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Personality Disorder Charts

PERSONALITY DISORDERS

1. Enduring patterns of perceiving, relating to, and thinking about the environment and oneself
2. These are persistent across time and situations, i.e., trait-like
3. They are inflexible and maladaptive

*Three Clusters:*
Cluster A: Odd/eccentric	1. Paranoid Personality Disorder 2. Schizoid Personality Disorder 3. Schizotypal Personality Disorder
Cluster B: Dramatic/emotional or erratic	1. Antisocial Personality Disorder 2. Borderline Personality Disorder 3. Histrionic Personality Disorder 4. Narcissistic Personality Disorder
Cluster C: Anxious/fearful	1. Avoidant Personality Disorder 2. Dependent Personality Disorder 3. Obsessive/compulsive Personality Disorder

GENDER BIASES IN DIAGNOSIS
Ford & Widiger	-Provided clinical descriptions of clear (DSM criteria) cases of: Antisocial; Histrionic -Half of each set described the person as male, the other half as female

PERSONALITY DISORDERS
		Prevalence	Gender
Cluster A
	Paranoid Schizoid Schizotypal	2% <1% 4%	More males More males More males
Cluster B
	Antisocial Borderline Histrionic Narcissistic	3% males; <1% females 2.5% 2% <1%	Far more males Far more females Equal More males
Cluster C
	Avoidant Dependent Obsessive/compulsive	<1% 2% 4%	Equal Equal More males

ESSENTIAL FEATURES OF CLUSTER A PERSONALITY DISORDERS
Diagnosis	Pervasive Pattern
Paranoid	Distrust and suspiciousness of others Interpretation of others� motives as malevolent
Schizoid	Detachment from social relationships Restricted range of expression of emotions in interpersonal settings
Schizotypal	Social and interpersonal deficits marked by: � acute discomfort with close relationships � reduced capacity for close relationships Cognitive or perceptual distortions Eccentricities of behavior

PARANOID PERSONALITY DISORDER
Turkat et al. (1990)	Had subjects role-play unstructured interactions where stooge (i.e., the supposed other subject) would make ambiguous responses.
	Paranoid subjects more likely to interpret these as hostile and more likely to respond with anger.
Thompson et al. (1988)	Found paranoid subjects responded to ambiguous stimuli by accusing experimenter of misleading them.

SCHIZOID PERSONALITY DISORDER
Slater & Roth (1969)	Claimed schizoid was simply part of schizophrenia - occurs prior to full blown disorder
Wolff & Chick (1980)	Follow-up study of schizoid children - only 9% developed schizophrenia
Livesley (1987)	Had 473 psychiatrists identify prototypic features:
	Resultant Dimensions:
	Low affiliation - e.g. crosses street to avoid acquaintances declines invitations watches rather than participates does not initiate conversations
	Defective social skills, e.g., can�t generate topics of conversation avoids eye contact awkward body movements and gestures
	Self-absorption, e.g., lives in own world inattentive to what others say perceives thoughts as more real than external events

SCHIZOTYPAL PERSONALITY DISORDER

Have difficulty in experiments focusing their attention on task at hand. This has been taken to explain their digressive speech.

Consistent with this it has been found that schizotypals make more loose associations in their speech and yet they respond only to concrete aspects of others� speech.

ESSENTIAL FEATURES OF CLUSTER B PERSONALITY DISORDERS
Diagnosis	Pervasive Pattern
Antisocial	Disregard for the rights of others Violation of the rights of overs
Borderline	Instability of interpersonal relationships Instability of self-image Instability of affects (emotions) Marked impulsivity
Histrionic	Excessive emotionality Attention seeking
Narcissistic	Grandiosity in fantasy or behavior Need for admiration Lack of empathy

ANTISOCIAL PERSONALITY DISORDER
Features:	1. Failure to conform to social norms 2. Deceitful 3. Impulsive, reckless, thrill-seeking 4. Irritable/aggressive 5. Irresponsible 6. Lack of remorse, shame, embarrassment
Underlying lack of emotionality (Eysenck and others) Leads to failure to learn via emotional feedback (i.e., unresponsive to rewards or punishers)
Consistent with the "fearlessness" hypothesis, i.e., APDs have higher threshold for fear (Lykken)

BIOLOGICAL VIEW INHERITED/INFORM LOW AROUSAL
Evidence:	1. Induce expectation of stress: Norms show increased arousal; psychopaths show little change 2. EEG studies reveal greater frequency of slow wave brain activity in psychopaths 3. Adoptee studies - higher rates of psychopathy and criminality in biological than in adoptive family
Effects:	1. Emotional feedback will not be strong enough to affect them 2. Low arousal induces boredom which leads to stimulus seeking - take risks, seek thrills, choose novel stimuli

ANTISOCIAL PERSONALITY DISORDER
XYY Syndrome - supposedly extra maleness should increase aggression
Research:	Jacobs et al. (1965) found more criminals had XYY
But:	XYY also more common
Also:	Most XYY are peaceful and retarded Only 2% of criminals are XYY although higher than in noncriminals Most XYY convicted of property not violent offenses (Although higher convictions than nonXYY)

EYSENCK�S THEORY

High Neuroticism
///
Introvert///////Extravert
///
Low Neuroticism

Neuroticism =	Strength of emotional response
Introversion/Extraversion =	Speed of conditioning
Psychopaths =	Low Neuroticism/high extraversion i.e., little emotional responding and slow to condition (i.e., needs more trials)
Psychopaths =	Thus psychopaths do not learn from emotional feedback so don�t acquire social rules

LYKKEN�S STUDY
Many previous studies have shown that psychopaths were unresponsive to punishment in studies of aversive learning.
Questions:	1. Are psychopaths deficient in all learning or just emotional learning? 2. Do psychopaths score poorly on these studies simply because they are not cooperative?
Study	1. Had all subjects (psychopaths and normals) complete a serial learning task 2. Two aspects: manifest task; hidden task � Manifest task = Correct responses by lever pressing � Hidden task = Avoidance of levers that produced shocks

LYKKEN�S APPARATUS

	1	2	3	4
Red lights	�	�	�	�
Green lights	m	m	m	m
Levers	n	n	n	n

For example,
Manifest sequence	1 4 2 3, 3 2 4 1, 1 4 2 3
Hidden/shocked sequence	3 2 4 1, 1 4 2 3, 3 2 4 1
TRIAL 1	Press 1 = Green light 3 = Red light plus shock 2 + 4 = Red light alone
TRIAL 2	Press 4 = Green light 2 = Red light plus shock 3 + 1 = Red light alone

SCHACHTER & LATANE

Repeated Lykken�s study but subjects received an injection of either
(a) saline or
(b) adrenalin to increase anxiety

SCHMAUK�S STUDY

Same procedure as Lykken but varied type of punisher:
a) Physical punisher (electric shock)
b) Tangible punisher (took back 25 cents for every error)
c) Social punisher (experimenter reprimands)

SOCIAL LEARNING
1. Inconsistent/harsh punishment by parents 2. Unloved 3. Psychopathic/violent parents - modeling
Learn to be:	-Indifferent to physical/verbal punishment -Oppositional in response to physical or verbal punishment -Model psychopathic and violent behavior

STEWART�S STUDY
Psychopaths vs. nonpsychopaths on sentence completion
Task - fill in verb. Task structured so that can use either (a) aggressive verb or (b) passive verb
Subject groups divided in half	One half punished for selecting aggressive meaning Other half punished for selecting passive meaning
Responses	Nonpsychopaths Low - punished meaning High - unpunished meaning
	Psychopaths High - punished meaning Low - unpunished meaning

BORDERLINE PERSONALITY DISORDER

Suicide rate of 8.5%
Females more likely to also have mood disorder and be self-destructive
Males more likely to also have Attention-deficit disorder or Antisocial Personality
Many problems in childhood; attachment with parents
Common for them to have been victims of incest or other sexual abuse as children
Close relatives 5x more likely to be borderline than general population

BIOLOGICAL BASES TO BORDERLINE PERSONALITY DISORDER
Genetics	Relatives 5x more likely to be BPD than among norms
Serotonin	Impulsivity negatively related to serotonin Greater impulsivity - lower serotonin activity
Sleep	Significant abnormalities in REM sleep - more rapid onset - more intense
Many features similar to depression: 1. High suicide rates 2. Low levels of serotonin 3. REM sleep abnormalities 4. Commonly also diagnosed as mood disorder
Self-destructive acts of Borderlines:
Suicide threats Overdoes Self-mutilation Drug abuse Promiscuity Accidents (reckless driving)		20% 19% 17% 18% 17% 7%

HISTRIONIC PERSONALITY DISORDER

Overlap with Borderline is significant e.g., Morey (1988) found this overlap in criteria interpretations was 54%
Also often hard to distinguish Histrionic from Depression and from Anxiety Disorders

NARCISSISTIC PERSONALITY DISORDER

They typically react negatively to criticism:
With rage, shame or humiliation (Gramzow, 1992)
Pessimistic, futility, and depression (Svrakic, 1990)
Cold indifference (Messer, 1985)

ESSENTIAL FEATURES OF CLUSTER C PERSONALITY DISORDERS
Diagnosis	Pervasive Pattern
Avoidant	Social inhibition Feelings of inadequacy Hypersensitivity to negative evaluation
Dependent	Excessive need to be taken care of Submissive and clinging behaviors Fears of separation
Obsessive-compulsive	Preoccupation with orderliness and perfectionism Preoccupation with mental and interpersonal control Restricted flexibility, openness, and efficiency

DIFFERENCES BETWEEN:
Avoidant Personality Disorder	Social Phobia
Fears social relations	Fears social circumstances
More likely to be depressed	Less likely to be depressed
Fear of rejection	Fear of negative evaluation

DIFFERENCES BETWEEN:
Obsessive/compulsive Personality Disorder	O/C Disorder
Preoccupied with order/rules Ego-syntonic	Fears some consequences of failing to complete O or C Ego-dystonic

IMPULSE DISORDERS

Persistent failure to resist temptation or an impulse to act in a harmful way to self or others

Increasing tension � commit the act � feel relief � then feel guilt or regret

IMPULSE DISORDERS:
Explosive	Episodes of assault � unassertive
Kleptomania	Cannot resist temptation to steal � not profit-driven � unassertive
Pyromania	Firesetting accompanied by pleasure, relief, or gratification � Mixed: psychotic; unassertive; powerless
Trichotillomania	Hair pulling; body picking � negative body image � lonely � unassertive

PATHOLOGICAL GAMBLERS
response to stress sees life as boring do not believe they can control themselves whole life revolves around gambling excitement more important than winning
4 million plus in USA - Bet $286 million in 1991 and increasing Commonly low income/low educated males Increasing with legalization: More casinos, more pathological gamblers
Course:	Early wins followed by losses so ups ante with increasing desperation Family and social life neglected Work disrupted Suicide common Only seek treatment when hit rock bottom
Avenues:	Horse races, cards, casino games, lotteries, bingos More casinos, more pathological gamblers
Stages:	Recreational Winning Losing Desperation
Reinforcement Schedule: Continuous � Accelerates acquisition Intermittent � Retards extinction Animals will bar-press several thousand times in absence of reward after behavior is established under intermittent reinforcement
Pathological gamblers tend to be: � self-centered; anxious; frustrated; impulsive � Gambling associated with "high" and "withdrawal" All these features are same as substance abusers

RELAPSE PREVENTION WITH GAMBLERS

1. Identify preceding factors
(e.g., depression, anxiety, low self-esteem, stress, relationship problems)

2. Identify behavioral chain
(e.g., depressed � feels entitled to gamble � excuses/rationalizations � goes to track just to look around � more excuses/rationalizations � has a drink � more excuses (e.g., one bet won�t hurt � gambles)

3. Develop plans to deal with preceding factors and strategies to avoid risky situations

4. Generate warning signs

PYROMANIA
Firesetting - Generic term Arson - Legal term Pyromania - For relief/pleasure
Firesetters	30% profit motive 30% revenge/jealousy 28% relief 12% pleasure/excitement 1-2% sexual pleasure
Research: Less than 3% firesetters meet criteria for pyromania In Ontario, Fire Marshall�s data: 0.1% pyromaniacs

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