Transcript Chapter 14, Personality Disorders

Personality
Disorders
A Closer Look at Psychological
Disorders
Personality Disorders
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Personality disorders are a class of
disorders marked by extreme, longstanding, inflexible personality traits that
cause subjective distress or impaired
social and occupational functioning.
They are not so much severe mental
disorders as dysfunctional styles of living.
They impair social functioning – sufferers
seem unable to establish meaningful
relationships with other people, to
assume social responsibilities, or to
adapt to their social environment.
The behavior patterns are usually evident
by adolescence and obvious to others,
but the person with the disorder often
does not recognize the problem exists,
which makes treatment difficult.
Classification of Personality Disorders
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The DSM-IV lists 10 personality disorders, divided into
three “clusters,” or categories.
Personality
Disorders
Cluster A:
Odd or Eccentric
behaviors
Cluster B:
Dramatic, emotional,
or impulsive
behaviors
Cluster C:
Anxious or fearful
behaviors
Cluster A
Odd or Eccentric Behaviors
(Paranoid, Schizoid, and
Schizotypal Personality Disorders)
Paranoid Personality Disorder
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Paranoid personality disorder is characterized by a
deep distrust of others and a constant suspicion that
people around you have sinister motives.
They search for hidden meanings in everything and
read hostile intentions into the actions of others.
This suspiciousness gets in the way of personal
connections, so they have few, if any, meaningful
relationships.
They are quick to challenge the loyalties of friends
and loved ones and often appear cold and distant to
others. They usually shift blame to others and tend
to carry long grudges. They are described as being
tense, volatile, and sensitive to criticism.
Examples: “The Raven” by Edgar Allan Poe,
conspiracy theorists, Richard Nixon. Scooby Doo
and Shaggy, Hitler and Stalin
Causes:
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Possible relationship to schizophrenia
Possible role of early experience
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Trauma
Abuse
Learning
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“World is dangerous”
Schizoid Personality Disorder
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Detached from social relationships, their social skills are
often weak. They are the true hermits, preferring the life of
the loner and avoiding intimate interactions with others at
all costs. They also do not desire sexual relationships.
They genuinely prefer to be alone and do not secretly wish
for popularity. They do not show a need for attention or
acceptance.
They tend to seek jobs that require little social contact and
are perceived as humorless and distant.
They show a limited range of emotion and appear cold and
detached.
They appear unaffected by both praise and criticism.
No disorder in thought.
Examples: Daria, Sherlock Holmes, Angela from The
Office, Severus Snape?
Read about how Belle
Causes:
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Limited research
Precursor: childhood shyness
Possibly related to:
 Abuse/neglect
 Autism
 Dopamine
in Beauty and the Beast
exhibits symptoms of
Schizoid PD:
http://www.cracked.com/article_
19336_6-beloved-charactersthat-had-undiagnosed-mentalillnesses.html
The film Taxi Driver
provides a depiction of
features of this disorder.
Schizotypal Personality Disorder
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Some people believe that schizotypal personality disorder is a mild
form of schizophrenia.
Psychotic-like symptoms (they do have disorder in thought)
 Magical thinking – the irrational belief that one can bring about a
circumstance or event by thinking about it or wishing for it; normal
in preschool children (my husband taking the dog out for a walk is
the direct result of me thinking an hour earlier it should be done).
Superstitions, preoccupations with the paranormal or “magical.”
 Ideas of reference - the belief that casual events, people's
remarks, etc. are referring to oneself when, in fact, they are not.
 Illusions - having illusions, or attributing a particular event to
some mysterious force or person who is not present. Affected
people may also feel they have special powers to influence
events or predict an event before it happens.
Odd and/or unusual
 Appearance – Their personal appearance may look unkempt—
clothing choices that do not "fit together," clothes may be too
small or large, or clothes may be noticeably unclean.
 Behavior – odd perceptions, beliefs, behaviors and thoughts
(often unconventional beliefs such as being convinced of having
extra sensory abilities).
Schizotypal Personality Disorder, cont.
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Socially isolated
 Detachment from, and great discomfort in, social
relationships
Highly suspicious
 Often suspicious of others and display paranoid
tendencies.
Examples: Kramer (Seinfeld), Napolean Dynamite, Zach
G. in Dinner for Schmucks, Willy Wonka, Buddy the Elf
Causes:
 Schizophrenia phenotype (possibly related to
schizophrenia)?
 Lack full biological or environmental contributions
 Preserved frontal lobes
 People with schizotypal PD, like patients with
schizophrenia, may be quite sensitive to interpersonal
criticism and hostility, and there is now evidence to
suggest that parenting styles, early separation and
early childhood neglect can lead to the development of
schizotypal traits
Drawings done by patients diagnosed
with schizotypal personality disorder
Drawing done by a 15 year old with schizotypal
personality disorder. Said he felt as though he
had a “two-sided personality.”
Titled “Birth, Death, Anger, tick,
tick, tick…Soul taker”
Cluster B
Dramatic, Emotional, or
Impulsive Behaviors
(Narcissistic, Histrionic, Borderline, and
Antisocial Personality Disorders)
Narcissistic Personality Disorder
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Named after the Greek myth of Narcissus, who fell
in love with his own reflection in a pool of water
and pined away over it until he was eventually
changed into a flower.
Characteristics of someone with Narcissistic PD:
 Exaggerated and unreasonable sense of selfimportance
 Extreme sensitivity to criticism
 A constant need for attention
 A tendency to arrogantly overestimate personal
abilities and achievements.
 Self-centered and envious.
 They exaggerate their achievements, expecting
others to recognize them as being superior.
 They tend to be choosy about picking friends,
since they believe that not just anyone is
worthy of being their friend.
 They are generally uninterested in the feelings
of others (remember Taylor Swift?) and may
take advantage of them.
Narcissistic Personality Disorder, cont.
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Other examples of narcissists:
 Tom Cruise in the film Magnolia (He plays a
character called Frank T.J. Mackey, author of a
book called Seduce and Destroy, a self-help
system for men to get women to sleep with them).
 Dorian Gray, from the book The Picture of Dorian
Gray by Oscar Wilde.
 TV: Gregory House, Michael Scott (The Office)
 Charles Manson
http://www.youtube.com/watch?v=f9jRDHGabp8
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Also Donald Trump, Kanye West, Justin Bieber
Do Facebook and other social networking sites
make us more narcissistic?
http://www.youtube.com/watch?v=71xHUBWLC1k
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MadTV spoof: http://www.youtube.com/watch?v=TQ1Z_5c0L3Q
Causes
 Deficits in early childhood learning
 Altruism
 Empathy
Spencer Pratt:
http://www.youtub
 Sociological view
e.com/watch?v=In
 Increased individual focus
H9mQ2Mw1w
 “Me generation”
Histrionic Personality Disorder
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Common diagnosis in females
Emotional shallowness and overly dramatic
behavior.
Vague, superficial speech
They need to be the center of attention all the time,
often interrupting others in order to dominate the
conversation.
They may dress provocatively or exaggerate
illnesses in order to gain attention.
They also tend to exaggerate friendships and
relationships, believing that everyone loves them
Other characteristics: Excessively emotional,
sensational, sexually provocative, impulsive,
appearance-focused, impressionistic
Examples: Miss Piggy, Kim Kardashian, Miley
Cyrus, The Plastics in Mean Girls
Is Scarlett O’Hara
Causes
a sufferer?
http://www.cracked.com/ar
 Little research
ticle_19336_6-beloved Links with antisocial personality
characters-that-hadundiagnosed-mentalillnesses_p2.html
Borderline Personality Disorder
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A better name would be “emotionally unstable disorder” – the
term borderline goes back to when sufferers were thought to be
borderline schizophrenic (docs now know they’re often not)
Lack of stability in interpersonal relationships, self-image, and
emotion.
 Impulsivity
 An intense fear of abandonment
 Very poor self-image
 Turbulent relationships
People with this disorder are prone to constant mood swings and
bouts of anger.
 They are quick to anger when their expectations are not met.
 They will take their anger out on themselves, causing
themselves injury (self-mutilation)
Suicidal threats and actions are not uncommon
Examples: Meg Griffin (Family Guy), mother and daughter from
Black Swan, Anakin Skywalker/Darth Vader, Kathy Bates in
Misery, Angelina Jolie in Girl Interrupted, Uma Thurman in My
Super Ex-Girlfriend
Examples of movies that possibly feature borderline personality
disorder (WARNING – these movies would definitely need
parental permission!):
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Fatal Attraction (http://www.youtube.com/watch?v=e3oF8Po4qWc )
and The Hand that Rocks the Cradle
(http://www.youtube.com/watch?v=wjtfG8r14Uk)
Borderline Personality Disorder, cont.
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Comorbid disorders
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Depression – 24-74%
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Bipolar – 4-20%
Substance abuse – 67%
Eating disorders
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Suicide – 6%
25% of bulimics have BPD
Causes
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Genetic/biological components
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Serotonin
Frontolimbic circuit (volume loss of the hippocampus and the
amygdala)
Cognitive biases
Early childhood experience
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Neglect
Trauma
Abuse
Interview with BPD
patient:
http://www.youtube
.com/watch?v=eO
phgCJX1FY
Antisocial Personality Disorder
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Formerly known as psychopathic or
sociopathic personality disorder – it is the
most dramatic and troubling of all the
personality disorders.
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Because of this, this one requires a closer look…
Symptoms of Antisocial Personality
Disorder
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This disorder is more likely to occur in males than females, and
usually develops by adolescence. (Warning signs as a child:
setting fires, abusing animals, destruction of property, theft,
victim of sexual abuse)
It is characterized by a lack of conscience, empathy, and
remorse for wrongdoing, even toward friends and family
members.
People with this disorder exhibit a persistent disregard for and
violation of others’ rights (“social predators”). They treat people
as objects – as things to be used for gratification and cast aside
coldly when no longer wanted.
They live for the moment and take action without thinking about
consequences.
They seek thrills, they are often aggressive, and they do not feel
shame or guilt if they break social rules or injure other people
along the way.
Getting caught does not bother them, either. No matter how
many times they are punished or jailed, they never learn to stay
out of trouble.
However, interestingly enough, they can get away with
destructive behavior because they are intelligent, entertaining,
and able to feign emotions they do not feel. They are also very
deceitful.
They win affection and confidence from others of whom they
then take advantage.
More on Antisocial Personality Disorder
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People with this disorder are prone to
criminal behavior, believing that their victims
are weak and deserving of being taken
advantage of. They tend to lie, steal, or
worse.
Nature of psychopathy
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Glibness/superficial charm
Grandiose sense of self-worth
Proneness to boredom/need for stimulation
Pathological lying
Conning/manipulative
Lack of remorse
Overlap with ASPD, criminality
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Intelligence may separate those who do and do
not get in trouble with the law
Overlap and lack of
overlap among
antisocial personality
disorder, psychopathy,
and criminality.
Examples of People who have
Antisocial Personality Disorder
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Most Evil episode –
“Bundy, Gacy,
Ridgeway, Sells”
http://www.youtube.
com/watch?v=a_9xj
Rx6bGY
Serial killers who have no regard for the victims (“I think
of killing like smoking a cigarette, like another habit”)
Alfred Jack Oakley – a con-artist who met women
through personal ads claiming to be a millionaire movie
producer, pilot, and novelist. He used his smooth-talking
charm to steal all of their possessions. When convicted,
Oakley complimented the prosecutor’s skills and the
jury’s wisdom and claimed remorse. This may be what
got him probation instead of jail time.
Some leaders of religious sects or cults are believed to
be suffering from antisocial personality disorder.
Examples: A Clockwork Orange, In Cold Blood, The
Dark Knight (Joker), Silence of the Lambs (Hannibal
Lector) Girl, Interrupted (Lisa), House of Cards (Francis
Underwood), Scar (Lion King), Bernie Madoff, and
Video Examples
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Psychopaths documentary:
http://www.youtube.com/watch?v=2PaQjV_onl0
(5 parts total, this link will take you to part 1)
Serial Killers Speak:
http://www.youtube.com/watch?v=T6-6di9GJ5M
Read “The Neuroscientist Who Discovered He
Was A Psychopath” here:
http://www.salon.com/2013/11/23/this_neuroscie
ntist_discovered_he_was_a_psychopath_partne
r/ or watch his TED talk here:
http://www.ted.com/talks/jim_fallon_exploring_th
e_mind_of_a_killer.html
Etiology of Antisocial Personality Disorder
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Developmental considerations
 Early histories of behavioral problems
 Conduct disorder
 Family history of:
 Inconsistent parental discipline
 Variable support
 Criminality
 Violence
Brain differences
 PET scans of 41 murderers revealed reduced activity in
the frontal lobes. In a follow-up study, repeat offenders
had 11% less frontal lobe activity (Raine et al., 1999;
2000).
Gene-environment interaction
 Genetic predisposition
 Environmental triggers
Normal
 Family stress
 Reinforcement of antisocial behaviors
 Alienation from good role models
 Poor occupational/social function
Arousal hypotheses
 Underarousal hypothesis – Cortical arousal is too low
 Fearlessness hypothesis – Fail to respond to danger
cues
Murderer
Cluster C
Anxious or Fearful Behaviors
(Avoidant, Dependent, and
Obsessive-Compulsive
Personality Disorders)
Avoidant Personality Disorder
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They are so sensitive about being rejected that
personal relationships become difficult.
Similar to social phobia in the sense that these people
tend to be “loners” with a long-standing pattern of
avoiding social situations and of being particularly
sensitive to criticism or rejection.
They consider themselves to be socially inept or
personally unappealing, and avoid social interaction
and relationships for fear of being ridiculed or
humiliated.
They have a pervasive pattern of social inhibition,
feelings of inadequacy, and extreme sensitivity to
negative evaluation.
It has been suggested that maybe Seung-Hui Cho,
the Virginia Tech shooter, suffered from Avoidant PD
(http://www.nytimes.com/2007/04/20/us/20psych.html)
Examples: Boo Radley, old guy from Up, Shrek,
Edward Scissorhands, Beast from Beauty and the
Beast, Elsa from Frozen
Causes
 Sub-schizophrenia disorder?
 Difficult temperament
 Early parental rejection
 Interpersonal isolation and conflict
Dependent Personality Disorder
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Characterized by a pervasive psychological
dependence on other people.
They behave in clingy, submissive ways and
display a strong need to have others take care
of them.
They display helplessness and a difficulty in
making even minor decisions without an
excessive amount of advice and reassurance
from others.
They also have an unreasonable fear of
abandonment, feelings of inadequacy,
extreme sensitivity to criticism, and a timid,
passive demeanor.
Examples: Buster from Arrested Development
Causes
 Little research
 Early experience
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Death of a parent
Rejection
Attachment
Obsessive-Compulsive Personality
Disorder
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OCPD shares many features of OCD, but it’s deeper and
heavier.
From the DSM-IV:"Although OCPD and OCD have similar
names, the clinical manifestations of these disorders are quite
different. OCPD is NOT characterized by the presence of
obsessions or compulsions and instead involves a pervasive
pattern of preoccupation with orderliness, perfectionism, and
control and must begin by early adulthood."
Characterized by a general psychological inflexibility, rigid
conformity to rules and procedures, perfectionism, and
excessive orderliness.
People with OCPD tend to stress perfectionism above all else,
and feel anxious when they perceive that things aren't "right".
They have a preoccupation with details, orderliness, perfection
(doing things the “right way”), and control
Poor interpersonal relationships
Obsessions and compulsions are rare
Examples:Monica Gellar (Friends), Soup Nazi (Seinfeld),
Sheldon Cooper (BBT) Roy Walker (Matchstick Men), Bree
Van de Kamp (Desperate Housewives):
http://www.youtube.com/watch?v=Ae5KAByFGGA
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Causes
 Limited research
 Weak genetic contributions
 Predisposed to favor structure?
The Three Clusters of Personality
Disorders - Recap
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Cluster A: Odd or Eccentric
Schizoid – defective in capacity for forming social relationships
Schizotypal – social deficits and oddities in thinking, perception, and
communication
 Paranoid – pervasive and unwarranted suspiciousness and mistrust.
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Cluster B: Dramatic, Emotional, or Impulsive
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Cluster C: Anxious or Fearful
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Histrionic – overly dramatic, tending to exaggerate expressions of emotion
Narcissistic – grandiosely self-important, lacking interpersonal empathy
Borderline – unstable in self-image, mood, and interpersonal relationships
Antisocial – chronically violating the rights of others, non-accepting of social
norms, inability to form attachments.
Avoidant – excessively sensitive to potential rejection, humiliation or shame
Dependent – excessively lacking in self-reliance and self-esteem
Obsessive-compulsive – preoccupied with organization, rules, schedules, lists,
and trivial details.
Specific personality disorders are poorly defined, and there is much overlap
among them…some theorists propose replacing the current categorical
approach with a dimensional one.
Table 14-2, p. 580