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Chapter 13

CH.13 from 4TH ED.

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University of Toronto Scarborough

13: PERSONALITY DISORDERS - Personality disorders are a heterogeneous group of disorders that are coded on Axis II of the DSM CLASSIFYING PERSONALITY DISORDERS: CLUSTERS, CATEGORIES, AND PROBLEMS - 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 ASSESSING PERSONALITY DISORDERS - 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 PERSONALITY DISORDER CLUSTERS - 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 ODD/ECCENTRIC CLUSTER (A) - 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 - 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, Gibbonparanoid ideation, illusions, ideas of reference; high comorbidity with other PDs DRAMATIC/ERRATIC CLUSTER (B) - 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) - ETIOLOGY OF BPD 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 psychopathy 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  Female youth offenders, relative to males with high psychopathy, are more likely to have a history of psy
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