Transcript Personality Disorders

Survey of Modern Psychology
Fall 2010
Personality Disorders
Personality Disorders
As they currently appear in the DSM-IV-TR
• Cluster A “Odd or Eccentric”
– Paranoid Personality Disorder
– Schizoid Personality Disorder
– Schizotypal Personality Disorder
• Cluster B: “Dramatic, emotional, or erratic”
–
–
–
–
Antisocial Personality Disorder
Borderline Personality Disorder
Histrionic Personality Disorder
Narcissistic Personality Disorder
• Cluster C “Anxious or fearful”
– Avoidant Personality Disorder
– Dependent Personality Disorder
– Obsessive-Compulsive Personality Disorder
Proposed Changes for DSM-V
• Will likely include “Personality Disorder Types”
– This would use a system of “graded membership” – to
what degree does the person have this type of
personality
•
•
•
•
•
Antisocial/Psychopathic Type
Avoidant Type
Borderline Type
Obsessive-Compulsive Type
Schizotypal Type
Proposed Changes for DSM-V
A. Type rating. Rate the patient’s personality using the 5-point
rating scale shown below. Circle the number that best describes
the patient’s personality.
5 = Very Good Match: patient exemplifies this type
4 = Good Match: patient significantly resembles this type
3 = Moderate Match: patient has prominent features of this type
2 = Slight Match: patient has minor features of this type
1 = No Match: description does not apply
B. Trait ratings. Rate extent to which the following traits associated
with the [whichever] Type are descriptive of the patient using this
four-point scale:
0 = Very little or not at all descriptive
1 = Mildly descriptive
2 = Moderately descriptive
3 = Extremely descriptive
Defining a Personality Disorder
• Enduring patterns of perceiving, relating to,
and thinking about the environment and
oneself that are exhibited in a wide range of
social and personal contexts
• Only when personality traits are inflexible and
maladaptive and cause significant functional
impairment or subjective distress do they
constitute Personality Disorders
Defining a Personality Disorder
• The essential feature of a Personality Disorder is
an enduring pattern of inner experience and
behavior that deviates markedly from the
expectations of the individual's culture and is
manifested in at least two of the following areas:
• Criterion A
–
–
–
–
Cognition
Affectivity
Interpersonal functioning
Impulse control
Defining a Personality Disorder
• Criterion B:
– The enduring pattern is inflexible and pervasive
across a broad range of personal and social
situations
• Criterion C:
– The enduring pattern leads to clinically significant
distress or impairment in social, occupational, or
other important areas of functioning
Defining a Personality Disorder
• Criterion D:
– The pattern is stable and of long duration, and its onset
can be traced back at least to adolescence or early
adulthood
• Criterion E:
– The enduring pattern is not better accounted for as a
manifestation or consequence of another mental disorder
• Criterion F:
– The enduring pattern is not due to the direct physiological
effects of a substance (e.g., a drug of abuse, a medication)
or a general medical condition (e.g., head trauma)
Defining a Personality Disorder
DSM-V Proposed Changes
Personality disorders represent the failure to
develop a sense of self-identity and the
capacity for interpersonal functioning that
are adaptive in the context of the individual’s
cultural norms and expectations.
1. Impaired sense of self identity
2. Failure to develop effective interpersonal
functioning
Diagnosing a Personality Disorder
• Requires evaluation of the individual's long term
patterns of functioning
• The personality traits must be distinguished from
those that emerge in response to specific
situational stressors or more transient mental
states
• The clinician should address the stability of the
personality traits over time and across different
situations
• The individual may not consider these traits
problematic; they are often ego-syntonic
Diagnosing a Personality Disorder
• Evaluation must take into account the individual's
ethnic, cultural, and social background
• Traits of a personality disorder that appear in
childhood do not always continue to adulthood;
to diagnose a person under 18 with a personality
disorder requires that the trait has been present
at least 1 year
– Antisocial Personality Disorder cannot be diagnosed
until 18 years of age
• May be exacerbated by the loss of a significant
support or stabilizing situation (e.g., a job)
Personality Disorders: Notes
• Antisocial Personality Disorder and Borderline
Personality Disorder tend to become less evident
or remit over time
• Antisocial Personality Disorder is more frequently
diagnosed in males; Borderline, Histrionic, and
Dependent Personality Disorders are more often
diagnosed in females. It is unclear whether there
is a real difference in prevalence, or if there’s a
tendency to over/under diagnose based on
traditional gender roles and behaviors
Paranoid Personality Disorder
A. A pervasive distrust and suspiciousness of
others such that their motives are
interpreted as malevolent, beginning by
early adulthood and present in a variety of
contexts, as indicated by four (or more) of
the following:
Paranoid Personality Disorder
(4 or more)
1. Suspects, without sufficient basis, that others
are exploiting, harming, or deceiving him or her
2. Is preoccupied with unjustified doubts about
the loyalty or trustworthiness of friends or
associates
3. Is reluctant to confide in others because of
unwarranted fear that the information will be
used maliciously against him or her
4. Reads hidden demeaning or threatening
meanings into benign remarks or events
Paranoid Personality Disorder
(4 or more)
5. Persistently bears grudges, i.e., is unforgiving
of insults, injuries, or slights
6. Perceives attacks on his or her character or
reputation that are not apparent to others
and is quick to react angrily or to
counterattack
7. Has recurrent suspiciousness, without
justification, regarding fidelity of spouse or
sexual partner
Paranoid Personality Disorder
B. Does not occur exclusively during the course of
Schizophrenia, a Mood Disorder With Psychotic
Features, or another Psychotic Disorder and is
not due to the direct physiological effects of a
general medical condition
Note: if criteria are met prior to the onset of
Schizophrenia, add “Premorbid,” e.g., “Paranoid
Personality Disorder (Premorbid).”
Paranoid Personality Disorder: Notes
• More common in males
• Should not be confused with behaviors that
are influenced by sociocultural factors or life
circumstances
• Increased prevalence in relatives of people
with Schizophrenia
Paranoid Personality Disorder: Notes
• Prevalence:
– General population: .5% - 2.5%
– Inpatient settings: 10% - 30%
– Outpatient settings: 2% - 10%
• More likely to experience Major Depressive
Disorder, Agoraphobia, OCD, Substance Abuse
Schizoid Personality Disorder
A. A pervasive pattern of detachment from
social relationships and a restricted range of
expression of emotions in interpersonal
settings, beginning by early adulthood and
present in a variety of contexts as indicated
by four (or more) of the following:
Schizoid Personality Disorder
(4 or more)
1. Neither desires nor enjoys close relationships, including
being part of a family
2. Almost always chooses solitary activities
3. Has little, if any, interest in having sexual experiences
with another person
4. Takes pleasure in few, if any, activities
5. Lacks close friends or confidants other than first degree
relatives
6. Appears indifferent to the praise or criticism of others
7. Shows emotional coldness, detachment, or flattened
affectivity
Schizoid Personality Disorder: Notes
• Often prefer mechanical or abstract tasks
• Reduced experience of pleasure from sensory or
interpersonal experiences
• May be oblivious to normal subtleties of social
interactions and do not respond appropriately to
social cues
– May seem socially inept, superficial, or self-absorbed
• Often seem aloof or cold
• Often react passively to adverse events and seem
directionless
Schizoid Personality Disorder: Notes
• May be comorbid with Major Depressive
Disorder
• May experience brief Psychotic Episodes
(lasting minutes to hours)
• Is sometimes an antecedent of Delusional
Disorder or Schizophrenia
• Slightly more common in males and may
cause more impairment in males
• Uncommon in clinical settings
Schizotypal Personality Disorder
A. A pervasive pattern of social and
interpersonal deficits marked by acute
discomfort with, and reduced capacity for,
close relationships as well as by cognitive or
perceptual distortions and eccentricities of
behavior, beginning by early adulthood and
present in a variety of contexts as indicated
by five (or more) of the following:
Schizotypal Personality Disorder
(5 or more)
1. Ideas of reference (excluding delusions of reference)
[a less firmly held idea]
2. Odd beliefs or magical thinking that influences
behavior and is inconsistent with subcultural norms
(e.g., superstitiousness, belief in clairvoyance,
telepathy, or “sixth sense”; in children and
adolescents, bizarre fantasies or preoccupations)
3. Unusual perceptual experiences, including bodily
illusions
4. Odd thinking and speech (e.g., vague, circumstantial,
metaphorical, over-elaborate, or stereotyped)
Schizotypal Personality Disorder
(5 or more)
5. Suspiciousness or paranoid ideation
6. Inappropriate or constricted affect
7. Behavior or appearance that is odd, eccentric,
or peculiar
8. Lack of close friends and confidants other than
first-degree relatives
9. Excessive social anxiety that does not diminish
with familiarity and tends to be associated with
paranoid fears rather than negative judgments
about self
Schizotypal Personality Disorder:
Notes
• May express unhappiness about their lack of
relationships
• Tend to feel like, and behave like, outsiders
• Often seek treatment for associated features
– Anxiety, depression, etc.
• 30% - 50% who are diagnosed also have a diagnosis of Major
Depressive Disorder
– In response to stress, may experience transient
psychotic episodes
• Slightly more common in males
Schizotypal Personality Disorder:
Notes
• Occurs in about 3% of the general population
• Usually is relatively stable, very few develop a
Psychotic Disorder
• More prevalent among first degree relatives of
Schizophrenics
• Symptoms may appear transiently in
adolescents
Avoidant Personality Disorder
A. A pervasive pattern of social inhibition,
feelings of inadequacy, and hypersensitivity
to negative evaluation, beginning by early
adulthood and present in a variety of
contexts, as indicated by four (or more) of
the following:
Avoidant Personality Disorder
(4 or more)
1.
2.
3.
4.
5.
6.
7.
Avoids occupational activities that involve significant
interpersonal contact, because of fears of criticism, disapproval,
or rejection
Is unwilling to get involved with people unless certain of being
liked
Shows restraint within intimate relationships because of the fear
of being shamed or ridiculed
Is preoccupied with being criticized or rejected in social situations
Is inhibited in new interpersonal situations because of feelings of
inadequacy
Views self as socially inept, personally unappealing, or inferior to
others
Is unusually reluctant to take personal risks or to engage in any
new activities because they might prove embarrassing
Avoidant Personality Disorder: Notes
• May decline offers of job promotions because of
a fear of criticism
• Low threshold for criticism; feel extremely hurt at
any slight disapproval
• Tend to be shy, quiet, inhibited, and “invisible”
because of a fear that any attention would be bad
• Expect that whatever they say will be wrong, so
tend to stay mute
• Want to have social relationships, but are fearful
Avoidant Personality Disorder: Notes
• Because of a fearful and tense demeanor,
might be more likely to be noticed and
ridiculed (hence confirming fears)
• May fantasize about idealized relationships
with others
• High comorbidity with mood and anxiety
disorders (especially Social Phobia,
Generalized Type)
• Become overly attached to anyone with whom
they are close
Avoidant Personality Disorder: Notes
• Equally prevalent in males and females
• Prevalence:
– General population: .5% - 1%
– Outpatients: 10%
• Avoidant behavior often starts in infancy or
childhood
– Usually shyness decreases with age, with Avoidant
Personality Disorder, it increases
– Avoidant Personality Disorder may remit slightly
with age
Dependent Personality Disorder
A. A pervasive and excessive need to be taken
care of that leads to submissive and clinging
behavior and fears of separation, beginning
by early adulthood and present in a variety
of contexts, as indicated by five (or more) of
the following:
Dependent Personality Disorder
(5 or more)
1. Has difficulty making everyday decisions
without an excessive amount of advice and
reassurance from others
2. Needs others to assume responsibility for most
major areas of his or her life
3. Has difficulty expressing disagreement with
others because of fear of loss of support or
approval
Note: Do not include realistic fears of retribution
4. Has difficulty initiating projects or doing things
on his or her own (because of a lack of selfconfidence in judgment or abilities rather than
a lack of motivation or energy)
Dependent Personality Disorder
(5 or more)
5 Goes to excessive lengths to obtain nurturance
and support form others, to the point of
volunteering to do things that are unpleasant
6 Feels uncomfortable or helpless when alone
because of exaggerated fears of being unable to
care for himself or herself
7 Urgently seeks another relationship as a source
of care and support when a close relationship
ends
8 Is unrealistically preoccupied with fears of being
left to take care of himself or herself
Dependent Personality Disorder: Notes
• May occur in an individual with a general medical
condition or disability, but the difficulty in taking
responsibility goes beyond what would normally be
associated with that condition/disability
• Will agree with something he or she feels is wrong
rather than risk losing the person
• Often do not learn skills of independent living
• May tolerate abuse (when there are clear options/ways
to leave the relationship)
• Increased risk of Mood and Anxiety Disorders
• Chronic illness or childhood Separation Anxiety
Disorder may be predisposing conditions
• Among the most frequently reported Personality
Disorders in clinics
Obsessive-Compulsive Personality
Disorder
A. A pervasive pattern of preoccupation with
orderliness, perfectionism, and mental and
interpersonal control, at the expense of
flexibility, openness, and efficiency,
beginning by early adulthood and present in
a variety of contexts, as indicated by four (or
more) of the following:
Obsessive-Compulsive Personality Disorder
(4 or more)
1. Is preoccupied with details, rules, lists, order,
organization, or schedules to the extent that the
major point of the activity is lost
2. Shows perfectionism that interferes with task
completion (e.g., is unable to complete a project
because his or her own overly strict standards are
not met)
3. Is excessively devoted to work and productivity to
the exclusion of leisure activities and friendships (not
accounted for by obvious economic necessity)
4. Is overconscientious, scrupulous, and inflexible about
matters of morality, ethics or values (not accounted
for by cultural or religious identification)
Obsessive-Compulsive Personality Disorder
(4 or more)
5 Is unable to discard worn-out or worthless
objects even when they have no sentimental
value
6 Is reluctant to delegate tasks or to work with
others unless they submit to exactly his or
her way of doing things
7 Adopts a miserly spending style toward both
self and others; money is viewed as
something to be hoarded for future
catastrophes
8 Shows rigidity and stubbornness
Obsessive-Compulsive Personality
Disorder: Notes
• Attempt to maintain control through
painstaking attention to rules, trivial details,
procedures, lists, schedules, etc.
• Excessively careful and prone to repetition
• Extraordinary attention to detail and
repeatedly checking for possible mistakes
• Oblivious to the fact that other people tend to
be annoyed by the delays and inconveniences
from this behavior
• Time is poorly allocated, the most important
tasks are often left to the last minute
Obsessive-Compulsive Personality
Disorder: Notes
• May pay so much attention to making every
detail of a project perfect that the project is never
completed
• Hobbies and recreational tasks are approached as
serious tasks requiring organization
• Rigidly deferential to authority and insist on
literal compliance to rules with no rule-bending
for extenuating circumstances
• May be very self-critical
• “Pack rats” because “you never know when you
Obsessive-Compulsive Personality
Disorder: Notes
• May show surprise or annoyance if others
suggest that an activity or task may be done a
different way
• Even if the individual recognizes that
compromise might be in their best interest,
they refuse to do so because of “the principle
of the thing”
• Prone to anger when they cannot maintain
control or there is no clear rule
• Preoccupation with logic and intellect
Obsessive-Compulsive Personality
Disorder: Notes
• High comorbidity with Anxiety Disorders
– The majority of people with OCD do not have
OCPD
– May be an association between Eating Disorders
and OCPD
• Prevalence:
– 1% of general population
– 3% - 10% in mental health clinics
In OCPD, there are no actual obsessions or
Histrionic Personality Disorder
A. A pervasive pattern of excessive
emotionality and attention seeking,
beginning by early adulthood and present in
a variety of contexts, as indicated by five (or
more) of the following:
Histrionic Personality Disorder
(5 or more)
1. Is uncomfortable in situations in which he or
she is not the center of attention
2. Interaction with others is often characterized
by inappropriate sexually seductive or
provocative behavior
3. Displays rapidly shifting and shallow
expression of emotions
4. Consistently uses physical appearance to
draw attention to self
Histrionic Personality Disorder
(5 or more)
5. Has a style of speech that is excessively
impressionistic and lacking in detail
6. Shows self-dramatization, theatricality, and
exaggerated expression of emotion
7. Is suggestible, i.e., easily influenced by
others or circumstances
8. Considers relationships to be more intimate
than they actually are
Histrionic Personality Disorder: Notes
• Need to be “the life of the party” and will do
something dramatic to get attention
– In treatment, will tend to be overly flattering, bring gifts,
give dramatic descriptions of symptoms and replace them
with new symptoms each visit
• Excessively use physical appearance to draw attention
• Fish for compliments and be excessively upset by
critical comments
• Express strong and dramatic opinions, but have no
information or reasons to back them up
• Excessively emotional
Histrionic Personality Disorder: Notes
• Emotions may appear to be turned on and off too
quickly to be authentic
– Will often accuse others of faking their feelings
• Opinions and feelings are overly influenced by
others
• May be overly trusting, especially of authority
figures
• Difficulty achieving real emotional intimacy
• Often control partners through emotional
manipulation
• May alienate others because of constantly
demanding attention
Histrionic Personality Disorder: Notes
• Thought to be more common in women
– Behavioral expression does seem to be strongly
influenced by social norms and stereotypes
• A man might present as particularly “macho” and seek
attention by bragging about his athleticism
• More prone to suicidal gestures and threats;
unclear what the risk of suicide is
• Prevalence:
– General population: 2% - 3%
– Mental health clinics: 10% - 15%
Narcissistic Personality Disorder
A. A pervasive pattern of grandiosity (in fantasy
or behavior), need for admiration, and lack
of empathy, beginning by early adulthood
and present in a variety of contexts, as
indicated by five (or more) of the following:
Narcissistic Personality Disorder
(5 or more)
1. Has a grandiose sense of self-importance (e.g.,
exaggerates achievements and talents, expects
to be recognized as superior without
commensurate achievements)
2. Is preoccupied with fantasies of unlimited
success, power, brilliance, beauty, or ideal love
3. Believes that he or she is “special” and unique
and can only be understood by, or should
associate with, other special or high-status
people (or institutions)
4. Requires excessive admiration
Narcissistic Personality Disorder
(5 or more)
5. Has a sense of entitlement, i.e., unreasonable
expectations of especially favorable treatment
or automatic compliance with his or her
expectations
6. Is interpersonally exploitative, i.e., takes
advantage of others to achieve his or her own
ends
7. Lacks empathy: is unwilling to recognize or
identify with the feelings and needs of others
8. Is often envious of others or believes that
others are envious of him or her
9. Shows arrogant, haughty behaviors or attitudes
Narcissistic Personality Disorder: Notes
• In their inflated judgments of their own
accomplishments, there’s an implicit
underestimation/devaluation of others
• Fragile self esteem
• Believe that their needs are more important
than other people’s needs
• Expect to be recognized by others as superior
• Fish for compliments
• Assume that other people are interested in
Narcissistic Personality Disorder: Notes
• More common in men
• Prevalence:
– General population: less than 1%
– Clinical populations: 2% - 16%
• May perform low or avoid competitive situations
where defeat is possible
• May be associated with Hypomania, Anorexia,
and Substance Abuse
– The behaviors are particularly common in people who
abuse cocaine; this appears to be substance induced
Adolescents may show narcissistic traits, but these
traits do not necessarily indicate a disorder
Borderline Personality Disorder
A. A pervasive pattern of instability of
interpersonal relationships, self-image, and
affects, and marked impulsivity beginning by
early adulthood and present in a variety of
contexts as indicated by five (or more) of the
following
Borderline Personality Disorder
(5 or more)
1. Frantic efforts to avoid real or imagined
abandonment
Note: Do not include suicidal or self-mutilating behavior
covered in Criterion 5
2. A pattern of unstable and intense interpersonal
relationships characterized by alternating between
extremes of idealization and devaluation
3. Identity disturbance: markedly and persistently
unstable self-image or sense of self
4. Impulsivity in at least two areas that are potentially
self-damaging (e.g., spending, sex, substance abuse,
reckless driving, binge eating)
Note: Do not include suicidal or self-mutilating behavior
covered in Criterion 5
Borderline Personality Disorder
(5 or more)
5 Recurrent suicidal behavior, gestures, or
threats, or self-mutilating behavior
6 Affective instability due to a marked reactivity
of mood (e.g., intense episodic dysphoria,
irritability, or anxiety usually lasting a few hours
and only rarely more than a few days)
7 Chronic feelings of emptiness
8 Inappropriate, intense anger or difficulty
controlling anger (e.g., frequent displays of
temper, constant anger, recurrent physical
fights)
9 Transient, stress-related paranoid ideation or
severe dissociative symptoms
Borderline Personality Disorder: Notes
• Intense abandonment fears and inappropriate
anger when faced with realistic time limited
separations or unavoidable changes in plans
– E.g., sudden despair when a therapy session is over
– E.g., panic or fury if a close acquaintance is a few
minutes late
• The individual believes that the “abandonment”
implies that he or she is bad
• Intolerant of being alone and constantly need to
be surrounded with people
• May try to avoid abandonment with suicidal
behaviors
Borderline Personality Disorder: Notes
• May idealize other upon a first meeting,
demand to spend a lot of time together, and
quickly share personal details early in a
relationship
• Switch quickly to devaluing the same people
– Believing that the other person does not care
enough, give enough, or is not “there” enough
• Can only nurture with the expectation that the
other person will meet their needs on demand
Borderline Personality Disorder: Notes
• Prone to sudden changes in self-image
– E.g., shifting goals, values, career plans, sexual
identity, etc.
• Polarized view of the self and others
– Either all good or all bad
• May have a feeling of “not existing” at times if
the person feels that they do not have any
meaningful relationships or support
• Poor performance in unstructured situations
Borderline Personality Disorder: Notes
• 8% - 10% commit suicide
– Recurrent suicidal ideation or behavior is often
why a person with BPD begins therapy
– Suicide attempts and gestures are usually
precipitated by threats of separation, rejection, or
the expectation that the individual assume
increased responsibility
• Self-mutilation may also occur during a
dissociative period and brings relief by
reaffirming the individual’s ability to feel
Borderline Personality Disorder: Notes
• Tend to feel chronically bored and constantly
seek something to do
• Symptoms, negative emotions, and outbursts
tend to be transient, lasting minutes to hours
– The real or perceived return of a caregiver’s
nurturance usually results in an immediate
remission of symptoms
• Pattern of undermining themselves when a
goal is about to be realized (e.g., dropping out
of school just before graduation; regressing
severely after a discussion of how well therapy
Borderline Personality Disorder: Notes
• May feel more secure with transitional objects
than with real relationships
• Commonly there are childhood histories of
abuse, neglect, and early parental loss or
separation
• High comorbidity with Mood Disorders,
Substance Related Disorders, Eating Disorders
(especially Bulimia), PTSD, and ADHD
Borderline Personality Disorder: Notes
• More commonly diagnosed in females (75%)
• Prevalence:
– General population: 2%
– Outpatient: 10%
– Inpatient: 20%
• Symptoms tend to diminish with age
• 5 times more common among first degree
relatives
Borderline Personality Disorder:
Treatment
• Dialectical Behavioral Therapy (DBT)
– Focuses on acceptance and change
• The client has value and is worthwhile
• The client has behavior that needs to be changed
– Sets boundaries for treatment
Borderline Personality Disorder:
Treatment
• Components of DBT
1. Mindfulness: being aware of one’s experience
2. Interpersonal effectiveness: learning to ask for
things and to say no
3. Emotional regulation: moderating emotions so
they work for you, not against you
4. Distress tolerance: ability to experience
distressing or upsetting events without resorting
to damaging behaviors
Borderline Personality Disorder: Final
Notes
• High rate of relapse
• Clients with BPD tend to be difficult
– Resistant to treatment, idealizing and devaluing
the therapist, crossing boundaries/unrealistic
expectations
• DBT is so far the most effective treatment, but
more work is needed
Antisocial Personality Disorder
A. There is a pervasive pattern of disregard for
and violation of the rights of others
occurring since age 15 years, as indicated by
three (or more) of the following:
Antisocial Personality Disorder
(3 or more)
1. Failure to conform to social norms with
respect to lawful behaviors as indicated by
repeatedly performing acts that are grounds
for arrest
2. Deceitfulness, as indicated by repeated
lying, use of aliases, or conning others for
personal profit or pleasure
3. Impulsivity or failure to plan ahead
4. Irritability and aggressiveness, as indicated
by repeated physical fights or assaults
Antisocial Personality Disorder
(3 or more)
5. Reckless disregard for safety of self or others
6. Consistent irresponsibility, as indicated by
repeated failure to sustain consistent work
behavior or honor financial obligations
7. Lack of remorse, as indicated by being
indifferent to or rationalizing having hurt,
mistreated, or stolen from another
Antisocial Personality Disorder
B. The individual is at least age 18 years
C. There is evidence of Conduct Disorder with
onset before age 15 years
D. The occurrence of antisocial behavior is not
exclusively during the course of
Schizophrenia or a Manic Episode
People with Antisocial Personality Disorder
were formerly referred to as “Psychopaths”
or “Sociopaths”
Antisocial Personality Disorder
Childhood behaviors (characteristic of Conduct
Disorder) include:
1. Aggression to people and animals
2. Destruction of property
3. Deceitfulness or theft
4. Serious violation of rules
Antisocial Personality Disorder: Notes
• Central features are deceit and manipulation
• Disregard the wishes, rights, and feelings of
others
• Decisions occur impulsively without
consideration of consequences to the self or
others
• Tend to be irritable and aggressive; disregard for
the safety of self and others
– E.g., reckless driving, including recurrent speeding,
DWI’s, multiple accidents
• May neglect a child in a way that puts the child in
danger
Antisocial Personality Disorder: Notes
• Consistently irresponsible
– E.g., long periods of unemployment, leaving jobs
without plans for a new one, repeated unexplained
absences from work
• Show little or no remorse for the consequences
of their actions
– Or may provide a superficial rationalization
• “life’s unfair”
• “losers deserve to lose”
• “he had it coming anyway”
– Blame the victim for being helpless, foolish, or just
deserving their fate
– May minimize the consequences, or show complete
indifference
Antisocial Personality Disorder: Notes
• Believe that everyone is out for him or herself
• One should stop at nothing to avoid being pushed
around
• Tend to lack empathy, be callous, cynical, and
contemptuous of the feelings, rights, and
sufferings of others
• Inflated sense of self and arrogant self-appraisal
• Often have superficial charm, good at charming
and manipulating others with jargon
• Tend to be irresponsible and exploitative in
relationships, especially sexual relationships
Antisocial Personality Disorder: Notes
• More likely than the general population to die
prematurely by violent means
– E.g., suicide, accidents, homicides
• Tend to experience:
– Dysphoria, inability to tolerate boredom,
depressed mood
• High comorbidity with:
– Anxiety Disorders, Depressive Disorders,
Substance Related Disorders, Somatization
Disorder, ADHD Pathological Gambling, and other
Antisocial Personality Disorder: Notes
• Conduct Disorder is more likely to evolve into
Antisocial Personality Disorder if:
– Abuse or neglect as a child
– Unstable or erratic parenting
– Inconsistent discipline
• Seems to be associated with low socioeconomic status and urban settings
– This raises the concern that there is bias in giving
the diagnosis, and possibly that antisocial
behaviors serve a protective and adaptive purpose
Antisocial Personality Disorder: Notes
• Prevalence:
– General population:
• Males: 3%
• Females: 1%
– Clinical settings: 3% - 30% depending on the
population being sampled
• Higher in substance abuse treatment settings and
prison settings
• Is usually chronic, but may remit somewhat in
middle age
Antisocial Personality Disorder: Notes
• More common among first degree relatives
– Higher risk to biological relatives of females
– Biological relatives are also at a higher risk for
Somatization Disorder and Substance-Related
Disorders
• Adoption studies indicate that both genetics and
environment play a role
– Adopted children resemble their biological parents
more than their adopted parents, but the
environment in the adoptive family also influences
risk