Disorders of Personality

Disorders of PersonalityChapter 191 2015 M. Guthrie Yarwood1Announcements 2015 M. Guthrie Yarwood2Todays Class: Personality Disorders

Wednesday: Finish up personality disordersHelp Josh and Lina with their ASPD scaleUndergraduate Research Exhibition

FridayDr. Pincus Guest Lecture on Treatment for PD2Its A Party!3

2015 M. Guthrie Yarwood34CharacterPersonality DisorderPathological Personality TraitDonna HistrionicWilliam SchizotypalSherry BorderlineWinstonNarcissisticPeterObsessive-CompulsiveDoreen ParanoidAlanAntisocialMargie AvoidantHaroldSchizoidCarrieDependent 2015 M. Guthrie Yarwood4What is a personality disorder?5Symptoms = maladaptive variations within the domains of traits, emotions, cognitions, motives, and self-concept

Stable over time and across situations

Extreme scores on Big Five and HEXACO

All involve distress and impaired social relationships

2015 M. Guthrie Yarwood5Prevalence: 9 13%6PDPrevalenceParanoid2 4 Schizoid3 5Schizotypal4Antisocial.2 3Borderline1.6 6Histrionic1.8Narcissistic0 to 6.2Avoidant2.4Dependent.5 to .6Obsessive-Compulsive2.1 to 7.9Note. Prevalence statistics from community samples. 2015 M. Guthrie Yarwood6Section II of DSM-V7Current System for DSM-V 2015 M. Guthrie Yarwood7Three Clusters8Odd, EccentricDramatic, Emotional, Erratic, Impulsive, AggressiveAnxious, Fearful 2015 M. Guthrie YarwoodAny problems?8Problems with categorical system: Number symptoms required for diagnoses9 2015 M. Guthrie Yarwood9Problems with categorical systemPD share similar symptoms (correlated across disorders)Histrionic and NarcissisticBorderline, Avoidant, and DependentComorbidity

Symptoms within same disorder appear to be un-correlatedParanoidSchizotypalBorderline

10 2015 M. Guthrie Yarwood10Problems with categorical system:Gender Differences11Cluster A: Paranoid, Schizoid, SchizotypalCluster B: Antisocial, Borderline, Histrionic, NarcissisticCluster C: Avoidant, Dependent, OCPD

2015 M. Guthrie Yarwood11Section III of DSM-V12Proposed System for DSM-V 2015 M. Guthrie Yarwood12Announcements 2015 M. Guthrie Yarwood13Todays Class: Personality Disorders

Wednesday: Finish up personality disordersHelp Josh and Lina with their ASPD scaleUndergraduate Research Exhibition

FridayDr. Pincus Guest Lecture on Treatment for PD1314 2015 M. Guthrie Yarwood14Proposed System15This model includes 6 PD and 1 Other:AntisocialAvoidantBorderlineNarcissisticObsessive-CompulsiveSchizotypalPersonality Disorder Trait Specified

Does not include:Paranoid, Schizoid, Histrionic, Dependent 2015 M. Guthrie Yarwood15Proposed System: Impaired Personality Functioning 2015 M. Guthrie Yarwood16Self-ProblemsIdentity ProblemsSelf-Direction Problems

Interpersonal ProblemsEmpathy ProblemsIntimacy Problems

0 Healthy, Adaptive Functioning1 Some Impairment2Moderate Impairment3 Severe Impairment4 Extreme Impairment16Proposed System: Impaired Personality Functioning17Self-ProblemsIdentity Problems: No sense of self, unstable (fragile) self-esteem, inability to regulate emotions, emotions inappropriate for context

Self-Direction ProblemsInability to set realistic or purposeful goals, inability to reflect on outcomes of behaviors, lack internal meter for behavior

2015 M. Guthrie Yarwood17Proposed System: Impaired Personality Functioning18Interpersonal ProblemsEmpathy ProblemsInability to understand other peoples experiences/motivationsInability to engage in perspective-takingDoes not understand how his/her behavior affects othersIntimacy ProblemsLacks positive, long-term relationships; instead, negative interactionsView relationships in terms of pleasure or pain to the selfSocial behavior not reciprocal; focuses on own basic needs

2015 M. Guthrie Yarwood18Impaired Personality Functioning 2015 M. Guthrie Yarwood19Self-Problems:IdentitySelf-Direction

Interpersonal Problems:Empathy IntimacyAntisocialAvoidantBorderlineNarcissisticObsessive-CompulsiveSchizotypalParanoidSchizoidHistrionicDependent

1920 2015 M. Guthrie Yarwood20Pathological Personality Trait DomainTraitsNegative AffectivityEmotional Lability; Anxiousness, Separation Insecurity, Submissiveness, Hostility, Depressivity, SuspiciousnessDetachmentWithdrawal; Anhedonia, Intimacy Avoidance, Depressivity, Suspiciousness; Restricted AffectivityAntagonismManipulativeness; Deceitfulness; Grandiosity, Attention Seeking; Callousness; HostilityDisinhibition Irresponsibility; Impulsivity; Distractibility; Risk Taking;(Lack of) Rigid PerfectionismPsychoticismUnusual Beliefs and Experiences; Eccentricity; Cognitive and Perceptual Dysregulation21 2015 M. Guthrie Yarwood21Pathological Personality Trait Domains22Negative Affectivity (v. Emotional Stability)Detachment (v. Extraversion)Antagonism (v. Agreeableness)Disinhibition (v. Conscientiousness)Psychoticism (v. Lucidity) 2015 M. Guthrie Yarwood2223CharacterPersonality DisorderPathological Personality TraitDonna HistrionicWilliam SchizotypalSherry BorderlineWinstonNarcissisticPeterObsessive-CompulsiveDoreen ParanoidAlanAntisocialMargie AvoidantHaroldSchizoidCarrieDependent 2015 M. Guthrie Yarwood2324CharacterPersonality DisorderPathological Personality TraitDonna HistrionicDisinhibition; Antagonism; NA; DetachmentWilliam SchizotypalPsychoticism; DetachmentSherry BorderlineNA; DisinhibitionWinstonNarcissisticAntagonismPeterObsessive-CompulsiveDisinhibition (High C); NA; DetachmentDoreen ParanoidDetachment; NA; AntagonismAlanAntisocialAntagonism, DisinhibitionMargie AvoidantNA; DetachmentHaroldSchizoidDetachmentCarrieDependentNA 2015 M. Guthrie Yarwood24 2015 M. Guthrie Yarwood25(Paulhus et al., 2014)25Some Important Distinctions 2015 M. Guthrie Yarwood26Narcissistic v. Antisocial

OCPD v. OCD

Schizoid v. Schizotypal v. Paranoid

Histrionic v. Antisocial v. Narcissistic v. Dependent

Dependent v. Borderline

Dependent v. Avoidant2627CharacterPersonality DisorderPathological Personality TraitDonna HistrionicDisinhibition; Antagonism; NA; DetachmentWilliam SchizotypalPsychoticism; DetachmentSherry BorderlineNA; DisinhibitionWinstonNarcissisticAntagonismPeterObsessive-CompulsiveDisinhibition (High C); NA; DetachmentDoreen ParanoidDetachment; NA; AntagonismAlanAntisocialAntagonism, DisinhibitionMargie AvoidantNA; DetachmentHaroldSchizoidDetachmentCarrieDependentNA 2015 M. Guthrie Yarwood27 2015 M. Guthrie Yarwood28Causes of PD28What do you think causes personality disorders?29EnvironmentGeneticsBiologyInteraction b/w Environment, Genes, and Biology

2015 M. Guthrie Yarwood29Some Environmental Factors30Childhood Trauma: number and type of childhood traumas73% report abuse and 82% report neglect

Verbal Abuse (Johnson et al., 2001)Children 3x more likely to receive PD diagnosis in adulthood.

High Reactivity: Sensitivity to stimuli (light, noise, texture)As children, more likely to develop shy, anxious, timid personality

High quality relationships as protective factor

2015 M. Guthrie Yarwood30Cluster A: Genetics!31Paranoid: Relatives diagnosed w/ schizophrenia

Schizoid: Relatives diagnosed w/ schizophrenia & schizotypal

Schizotypal: First-degree biological relatives diagnosed w/ schizophrenia

Dopamine

2015 M. Guthrie Yarwood31Cluster B: Antisocial and Borderline PD32Environmental Stressors

Genetics: First-degree biological relatives with diagnosis

Brain AbnormalitiesBoth Borderline and Antisocial: levels of 5-HT (serotonin) associated with impulsivity and aggression

Genetics x Environment: ASPD: Interaction between testosterone and childhood sexual abuse

2015 M. Guthrie Yarwood32Cluster B: Narcissistic and Histrionic33Narcissistic: Extremes in parenting Extreme pampering (noncontingent rewards) ORParental neglect/abuse

Histrionic???We dont know yet! 2015 M. Guthrie Yarwood33Cluster C: Dependent and Avoidant PD34Dependent:Environment: Authoritarian or overprotective parenting style

Avoidant:Biology: Lower levels of adrenalineEnvironment: Stressors that trigger genetic vulnerabilityAnxiety may impair social relationships and participation in activitiesNo history of childhood abuse

2015 M. Guthrie Yarwood34Cluster C: OCPD - Genetics 2015 M. Guthrie Yarwood35Genetics relatives with OCD

Biology: Malfunctioning Gene contributed to OCPD and OCDSERT mutation, Ile425ValOf 7 family members with this mutation, 5 diagnosed w/ OCD and 1 diagnosed with OCPD Mutation seems to lock serotonin transporter in overactive state**More research needed(Ozaki and colleagues, 2003)35Coming Up! 2015 M. Guthrie Yarwood36How do we treat personality disorders?36