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Chapter 13

PSYB32H3 Chapter Notes - Chapter 13: Obsessive–Compulsive Personality Disorder, Schizoid Personality Disorder, Paranoid Personality Disorder

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- Personality disorders are a heterogeneous group of disorders that are coded on Axis II of the DSM
- Reliability of personality disorder diagnoses has improved because of 2 developments:
o 1. The publication of specific diagnostic criteria
o 2. The development of structured interviews specially designed for assessing personality disorders
- Anti-social personality disorder has high test-retest ability
- Overall age-related decline over time in personality dysfunction as ppl get older
- Low test retest reliability; often difficult to diagnose a single, specific personality disorder because many people
exhibit a wide range of traits that make several diagnoses applicable
- Livesly identified 3 types of life tasks and proposed failure with any one task is enough to warrant a personality
disorder diagnosis:
o 1. To form stable, coherent, representations of self and others
o 2. To develop the capacity for intimacy and positive affiliations with others
o 3. To function adaptively in society by engaging in prosocial and co-operative behaviours
- ppl with PDs typically unaware that a problem exists, however great deal of stress for ppl around them
- diagnosis of PD enhanced when family/friends are used as informants
- use of clinical interviews and self-report measures
- Harkness, McNulty, Ben-Porath PSY-5 consists of dimensions assessing negative emotionality/neuroticism,
lack of positive emotionality, aggressiveness, lack of constraint, and psychotism
- MCMI corrects for tendencies like denial and random responding
- Personalized therapy
- 2 issues involving self-report measures:
o 1. The measures differ in their content and are not equivalent
o 2. The cut-off point used to determine the presence of a personality disorder often over estimate the
number of ppl who meet the diagnostic criteria or particular disorders
- Grouped into 3 clusters:
o Individuals in cluster A (paranoid, schizoid, and schizotypal) seem odd or eccentric. These disorders
reflect oddness and avoidance of social contact.
o Individuals in cluster B (borderline, histrionic, narcissistic, and anti-social) seem dramatic, emotional or
erratic. Behaviours are extrapunitive and hostile.
o Individuals in cluster C (avoidant, dependent, and obsessive compulsive) appear fearful.
o Suggestion that a fourth cluster (D) be added splitting the obsessive-compulsive features into separate
category reflecting the themes of obsession and inhibition
- Paranoid personality disorder (PPD)suspicions of others’ preoccupied with unjustified doubts about
trustworthiness/loyalty of others; different from schizophrenia and paranoid type because hallucinations are not
present; occurs mostly in men; co occurs with borderline, schizotypal, avoidant PDs
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- Schizoid personality disorder don’t desire/enjoy social relationships; don’t report strong emotions; loners with
solitary interests
- Schizotypal PD have interpersonal difficulties of schizoid personality and excessive social anxiety
o Diagnostic criteria derived by Spitzer, Endicott, Gibbonparanoid ideation, illusions, ideas of reference;
high comorbidity with other PDs
- Borderline personality disorder (BPD) impulsivity, instability in relationships, mood and self-image;
argumentative, irritable; scared of being alone so demand attention; often attempt suicide (mostly female)
o Object-relation theory concerned with the way children incorporate the values/ images of important
ppl (i.e. parents)
o Hypothesize ppl react to their world thru the perspectives of ppl from their past
o BPD ppl engage in defence mechanism called splitting: dichotomizing objects into all good or all bad
o Kernberg children with adverse childhood experiences will cause insecure egos
o Biological factors runs in families, suggests genetic component; poor functioning of frontal lobes, low
levels of serotonin (associated with impulsivity)
o Linehan’s stress diathesis theory – BPD developed when ppl with a biological diathesis for having a
difficulty controlling their emotions are raised in a family environment that is invalidating person’s
wants/needs/feelings are discounted/disrespected/disregarded
Dysregulation and invalidation interact with each other
Emotional dysregulation in children great demands on family invalidation by family thru
punishing/ignoring emotional outbursts by child to which parents attend
- Histrionic personality disorder overly dramatic plus attention seeking; more among women; use physical
features to draw attention
- Narcissistic people grandiose view of their own uniqueness and abilities; preoccupied with fantasies of great
success; bossy; lack empathy
o Clinicians regard NPD as a product of our times and our system of values
- Antisocial personality disorder and psychopathy
o Characteristics of ASPD
Conduct disorder present is present before age 15
Pattern of antisocial behaviour continues in adulthood
o Characteristics of psychopathy
Tendency to lie compulsively
Act without concern/regard for society
Robert Hare (UBC prof)wrote about Donald S. the psychopath
Clerkley poverty of emotions, no shame, superficially charming, lack anxiety;
antisocial behaviours performed impulsively
o Controversies with diagnoses of APD and psychopathy
Almost all psychopaths diagnosed with APD but many ppl with APD don’t meet criteria for
o Research and theory on etiology of APD + psychopathy
Childhood roots of psychopathy research has shown the following:
Genetically influenced psychopathic personality in adolescents is a strong predictor of
adult anti-social behaviour
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