Personality Disorders

Transcription

1 Personality Disorders Todd B. Kashdan, Ph.D. Department of Psychology George Mason University

2 Personality = Temperament + Character

3 DSM-IV Definition of Personality Disorder A. Enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual s culture. Manifested in two (or more) areas: Cognition, Affect, Social functioning, or Impulse Control B. pattern is inflexible and pervasive across a broad range of personal and social situations. C. leads to clinically significant distress or impairment D. pattern is stable and of long duration and its onset can be traced back at least to adolescence or early adulthood.

4 DSM-IV Personality Disorders A. Cluster A (odd/eccentric) 1. Paranoid 2. Schizoid 3. Schizotypal B. Cluster B (dramatic/emotional/impulsive) 1. Antisocial 2. Borderline 3. Histrionic 4. Narcissistic C. Cluster C (anxious/fearful) 1. Avoidant 2. Dependent 3. Obsessive-Compulsive D. Personality Disorder Not Otherwise Specified

5 The Odd-Eccentric Personality Disorders Paranoid personality disorder mistrust and suspicion of other people that is unwarranted Schizoid personality disorder lack of interest in and avoidance of social relationships; emotional coldness Schizotypal personality disorder inhibited or inappropriate emotion and social behavior, perceptual distortions, disorganized speech. Weak Relationship to Schizophrenia Strong

6 The Dramatic-Emotional Personality Disorders Antisocial personality disorder Borderline personality disorder Histrionic personality disorder Narcissistic personality disorder criminal, impulsive, callous, or ruthless behavior; disregard for rights of others; no respect for social norms. Rapidly shifting and unstable mood, self-concept, and interpersonal relationships; impulsive Rapidly shifting moods, unstable relationships, and intense need for attention and approval; dramatic, seductive behavior (self-dramatization) Grandiose thoughts and feelings of one s s own worth; preoccupation with being admired; obliviousness to others needs.

7 Antisocial Personality and Psychopathy

8 The Anxious-Fearful Personality Disorders Avoidant personality disorder Sense of inadequacy, and fear of being criticized, which leads to social anxiety and avoidance Dependent personality disorder: Pervasive selflessness, need to be cared for, rejection fears, leading to dependence on and submission to others. Obsessive-compulsive personality disorder Rigidity in one s activities and relationships, including emotional construction, perfectionism, and anxiety about even minor disruptions in routine.

9 Problems with DSM-IV Categories Sxs are often only extreme versions of otherwise normal traits. Majority of people diagnosed with one disorder tend to meet criteria for more.

10 Gender Bias in Construction and Application Differences in frequencies Lack of recognition that the expressions of symptoms of a disorder may vary between women and men

11 imagine a party where everyone had Personality Disorders

12 Donna danced into the party and immediately became the center of attention. With sweeping gestures of her arms and dramatic displays of emotion, she boasted about her career as an actress in a local theatre group. During a private conversation, a friend inquired about the rumors that she was having some marriage difficulties. In an angry outburst, she denied any problems and claimed that her marriage was as wonderful and charming as ever. Shortly after, while drinking a second bourbon, she fainted. William wandered into the party, but didn t t stay long. The negative forces in the room were unsettling to his psychic soul-spot. spot. The few guests he spoke to felt somewhat uneasy with this aloof space cadet.

13 imagine a party where everyone had PDs II Sherry paraded into the party drunk and continued to drink throughout the night. Laughing and giggling, she flirted with many of the men and to two of them expressed her deep affection. Twice during the evening she disappeared for almost half an hour, each time with a different man. After a violent argument with one of them, because he took too long to get her a drink, she locked herself into the bathroom and attempted to swallow a bottle of aspirin. Winston spent most of his time talking about his trip to Europe, his new Mercedes, and his favorite French restaurants. People seemed bored being around him, but he kept right on talking. When he made a critical remark about how one of the women was dressed and hurt her feelings he could not apologize for his obvious blunder. He tried to talk his way around it, and even seemed to be blaming her for being so upset.

14 imagine a party where everyone had PDs III Peter arrived at the party exactly on time. He made a point of speaking to every guest for five minutes. He talked mostly about technology and finance, and avoided any inquiries about his feelings or personal life. He left precisely at 10PM because he had work to do at home. Before entering, Doreen watched the party for several minutes from outside through the window. Once she went in, she seemed very uncomfortable. When people tried to be nice to her, she looked guarded and mistrustful. People quickly became uncomfortable with her habit of finding fault with every little thing you said or did. She didn t t stay very long at the party. Margie didn t t come to the party, even though she promised the hostess that she would bring the ice. The hostess was very upset that everyone had warm drinks.

15 imagine a party where everyone had PDs IV Harold wasn t t invited to the party. No one really knows him very well because he rarely talks. In fact, he spends most of his time at home reading. Byron was sweating when he walked through the door. With fleeting eye-contact, he waved quickly to a few people that he knew, and headed straight for the liquor. People talked to him while he drank, but he just nodded his head, rather than remove the drinks from his lips to talk. After a slew of alcohol, l, he took a seat at the far end of a couch, away from the animate conversations in the middle of the room. When a few minutes of tapping his feet against the floor went by, he quickly left the t party without saying good-bye to anyone. He didn t t want to make a fool of himself.

16 DIMENSIONAL vs. CATEGORICAL

17 Examples of Dimensional Systems Interpersonal Circumplex - Leary, Wiggins, Pincus Three factors - Eysenck & Eysenck Five factors - Costa & McCrae Seven factors - Cloninger et al.

18 Personality Disorders on the Interpersonal Circumplex Model Dominance Narcissistic PD Histrionic PD Coldheartedness Antisocial PD Schizoid PD Avoidant PD Nurturance Dependent PD Submissiveness

19 The Five-Factor Factor Model of Personality Neuroticism Calm Worrying Even-tempered Temperamental Self-satisfied Self-pitying Comfortable Self-conscious Unemotional Emotional Hardy Vulnerable Extraversion Reserved Affectionate Loner Joiner Quiet Talkative Passive Active Sober Fun-loving Unfeeling Passionate Openness to Experience Down-to to-earth Imaginative Uncreative Creative Conventional Original Prefer routine Prefer variety Uncurious Curious Conservative Liberal Agreeableness Ruthless Soft-hearted Suspicious Trusting Stingy Generous Antagonistic Acquiescent Critical Lenient Irritable Good-natured Conscientiousness Negligent Conscientious Lazy Hardworking Disorganized Well-organized Late Punctual Aimless Ambitious Quitting Persevering Adapted from Costa & McCrae 1986

20 Cloninger s s Seven-Factor Model 1. Temperament Domains (Moderately heritable, not greatly influenced by family environment) a. Novelty Seeking b. Harm Avoidance c. Reward Dependence d. Persistence 2. Character Domains (Moderately influenced by family environment, only weakly heritable) a. Self-transcendence b. Cooperativeness c. Self-directedness

21 Three Major Brain Systems Influencing Stimulus Response Characteristics Brain System (Related Personality Dimension) Principal Monoamine Neuromodulator Relevant Stimuli Behavioral Response Behavioral activation (novelty seeking) Dopamine Novelty Potential reward Exploratory pursuit Appetitive approach Potential relief of monotony or punishment Active avoidance, escape Behavioral inhibition (harm avoidance) Serotonin Conditioned signals for punishment, novelty, or frustrative nonreward Passive avoidance, extinction Behavioral maintenance (reward dependence) Norepinephrine Conditioned signals for reward or relief of punishment Resistance to extinction

22 ORDER VS. DISORDER

23 The Personality Style-Personality Disorder Continuum

24

25 Shedler-Westen Assessment Procedure-200 (SWAP-200) Q-sort method Fixed distribution

26 Sample Personality Disorder Score Profile for a Patient with Borderline Personality Disorder from Westen D and Shedler J, AJP, 1999

27 Prevalence of PDs in a Community Sample (N=2053) Overall 13.4% Torgersen, Kringlen, Cramer, 2001

28 Prevalence of PDs in a Community Sample (N=2053) Personality Disorder Paranoid 2.4 Schizoid 1.7 Schizotypal 0.6 Antisocial 0.7 Borderline 0.7 Histrionic 2.0 Narcissistic 0.8 Avoidant 5.0 Dependent 1.5 Obsessive-Compulsive 2.0 Passive-Aggressive 1.7 Self-Defeating 0.8 Present Prevalence Torgersen, Kringlen, Cramer; 2001