Lecture 18 - Personality II.pptx

Personality II Geneviève Trudel, PhD Candidate University of Ottawa Reminder • Last day to submit questions for your final exam! https://uottawapsy.az1.qualtrics.com/jfe/fo rm/SV_1HQ9wQubyeOtRxc • Course Evaluation Outline • Cluster A disorders • Cluster B disorders • Anti-social personality dis...

Personality II Geneviève Trudel, PhD Candidate University of Ottawa Reminder • Last day to submit questions for your final exam! https://uottawapsy.az1.qualtrics.com/jfe/fo rm/SV_1HQ9wQubyeOtRxc • Course Evaluation Outline • Cluster A disorders • Cluster B disorders • Anti-social personality disorder • Borderline personality disorder • Cluster C disorders There are 10 “distinct” personality disorders in DSM-5 Paranoid Schizoid Borderlin e Schizotypa l Antisocial Histrionic Narcissisti c Avoidant Dependen t Obsessivecompulsive There are 10 “distinct” personality disorders in DSM-5 Paranoid Schizoid Cluster A: “odd” and “eccentric” Schizotypa l Antisocial Borderlin Cluster B: e Narcissisti c Dependen t “dramatic” , “emotional ”, “erratic” Histrionic Avoidant Obsessivecompulsive Borderlin e Antisocial Histrionic Narcissisti c Anti-social personality disorder Psychopath? Anti-social personality disorder? Sociopath? There is no diagnostic distinction in DSM5 between psychopaths and sociopaths: they both receive a diagnosis of AntiSocial Personality Disorder Researchers have investigated potential differences between subtypes of ASPD DSM-5 Criteria: Anti-Social Personality Disorder 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: • Failure to conform to social norms with respect to lawful behaviors, as indicated by repeatedly performing acts that are grounds for arrest. • Deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure. • Impulsivity or failure to plan ahead. • Irritability and aggressiveness, as indicated by repeated physical fights or assaults. • Reckless disregard for safety of self or others. • Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations. • Lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another. B. The individual is at least age 18 years. C. There is evidence of conduct disorder with onset before age 15 years. D. The occurrence of antisocial behavior is not exclusively during the course of Characteristics of Anti-Social Personality Disorder • Up to 5.7% of adult males; 44% among new male inmates in the Correctional Service of Canada • Men with ASPD are more than twice as likely to die an unnatural death • Individuals with ASPD are at a high risk of criminal offending, although only a minority will be violent to others. (Adshead & Jacob, 2012) • Neurobiological differences in psychopaths • Underarousal hypothesis  evidence that people with ASPD are chronically understimulated • Fearlessness hypothesis  people with ASPD do not experience fear to the same degree as other people Optional video on the difference between psychopathy, sociopathy, and narcissism: https://www.youtube.com/watch? v=6dv8zJiggBs&list=LL&index=6 Could anti-social traits be beneficial in some professions? 1. CEO 2. Lawyer 3. Media (Television/Radio) 4. Salesperson 5. Surgeon 6. Journalist 7. Police officer 8. Clergy person 9. Chef 10. Civil servant Dr. James Fallon (not Jimmy Fallon): https://www.youtube.com/watch?v=WFZ2g2BqFY&list=LL&index=5 Borderline personality disorder DSM-5 Criteria: Borderline Personality Disorder A. A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following: • Frantic efforts to avoid real or imagined abandonment. (Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.) • A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation. • Identity disturbance: markedly and persistently unstable self-image or sense of self. • Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating). (Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.) • Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior. • Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days). • Chronic feelings of emptiness. • Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays DSM-5 Criteria: Borderline Personality Disorder A. A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following: Unstable relationships • Frantic efforts to avoid real or imagined abandonment. (Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.) • A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation. • Identity disturbance: markedly and persistently unstable self-image or sense of self. • Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating). (Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.) • Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior. • Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days). • Chronic feelings of emptiness. • Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays Unstable identity Impulsivity Unstable affect John Gunderson: https://www.youtube.com/watch? v=3CPPoIw0rtQ&list=LL&index=9 *trigger warning : discussion on self-harm Borderline Personality Disorder • Was originally named in the 1930s because symptoms were at the “borderline” between psychosis and neurosis • One of the most common personality disorders: between 1.6-5.9% of the population (DSM-5, 2013); up to 20% of psychiatric inpatients • Due to self-harm and suicidal behaviours, high risk of suicide (~10% die by suicide, many more have attempted) • High comorbidity with mood disorders (80% comorbid depression; 10% comorbid bipolar disorder); substance use (up to 64%) • Overlaps with trauma: 76% report some type of childhood sexual trauma; over 90% report abuse or neglect before the age of 18 • Symptoms tend to improve as people with BPD get older: 75% achieve remission 6 years after initial treatment BPD is a complicated and highly stigmatized diagnosis. Some clinicians want to re-name the disorder: https://www.youtube.com/watch? v=_QHTz6JM1pY&list=LL&index=4 Marsha Linehan: https://www.youtube.com/watch? v=bULL3sSc_-I&list=LL&index=8 Suicide Prevention Crisis Lines Crisis Lines : - Ottawa Distress Centre - Calling within Ottawa: 613-722-6914 - Calling from outside Ottawa: 1-866996-0991 Words Matter Words Matter! Use Don’t Use “died by Suicide” or “took their own life” “committed suicide” Note: Use of the word commit can imply crime/sin “successful” or “unsuccessful” “attempted suicide” Note: There is no success, or lack of success, when dealing with suicide Source: Myth vs Fact • Suicide is not common. Myths vs Facts • Suicide is not common. MYT H Source: Myth vs Fact • There are often signs before a suicide. Myths vs Facts : Warning Signs There are often signs before a suicide. FACT • Thinking or talking about suicide • Having a plan for suicide • Withdrawal from family, friends or activities • Feeling like you have no purpose in life or reason for living • Increasing substance use, like drugs, alcohol and inhalants • Feeling trapped or that there's no other way out of a situation • Feeling hopeless about the future or feeling like life will never get better • Talking about being a burden to someone or about being in unbearable pain • Anxiety or significant mood changes, such as anger, sadness or helplessness • Giving away belongings • Sudden mood changes that are uncharacteristic and not circumstantial Myth or Fact • We shouldn’t talk about suicide as it may give people ideas they didn’t already have. Myth or Fact • We shouldn’t talk about suicide as it may give peopleMYT ideas they didn’t already have. H It’s OK to be Are you thinking Direct about suicide? Talking about suicide does not increase suicidal behavior. By talking openly and directly, you are sending the message that you (Source: https://emmresourcecenter.org/resources/presentation-suicidecare and want to help. Risk Factors https://www.cdc.gov/violenceprevention/datasources/ Protective Factors • Access to effective behavioral health care • Connectedness to individuals, family, community, and social institutions • Life skills, including problem solving skills and coping skills, ability to adapt to change • Self-esteem and a sense of purpose or meaning in life • Cultural, religious, or personal www.SuicideIsPrevent able.org How to help someone in crisis • Listening and showing concern • showing concern can be an immediate way to help someone • listening won't increase the risk of suicide and it may save a life • Ask questions • Talking with them and reassuring them that they're not alone • Letting them know you care • Connecting them others!! • crisis line • counsellor • trusted person (neighbour, friend, family member or Elder) Having the Conversation: Getting Ready You don’t have to have all the answers. The most important thing you can do is listen. K n o w t h e S i g n s >> • Take a deep breath • Create a safe environment • Give yourself plenty of time (don’t rush) • Be prepared with resources and also for their response (yes or no) • Listen more than you talk • Make sure to have your own supports in place F i n d t h e W o r d s >> R e a c h O u t >> 34 www.SuicideIsPreventable.org Starting the Conversation Yes, I am Honey, I’m worried about you. You just don’t seem yourself lately. Since you lost your job, you are withdrawn, your appetite has changed, you’ve lost some weight and you’ve been talking about no longer wanting to be here. Sometimes, when people are struggling, they think about suicide. Are you thinking about suicide? I am sorry to hear that you have been alone with those thoughts. Tell me what is going on for you. K n o w t h e S i g n s >> F i n d t h e W o r d s >> R e a c h O u t >> www.SuicideIsPreventable.org Dialectical Behaviour Therapy is an effective treatment for BPDChange Acceptance Emotion Regulation Distress Tolerance 4 Components of DBT Skills Interpersonal effectiveness Mindfulness Example of DBT skills Histrionic personality disorder • A pervasive pattern of excessive emotionality and attention seeking, beginning by early adulthood and present in a variety of contexts • Rarely diagnosed in clinical settings • Almost two-thirds also meet criteria for anti-social personality disorder Narcissistic personality disorder • A pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following: • Has a grandiose sense of selfimportance • Is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love. • Believes that he or she is “special” and unique and can only be understood by, or should associate with, other special or high-status people (or institutions). • Requests excessive admiration. • Has a sense of entitlement (i.e., unreasonable expectations of especially • Is interpersonally exploitative (i.e., takes advantage of others to achieve his or her own ends). • Lacks empathy: is unwilling to recognize or identify with the feelings and needs of others. • Is often envious of others or believes that others are envious of him or her. • Shows arrogant, haughty behaviors or There are 10 “distinct” personality disorders in DSM-5 Paranoid Schizoid Cluster A: “odd” and “eccentric” Schizotypa l Antisocial Borderlin Cluster B: e “dramatic” , “emotional ”, “erratic” Histrionic Narcissisti c Avoidant Dependen t Cluster C: “anxious ” and “fearful” Obsessivecompulsive Avoidant and dependent personality disorders are not commonly diagnosed A pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation, beginning by early adulthood and present in a variety of contexts • Similar to Separation Anxiety Disorder A pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation, beginning by early adulthood and present in a variety of contexts • It has been proposed that Avoidant Personality Disorder could be understood as part of Social Anxiety Disorder Avoidant Dependen t Obsessive-Compulsive Personality Disorder (OCPD) • Defined by extreme conscientiousness A. A pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following: • Is preoccupied with details, 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 (e.g., is unable to complete a project because his or her own overly strict standards are not met). • Is excessively devoted to work and productivity to the exclusion of leisure activities and friendships (not accounted for by obvious economic necessity). • Is overconscientious, scrupulous, and inflexible about matters of morality, ethics, or values (not accounted for by cultural or religious identification). • Is unable to discard worn-out or worthless objects even when they have no sentimental value. • Is reluctant to delegate tasks or to work with others unless they submit to exactly his or her way of doing things. Despite being distinct disorders, personality disorders share underlying features Paranoid Schizoid Cluster A: “odd” and “eccentric” Schizotypa l Antisocial Borderlin Cluster B: e “dramatic” , “emotional ”, “erratic” Histrionic Narcissisti c Avoidant Dependen t Cluster C: “anxious ” and “fearful” Obsessivecompulsive Next class • Sex and Gender