Issues in the Personality Disorders Flashcards
What is the Problem at Hand in antisocial personality disorders?
- The current DSM criteria for Antisocial
Personality Disorder (APD) is largely behaviourally based - Does not represent the traditional view of psychopathy
Where is the Psychopathy in Antisocial Personality Disorder?
- does not exist in the DSM (DSM had to become
an observable diagnostic manual) - cannot observably measure empathy
DSM – Early Editions for psychopathy?
Psychopathy has a long clinical history
Early editions of the DSM:
- “Sociopathic Personality Disorder” (DSM-I)
- “Personality Disorder, Antisocial Subtype” (DSM-II)
(not what a psychopath is)
DSM-II
- “Basically unsocialized…incapable of loyalty to
[others]…are grossly selfish, callous,
irresponsible, impulsive, and unable to feel guilt
or learn from experience or punishment…”
(closer)
DSM – Recent Editions for psychopathy?
- Earlier editions criticized for poor reliability
- Led to specific criteria of disorders
- Current criteria (DSM-IV-R)
- Largely behaviorally based (e.g., repeated lying,
physical fights) - Good reliability, but poor validity
- Reflects criminology instead of psychopathy
(nothing about lack of empathy or guilt, generalizing that all criminals have personality disorder)
What is the Hare Psychopathy Checklist – Revised (1991)?
- Designed to measure extent to which individual
meets criteria for psychopathy - Used in the majority of studies examining
psychopathy
Explain the Scale Structure (Hare, 2003) for psychopathy?
factor 1: interpersonal/ affective, key to psychopath
- has facet 1: interpersonal and facet 2: affective
factor 2: social deviance, can be anyone
- has facet 3: lifestyle and facet 4: antisocial
Comparing PCL-R to APD for psychopathy?
Commonalities (Ogloff, 2006):
- 3/8 (37.5%) of interpersonal or affective
symptoms
- 6/10 (60%) of social deviance symptoms
Particular concern is lack of affective criteria
- Only lack of remorse or guilt is included in APD
What are the Prevalence Comparisons for psychopathy?
Estimates
General population:
- 3-5% APD
- <1% PCL-R for psychopaths
Criminal population:
- 50-80% APD
- 15% PCL-R (male prisoners)
- 7% PCL-R (female prisoners)
most psychopaths are not criminals
How does psychopathy improve on DSM APD?
- APD diagnosis has little predictive power (Hare,
1996) - Psychopaths are 3-4 times more likely to re-
engage in violent behavior (Hemphill et al, 1998) - Ambiguity of APD criteria could lead to diagnostic
confusion (Hare, 1996)
- Personality traits only seen as “Associated
Features”
- A diagnosis of ‘psychopathy’ has criminal
consequences
How can we further our knowledge?
- Non-incarcerated psychopaths need to be
evaluated - APD clearly ignores the non-incarcerated variety
- May be found in the business and corporate
world (‘the liar par excellence’ Karpman, 1949) - What could we learn:
- What social environment creates behavioral
antisocial component
What makes a psychopath?
- A person with an emotional disorder (Kirkman,
2002) - Evidence in studies of emotion processing (e.g.,
Blair et al., 1995) - Several socio-biologists have proposed the
existence of mechanisms that control aggression
in some social animal species
E.g., Submissive dogs bare throats
What sums up issues with diagnosing psychopathy?
- APD is not the same as psychopathy
- The DSM must bring personality into the diagnostic criteria of APD
- Future research needs to examine psychopaths outside of criminal institutions
- Psychopaths may lack the cognitive mechanisms necessary to develop moral thinking
Borderline, narcissistic, and histrionic personality disorders: Is there really any difference?
- big problem figuring out who has what because
there is a lot of overlap - do not look the same in person but do on paper =
should we use categories - usually diagnosed with more than one= should
use a dimensional approach
What are the Personality disorders?
Cluster A: odd or eccentric
- Paranoid, schizoid, schizotypal
Cluster B: dramatic, emotional, or erratic
- Antisocial, borderline, narcissistic, histrionic
Cluster C: anxious or fearful
- Avoidant, dependent, obsessive-compulsive
What composes the Cluster B personality disorders?
Borderline PD:
- Instability of interpersonal relationships, self-
image, emotions, and control over impulses
Histrionic PD:
- Excessive emotionality and attention-seeking
Narcissistic PD:
- Grandiosity, need for admiration, and lack of
empathy
What is the Prevalence and onset for cluster B?
Borderline PD:
- 2% in general population
- Early adulthood
Narcissistic PD:
- Less than 1% in general population
- Early adulthood
Histrionic PD:
- 2-3% in general population
- Early adulthood
What are the criteria similarities
- Attention-seeking
- Manipulative behaviour
- Lack of empathy
- Poor sense of self
Borderline and histrionic:
- Impulsivity, emotionality
Borderline and narcissistic:
- Angry reactions to minor stimuli
Histrionic and narcissistic:
- Exaggeration of intimacy of relationships
What are the Co-occurance rates for cluster B?
- 38% of borderline PDs co-occurred with
narcissistic PD - 44.1% of histrionic PDs co-occurred with
borderline PD - 68% of histrionic PDs co-ocurred with narcissistic
PD
What are the Shared etiology of cluster B?
Torgersen, et al (2008):
- Common genetic and environmental factors
influencing all cluster B PDs
- Not including shared family environment or sex
- Heritability: 31% for histrionic PD, 24% for
narcissistic PD, and 35% for borderline PD
What are the distinguishing features of Borderline personality disorder?
- Self-destructiveness
- “Needy” interaction style
- Angry disruptions in close relationships
- Chronic feelings of loneliness and emptiness
- ELEMENT OF HARMFUL ACTIVITY
What are the distinguishing features of Narcissistic personality disorder?
- “Grandiose” interaction style (see right away)
- Relative lack of self-destructiveness,
abandonment concerns, and impulsivity - Excessive pride in achievements
- Attention from others must be admiring
- LACK OF EMPATHY
What are the distinguishing features of Histrionic personality disorder?
- Not generally self-destructive
- “Coquettish” interaction style
- Willingness to be viewed as fragile or dependent,
if it means getting attention - OVERLY DISPLAY NEEDINESS
What are some Problems with categorical approach for personality disorders?
High degree of overlap
- Diagnostic confusion
- Clinician reluctant to make more than one Axis II
diagnosis
Assumes clear divide between normal and abnormal personalities
- categories that are distinct = good, personality less distinct= bad
What is the Dimensional approach towards personality disorders?
- Personality disorders consist of dimensions, not
discrete categories, different models - Each dimension is a combination of
environmental and genetic factors - Continuity between normal and abnormal
personality
