*Tutorial 9 - Personality Disorders

Question 1

What diagnosis do you think would be most appropriate for Sam, if any?

Answer 1

Antisocial co-morbid with narcissism

Question 2

Give 4 reasons why the use of self-report questionnaires might be problematic for people like Sam?

Answer 2

Because many are

• dishonest
• have a disregard for rules & following instructions
• egocentonic
• don’t understand emotion so hard to know if one has felt things like remorse because they probably haven’t

Question 3

FIX CARD

Answer 3

Do you think that the general personality disorder cluster an individual’s presentation fits within is more important than the specific diagnosis? Why/Why not?

Question 4

FIX CARD

DSM-5 contains a proposed model in which Personality Disorders are dimensional, rather than separate categories. What are the possible implications of this?

Answer 4

Dimensional meaning it is grey area - spectrum, not black and white like categorical

so more diagnoses, treatment dif.
need cut off point?

not discrete disorders, just more ext. of traits in varying degrees

Question 5

Antisocial PD in DSM-5
vs
Cleckley’s Psychopathy criteria

Answer 5

Hervey Cleckley was the pioneer in describing Psychopathy and compiled a list of 16 traits. Robert Hare expanded and refined the list.

Question 6

Describe Hare’s “Psychopathy Checklist Revised (PCL-R)”?

Answer 6

• 20 item rating scale
• allows mental health professionals to compare a patient’s degree of psychopathy with that of a typical psychopath.
• Many in the field regard it as the best way to determining the presence and extent of psychopathy in an individual
• has two parts,
  1: a semi-structured interview and a
  2: review of the person’s records and history.
• The interview covers two aspects that help define the psychopath, selfish and insensitive exploitation of others (the classic traits of psychopaths as originally defined by Cleckley) and an unstable, antisocial lifestyle (more similar to the Antisocial PD behaviours as defined by DSM-5).

Question 7

What are Hare’s PCL-R 20 Traits?

Answer 7

1. Glibness and Superficial Charm – Smooth-talking, engaging and slick.
2. Grandiose Self-Worth – Greatly inflated idea of one’s abilities and self-esteem, arrogance and a
   sense of superiority.
3. Needs Stimulation/Prone to Boredom – An excessive need for new, exciting stimulation and risk-
   taking.
4. Pathological Lying – Shrewd, crafty, sly and clever when moderate; deceptive, deceitful, underhanded and unscrupulous when high.
5. Manipulative – Uses deceit and deception to cheat others for personal gain.
6. No Guilt/Remorse: no feelings or concern for losses, pain and suffering of others, coldhearted and
   unempathic.
7. Emotional Poverty – Limited range or depth of feelings; interpersonal coldness.
8. Lacks Empathy – A lack of feelings toward others; cold, contemptuous and inconsiderate.
9. Parasitic Lifestyle – Intentional, manipulative, selfish and exploitative financial dependence on
   others.
10. Poor Behavioral Controls – Expressions of negative feelings, verbal abuse and inappropriate
    expressions of anger.
11. Promiscuity – Brief, superficial relations, numerous affairs and an indiscriminate choice of sexual
    partners.
12. No Realistic Long-Term Goals – Inability or constant failure to develop and accomplish long-term
    plans.
13. Impulsiveness – Behaviors lacking reflection or planning and done without considering
    consequences.
14. Irresponsible – Repeated failure to fulfill or honour commitments and obligations.
15. Fails to Accept Responsibility for Own Behaviour – Denial of responsibility and an attempt to
    manipulate others through this.
16. Many Short-Term Marital Relationships – Lack of commitment to a long-term relationship.
17. Early Behaviour Problems – A variety of dysfunctional and unacceptable behaviours before age
    thirteen.
18. Juvenile Delinquency – Criminal behavioural problems between the ages of 13-18.
19. Revocation of Conditional Release – Violating probation or other conditional release because of
    technicalities.
20. Criminal Versatility – Diversity of criminal offences, whether or not the individual has been
    arrested or convicted.

Question 8

What are the DSM-5 criteria for anti-social personality disorder?

Answer 8

(A) A pervasive pattern of disregard for and violation of the rights of others, occurring since age 15 years, as indicated by three (or more) of the following:

1. Acts that are grounds for arrest
2. Lying, aliases, conning
3. Impulsivity, fail to plan ahead
4. Irritability, aggression (fights, assaults)
5. Reckless disregard for safety of others
6. Unstable work, debt defaults
7. Lack of remorse

(B) Must be at least 18

(C) Evidence of Conduct Disorder (CD) before 15.

(D) The occurrence of antisocial behaviour is not exclusively during the course of schizophrenia or bipolar disorder.

Question 9

What are the Cluster A disorders?

What common features do they share?

Answer 9

Cluster A is called the odd, eccentric cluster.

It includes:

1. Paranoid Personality Disorder
2. Schizoid Personality Disorder
3. Schizotypal Personality Disorder.

The common features of the personality disorders in this cluster are social awkwardness and social withdrawal.

Question 10

Cluster B

Answer 10

Cluster B personality disorders are characterised by dramatic, overly emotional or unpredictable thinking or behaviour.

They include 
antisocial personality disorder, 
borderline personality disorder, 
histrionic personality disorder and 
narcissistic personality disorder

Individuals with this Cluster B Personality Disorder in their actions regularly disregard and violate the rights of others. These behaviours may be aggressive or destructive and may involve breaking laws or rules, deceit or theft. (antisocial)

Individuals with this Cluster B Personality Disorder have an excessive sense of how important they are. They demand and expect to be admired and praised by others and are limited in their capacity to appreciate others’ perspectives. (narcissism)

Question 11

What are the Cluster C disorders?

Answer 11

Cluster C is called the anxious, fearful cluster.

It includes:
Avoidant Personality Disorder
Dependent Personality Disorder
Obsessive-Compulsive Personality Disorders

These three personality disorders share a high level of anxiety.

Question 12

What are the Cluster C disorders?

Answer 12

Cluster C is called the anxious, fearful cluster.

It includes:
Avoidant Personality Disorder
Dependent Personality Disorder
Obsessive-Compulsive Personality Disorders

These three personality disorders share a high level of anxiety.

Question 13

What’s the differences between OCD & OCPD?

Answer 13

In OCPD not necessarily get anxious if things are out of place at home - but more how they run their lives

Question 14

Would people with narcism get diagnosed?

Answer 14

Yeah, they may see a therapist for other reasons, then find that their problems are due to them. Probably went coz of anger mgmt issues, or depressed/isolated. Sometimes loved ones diagnosed them etc.

Very often ppl are never told if they are narcissistic. just treated without labelling.

Question 15

What is a personality disorder?

Answer 15

Personality disorders are disorders associated with personality traits such as agreeableness etc.
Traits are stable over time and place.
More tied to who the person is.

Question 16

What was the old term for antisocial personality disorder?

Answer 16

Psychopathy