chapter 9: personality traits

cluster A

- cluster A: paranoid, schizoid, schizotypal - beavhior is odd, eccentric or asocial, all three share symptoms with schizophrenia, - sometimes schizophrenia spectrum disorders - paranoid personality disorder: pervasive tendency to be inapproiately suspicosius of other people's motives/behaviors, constantly on guard, expect others to harm them, - trouble having friends, aggressiveness, self-fulfilling prophecy thinks someone is going to hurt them so then they respond badly - not delusional, Distrust/suspicious of others Self-blameless More common in males than females - schizoid personality disorder: pervasive pattern of indifference to other people, coupled with diminished range of emotional experience and expression, loners, cold aloof, don't experience strong emotions --Impaired social relationships Inability and lack of desire Little expression of emotion More common in males than females - schizotypal personality disorder: centers around peculiar patterns of behavior rather than on the emotional restriction and social withdrawal that are associated with schizoid personality disorder - perceptual and congnitive diturbance - bizarre fantasies and usual eprceutal experiences, difficult to follow speech, not psychotic or out of touch with reality Discomfort with close relationships Peculiar thought patterns Odd perception and speech More common in males than females

personality:

- efers to enduring patterns of thinking and behavior that define the person and distinguish him or her from other people - patterns are ways of expressing emotions as well as patterns of thinking about ourselves and other people - -enduring patterns of behavior and emotion bring the person into repeated conflict with others, and when they prevent the person from maintaining close relationships with others, an individual's personality may be considered disordered the study of individual differences Often expressed (and measured) in terms of interpersonal relationships, and reflects differences in the following: Social motivation (affiliation and achievement) Patterns of emotional expression Ways of thinking about ourselves and others In psychiatry, personality disorders have been defined by observations made by therapists while treating patients (a very different perspective)

impulse control disorders

- excessively inoved in pleasurable activities with painful consequences, buying, sex, - impulse control disorders: persistent, clinically significant behaviors that are not better explained by other disorders in DSM-5 - intermittent explosive disorder: aggresvvie beahvior resulting in serious assualtive acts or descrutiion of property - kleptomania: stealing for no reason - pyromania: setting of fires on purpose - not gambling anymore - impsule preceded by tension, and followed by pleasure ore relied, motivation different than compulsion, be happy not relieve anxiety - cricular, why do they set fires then,

antisocial treatment

- seldom seek professional help unless by the law, seldom effective, unable to trust therapist, - sparse lit, - frequency of criminal offenses, high rate of alcoholism makes it hard too - psychological interventions that are directed toward specific features of disorder might be useful, anger management, behavioral treatments,

are PDs important?

-Disrupt interpersonal relationships -Make therapy very difficult when they occur together with other disorders, such as depression and substance use disorders -May represent predispositions toward, or early manifestations of, other mental disorders

personal disorders

-More subtle and less incapacitating than many mental disorders (also controversial) -Rigid, inflexible, maladaptive patterns of relating to oneself and one's environment -Presumably evident by adolescence and stable over the adult lifespan -Most often untreated -Ego-syntonic (as opposed to ego-dystonic) Thoughts, behaviors, and symptoms are acceptable and fit in with one's self image Disorders like depression and panic disorder are ego-dystonic - presented in the DSM-5 emphasizes the duration of the pattern and the social impairment associated with the symptoms in question - an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the indivudal's culture - two or more of the following domains: cognition (such as ways of thinking about the self and others), emotional responses, interpersonal functioning, or impulse control

cluster C

Avoidant Sensitive to rejection; feelings of inadequacy; shy Insecure socially/social inhibition Similar prevalence in males and females Obsessive-Compulsive Preoccupation with orderliness and perfectionism, rules, trivial details Lack of warmth; difficulty relaxing Seen more in males than females Dependent Excessive need to be taken care of Submissive Clinging behavior Discomfort being alone Indecisiveness Similar prevalence in males and females

forms of PDs

Cluster A, B, c

avoidant

Cluster: C Main Feature: Pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation Trait Description: High Neuroticism (negative affectivity) Low Extraversion (detachment) Other Information: Prevalence: 1.2% general population Equally diagnosed in males and females Substantial overlap with anxiety disorders Criteria (4 or more): Avoids occupational activities that involve significant interpersonal contact, because of fears of criticism, rejection, or disapproval Unwilling to get involved with people unless certain of being liked Shows restraint within intimate relationships because of fear of being shamed or ridiculed Preoccupied with being criticized or rejected in social situations Inhibited in new interpersonal situations because of fear of inadequacy View self as socially inept, personally unappealing, or inferior to others Reluctant to take personal risks because they may prove embarrassing

problems with categorical approach

Considerable overlap among categories Problem setting thresholds (cut-off for diagnosis) Need for 10 diagnoses on Axis II creates unnecessary complexity (making decisions on 7 or 8 criteria for each category) It might be simpler and more accurate descriptively to use a few dimensions

general criteria for PDs

DSM-5 General Definition (2013): An enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual's culture Pattern manifested in 2 (or more) of the following ways: Cognition (ways of perceiving and interpreting self, others, events) Affectivity (range, intensity, liability, appropriateness) Interpersonal Functioning Impulse Control Pervasive and Inflexible Leads to distress or impairment Stable and long duration (onset traced to adolescence/early adulthood) Not better explained by another disorder Not substance induced or attributable to another medical condition

problems regarding PD

Diagnostic reliability is quite low Considerable overlap among categories Questions remain about stability over time -Not clear that they are "culturally universal" -Relatively less evidence to show that they can be treated successfully

cluster B disorder

Histrionic Excessive emotionality and attention seeking Concern with attractiveness Irritability and temper outbursts Similar prevalence in males and females Narcissistic Grandiosity, need for admiration, lack of empathy More common in males than females Antisocial Disregard for and frequent violation of the rights of others Lack of morals/ethics Usually seen in males Borderline Instability of interpersonal relationships, self-image, emotions, and control over impulses More common in females than males

emerging measures/models

Levels of Personality Functioning: -this is the "gate-keeper" that determines if the person has a disorder in this realm clinician begins by making ratings on four items: problems with view of self and others (identity and self-direction) problems with interpersonal relationships (empathy and intimacy) these are general markers for disorder Traits in the new Dimensional PD Model NEGATIVE AFFECTIVITY: emotional lability, anxiousness, separation insecurity, submissiveness, perseveration, depressivity DETACHMENT: withdrawal, intimacy avoidance, anhedonia, restricted affectivity, suspiciousness ANTAGONISM: manipulativeness, deceitfulness, grandiosity, attention seeking, callousness, hostility DISINHIBITION: irresponsibility, impulsivity, distractibility, risk taking, rigid perfectionism (lack of) PSYCHOTICISM: unusual beliefs and experiences, eccentricity, cognitive and perceptual dysregulation PD trait specified -most common form of PD diagnosis would become "PD Trait Specified Retain some PD types as compromise schizotypal, borderline, antisocial, avoidant, and OCPD (those included in Andy Skodol's CLPS study) public uproar led work group to retain narcissistic PD the others are dropped and replaced by one trait each, e.g., Dependent PD becomes high rating on submissiveness, Paranoid PD becomes high rating on suspiciousness not clear until last minute how many traits you'd have to exhibit to qualify for one of the types added criteria for intoxication and withdrawal

dependent PD

Main Feature: Pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation Causes: Role of parenting Trait Description: High Neuroticism (negative affectivity) Low Conscientiousness (disinhibition) Other Information: Prevalence: 0.3% general population Diagnosed more frequently in females in clinical settings Difficulty making everyday decisions without reassurance from others or excessive advice Needs others to assume responsibility for most major areas of life Difficulty expressing disagreement because of fear of loss of support Difficulty initiating projects because because of lack of self-confidence Goes to excessive lengths to obtain nurturance from others Feels uncomfortable when alone because of fears of being unable to care for self Urgently seeks new relationship as source of support when close relationship ends Unrealistically preoccupied with fears of being left alone to care for self

schizoid in more depth

Main Feature: Pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings Trait Descriptions: Low Extraversion (detachment) High Neuroticism (negative affectivity) Other Information: Prevalence: 0.6% general population Uncommon in clinical settings Criteria (4 or more): -Neither desires nor enjoys close relationships, including being part of a family -Almost always chooses solitary activities -Has little/no interest in sexual experiences with another person -Takes pleasure in few, if any, activities -Lacks close friends or confidants other that first-degree relatives -Appears indifferent to praise or criticism of others Shows emotional coldness, detachment, or flattened affectivity

antisocial PD

Main Feature: Pervasive pattern of disregard for, and violation of, the rights of others Trait Description: Low Agreeableness (antagonism) Low Conscientiousness (disinhibition) Evidence of Conduct Disorder before age 15: Conduct Disorder refers to a group of behavioral and emotional problems in children and adolescents Great difficulty following rules and behaving in a socially acceptable way Aggression to people and animals, destruction of property, deceitfulness, lying, or stealing, serious violations of rules Criteria (3 or more since age 15): Repeated acts that could lead to arrest Conning for pleasure/profit, repeated lying, use of aliases Failure to plan ahead or being impulsive Repeated assaults on others Reckless when it comes ot their or others' safety Poor work behavior or failure to honor financial obligations Rationalizing the pain they inflict on others Must be 18 years of age (evidence of Conduct Disorder before age 15) Characterized by a lack of regard for the moral or legal standards in the local culture Marked inability to get along with others or abide by societal rules Reactive aggression Callous-Unemotional (CU) traits in only some Extreme presentation as psychopathy

narcissitic PD

Main Feature: Pervasive pattern of grandiosity, need for admiration, and lack of empathy Trait Description: Low Agreeableness High Extraversion (seen in Grandiose Narcissism) High Neuroticism (seen in Vulnerable Narcissism) ' Criteria (5 or more): Grandiose sense of self-importance Preoccupation with fantasies of unlimited success, power, brilliance, ideal love Require excessive admiration Interpersonally exploitative Lacks empathy Sense of entitlement Envious of others or believes others envious of them Arrogant behavior/attitude Believes they are special and can only association with important people

borderline PD

Main Feature: Pervasive pattern of instability of interpersonal relationships, self image, and affects, and marked impulsivity -splitting: tendemcu tp see [pe[;e amd evemts alternately as entirely good or bad, split emotions - mood swings, unstable relationships impulse control disorders, substance abuse, psychodyanic views transformed into BPD - symptoms - pervasive pattern of instability in self-image in interpersonal relationships and in mood - snapshots, overlaps with other PD categories, - symptoms of BPD evident before onset of major depression, 29% developed depression - causes - genetic factors are involved, traits like neuroticism and impuslisivty influenced by genetics - how genetics interact with environment, parental loss, neglect, maltreatment, relationships with parents, lack of supervision, domestic violence, abuse, study of adolescents, evidence of abuse/neglect 4x more likely to develop PDs as adults, cluster B more common, not as close connection between antisocial/abuse, - sexual abuse: BPD, childhood neglect: antisocial, borderline, narcissitic, avoidant, maladatpive patterns of parenting and family relationships increase probability that a person will develop certain types of personality disorder Trait Description: High Neuroticism (negative affectivity) Low Conscientiousness (disinhibition) Low Agreeableness (antagonism) Other Information: Prevalence: 2.7% general population Most common PD in clinical settings (20% inpatient, 10% outpatient) More commonly diagnosed in women Generally, most severely dysfunctional PD criteria: Frantic efforts to avoid abandonment Unstable, intense interpersonal relationships Identity disturbance Impulsivity (sexual behavior, spending, substance abuse) Suicidal behavior, gestures, or threats, or self-mutilating behavior Affective instability Inappropriate, intense anger Chronic feelings of emptiness Stress related paranoid ideation, or dissociative symptoms treatment - pscyohtehrapy, treansference relationship: way patient behaves toward therapist reflects early relationships, increase ability to experience themselves in realistic way - most difficult to treat, rage at therapist, 1/2-2/3 patients discontinue treatment - dialectical behavior therapy: broadly based beavhioral strategies with more general principles of supportive psychotherapy - dialectics process of reasoning that places opposite or contradictory ideas side by side - strategies employed by the therapist in order to help the person appreciate and balance apparently contradictory needs to accept things as they are, work toward changing patterns of thinking and behavior that contribute to problems in regulation of emotions, - more comfy with strong emotions, integrated ways of thinking, good/bad, skill training , exposure, - therapist acceptance of patients, and their behaviors - previous history of self harm, patients assigned to receive DBT or treatment adjustment measured after a year, 60% of patients in treatment as usual group terminated prematurely, whereas rate in DBT group was only 17 percent - dBT reduction in frequency and severity of suicide attempts, fewer days in psychiatric hospitals - didn't differ on levels of depression/hopelessness - outcome measures indicated that women who were treated with dialectical behavior therapy experienced more improvement than women in the control groups with regard to symptoms such as depression/hopelessness - psychotropic med used in treatment of borderline patients, no disorder specific drug has been found, spectrum of psychoactive meds, different types of drugs recommended to treat individual symptoms, implosive aggression,

schizotypal PD

Main Feature: Pervasive pattern of social and interpersonal deficits, marked by acute discomfort with, and reduced capacity for, close relationships as well as by cognitive or perceptual distortions and eccentricities of behavior -meet criteria for additional disorders, esp other cluster A disorders paranoid/schizoid causes: somewhat related to schizophrenia -genetic contribution -first degree rleatives of schizphrenic patients are considerably more liekly than people in the general population to exhibit sypmtoms of schizotypal PD Trait Description: Higher Neuroticism (negative affectivity) Low Extraversion (detachment) Psychoticism criteria: 5 or more -Ideas of reference (incorrect interpretations of causal incidents; external events having particular meaning) -Odd beliefs or magical thinking that influences behavior and is abnormal -Unusual perceptual experiences, including bodily illusions -Odd thinking or speech Suspiciousness or paranoid ideation -Inappropriate or constricted affect -Behavior or appearance that is odd, eccentric, peculiar Excessive social anxiety (doesn't diminish with familiarity) treatment: -ego syntonic -comorbity, treatment aimed at this too -treatment value of antipsychotic drugs -antidepressants Most do not seek treatment - do not see own behavior as source of distress Often terminate treatment early Smaller dosage of antipsychotics has positive effects Some evidence that SSRIs may be beneficial Often don't respond well to psychotherapy Other Information: Prevalence: 0.6% Slightly more common in males

obsessive compulsive PD

Main Feature: Preoccupation with orderliness, perfectionism, mental and interpersonal control, at the expense of flexibility, openness, and efficiency Trait Description: High Conscientiousness (disinhibition) High Neuroticism Low Openness Low extraversion Other Information: Prevalence: 1.9% general population More often diagnosed in males Difference between OCD and OCPD: OCD requires obsessions OR compulsions Preoccupation with rules, lists, order, organization, or schedules to the extent that the major point of the activity is lost Shows perfectionism that interferes with task completion Excessive devotion to work/productivity to the exclusion of leisure Over conscientious and inflexible about matters of morality, ethics, or values Unable to discard worn-out or worthless objects even when they have no sentimental value Reluctant to delegate tasks to others Adopts miserly spending style; money hoarding for future catastrophes Rigidity and stubbornness

paranoid in more depth

Main Feature: Pervasive distrust and suspicion of others such that their motives are interpreted as malevolent Trait Description Low Agreeableness Low Openness Low Extraversion Other Information Prevalence: 1.9% general population Recommended by some for removal from DSM (lack of divergent validity) Criteria 4 or more -Suspects without basis that others are exploiting, harming, or deceiving them -Preoccupation with unjustified doubts about the loyalty of friends -Reluctant to confide in others because of fear that info will be used against them -Reads hidden threats into benign remarks -Persistently bears grudges -Perceives attacks on their character or reputation that are not apparent to others -Recurrent suspicion without justification regarding fidelity of spouse or sexual partner

dimensional analysis: big 5

PDs are maladaptive configurations of normal personality traits, or extreme variants of normal traits OCEAN Neuroticism (expression of negative emotions) Extraversion (interest in interacting with other people; positive emotions) Openness (willingness to consider and explore unfamiliar ideas, feelings, and activities) Agreeableness (willingness to cooperate and empathize with others) Conscientiousness (persistence in pursuit of goals; organization; dependability) -Explains comorbidity -Minimizes problem of heterogeneity -Explains gender differences in prevalence rates (men usually lower in agreeableness, women usually higher in neuroticism) -Explains changes over time Useful in treatment (strengths and weaknesses, predicts outcome variables)

culture and personality

PDs could be different culturally

difficult to treat

Person does not recognize that they have a problem Interpersonal difficulties interfere with the therapeutic relationship Very little research evidence on treatment efficacy because PDs overlap so extensively with other mental disorders

antisocial lifecourse

Person's options become narrowed; locked into further antisocial behavior Limited range of behavioral skills (can't pursue more appropriate responses) Ensnared by consequences of earlier behaviors (drug addiction, parenthood, school dropout, criminal record)

PSYCHOPATHY

Represent extreme subset of those with APD Not in DSM-5 Hare's Psychopathy Checklist (PCL-R) 20 items scored on a 3 point scale (0, 1, 2) Score above 30 used as cut-off by many investigators Factor 1: Personality Aggressive narcissism Selfish, callous, and remorseless use of others Factor 2: Case History Unstable, antisocial, & socially deviant lifestyle Many short-term marital relationships Criminal versatility Reactive and Proactive Aggression Emotional Interpersonal Glib and superficial Ego-centric and grandiose Lack remorse or guilt Lack of empathy Deceitful and manipulative Shallow emotions Social Deviance Impulsive Need for excitement

histroinic

Scarlett O'Hara was the prototype for HPD when DSM-III was written From Gone with the Wind (film in 1939 and the novel in 1936 Vivien Leigh played Scarlett, Clark Gable played Rhett Butler 10 Academy Awards, including best actress, best director, and best picture Main Feature: Pervasive pattern of excessive emotionality and attention seeking behavior Trait Descriptions: High Extraversion (low detachment) High Neuroticism Low Agreeableness Low Conscientiousness Criteria (5 or more): Uncomfortable when not center of attention Inappropriate sexually seductive/proactive behavior Rapidly shifting shallow expression of emotions Uses appearance to draw attention to self Excessively impressionistic speech Theatricality, exaggerated emotional expression Suggestible Considers relationships more intimate than they actually are

antisocial etiology

Social Inconsistent discipline (or complete lack of discipline) often seen in the prior family history of Antisocial men (Robins, 1966) Kids with a "difficult temperament" are especially irritating to parents Parents respond inappropriately (giving up, or becoming severe in punishment) Person selects friends who share antisocial interests and problems -interacting systems psychological Avoidance learning in the lab (sequences) Psychopaths unaffected by anticipation of punishment Hypothesis 1: they can ignore the effects of punishment; they are emotionally impoverished Hypothesis 2: they have trouble shifting their attention; they are impulsive biological Adoption studies point to influence of genetic factors Cadoret et al. (1995) found an interaction between genetic factors and rearing environment Adverse adoptive home environment increases risk of conduct disorder in offspring of antisocial parents

what is a personality diosrder

They are hypothetical constructs Like anxiety, intelligence, and so on An explanatory device An inferred internal event (cannot be seen directly) Has observable referents, but none define the construct exhaustively Defined in terms of a theoretical framework linking all of the referents

PDs as construct

They do not exist (literally) They are simply more or less useful To determine whether a construct is useful, we need to collect data Validity is an empirical question To say that a construct is completely meaningless is a very strong statement, and most likely an exercise in rhetoric What kind of evidence do we need to make decisions about the validity of PDs?

HOW TO MEASURE SOCIAL IMPAIRMENT

Using informant report: He can be hard to like He is difficult to get along with He has difficulty cooperating with other people He make other people feel awkward or uncomfortable

more on psychopathy

factor 1 personality "aggressive narcissism" Glibness/superficial charm Grandiose sense of self-worth Pathological lying Cunning/manipulative Lack of remorse or guilt Shallow affect (genuine emotion is short-lived and egocentric) Callous/lack of empathy Failure to accept responsibility for own action factor 2 case history socially deviant lifestyle Need for stimulation/proneness to boredom Parasitic lifestyle Poor behavioral control Lack of realistic long-term goals Impulsivity Irresponsibility Juvenile delinquency Early behavior problems Revocation of conditional release

cross-cultural psych

is scientific study of ways that human abehiovr and mental processes are influenced by social and cultural factors - identifying meaningful groups: selection of participants who are representative members of different cultures, a relatively straightforward process if the comparison is to be made between two small homogenous groups such as two isolated rural villages in two very different countries, who shares a common culture? what is a "cultural unit?" spanish speaking: PR, mexico, cuba - selecting equivalent measurement procedures: comparison between groups can be valid only if equivalent measurement procedures are used in both cults, in different cultures often speak different languages, questionnaires and psychological tests must be cross-validated to ensure that they measure the same concepts in different cultures - considering causal explanations: how to interpret this difference, cultural variables, would the differences disappear if other variables such as poverty, education, age, held constnat - avoiding culturally biased interpretations: middle class and white interpret results of cross-cultural research cautiously,

stability over time

most people still ahve these problems after awhile

frequency

of any PD is 10% -antisocial 3% -50% of people who meet criteria for one PD also meet for another disorder -75% of qualify for PD also meet major dep gender anrisocioal more common in women

different faces of narcisissm

positive: High self-esteem High positive affect Optimistic about future Low anxiety Very competitive and ambitious Independent (good leaders? negative: Abrasive and exploitative Disliked by others (but they may not care) Interpersonal problems Mood fluctuations (especially anger) Do not value empathy, compassion, or ability to compromise more: Extremely sensitive to interpersonal comparison (need for positive feedback that matches high self-esteem) Likely to derogate a person who gives negative feedback or perform better than they do (to defend vulnerable self-esteem) Care more about their own views of themselves than about the ways in which other people see them (but they need an audience) Given a choice between being liked or being admired, they will choose being admired every time May seek treatment because of depression ("narcissistic injury")

symptoms

social motivation: - motives describe the way that the person would like things to be and they help to explain why people behave in a particular fashion - two important motives: affiliation : sire for close relationships with others, power: desire for impact, prestige, or dominance cogntiive perspectievs regarding the self and others: - one central issue involves our image of ourselves - self image connected to mood states - useful to think of yourself in positive terms, but extreme grandiosity can be disruptive - when we misperceive the intentions and motives and abilities of other people, our relationship can be severely disturbed - unreasonable fears of being abandoned, criticized or rejected, misperceive other people in many different - some people with personality disorders experience persistent problems in social distance - antoher important element of interpersonal perception is the ability to empathize with others, to anticipate and decipher their emotional ereaction and use that knowledge to guide our own behavior temperament and personality - temperament refers to a person's most basic, characteristic styles of relating to the world - factors vary considerably in level or degree from one infant to the next, important implications for later development - children who demonstrate a lack of control when they are very young are much more likely than their to experience problems with hyperactivity and distractibility and conduct disorder - young children who are extremely shy are more likely to be anxious and socially inhibited in subsequent years - basic dimensions of temperament and personality, - five-factor model of personality, neuroticism, extraversion, openness, agreeableness, conscientiousness - personality disorders are malapative variations on the kinds of traits dramatically elevated levels of anger-hostility, impulsiveness, and excitement seeking are important, although some forms of personality disorder are addociated with high levels of anxiousness and vulnerability, people with antisocial personality disorder feruqnetly exhibit unusually low levels of anxiety and concern about danger context and personality - differences may not be evidence in all situations, some important personality features may be expressed only under certain challenging circumstances that require or facilitate a particular response - social cirumcstances freuqnely determine whether a specific pattern of behavior will be assigned a positive or negative meaning by other people

diagnosis

two approaches: categorical approaches, dimensional approach, rejected but was in section III of the manual, three clusters,

PD: bottom line

workgroup proposed a radical change, promoting a new dimensional model based on traits kept the original DSM-IV categorical system for PDs in complete form new dimensional model located in Section III of the manual (only disorder for which they provide two definitions)