Objectives for Friday, 17 November

1. Describe the general characteristics of disordered

personality in contrast to typical personality functioning.

2. Discuss debates about personality disorder diagnosis in

DSM-5, including the general use of dimensional
approaches and specific disorders that some experts
argue should be removed from the DSM.

3. Explain the DSM-5 Alternate Model for Personality

Disorders, including the three broad components.
Personality
Patterns of perceiving, relating to, and thinking
about the world and oneself:
• consistent over time
• consistent across areas of one’s life
• shaped by cultural expectations
• facilitate social and occupational functioning

Personality changes with experience, maturity, and external

demands in a way that promotes adaptation to the
environment.
Personality
Personality changes with experience, maturity, and
external demands in a way that promotes
adaptation to the environment

PersonalityTraits Astable characteristic abouta personthatinfluenceshow

they tend to think feel andbehave on an ongoing basis Theyreflectaspects
ofourbehaviourthatare consistent
overtime 3 situation
Personality Disorders
hhhfHl
ff

Éf
Enduring pattern of inner f
experience and behaviour that
deviates markedly from cultural lffof
pattern maladaptive behaviour

expectations. Manifests in at least

two areas:
• cognition

• affectivity
MANNER
symptomsmay
representscheme

• interpersonal functioning
presentation
states
of typical personality

• impulse control

• Inflexible and pervasive Man

• Distress or impairment

• Stable and long standing

Cognition

Common distorted thinking

patterns:

• All-or-nothing thinking

• Idealizing then devaluing other

people of the self

• Distrustful, suspicious thoughts

• Unusual or odd beliefs (contrary

to cultural standards)

• Perceptual distortions and body

illusions
Personality Disorders
Onset that can usually be traced back to adolescence or early
adulthood

NOT diagnosed in children due to the requirement that

personality disorders represent enduring problems over time

Often, the relationships people with PDs form are fraught with
problems and difficulties.

Many with PDs who experience relationship problems don’t

believe there is anything wrong with them.
Is this evidence of a
PD?
“It’s hard to be humble when you’re
as great as I am.”

“I’m not the greatest, I am the

double greatest.”

“I'm the most recognized and loved

man that ever lived...”

“I’m the king of the World...”

“If you even dream about beating

me, you better wake up and
apologize!”
Personality Disorders

What distinguishes normal personality from personality

disorders? Lo 1

Answer: When behaviour patterns become inflexible and

maladaptive to the point of causing distress or social /
occupational impairment one can conclude the presence of
a personality disorder
Personality Disorders
Don’t stem from reactions to
stress but from developing an
inflexible and distorted
personality.

Maladaptive ways of
perceiving, thinking, and
relating to the world.

Prevents people from

adjusting to external demands
and, thus, becomes self-
defeating.
Personality Disorders
Overdeveloped and
undeveloped behavioural
strategies specific to each
personality disorder are used
across situations and across
time.

Strategies developed to cope

with highly negative core
beliefs

Strategies may have been

adaptive when first developed
Epidemiology
Up to 10%-20% of the general population

Some more frequent in men (ASPD)

Some more frequent in women (BPD)

Increased rates of unemployment, homelessness,

domestic violence, and substance misuse.

Individuals with PDs are at higher risk of early death from

suicide or accidents.

Associated with poorer respond to treatment.

 CURRENT DOMINANT MODEL

Personality
Disorders

Cluster A Cluster B Cluster C

antisocial
paranoid avoidant
borderline
schizoid dependent
histrionic
schizotypal obsessive-compulsive
narcissistic

Odd/Eccentric Dramatic/Erratic Anxious/Fearful

Controversies
• Dimensional vs. categorical

• Where is the cut-off?

• Reliability of diagnoses

• Stability of diagnoses

• Overlap between diagnoses

• Gender and cultural issues

Controversies
• Need to infer traits to make
diagnosis, do not have specific
behaviours clinician can judge
 DIMENSIONAL VS CATEGORICAL

Dimensional Approach scamines constructs

on a continuum ratherthen as
discrete categoricalentities

Basisis that personality pathology reflects sctreme variants of typical

personalitytraits

Categorical Approach diagnostic approach taken by DSM inwhichan

individual either does or does not havea disorder

An individual may bediagnosed with onlya

PolytheticCriterion certain

subset of symptoms withouthavingto meet allcriteria

Limitations
of categorical approach
Lack
of empirical support for current PD organisation
High comorbidity among PDs far higher thanexpected ifeach PD
emerged from unique causes May resultfrom poor PD diagnostic
criteria
Unspecified PD more commonly diagnosed than a specificPD
indicating that people don't
fitinto Dsn categories
Polythetic Criterion leads to heterogenous groups People w different

symptoms classifiedundersame disorder

Because
of these criticisms APA proposed an Alternate model Integratesthe
FM in our formalclassification system
Alternate Proposed Model

Criterion A: Dimensional (0-4) rating of personality

functioning in self (identity and self-direction) and
interpersonal (empathy, intimacy) functioning
Example questions use to evaluate self and
quality of interpersonal relationships
How would you describe yourself?

How do you think other people describe you?

What are your relationships with other people like?

How well do you think you understand yourself?

How well do you understand other people?

Do you sometimes completely lose the sense of who you

are when interacting with others?
Alternate Proposed Model

Criterion A: Dimensional (0-4) rating of personality

functioning in self (identity and self-direction) and
interpersonal (empathy, intimacy) functioning

Criterion B: Dimensional ratings of an array of traits

Alternate Proposed Model

The essential features of a Personality Disorder are:

• Moderate or greater impairment in personality

(self/interpersonal)

• One or more pathological personality traits

detachment extraversion
negative emotional
affectivity stability
antagonism agreeableness
disinhibition conscientiousness
psychoticism lucidity
Alternate Proposed Model

Criterion A: Dimensional (0-4) rating of personality

functioning in identity, self-direction, and interpersonal
(empathy, intimacy) functioning

Criterion B: Dimensional ratings of an array of traits

Criterion C: Prototypical system of six PD types

avoidant narcissistic
schizotypal obsessive-compulsive
borderline antisocial
Alternate Proposed Model Example: BPD Criterion A

1. Identity: Marked instability of self-image, strong self-

criticism, feelings of emptiness, and stress-induced
dissociative states.

2. Self-direction: Unstable goals and values.

3. Empathy: Limited ability to see things from another’s

point of view, sensitivity to real or imagined criticism.

4. Intimacy: Conflicted relationships, difficulty trusting

others, separation insecurity, patterns of
overinvolvement/withdrawal.
Alternate Proposed Model Example: BPD Criterion B
Four or more of the following pathological personality traits
(requiring at least one of #5, #6, or #7)

1. Emotional lability (a facet of negative affectivity)

2. Anxiousness (a facet of negative affectivity)
3. Separation insecurity (a facet of negative affectivity)
4. Depressivity (a facet of negative affectivity)
5. Impulsivity (a facet of disinhibition)
6. Risk-taking (a facet of disinhibition
7. Hostility (a facet of antagonism)
Kruger & Markon (2014)
 FIVE FACTOR MODEL
Dimensionalapproach each trait andfacet is continuous in nature
Most widely accepted

Organises personality into 5 domains

Neuroticism

Extraversion

Opennessto experience
Conscientiousness

Agreeableness
What’s Coming Next?

1. Read chapter 12 if you haven’t already done so.

2. Complete online quiz #10 by Monday (20 Nov) at 2:00pm.

Objectives for Monday, 20 November
1. Compare and contrast the clinical features of the 10
personality disorders listed in DSM-5, with particular
emphasis on interpersonal functioning.
mmmm

CHARACTERISTICS ARE BLUE TEXT

SYMPTOM LIST IS NUMBERED
[Link]
Paranoid PD
t
distrust and suspiciousness
•

•
unfairly suspects others of
exploiting, harming, deceiving
preoccupied by doubts about
others’ loyalty, trustworthiness
fffffm
• reluctant to confide in others
• reads hidden meanings into benign
remarks, events [Link] interpersonal
cues
hostility
• persistently bearing grudges
• quick to react angrily
• recurrent unjustified suspicions of
infidelity
 Mro
Schizoid PD
detachment from social
relationships and restricted
emotional expression
• neither desires nor enjoys close
relationships or family
• almost always solitary Meat

• little or no interest in sex with others

• indifferent to praise or criticism
• emotionally cold, detached, or
flattened

iii
 Mno
Schizotypal PD
interpersonal difficulties IM
• unusual or restricted affect
• lack of close friends, confidants

i
• suspiciousness

Aitffiff Mno
cognitive/perceptual distortions
• ideas of reference
• odd beliefs/magical thinking
• paranoia
• unusual perceptual experiences
eccentric behaviour
• odd thinking and speech
• eccentric, peculiar behaviour
 www.i
MM
Avoidant PD
• avoidance of social situations
• hypersensitive to negative

Mggfiffff
evaluation and rejection

• inhibition in relationships due

to feelings of ineptitude and
inadequacy

• fears of being shamed or

ridiculed

www.m
 Moo
Dependent PD
• submissive, clinging behaviour
related to an excessive need to be
taken care of
• requires excessive

MENTEITH
advice/reassurance for everyday
decisions
• needs others to assume
responsibility
• difficulty expressing disagreement
with others
• lacks confidence to initiate projects
or do things on their own
• uncomfortable/helpless when alone
Obsessive-Compulsive
MM
PD mmmm mummy pÑ
• preoccupation with
orderliness, perfection, control
ffffh hff

ffpf
controlling coldandvindictive
• rigid perfectionism interferes
with task completion in interpersonal relationships
• excessively devoted to work
at cost of leisure time, Symptoms
of 0CPD arepresumed

ffhiÉf
friendship tobeego
syntonic notproblematic
• restricted emotional feepf
expression lack
of
emotionalresponsiveness
• overly conscientious, inflexible
about morality, ethics, values OCD considered as [Link]
• inflexibility individuals
by symptoms
aredistressed
• relationships suffer due to
stubbornness L
thoughtsand behaviours
unwillingness to discordworthlessobject
coincideinto
CLUSTERB Mamas
Narcissistic PD
• variable and vulnerable self-
esteem regulated via attention
and approval seeking
• overt or covert grandiosity, need
for admiration
• preoccupied with fantasies of
unlimited success tMffff

• exploitative, entitled
• envious of others
• arrogant
Histrionic PD
excessive emotionality and
attention seeking
• uncomfortable when not the centre
of attention
• consistently uses physical
appearance to draw attention to self
anand
• theatrical, dramatic style
• suggestible
• considers relationships to be more
intimate than they are

dibbidinition
immolating
 Mno
Borderline PD
• Unstable and intense
interpersonal relationships fffdH

characterized by alternating
between extremes of
idealization and devaluation.
• Affective instability due to a [Link]
marked reactivity of mood
• Frantic efforts to avoid real or
imagined abandonment
• Identity disturbance: markedly
and persistently unstable self-
i
image or sense of self
continued...
 Borderline PD
• Impulsivity in multiple ways that
are potentially risky
• Recurrent self-injury or suicidal
behaviour or threats mood
• Chronic feelings of emptiness
• Intense angry outbursts
• Transient, stress-related
paranoid ideation or severe
dissociative symptoms

inno
 Course of BPD
• Greatest impairment and
risk of suicide in young
adulthood.
anand

• Greater stability in 30’s and

40’s.

• 50-85% of those diagnosed

with BPD do not meet full
criteria 10 years later.
negative emotional
affectivity stability

disinhibition conscientiousness
What’s Coming Next?

1. We will finish discussing borderline personality disorder

(etiology) and also discuss antisocial personality disorder on
Wednesday.

2. Chapter 15 (child and youth psychopathology) coming up

on Friday.
Objectives for Wednesday, 24 November
1. Explain the biosocial model of borderline
personality disorder.

2. Describe the clinical features of antisocial

personality disorder.

3. Distinguish antisocial PD from psychopathy and

conduct disorder.
Etiology of BPD
• Biological
• Genetic: 5X more common among first-degree biological
relatives. Also increased familial risk for substance use
disorders, antisocial PD, mood disorders
• Poor functioning of the frontal lobes (disinhibition).
• Dysfunction in links between (overactive) limbic system and
(underactive) amygdala-dorsolateral PFC pathway
• Environmental evidence:
• History of physical and sexual abuse common in BPD
(estimates as high as 86%)
 BIOSOLIAL MODEL
Diathesis-Stress Theory: BPD
Biostrialmodel proposesthat
BPDemerges inpart duetoemotionally
vulnerableyouthbeingraisedin
environment
an invalidatingcoregiving
Antisocial PD
Pervasive pattern of disregard
for and violation of the rights
of others occurring since the
age of 15 years, as indicated

Mannose
by three (or more) of the
following:
Antisocial PD
• failure to conform to social norms with respect to lawful
and ethical behaviour
• repeatedly performing acts that are grounds for arrest

• egocentric, callous lack of concern for others

• deceitfulness
• reckless disregard for safety of self or others

• impulsivity or failure to plan ahead

• irritability and aggressiveness
• repeated physical fights or assaults
Antisocial PD
• consistent irresponsibility
• failure to sustain consistent work behaviour or honour financial
obligations

• lack of remorse
• indifferent to or rationalizing having hurt, mistreated, or stolen from
another
Antisocial PD Prevalence

• 3% males, 1% females (community sample)

• 47% males, 21% females (prison populations)
• More common in younger adults and those with lower SES
remorseless predators who use charm,
intimidation, and, if necessary,
impulsive and cold-blooded violence
to attain their ends
(Hare, 1996)
Psychopathy constellation
ofpersonalitytraitsthatleadtoantisocial
behaviour callousness andgrandiosity
Key characteristic: poverty of emotions (both positive and
negative)
• lack of remorse
• no sense of shame
• superficially charming
• manipulates others for personal gain
• lack of anxiety

Other characteristics
• promiscuous sexual behaviour
• many short-term marital relationships
• criminal versatility
Psychopathy Checklist (PCL-R)
Interpersonal/Affective Antisocial Criminal Lifestyle
• Glib/superficial charm • Early behavioural problems,
• Grandiose self-worth juvenile delinquency
• Manipulative/conning • Lack of realistic, long-term
plans
• Callous/no empathy
• Parasitic lifestyle
• Failure to accept
responsibility for own • Poor behavioural controls:
actions impulsive, irresponsible
• Pathological lying • Need for stimulation
• Lack of remorse/guilt • Revocation of conditional
release
• Shallow affect
Convicted Felons

Neither

Antisocial
Personality
Disorder
ASPD &
Psychopathy
 ASPD vs Psychopathy

Antisocial Personality

Psychopathy

Although ASPD andpsychopathy mayshare common behaviouralfeatures

of psychopathy focusheavily on callous

descriptions unemotional personalitytraitswhich
 effectively captured
by PD criteria
most individuals with ASPDalsosufferfrompsychopaths butthereverseisnottrue

ETIOLOGY RISK FACTORS

Role of the Family?

• Lack of affection On the other hand…

• Severe parental rejection • harsh or inconsistent
discipline could be
• Physical abuse reactions to a child’s
• Inconsistent (or no) discipline anti-social behaviour
• many individuals who
• Failure to teach child
responsibility toward others come from disturbed
backgrounds do not
• Parental antisocial behaviour develop psychopathy
Genetic Correlates
• Criminality and ASPD have heritable components

• á concordance for MZ than DZ pairs

• á prevalence of antisocial behaviour in adopted children

with bio-parents who had ASPD and substance abuse
Physiological Findings
• Skin conductance
• lower resting skin conductance
• less reactive to aversive stimulation
• electric shock
• distress in other humans
• Heart rate
• normal at rest but faster than normal when anticipating
intense or aversive stimuli
• Impulsivity
• activity in limbic system
• EEG: slow waves & spikes in temporal area
Differentiating Personality Disorders

• Avoidant PD vs. social anxiety disorder

• Schizotypal PD vs. schizophrenia

• Obsessive-compulsive PD vs. OCD

What’s Coming Next?

1. Read chapter 15 on child and youth psychopathology for

Friday.

2. Complete quiz #11 by 2:00pm on Monday.