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Lecture

PSYCH257 Lecture Notes - Antisocial Personality Disorder, Paranoid Personality Disorder, Histrionic Personality Disorder


Department
Psychology
Course Code
PSYCH257
Professor
Allison Kelly

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PSYCH 257: March 21 & 26, 2013
Chapter 12: Personality Disorders
Personality Disorders: enduring maladaptive patterns for relating to the environment and oneself,
exhibiting a wide range of contexts that cause significant functional impairment or subjective distress
An Overview
- Personality disorders are chronic (Axis 2) and affects every aspect of the person’s life
- May distress the person as well as people around them
o Someone other than the affected must make the judgement whether it is causing
significant functional impairment because the affected person cannot make such a
judgement
- People who have personality disorder and other psychological problems tends to do poorly in
treatment
CATEGORICAL AND DIMENSIONAL MODELS
- Are psychological issues extreme versions of normal personality traits (dimensions) or ways of
relating that are different from psychologically healthy behaviour (categories)?
- Categorical models of behaviour
o Pro: convenience
o Cons: yes or no (no in-betweens)
- Implementing a dimensional model in the DSM will:
1. Retain more information about each individual
2. Be flexible because it would permit categorical and dimensional differentiations
3. Avoid the arbitrary decisions involved in assigning a person to a diagnostic category
- Five-factor model of personality (Big Five): people are rated high, low, or in-between based on 5
dimensions:
1. Extraversion (talkative, active vs. passive, reserved)
2. Agreeableness (kind, trusting, warm vs. hostile, selfish, mistrustful)
3. Conscientiousness (organized, thorough, reliable vs. careless, negligent, unreliable)
4. Neuroticism (nervous, moody, temperamental vs. even-tempered)
5. Openness to experience (imaginative, curious, creative vs. shallow, imperceptive)
o Model is universal with people from different cultures receiving the same results
- Western and Shedler model: 12 personality dimensions , some of which not listed by the DSM
- The obstacle to adopting a dimensional model is the lack of consensus about framework
PERSONALITY DISORDER CLUSTERS
- Divided into 3 clusters by the DSM based on resemblance
o Cluster A: odd, eccentric
Paranoid, schizoid, schizotypal
o Cluster B: dramatic, emotional, erratic, elevated impulsivity
Antisocial, borderline, histrionic, narcissistic
o Cluster C: anxious, fearful
Avoidant, dependent, obsessive-compulsive
STATISTICS AND DEVELOPMENT
- American studies find that personality disorders are relatively common

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- Schizoid, narcissistic, and avoidant personality disorders are relatively rare
- Paranoid, schizotypal, histrionic, dependent, and obsessive-compulsive disorder are found in 1-4%
of the general population
- Thought to originate in childhood or adolescence and continue into adult years
- Research is lacking because people only seek treatment after years of experiencing the disorder
- Borderline personality disorder: volatile and unstable relationships, persistent problems in early
adulthood, frequent hospitalizations, severe depression, suicidal gestures
o Symptoms gradually improve if they survive into their 30s
- Antisocial personality disorder: disregard for the rights and feelings of others, continue
destructive behaviour like lying and manipulation through adulthood
o Some burnout by 40 and engage in less criminal activity
GENDER DIFFERENCES
- Borderline personality disorder is diagnosed way more in women than men (75% of cases)
- Histrionic and dependent personality used be to more identified with females but it is now
equal between both genders
- Psychologists may have incorrectly diagnosed more women with histrionic personality disorder
- Many characteristics of histrionic personality disorder are extreme typical traits of women
- Bias can occur at different stages of the diagnostic process: bias criteria (criterion gender bias),
bias assessment measures and implementation (assessment gender bias), clinician’s personal
bias
COMORBIDITY
- Personality disorders have high comorbidity (patients tend to be diagnosed with more than one)
- There is a considerable overlap of the different disorder
Cluster A Disorders
PARANOID PERSONALITY DISORDER: Cluster A disorder involving pervasive distrust and suspiciousness
of others such that their motives are interpreted as malevolent
Clinical Description
- Defining characteristic is pervasive unjustified mistrust
- Suspicions can be unfounded and events completely unrelated are interpreted as personal
attacks (ideas of reference)
- Mistrust with the people close to them makes relationships difficult
- Can be loud or quiet but obviously hostile towards others, appear tense, sensitive to criticism,
and have an excessive need for autonomy
- Although related to paranoid type of schizophrenia and delusional disorder, people with
paranoid personality disorder do not have delusional suspicions and psychotic symptoms (eg.
hallucinations)
Causes
- Genetics do play a strong role in paranoid personality disorder
- Early mistreatment or traumatic childhood experiences may play a role in the development
o However, there may be a bias because these people are prone to viewing the world as a
threat

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- Early upbringing may have instilled maladaptive assumptions about others (eg. “people are
malevolent and deceptive”)
- Certain cultural groups such as prisoners, refugees, people with hearing impairments, and the
elderly are more susceptible because of their unique experiences
Treatment
- Mistrustful of people and unlikely to seek professional help
- When they do seek therapy, it is usually for another problem (anxiety or depression) or there is
a crisis trigger in their lives
- First step is to establish a meaningful therapeutic alliance between the client and therapist
- Cognitive restructuring therapy may be used to counter the person’s beliefs that all people are
malevolent and cannot be trusted
- Only a small percent (11%) of patients will continue with treatment long enough to be helped
SCHIZOID PERSONALITY DISORDER: Cluster A disorder featuring a pervasive pattern of detachment
from social relationships and a restricted range of expressed emotions
Clinical Description
- Neither desire or enjoy closeness with others, romantic or sexual relationships
- Appear cold, aloof, and detached; is not affected by criticism or praise
- Homelessness is prevalent because of their lack of close friendships and lack of dissatisfaction
about not having a sexual relationship
- Consider themselves to be observers of the world rather than participants
- Do not have very unusual thought processes that characterize other cluster A disorders
- Social isolation, poor rapport, and constricted affect (no positive or negative emotion)
Causes and Treatments
- Childhood shyness is reported as a precursor to schizoid personality disorder later in life
- Abuse and neglect in childhood are reported among individuals with this disorder
- Parents of children with autism are more likely to have it
- Biological dysfunction found in autism and schizoid combines with early learning or early
problems with interpersonal relationships to produce the social deficits of the schizoid
- People with a lower density of dopamine receptors have a higher measure of detachment
- Rare for people with schizoid to request treatment until it is for another crisis like extreme
depression or losing a job
- Treatment involves pointing out the value in social relationships, teaching emotions felt by
others to learn empathy, social skills training, role-playing to help patient practice
SCHIZOTYPAL PERSONALITY DISORDER: Cluster A disorder involving a pervasive pattern of interpersonal
deficits featuring acute discomfort with, and reduced capacity for, close relationships, as well as, by
cognitive or perceptual distortions and eccentricities of behaviour
- Similar to schizophrenia but without some of the more debilitating symptoms (ie. Hallucinations
and delusions)
Clinical Description
- Have psychotic-like symptoms, social deficits, and sometimes cognitive impairments or paranoia
- May be odd/ bizarre in the way they relate to other people, in their behaviour and how they
dress
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