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Chapter Twelve - Personality Disorders.docx

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David Moscovitch

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[ TWELVE ] – PERSONALITY DISORDERS Personality disorders = enduing patterns of receiving, relating to, and thinking abt env’ and oneself tht are exhibited in wide range of social and personal contexts; are inflexible and maladaptive, and cause significant f’nal impairment/subjective distress OVERVIEW  Are chronic; dN come and go but originate in childhood and cont’ t/o adulthood  Chronic problems pervade every aspect of life  Many who have PD in addition to other psychological problems tend to do poorly in trtmt Categorical and Dimensional Models  Debated: whether PDs are extreme v.’s of otherwise normal personality variations (dimensions) or ways of relating tht are diff from psychologically healthy beh’ (categorical)  Categorical models of beh’ adv↑: convenience - w/ simplification comes problems (leads to reification of Ds—real ―things‖) - dN rate HOW ______ you are when yu have ______ PD  Adv↑’s of dimensional model: 1.) retain more info abt each indvdl 2.) be more flexible b/c would permit both categorical & dimensional differentiations among indvdls 3.) avoid often arbitrary decisions involved in assigning person to diagnostic category  Widely accepted basic personality dimension: five-factor model of personality (―Big Five‖) - ppl can be rated on series of personality dimensions and combo of 5 describes why ppl are so diff - factors are: i.) extraversion—talkative, assertive & active vs. silent, passive & reserved ii.) agreeableness—kind, trusting &warm vs. hostile, selfish & mistrustful iii.) conscientiousness—organized, thorough & reliable vs. careless, negligent & unreliable iv.) neuroticism—nervous, moody & temperamental vs. even-tempered v.) openness to experience—imaginative, curious & creative vs. shallow & imperceptive - on each dimension, ppl rated high/low/somewhere inbtwn Statistics and Development  PD found in 0.5-2.5% of general pop’n—10-30% of those served in inpatient settings, and 2-10% of those in outpatient settings Gender Differences  F make up 75% of identified BPD cases  Being a F i↑’d likelihood of being diagnosed w/ histrionic PD (i.e. instead of ASPD) CLUSTER A DISORDERS Paranoid Personality Disorder  Excessively mistrustful & suspicious of others w/o any justification in situations most other ppl would agree tht their suspicions are unfounded - even events tht have nothing to do w/ them are interpreted as personal attacks i.e. barking dog or delayed airline flight seen as deliberate attempt to annoy them  Assume ppl are out to harm/trick them (TF) tend not to confide in others - extends to ppl close to them and makes meaningful rel’nshps very difficult  Often appear tense and ―ready to pounce‖ when they think they’ve been slighted by someone  Sensitive to criticism and have excessive need for autonomy  Suspiciousness dN reach delusional proportions Causes  Relatives of indvdls w/ scz MAY be more likely to have PPD than ppl who dN have relative w/ scz  Maladaptive way of seeing world by those w/ PDD  misinterpretation (vicious cycle)  Speculation: roots in early upbringing i.e. parents may teach to be careful abt making mistakes and to impress tht they are diff from others  Cultural factors: certain groups of ppl thought to be susceptible b/c of unique exp’s i.e. imagine you were immigrant who had difficulty w/ lang and customs of new culture; innocuous things as others laughing and talking quietly might be interpreted as somehow directed at you Treatment  Unlikely to seek professional help b/c mistrustful  When they do, trigger usually crisis in life/other problems (i.e. depression, anxiety) and not necessarily PD  Therapists try to provide atmosphere conducive to dvlp’g sense of trust - often use cognitive therapy to counter person’s mistaken assumptions abt others, focusing on changing person’s beliefs tht all ppl are malevolent and most ppl cannot be trusted  To date: no confirmed form of trtmt tht can significantly improve lives of ppl w/ PPD Schizoid Personality Disorder  Pattern of detachment from soc’ rel’nshps and very limited range of emotions in interpersonal situations  Neither desire/enjoy closeness w/ others, including romantic/sexual rel’nshps - aar ―aloof‖, ―cold‖, and ―indifferent‖ to others  dN seem affected by praise/criticism  homelessness prevalent  ―consider themselves to be obsv’rs rather than pp’s in world around them‖ Causes and Treatment  Preference for soc’ isolation resembles aspects of autism - possible tht ~ bio’ dysf’n combines w/ early learning or early problems w/ interpersonal rel’nshps to produce social deficits  Rare for person w/ this to request trtmt (except in response to crisis such as extreme depression / losing job)  Therapists often begin trtmt by pointing out value in soc rel’nshps  May need to be taught emotions felt by others in order to learn empathy  Social skills training  Therapist takes part of friend/significant other—role-playing Schizotypal Personality Disorder  Typically socially isolated  Tend to be suspicious, have odd beliefs, have paranoid thoughts, express little emotion, and may dress/ behave in ways tht would seem unusual to many of us  Have ideas of reference—think insignificant events relate directly to them  Engage in magical thinking—believing, for i.e., tht they are clairvoyant or telepathic  Report unusual perceptual exp’s such as illusions—feeling presence of another when alone Causes  i↑’d prevalence of schizotypal PD among relatives of ppl w/ scz who dN also have scz themselves  env’ can strongly influence schizotypal PD  cognitive assessment of ppl w/ D point to mild-moderate decrements in their ability to perform on tests involving memory and learning - suggest some damage in LH Treatment  estimate: 30-50% who seek help also meet criteria for major depressive D  general approach: teach social skills to help reduce isolation from and suspicion of others  unusual tactic: not to encourage major changes, but to help person accept and adjust to solitary lifestyle  meds trtmt ~ to scz CLUSTER B DISORDERS Antisocial Personality Disorder  hist. of failing to comply w/ social norms and violating rights of others  perform actions most of us would find unacceptable (i.e. stealing from friends & family)  tend to be irresponsible, impulsive, and deceitful  appear unable to tell difference btwn truth and lies they make up to further their own goals  substance abuse common (in 83% of ppl w/ ASPD) and lifelong pattern in them  other labels of ASPD: manie sans délire (mania w/o delirium), moral insanity, egopathy, sociopathy, psychopathy *note: important difference btwn ASPD & psychopathy  Cleckley criteria: 1.) superficial charm and good intelligence 2.) absence of delusions and other signs of irrational thinking 3.) absence of ―nervousness‖ and other psychoneurotic manifestations 4.) unreliability 5.) untruthfulness and insincerity 6.) lack of remorse/shame 7.) inadequately motivated AS beh’ 8.) poor judgment and failure to learn by exp’ 9.) pathologic egocentricity and incapacity for love 10.) general poverty in major affective reac’ns 11.) specific loss of insight 12.) unresponsiveness in general interpersonal rel’ns 13.) fantastic and uninviting beh’ 14.) suicide rarely carried out 15.) sex life impersonal, trivial, and poorly integrated 16.) failure to follow any life plan  Hare criteria: 1.) glibness/superficial charm 2.) grandiose sense of self-worth 3.) proneness to boredom/need for stimulation 4.) pathological lying 5.) conning/manipulative 6.) lack of remorse  DSM-IV criteria focuses almost entirely on obsv’able beh’s whereas Cleckley/Hare criteria focus 1’ly on underlying personality traits - b/c difficult to assess personality traits  Some psychopaths are not criminals and some dN display aggressiveness of ASPD DSM-IV criterion  Not everyone who has psychopathy/ASPD becomes involved w/ legal sys - what separates may be IQ  Identifying psychopaths among criminal pop’n seems to have important implications for predicting future criminal beh’ - psychopathic criminals are more likely than non-psychopathic criminals to repeat their criminal offences, especially those tht are vio’/sexual in nature  Conduct disorder = children who engage in beh’s tht violate society’s norms  Many adults w/ ASPD/psychopathy had conduct disorder as children - likelihood i↑’s if child has both conduct disorder and ADD/ADHD Genetic Influences  Some genetic influence on criminality and AS beh’, but actual dvlpmt of criminality may req’ env’ factors (i.e. deficit in early, high-quality contact w/ parents or parent-surrgates)  Gene-environment interaction = genetic factors may be important only in presence of certain env’ influences Neurobiological Influences  Studies suggest executive cognitive f’n deficits in psychopaths  Underarousal hypothesis = abnormally low levels of cortical arousal (TF) seek to boost  Cortical immaturity hypothesis = cerebral cortex of psychopaths is at relatively primitive stage of dvlpmt (may help explain why beh’ often childlike & impulsive)  Fearlessness hypothesis = psychopaths possess higher threshold for exp’g fear than most other indvdls  Psychopaths may have difficulty associating certain cues/signals w/ impending punishment/danger  Possibility of one genetic component—agg’n  MAOA is enzyme tht breaks down NTs involved in our ―flight/fight‖ - if not working properly, may build up and affected ppl will have trouble handling stressful situations  Gray: 3 major brain sys’s influence learning and emotional beh’ 1
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