PSYC30014 Lecture Notes - Lecture 9: Schizotypal Personality Disorder, Histrionic Personality Disorder, Antisocial Personality Disorder
18 Jun 2018
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Lecture 9
- Personality: refers to individual differences in characteristic patterns of thinking,
feeling, and behaving
- Personality Disorder: “An enduring pattern of inner experience and behaviour that
deviates markedly from the expectations of the individual’s culture [defined by age,
gender, etc] and is manifested in 2 or more of the following areas: cognition (ways of
thinking and interpreting self, others, events) and affectivity (range, intensity, lability
[exaggerated changes in mood/affect in quick succession] and appropriateness of
emotional response)
- Core features of PD [based on Theodore Millon]:
- 1) Functional inflexibility
- → failure in adaptation to changing and varied life experience [reflected in repeated
ways of responding to things regardless of what the life experience/thing is]
- → a tendency to rigidly apply a range of behavioural strategies or responses across
diverse life situations (even when inappropriate) [incapacity to adapt one’s response
to situations even when response is inappropriate or will cause difficulty for
individual; OCPD - may have rigidity in the way environment is arranged around
them, need for environment to be arranged in that way is difficult for them to change
even in situations where it might not be the best setup; e.g. Camping in Central
Australia → need everything to be neat and tidy even though there is dust/dirt
everywhere, will have anxiety because things aren’t how they should be → inability to
adjust to that setting]
- 2) Self defeating behaviour patterns [stem from functional inflexibility]
- → typical ways of responding or coping that worsen the current situation or are
explicitly damaging the person
- → nevertheless, the person demonstrates limited capacity to intervene constructively
or to learn from experience
- 3) Tenuous stability under stress
- → marked instability in mood, thinking and behaviour during difficult periods [lability
in mood, chaotic thoughts, frantic behaviour that may be ill-directed]
- PDs first introduced in a systematic fashion by the DSM-III in 1980
- Forced clinicians to think of PDs as co-existing with other presentations [not just ⇒
think about state based or episodic behaviours, think about how personality might
interact with other disorders and other treatment (adherence, response, seeking);
force to think systematically]
- As having an effect on other presentations ⇒
- 10 different disorders outline
- DSM 3 and 4 - multiaxial presentation (Axis 1: mood, psychotic, substance use,
anxiety, eating disorders; Axis 2: personality disorders)
- DSM5: General Diagnostic Criteria:
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-A. An enduring pattern of inner experience and behaviour that deviates markedly
from the expectations of the individual’s culture. This pattern is manifested in two (or
more) of the following areas:
- • Cognition (i.e., ways of perceiving and interpreting self, other people, and events).
- • Affectivity (i.e., the range, intensity, lability, and appropriateness of emotional
response).
- • Interpersonal functioning.
- • Impulse control.
-B. The enduring pattern is inflexible and pervasive across a broad range of personal
and social situations.
-C. The enduring pattern leads to clinically significant distress or impairment in social,
occupational, or other important areas of functioning.
-D. The pattern is stable and of long duration, and its onset can be traced back at
least to adolescence or early adulthood.
-E. The enduring pattern is not better explained as a manifestation or consequence of
another mental disorder.
-F. The enduring pattern is not attributable to the physiological effects of a substance
(e.g., a drug of abuse, a medication) or another medical condition (e.g., head
trauma).
- General caveats re diagnosis: persistence over time; cultural background;
children/adolescents; gender [antisocial PD diagnosed more in males than females;
borderline, histrionic, dependent PD diagnosed more frequently in females];
confusing labels with explanations [stigma e.g. borderline PD]; semi-structured
interview [well developed or well validated interviews such as SCID-2]; trained
clinicians; 1-3 hours [depending on presentation]; need for collateral information;
‘overshadowing’ [patient presents with another serious mental health problem;
address the major problem and ignore underlying personality issues → treatment
does not go as well or patient does not return]
-Cluster A: odd or eccentric presentations
-Paranoid PD: a pattern of distrust and suspiciousness such that others’ motives are
interpreted as malevolent.
-Schizoid PD: a pattern of detachment from social relationships and a restricted
range of emotional expression.
-Schizotypal PD: a pattern of acute discomfort in close relationships, cognitive or
perceptual distortions, and eccentricities of behaviour.
-Cluster B: dramatic, erratic, or emotional presentations
-Antisocial PD: a pattern of disregard for, and violation of, the rights of others.
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-Borderline PD: a pattern of instability in interpersonal relationships, self-image, and
affects, and marked impulsivity.
-Histrionic PD: a pattern of excessive emotionality and attention seeking.
-Narcissistic PD: a pattern of grandiosity, need for admiration, and lack of empathy.
-Cluster C: anxious or fearful presentations
-Avoidant PD: a pattern of social inhibition, feelings of inadequacy, and
hypersensitivity to negative evaluation.
-Dependent PD: a pattern of submissive and clinging behaviour related to an
excessive need to be taken care of.
-Obsessive-compulsive PD: a pattern of preoccupation with orderliness,
perfectionism, and control
- Cluster A: ‘odd’ or eccentric
- Paranoid: a pattern of distrust and suspiciousness such that others’ motives are
interpreted as malevolent; easily slighted, suspicious, bears grudges, reads hidden
meanings onto benign remarks, questions loyalty of others, expects to be exploited
- Schizoid: a pattern of detachment from social relationships and a restricted range of
emotional expression; no close friends or confidants, indifferent to praise and
criticism, solitary, rarely experiences strong emotions, doesn’t want or enjoy close
relationships, constricted affect, little desire for sexual experiences
- Schizotypal: a pattern of acute discomfort in close relationships, cognitive or
perceptual distortions, and eccentricities of behaviour; ideas of reference, excessive
social anxiety, odd beliefs or magical thinking, odd speech, odd or eccentric
behaviour, unusual perceptual experiences, no close friends or confidants,
suspicious, inappropriate or constricted affect
-Paranoid Personality Disorder:
- → Pervasive distrust: easily slighted; suspicious; bears grudges; reads hidden
meanings into benign remarks; questions loyalty of others; expects to be exploited
- → Begins early by early adulthood/late adolescence
- → Present in a variety of contexts
- → Not better accounted for by other disorder or medical condition
- → 2.3% - 4% of the population
-Schizoid Personality Disorder:
- Pervasive detachment: no close friends or confidants; indifferent to praise and ⇒
criticism; solitary; rarely experiences strong emotions; doesn’t want or enjoy close
relationships; constricted affect; little desire for sexual experiences
- 3% - 4% of population⇒
-Schizotypal Personality Disorder
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find more resources at oneclass.com
