Clinical features of personality disorders

• Personality disorders in DSM-1V

1. These problems involve long standing, chronic dysfunctional patterns
2. Axis II used to code disorders
3. Misdiagnoses often occur

• Less defined symptoms than with Axis 1 disorders
• More exaggerations than aberrations.
• Diagnoses are not mutually exclusive
• Dimensional, forced categories, underlying prototypes

• General Types of personality disorders

1. Cluster A includes paranoid, schizoid, and schizotypal
• Odd, eccentric
2. Cluster B includes histrionic, narcissistic, antisocial, and borderline
• Dramatic, emotional, erratic
3. Cluster C includes avoidant, dependent, and obsessive-compulsive
• anxious, apprehensive, fearful
4. Personality Disorder NOS

• Not Otherwise Specified for incomplete, mixed, or unusual pattern
• Provisional Disorders: Depressive and passive-aggressive in appendix of DSM-IV

Specific DSM-IV Personality Disorders
 
 

• Typical symptoms are suspiciousness, rigidity, and argumentativeness
• Constantly "on guard" for attacks
• Not a psychotic condition

• Inability to form social relationships and an indifference to them
• Little need for love and belonging
• Early views saw this as a precursor to schizophrenia, but probably not as now defined (see Schizoptypal PD instead)

• Reclusive, oversensitive, and eccentric
• Odd thought, perception, & speech
• Genetic association with schizophrenia is widely suspected, yet not conclusive

• Immaturity, emotional instability, and self-dramatization are key features
• Attention-seeking is prominent
• Sexual adjustment is usually poor

• An exaggerated sense of self-importance and need for approval
• Fragile, low self-esteem
• Inability to assume perspective of others

• Violate other's rights without remorse
• Can be intelligent & charming, or brutal
• New term for "psychopathy / sociopathy." (more on this later)

• Common symptoms: impulsivity, anger, instability, and unpredictability
• Failure to complete the process of identity formation.

• Rejection & Disparagement; feared & anticipated.
• Desire affection and are lonely
• often confused with schizoid personality disorder, social phobia
• Social skills training often insufficient

• Extreme dependency on others and panic when alone.
• Self-confidence is lacking
• allow others to take over decision-making

• Essential features:
• Overconcern with rules, order, control
• lack of warmth
• overconscientiousness
• Characteristics:
• Like OCD but without true obsession/compulsions
• Rigidity, Perfectionist
• Hoarding, Miserly
• Dogmatic, Inefficient

• Passive--aggressive personality disorder

• Depressive personality disorder

  What causes Personality Disorders?

• Overdeveloped & Underdeveloped Strategies (see text p350. Study this!)
• Core dysfunctional beliefs

• difficult to study thoroughly, knowledge very limited

1. Diagnosis is often tricky
2. Personality Disorders frequently occur together (co-morbidity)
3. Retrospective studies are typical, limiting

• Biological factors may predispose to particular disorders

1. Constitutional predispositions may be inherited
2. These probably interact with environmental influences

• Psychosocial factors seem critically important

1. Childhood interactions may be key factors
2. Speculation vastly exceeds knowledge

1. These disorders are resistant to therapy
2. These people are often seen as part of another person's treatment
3. People with personality disorders usually do not seek therapy

• They lack motivation in treatment
• They usually drop out of therapy

1. 3. Traditional therapy methods are often inoptimal

• The therapist needs to be flexible
• Antidepressants are sometimes used; so are many other drugs

Antisocial Personality and Psychopathy

1. Antisocial personality and Psychopathy/Sociopathy
1. Psychopathy and Sociopathy are older, largely synonymous terms
2. Antisocial Personality disorder represents these in DSM-IV, albeit imperfectly
2. Defining Characteristics
1. Inadequate conscience development

• They act out tensions
• They often appear sincere

1. Irresponsible and impulsive behavior

• They take what they want
• Prone to thrill-seeking actions

1. Ability to impress and exploit others

• They are frequent liars
• Understand /use the other's weaknesses

1. Rejection of authority
2. Unable to maintain "good" relationships

• They can easily win "friends"
• Can be violent toward "friends" and family

1. Repetitive patterns of predatory behavior

• They show often enact the same social dramas repeatedly, e.g.., as illustrated in the case of Donald
• Intelligence can protect those with Antisocial Personality Disorder from criminality

1. Causes of psychopathy & antisocial personality
1. Biological factors

• Genetic influence
• Deficient aversive emotional responsiveness/ conditioning

1. They fail to learn from punishment
2. They may have underlying constitutional deficiencies

1. Family relationships
1. Early studies pointed to early parental loss and emotional deprivation as causal agents
2. Severe parental rejection and lack of parental affection appear related to its development
3. Inconsistency in dispensing rewards and punishment may be a parental factor
2. A developmental perspective on psychopathy and antisocial personality

0. Childhood antisocial behaviors
1. Oppositional defiant disorder is an early diagnosis
2. Early neurophysiological vulnerabilities

Unresolved Issues on Axis II of DSM-IV

• Axis II diagnoses are often unreliable
• Personality processes are probably more dimensional in nature

1. Arbitrary decisions define the degree of a trait
2. Diagnoses are not based upon mutually exclusive criteria
3. Clearer sets of classification rules need to be formulated