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Chapter Fourteen
Personality Psychopathology
Personality Psychopathology
• Concept of “personality” in psychology means
three things:
– Refers to individual’s recognizable behaviors in
which pattern, order, and regularity can be
identified
– Personality is a psychological construct
– Personality influences how we respond but also
causes us to act in certain ways
• Can personalities be pathological?
Personality Psychopathology (cont’d.)
• Personality disorder:
– Characterized by impairment in self and
interpersonal functioning and presence of
inflexible, long-standing, pathological personality
traits
– Many individuals with personality disorders are
never diagnosed
– 5-15% of hospital admissions and outpatient
clinics
– Lifetime prevalence: 9-13%
Diagnosing Personality
Psychopathology
• Can be diagnosed through two routes:
– Being categorized as showing characteristics from
one of the six specific personality disorder types
– Possessing certain specific personality traits that
impair functioning
Diagnosing Personality
Psychopathology (cont’d.)
Figure 14-1 Diagnosing Personality Disorders: Two Paths
Levels of Personality Functioning
• According to the DSM-5:
– Impairments in self functioning and in
interpersonal functioning, meeting all criteria:
– Degree of impairment is measured on five-point
“Levels of Personality Functioning” scale
• From no impairment to extreme impairment
Sociocultural Considerations
• DSM-5 recognizes importance of cultural,
ethnic, and social background
– “Impairment or adaptive” implies within the
individual’s contextual norms and expectations
• Gender implications:
– Borderline personality disorder in women
– Antisocial personality disorder in men
– Gender bias plays a role
Personality Disorder Types and Trait
Specified: A Hybrid Approach
• Less emphasis on Axis I versus Axis II
– Personality disorders are chronic, developmental,
and relatively inflexible patterns of responding
that are less likely to be changed in treatment
– Personality disorders can coexist with one or more
clinical disorders
• Hybrid approach: difference between
categorical disorders and those described on
continuum of traits
Personality Disorder Types
• Six personality disorder types:
– Schizotypal
– Borderline
– Avoidant
– Narcissistic
– Obsessive-compulsive
– Antisocial
• Diagnosis involves “matching” individual with
DSM-5 description of disorder
Schizotypal Type
• Characterized by peculiar thoughts and
behaviors and by poor interpersonal
relationships
• Many with disorder believe they have magical
abilities or special powers; some are subject
to recurrent illusions
• Primarily cognitive distortions; affective and
interpersonal problems are secondary
Schizotypal Type (cont’d.)
• Characteristics resemble a less serious form of
schizophrenia
– Possible genetic link
• Treatment:
– Dynamic, supportive, cognitive-behavioral, and
group psychotherapy
– Small doses of anxiolytics can be used for anxiety
Borderline Type
• Characterized by intense fluctuations in mood,
self-image, and interpersonal relationships
• Those with disorder are impulsive, have
chronic feelings of emptiness, and form
unstable relationships
• May be friendly one day and hostile the next
• Probability of suicide higher
Borderline Type (cont’d.)
• Most commonly diagnosed personality
disorder
• May exhibit transient psychotic symptoms
such as auditory hallucinations, but they know
these are unacceptable
• May best be viewed on a continuum
Borderline Type (cont’d.)
• Diverse models used to conceptualize:
– Psychodynamic perspective
• Stress in early childhood experiences
– Contemporary explanations
• Mood regulation as central to disorder
• Biological factors including abnormal prefrontal cortex
structures and amygdala activation pattern
– Cognitive-oriented approaches
• Distorted or inaccurate attributions
– Dialectical behavioral therapy (DBT)
• Smaller drop-out rate and suicidal behaviors
Avoidant Type
• Characterized by a fear of rejection and
humiliation and a reluctance to enter into
social relationships
• Want social interactions but fear them
• Disagreements over diagnostic category
• Treatment:
– Cognitive-behavioral, psychodynamic,
interpersonal, and psychopharmacological
Narcissistic Type
• Characterized by exaggerated sense of selfimportance, exploitative attitude, and lack of
empathy
• Symptoms may present in adolescents who
are later diagnosed as adults
• Individual psychotherapy and group therapy
are recommended
– Little treatment success
Obsessive-Compulsive Type
• Characterized by perfectionism, a tendency to
be interpersonally controlling, devotion to
details, and rigidity
• Differs from OCD:
– Pervasive character disturbance
– Individuals see their way of functioning as correct
• Treatment:
– Cognitive-behavioral and supportive forms of
psychotherapy; no medications are currently
available
Antisocial Type
• Characterized by a failure to conform to social
and legal codes, a lack of anxiety and guilt, and
irresponsible behaviors
• Composed of three factors:
– Arrogant and deceitful interpersonal style
– Deficient affective experience
– Impulsive and irresponsible behavioral style
Antisocial Type (cont’d.)
Antisocial Personality Disorder (George), Part 1 George describes the symptoms of
his antisocial personality disorder.
Antisocial Type (cont’d.)
Antisocial Personality Disorder (George), Part 2 George describes the symptoms of
his antisocial personality disorder.
Antisocial Type (cont’d.)
• Problems with self-identity integration
• Much more frequent in urban environments
and in lower SES
• Distinct from impulse control problems
• Difficult population to study
– Only one out of seven seek treatment
Former Personality Disorders
• Originally 10 disorders identified in DSM-IVTR; clinical evidence did not support four of
these:
– Paranoid, schizoid, histrionic, and dependent
personality disorders
• Justification for removal:
– Absence of research
– Excessive co-occurrence
– Arbitrary diagnostic thresholds
• DSM-5: continuum of personality traits
Multipath Analysis of One Personality
Disorder: Antisocial Type
Figure 14-2 Multipath Model of Antisocial Personality Disorder The dimensions
interact with one another and combine in different ways to result in antisocial personality
disorder.
Biological Dimension
• Genetic influences
– Heredity looks to be a factor
• Twin studies
– Evidence supports for genetic basis does not
preclude environmental factors; undoubtedly
caused by both
• Difficult to determine causal relationship
– Genetic studies do not show how antisocial type is
inherited
Biological Dimension (cont’d.)
• Autonomic nervous system abnormalities
• Genetic predisposition to fearlessness or lack
of anxiety
• Arousal, sensation-seeking, and behavioral
perspectives
Psychological Dimension
• Psychodynamic perspective:
– Faulty superego development
• Cognitive perspective:
– Core unconscious beliefs that influence behavior
• Learning perspective:
– Inherent neurobiological characteristics that delay
or impede learning
– Lack of positive role models
– Presence of poor role models
Psychological Dimension (cont’d.)
Figure 14-3 Effect of Type of Punishment on Psychopaths and Others The effects of
three different types of punishment on an avoidance learning task are shown for three
groups of participants. Although physical or social punishment had little impact on
psychopaths’ learning, monetary punishment was quite effective.
Source: Schmauk (1970).
Social Dimension
• Family and socialization:
– Impoverished backgrounds
– Poor parental supervision and involvement
– Neglect, hostility, maltreatment, abuse
– Parental rejection/deprivation
– Dysfunctional family structure
– Parental separation or absence
– Do not learn to pay attention to social stimuli
Sociocultural Dimension
• Gender:
– Males more likely to exhibit both conduct
disorders and antisocial personality disorder than
females; possibly different pathways
– Relational aggression in women
• Cultural values:
– “Rugged individualism” in U.S.
• Competitive environment bred by U.S. values could fuel
aggressive and violent behavior
Treatment of Antisocial Personality
Disorder
• Individuals feel little anxiety and as a result,
lack motivation for treatment
– Approaches that require cooperation of client may
be ineffective
– Programs may need enough control to force
confrontation of relationships and affect behavior
• Behavior modification:
– Most useful is skill-based and behavioral
treatment using material rewards, but not longlasting
Treatment of Antisocial Personality
Disorder (cont’d.)
• Cognitive approaches:
– Therapist must build rapport and guide client
away from thinking in terms of self-interest and
immediate gratification, and toward higher levels
of thinking regarding self and others
• Current treatments not effective
– Need to focus on antisocial youths who appear
amenable to treatment and involve families and
peers
– Individuals may respond to programs involving
physical and mental stimulation
Personality Disorder Trait Specified
• Personality disorders viewed as extremes of
underlying dimensions of normal personality
traits (assessed on scaled continuum)
• DSM-5 uses five-point degree of match
between description of disorder type and
client
Personality Disorder Trait Specified
(cont’d.)
• Five-domain trait dimensional diagnostic
system for assessing personality disorders
– Trait: specific personality characteristic possessed
by individual; may be organized around a domain
– Existence of one or more domain traits that impair
interpersonal functioning is sufficient to indicate
personality disorder
Personality Disorder Trait Specified
(cont’d.)