)
  • Severely restricted range of emotions – appear cold, detached, aloof
  • Social detachment and withdrawal – does not desire close interpersonal relationships
  • No odd behaviors or language
  • not more common in families of schizophrenics

Antisocial personality disorder

• Antisocial Personality Disorder
  • A predatory attitude toward other people
  • A chronic indifference to and violation of the rights of one’s fellow human beings
  • A history of illegal or socially disapproved activity beginning before age 15 and continuing into adulthood
  • Failure to show constancy and responsibility in work, sexual relationships, parenthood, or financial obligations
  • Irritability and aggressiveness
  • Reckless and impulsive behavior
  • Disregard for the truth (lie easily)
  • CONNECTED TO CONDUCT DISORDER ON AXIS 1
    

Conduct disorder

(Antisocial PD)

• Conduct disorder
  • Truancy, vandalism, running away
  • Lying, acting out in school
  • “Homicidal triad” – firesetting, bedwetting, and cruelty to animals (early signs of murderer…all have been disproven by research except cruelty to animals)
  • Some people with conduct disorder do NOT grow up to be big trouble makers later, so it’s hard to differentiate.

Prevalence of Antisocial PD

• • • 1% women, 4-6% men
    • 50-70% of incarcerated criminals
    • About 50% of diagnosed substance abusers are diagnosed with antisocial PD (often bc they do illegal things to get substances)

Psychopathy

(Antisocial PD)

• 
  
  • • “Malignant narcissism”
    • Have only the shallowest emotions
    • Poor judgment and failure to learn from experience
    • Ability to maintain a pleasant and convincing exterior. Good con people (gift of gab)
    • Superficial charm
    • Grandiose sense of self-importance
    • Ted Bundy
    • Instrumental Aggression

Instrumental Aggression

aggression is goal oriented (as opposed to reactive aggression, which is a hostile response to a perceived provocation)

Psychopathy vs. ASPD vs. Criminal Behavior

Numbers

Psychopaths in general pop – 1%
Psychopaths in correctional system – 15-25% (22% max security, 10% minimum security)
ASPD in general pop – 4-6% (males)
ASPD in forensic pops – 50-80%

Note about personality disorders and the DSM-IV

Personality disorders are different than other psychological disorders in the DSM-IV. They aren’t part of a medical model because they aren’t really curable. That’s why they’re on axis 2.

Borderline PD

• Identity problems, reliance on others (difficulty with break ups)
• Ambivalence, splitting of others
• Impulsive and self-destructive behavior (parasuicidal behaviors-cutting, burning. Not actually trying to kill themselves, but using it as a way to manage emotions or to “feel real”)
• Often acting like adolescents
• *Difficulty in controlling anger and other emotions* (Mood swings that shift often)

Prevalence of Borderline PD

• More common in women and people of color
• Common in hospitals – because they often come to attention of doctors. They harm themselves and they are really miserable, want to get better.
• Gender and racial bias? Guys might act out more than just feeling depressed, act aggressive which is more common for guys in society.

Dialectical Behavior Therapy

Great for Borderline Personality Patients

• Interaction between biological predisposition and invalidating environment
• Children fail to learn skills and identify and regulate emotions. Theory is that people who are born as very emotional people combined with invalidating environment (where emotions cannot be trusted, needs/wants not important)
• Therapy cognitive-behaviorally based - involves skills training in regulating emotions and tolerating stress
• Draws from Zen tradition of mindfulness

Theories of Borderline PD

• May be related to depression (lots of overlap between BPD, depression, dissociative).
• May be history of mood disorder in families
• May be related to DID - dissociation, numbness. History of abuse

Narcissistic Personality Disorder

• A grandiose sense of self-importance, often masking feelings of inferiority (brags but requires constant reassurance)
• Fantasies of unlimited power, success, love, admiration
• Enraged by criticism
• Demanding in relationships (splitting-view people as good or bad)
• Hardly ever go to therapy-don’t want to acknowledge anything is wrong
• Adolph Hitler?
• Naomi Campbell?
• CONNECTED TO MANIC SYMPTOMS ON AXIS 1
  

Treatment of schizotypal PD

antipsychotics

Histrionic PD

Rapidly shifting moods, unstable relationships, and intense need for attention and approval; dramatic, seductive behavior

connected to somatoform/mood disorders on axis 1

7 contributors to Antisocial PD

1. Genetic Predisposition
2. Testosterone (too much)
3. Serotonin (not enough)
4. ADHD - develop ASPD in response to social rejection
5. Executive functions - deficits in planning and self-monitoring
6. Arousabilty - low
7. Social cognitive factors - harsh parents who promote aggression

Avoidant PD

• afraid of critcism, so avoid all situations in which it may occur
• depressed and lonely
• Cognitive-behavioral therapy = helpful

Avoidant PD, prevalence

1-7 %

Avoidant PD, comorbidity

Dysthemic disorder

major depression

severe anxiety

Dependent PD

• anxious about interpersonal interactions
• deep need to be cared for by others
• total dependence and submission to others
• AXIS 1 - similar to separation anxiety, dysthemic disorder

Prevalence of dependent PD

1 - 6 %

more women than men

Comorbidity: major depression, dysthemia, chronic anxiety

Therapy for depended PD

non-directive and humanistic - help build confidence

cognitive-behavioral - increase assertive behavior and decrease anxiety. challenge assumptions about self

Obsessive-Compulsive PD

• grim and austere
• tensely in control of emotions
• lacking in spontaneity
• extremely concerned with efficiency
• see people in terms of "rank"
• Prevalence - 1-7%, more common in men

DSM-IV vs. Big 5 Personality Traits

Some people say DSM-IV should NOT be so atheoretical, and instead focus on the continuity between personality disorders and the big 5. Esp. in light of gender differences.