Chapter Fourteen Personality Psychopathology. Concept of “personality” in psychology means three things: – Refers to individual’s recognizable behaviors.

Chapter Fourteen

Personality Psychopathology

Personality Psychopathology

• Concept of “personality” in psychology means three things:– Refers to individual’s recognizable behaviors in

which pattern, order, and regularity can be identified

– Personality is a psychological construct– Personality influences how we respond but also

causes us to act in certain ways

• Can personalities be pathological?

Personality Psychopathology (cont’d.)

• Personality disorder: – Characterized by impairment in self and

interpersonal functioning and presence of inflexible, long-standing, pathological personality traits

– Many individuals with personality disorders are never diagnosed

– 5-15% of hospital admissions and outpatient clinics

– Lifetime prevalence: 9-13%

Diagnosing Personality Psychopathology

• Can be diagnosed through two routes:– Being categorized as showing characteristics from

one of the six specific personality disorder types– Possessing certain specific personality traits that

impair functioning

Diagnosing Personality Psychopathology (cont’d.)

Figure 14-1 Diagnosing Personality Disorders: Two Paths

Levels of Personality Functioning

• According to the DSM-5:– Impairments in self functioning and in

interpersonal functioning, meeting all criteria:– Degree of impairment is measured on five-point

“Levels of Personality Functioning” scale• From no impairment to extreme impairment

Sociocultural Considerations

• DSM-5 recognizes importance of cultural, ethnic, and social background– “Impairment or adaptive” implies within the

individual’s contextual norms and expectations

• Gender implications:– Borderline personality disorder in women– Antisocial personality disorder in men– Gender bias plays a role

Personality Disorder Types and Trait Specified: A Hybrid Approach

• Less emphasis on Axis I versus Axis II– Personality disorders are chronic, developmental,

and relatively inflexible patterns of responding that are less likely to be changed in treatment

– Personality disorders can coexist with one or more clinical disorders

• Hybrid approach: difference between categorical disorders and those described on continuum of traits

Personality Disorder Types

• Six personality disorder types: – Schizotypal– Borderline– Avoidant– Narcissistic– Obsessive-compulsive– Antisocial

• Diagnosis involves “matching” individual with DSM-5 description of disorder

Schizotypal Type

• Characterized by peculiar thoughts and behaviors and by poor interpersonal relationships

• Many with disorder believe they have magical abilities or special powers; some are subject to recurrent illusions

• Primarily cognitive distortions; affective and interpersonal problems are secondary

Schizotypal Type (cont’d.)

• Characteristics resemble a less serious form of schizophrenia– Possible genetic link

• Treatment: – Dynamic, supportive, cognitive-behavioral, and

group psychotherapy– Small doses of anxiolytics can be used for anxiety

Borderline Type

• Characterized by intense fluctuations in mood, self-image, and interpersonal relationships

• Those with disorder are impulsive, have chronic feelings of emptiness, and form unstable relationships

• May be friendly one day and hostile the next• Probability of suicide higher

Borderline Type (cont’d.)

• Most commonly diagnosed personality disorder

• May exhibit transient psychotic symptoms such as auditory hallucinations, but they know these are unacceptable

• May best be viewed on a continuum

Borderline Type (cont’d.)

• Diverse models used to conceptualize:– Psychodynamic perspective

• Stress in early childhood experiences

– Contemporary explanations• Mood regulation as central to disorder• Biological factors including abnormal prefrontal cortex

structures and amygdala activation pattern

– Cognitive-oriented approaches• Distorted or inaccurate attributions

– Dialectical behavioral therapy (DBT)• Smaller drop-out rate and suicidal behaviors

Avoidant Type

• Characterized by a fear of rejection and humiliation and a reluctance to enter into social relationships

• Want social interactions but fear them• Disagreements over diagnostic category• Treatment:

– Cognitive-behavioral, psychodynamic, interpersonal, and psychopharmacological

Narcissistic Type

• Characterized by exaggerated sense of self-importance, exploitative attitude, and lack of empathy

• Symptoms may present in adolescents who are later diagnosed as adults

• Individual psychotherapy and group therapy are recommended– Little treatment success

Obsessive-Compulsive Type

• Characterized by perfectionism, a tendency to be interpersonally controlling, devotion to details, and rigidity

• Differs from OCD: – Pervasive character disturbance– Individuals see their way of functioning as correct

• Treatment: – Cognitive-behavioral and supportive forms of

psychotherapy; no medications are currently available

Antisocial Type

• Characterized by a failure to conform to social and legal codes, a lack of anxiety and guilt, and irresponsible behaviors

• Composed of three factors:– Arrogant and deceitful interpersonal style– Deficient affective experience– Impulsive and irresponsible behavioral style

Antisocial Type (cont’d.)

Antisocial Personality Disorder (George), Part 1 George describes the symptoms of his antisocial personality disorder.

Antisocial Type (cont’d.)

Antisocial Personality Disorder (George), Part 2 George describes the symptoms of his antisocial personality disorder.

Antisocial Type (cont’d.)

• Problems with self-identity integration• Much more frequent in urban environments

and in lower SES• Distinct from impulse control problems• Difficult population to study

– Only one out of seven seek treatment

Former Personality Disorders

• Originally 10 disorders identified in DSM-IV-TR; clinical evidence did not support four of these:– Paranoid, schizoid, histrionic, and dependent

personality disorders

• Justification for removal:– Absence of research– Excessive co-occurrence – Arbitrary diagnostic thresholds

• DSM-5: continuum of personality traits

Multipath Analysis of One Personality Disorder: Antisocial Type

Figure 14-2 Multipath Model of Antisocial Personality Disorder The dimensions interact with one another and combine in different ways to result in antisocial personality

disorder.

Biological Dimension

• Genetic influences– Heredity looks to be a factor

• Twin studies

– Evidence supports for genetic basis does not preclude environmental factors; undoubtedly caused by both

• Difficult to determine causal relationship

– Genetic studies do not show how antisocial type is inherited

Biological Dimension (cont’d.)

• Autonomic nervous system abnormalities• Genetic predisposition to fearlessness or lack

of anxiety• Arousal, sensation-seeking, and behavioral

perspectives

Psychological Dimension

• Psychodynamic perspective: – Faulty superego development

• Cognitive perspective: – Core unconscious beliefs that influence behavior

• Learning perspective: – Inherent neurobiological characteristics that delay

or impede learning– Lack of positive role models– Presence of poor role models

Psychological Dimension (cont’d.)

Figure 14-3 Effect of Type of Punishment on Psychopaths and Others The effects of three different types of punishment on an avoidance learning task are shown for three

groups of participants. Although physical or social punishment had little impact on psychopaths’ learning, monetary punishment was quite effective.

Source: Schmauk (1970).

Social Dimension

• Family and socialization: – Impoverished backgrounds– Poor parental supervision and involvement– Neglect, hostility, maltreatment, abuse– Parental rejection/deprivation– Dysfunctional family structure – Parental separation or absence – Do not learn to pay attention to social stimuli

Sociocultural Dimension

• Gender: – Males more likely to exhibit both conduct

disorders and antisocial personality disorder than females; possibly different pathways

– Relational aggression in women

• Cultural values: – “Rugged individualism” in U.S.

• Competitive environment bred by U.S. values could fuel aggressive and violent behavior

Treatment of Antisocial Personality Disorder

• Individuals feel little anxiety and as a result, lack motivation for treatment– Approaches that require cooperation of client may

be ineffective– Programs may need enough control to force

confrontation of relationships and affect behavior

• Behavior modification: – Most useful is skill-based and behavioral

treatment using material rewards, but not long-lasting

Treatment of Antisocial Personality Disorder (cont’d.)

• Cognitive approaches: – Therapist must build rapport and guide client

away from thinking in terms of self-interest and immediate gratification, and toward higher levels of thinking regarding self and others

• Current treatments not effective– Need to focus on antisocial youths who appear

amenable to treatment and involve families and peers

– Individuals may respond to programs involving physical and mental stimulation

Personality Disorder Trait Specified

• Personality disorders viewed as extremes of underlying dimensions of normal personality traits (assessed on scaled continuum)

• DSM-5 uses five-point degree of match between description of disorder type and client

Personality Disorder Trait Specified (cont’d.)

• Five-domain trait dimensional diagnostic system for assessing personality disorders– Trait: specific personality characteristic possessed

by individual; may be organized around a domain– Existence of one or more domain traits that impair

interpersonal functioning is sufficient to indicate personality disorder

Personality Disorder Trait Specified (cont’d.)