Personality Disorders - Task 9 - What is Normal PDF

Task 9 - What is normal? Personality disorders - Ashton chapter From an evolutionary perspective, it is acceptable that all levels of personality characteristics are equally adaptive, because they have persisted for so long. However, if the influence...

Task 9 - What is normal? Personality disorders - Ashton chapter From an evolutionary perspective, it is acceptable that all levels of personality characteristics are equally adaptive, because they have persisted for so long. However, if the influence of one's personality on personal well- being and that of others is considered, then different levels of personality traits are far from being equally adaptive. People who work in mental health settings state that extreme levels of some personality characteristics are maladaptive enough to result in personality disorders. Personality disorders - stable and enduring patterns of thought, feeling, and behavior (i.e. personality traits) that emerge in adolescence or early adulthood, deviate from the norms of one's culture, are pervasive and inflexible across many aspects of one's life, and lead to distress or impairment. The DSM-5 includes 10 personality disorders grouped in 3 clusters according to the similarity of their symptoms. This grouping is not based on factor analysis, but on clinicians' views of similarities of content among some of the disorders. The DSM-5 Personality disorders Schizoid Schizoid personality disorder - involves an extreme degree of detachment from social relationships and a very limited expression of emotions in interpersonal settings. Schizoid individuals are not interested in family relationships, friendships, or sexual relationships, and instead prefer almost always to be alone. They are also emotionally detached - they express no affection for others and are indifferent to praise/criticism. Even in the nonsocial settings they prefer, they feel little joy or pleasurer. Schizotypal Schizotypal personality disorder - also involves detachment from social relationships, but in addition to that, there is also an extreme discomfort with such relationships, and a pattern of odd thinking and eccentric behaviors. Schizotypal persons tend to be highly superstitious or fascinated with the paranormal, and may even have bizarre perceptual experiences, such as “seeing” things happening far away. They may also have unusual "ideas of reference", whereby they perceive a special personal meaning in everyday events or objects (e.g. billboards, tv commercials etc.). Others consider their behavior & appearance odd, peculiar or eccentric. Paranoid Paranoid personality disorder - shares some features with schizoid & schizotypal disorder, but is characterized by a strong suspiciousness of others' motives and by a sense of being persecuted. Paranoid individuals suspect without good reason that others are trying to harm, deceive, or exploit them, and tend to dwell on doubts about the loyalty of those around them. They are quickly offended in response to actions/comments that may be entirely innocent. They tend to hold grudges against people who they perceive as causing harm. Antisocial Antisocial personality disorder - characterized by a tendency to disregard & violate the rights of others. Antisocial individuals are very deceitful, exploit others for personal gain and feel no remorse for the caused harm to others. They also tend to be aggressive, irresponsible, impulsive and reckless. Borderline Borderline personality disorder - involves extreme instability in one's own self-image and in one's relationships with others, along with extreme impulsivity in various contexts. Borderline individuals have intense & unstable love/hate relationships with others, and tend to worry frantically about the possibility of being abandoned. Impulsive behavior can include drug abuse, eating binges, spending sprees, sexual escapades (sexual experiences involving risk or excitement) & self-harming behaviors (e.g. self-mutilation or suicide attempts). Borderline people are extremely moody, have little sense of personal identity or of meaning in life. Histrionic Histrionic personality disorder - characterized by an exaggerated display of emotions and by excessive attention seeking. Histrionic individuals have an intense need to be the center of attention &they feel uncomfortable when they are not. They use their physical appearance to draw attention, and have a seductive, sexually provocative style. Personality Page 1  They use their physical appearance to draw attention, and have a seductive, sexually provocative style. They display emotions in a dramatic & exaggerated way, yet these emotions are shallow and volatile. They are easily influenced by others & consider casual acquaintances as much closer relationships than they are. Narcissistic Narcissistic personality disorder - involves the tendency to consider oneself as a superior individual who deserves the admiration of others, and a selfish lack of concern for others' needs. Narcissistic people think they are entitled to special treatment and admiration, and generally have an arrogant style, often exploiting others and failing to appreciate their needs. They also tend to fantasize about having high status and to envy those who are highly successful. Avoidant Avoidant personality disorder - defined by social inhibition and shyness, feelings of inadequacy, and oversensitivity to potential negative evaluation. Avoidant people have such strong fears of criticism, disapproval, and rejection that their social interactions are severely restricted (they are unwilling to participate socially unless certain of being liked, and tend to avoid work activities that involve interpersonal contact). Avoidant people, like schizoid & schizotypal, lack social connection, but they actually want it - they are just afraid of rejection. Dependent Dependent personality disorder - characterized by an excessive need to be taken care of and by submissive, clinging behavior and fears of separation. Dependent individuals require a great deal of advice and reassurance even in making everyday decisions, and lack the confidence to undertake projects on their own. They need other people to take responsibility for important features of their lives, and feel unable to take care of themselves when alone. They are willing to sacrifice a lot to maintain the support & nurturance of others, e.g. by volunteering to do unpleasant tasks or by avoiding any expression of disagreement. They desperately seek a new relationship if a close relationship ends. Obsessive compulsive Obsessive-compulsive personality disorder - involves preoccupation with orderliness, perfection and control. The obsessive-compulsive person tends to be so preoccupied with details (e.g., lists, schedules) that the entire point of an activity is lost. He/she may be so concerned with attaining perfection and following specific rules that he/she fails to complete their tasks or projects, or delegate any tasks to others. He/she tends to put work ahead of personal relationships and to be highly stubborn and inflexible. There is a tendency to hoard money unnecessarily (rather than spend it) and to hoard objects unnecessarily (rather than discard them). This is not OCD. OCD involves repeated behaviors (e.g. hand washing, counting or tapping) and is not a personality disorder. Problems with the DSM-5 Personality disorders Symptoms of a given disorder do not necessarily co-occur. One example of this involves obsessive-compulsive personality disorder, for which some symptoms, such as rule following and tidiness, are not correlated with other symptoms, such as stubbornness and obstinacy. In addition, it is possible in some cases that two persons diagnosed with the same disorder might not have any symptoms in common. There are some symptoms that tend to co-occur despite being listed in different personality disorders. For example, the conning and deceitful behavior that characterize antisocial personality disorder tend to be observed in the same persons who also show the grandiosity and sense of entitlement that characterize narcissistic personality disorder. As a result, many people are diagnosed with 2 or more personality disorders at the same time. Comorbidity is often observed for the following pairs of disorders: ○ Schizoid & schizotypal ○ Avoidant & dependent ○ Histrionic & borderline Clusters of disorders do not match factor analysis results. A personality disorder should be seen as a continuum, not as a category. Most researchers believe that having a personality disorder is a matter of degree, so that some people may have slight indications of a disorder, whereas other people may have a severe case. An alternative system for personality disorders A new system has been proposed that includes 2 essential features of a personality disorder: impaired personality functioning and the presence of pathological personality traits. Impaired personality functioning Problems in personality functioning can involve the self or can be interpersonal. "Self" problems Identity problems Self-direction problems A person might not have a sense of himself/herself as a unique person, A person might not be able to set realistic or meaningful goals in his/her if he or she identifies too strongly with some other person(s), or life. alternatively if he or she is too much concerned with being independent of certain others. A person might have self-esteem that is highly unstable, being easily A person might lack any internal standards for behaving prosocially, and Personality Page 2  A person might have self-esteem that is highly unstable, being easily A person might lack any internal standards for behaving prosocially, and threatened by negative experiences, or might have a distorted thus miss out on opportunities for fulfillment from cooperation with appraisal of his or her strengths and weaknesses. others. A person might not be able to regulate his or her emotions or even to A person might be unable to reflect constructively on his or her own recognize what emotions he or she experiences experiences or motivations. Interpersonal problems Empathy problems Intimacy problems A person might be unable to understand the experiences or A person might be lacking in positive, sustained relationships with motivations of other people. people in general. A person might be unable to understand or unwilling to consider the A person might be unable to engage in close, caring relationships with perspectives of others. any other persons. A person might have little understanding of how his/her own behavior A person might be unwilling or unable to cooperate with others. affects others. Pathological personality traits The specific self- and interpersonal problems that one may have depend on his/her levels of various personality traits. The new system recognizes 25 specific personality traits (called trait facets), which are potentially pathological or maladaptive. They are classified into 5 domains, which are quite similar to the general personality trait domains (Big 5 / HEXACO). Negative affectivity domain - involves intense & frequent experience of negative emotions (similar to Big 5 Neuroticism). Traits: emotional lability (frequent mood changes, intense emotional reactions), anxiousness, separation insecurity, perseveration (continuing a behavior that is no longer effective), submissiveness & hostility. Detachment domain - involves withdrawal from social interactions and from other people (similar to Introversion). Traits: detachment, withdrawal, anhedonia, intimacy avoidance, depression, suspiciousness. Antagonism domain - involves acting in ways that create difficulties for other people (similar to low Agreeableness & low Honesty-Humility). Traits: manipulativeness, deceitfulness, grandiosity, attention seeking, callousness. Disinhibition/compulsivity domain - involves being impulsive, without thinking of consequences (similar to low Conscientiousness). Traits: irresponsibility, impulsivity, rigid perfectionism (pathologically low disinhibition, high compulsivity), distractibility, risk taking. Psychoticism domain - involves unusual, bizarre thoughts and perceptions. Does not have similarity to general personality factors, except that ecce ntricity and oddness are related to Openness & low Conscientiousness. Traits: unusual beliefs and experiences (bizarre thoughts, hearing & seeing things), eccentricity (perceived as odd & unusual), cognitive & perceptual dysregulation (feeling disconnected from own thoughts and body). The 25 maladaptive personality traits are measured with self-report scales that have high convergent validity correlations with observer reports. The scales contain mostly undesirable statements and are thus influenced strongly by self-report response styles (e.g. desirability). There are fairly high correlations between scales that measure theoretically unrelated traits (=> limited discriminant validity). Diagnosing personality disorders in the proposed new system In order to diagnose someone with a personality disorder, a clinician needs to find both impaired personality functioning & pathological personality traits. Furthermore, the impaired personality functioning and pathological personality traits must be relatively stable across time and consistent across situations. Also, the impaired personality functioning and pathological personality traits must not be considered as normal for the person's stage of development or for the society and culture from which the person comes. Finally, the impaired personality functioning and pathological personality traits must not be due to the effects of some substance (e.g. a medication or drug) , and not due to any medical condition (e.g. a serious head injury). In the new system, a clinician can distinguish between patients having more/less severe cases of personality disorder by cons idering the severity of the patients' impairments in personality functioning and the severity of their pathological personality traits. Origins of personality disorders: developmental change and stability, biological bases, heredity and environment, and evolutionary function Most personality disorder symptoms correspond to extreme/maladaptive levels of the same personality traits that differentiate people in general, but there are a few exceptions: Self-harming behaviors (associated with borderline PD) and major perceptual distortions (associated with schizotypal PD) are expressed only in a small percentage of people. Therefore, any questions that concern the nature of personality disorders will have similar answers to the questions about pe rsonality in general (with the exception of the causes behind Borderline & Schizotypal). Even though Borderline symptoms show heritability of around 0.40, it is thought that these symptoms are partly caused by various kinds of trauma during childhood (e.g. being sexually or physically abused). ○ Still, correlations between childhood abuse and Borderline PD are not that high( such interventions may be adaptable to treat personality disorder. The intersection of mental state disorder and personality disorder Personality disorder can be diagnosed in up to 1/2 of patients with mental state disorder (mood disorder), making it one of t he most common psychiatric disorders. The outcomes for mental state disorder in the presence of personality disorder are poorer. This raises the possibility that personality disorder may underlie many instances of treatment-resistant mental state disorders. Diagnosing personality disorder together with mental state disorder can lead to better treatment decisions. For example, identification of substantial neuroticism or negative affectivity in a patient presenting with treatment-resistant depression might suggest the need for structured psychotherapy as the primary intervention, as opposed to combination pharmacotherapy. Treatment of personality disorder - Bateman article Introduction Personality disorders often co-occur with other mental disorders, making it difficult to distinguish between symptomatic improvement of comorbid disorders and genuine personality change during treatment. Additionally, essential features of personality disorders (e.g. impaired interpersonal function & identity problems), are hard to measure, and there's limited evidence that these core aspects improve significantly or reliably with treatment. Even if patients lose a formal diagnosis of a personality disorder during treatment, their occupational and social adaptation often remains impaired. There is evidence for substantial improvements, for example in reduction of suicide attempts, risk taking, and aggression in borderline personality disorder. However, interpersonal dysfunction and social disturbance can continue & identity problems may remain. In the long term, patients often continue to feel miserable about their lives, struggle to manage constructive intimate relationships, and under- function in employment and education. At present, long-term follow-up of treatment is limited. Present research is concentrated on borderline & antisocial, and as a result any review is biased towards them. Personality Page 7 Treatment approaches There are 2 main approaches to the treatment of personality disorders. Psychosocial treatments - based on the fact that personality and its disorders arise from a complex gene-environment interaction and developmental processes, are affected by adverse life events, and the primary manifestations of the disorder are difficulties with personal & social relationships. Pharmacological treatments - based on the idea that behavioral traits associated with personality disorders may be associated with neurochemical abnormalities in the CNS. More than 70% of all drug trials on personality disorders were on participants with borderline personality disorder. These tr ials tend to have poor design. Therefore this psychobiological model remains largely untested for other personality disorders. Aims of treatment Drug treatment focuses on specific aspects of personality disorders' pathological effects (e.g. affective instability & cognitive-perceptual disturbances). Psychosocial treatment, mainly for borderline, aims to reduce acute life-threatening symptoms and improve distressing mental state symptoms. A few psychosocial treatments focus on personal identity, some on interpersonal interaction, on social adjustment, or on the general difficulties of people with mixed personality disorders by using psychoeducation & problem-solving. Follow-up of people with personality disorder after treatment (mainly borderline personality disorder) suggests that the initial aim s to reduce acute symptoms are largely met but not the more complex aims of improvement of the personality structure itself. This does not depend on the focus, context or form of treatment. Cluster A personality disorders There has been limited research and treatment for cluster A disorders, in part because these individuals do not typically experience loneliness or envy close relationships, making it challenging for mental health professionals to address their needs. Treatment recommendations are primarily based on clinical evidence, as well as a lack of well-organized randomized controlled trials for cluster A disorders. Psychosocial treatment (e.g. cognitive therapy) may help individuals with schizotypal personality disorder, but further research is needed to confirm its effectiveness. Paranoid personality disorder presents a distinct clinical challenge, as individuals with this disorder are highly vigilant for perceived aggression and hostility from others, even in the absence of evidence. Challenging interventions are often unwelcome due to their suspicious nature, and no treatment trials are currently being conducted for individuals with paranoid symptoms. No drug trials for schizoid or paranoid personality disorders have been conducted, making it difficult to determine the efficacy of drugs for these conditions. Cluster B personality disorders Many existing psychosocial treatments were adapted for borderline personality disorder. Even though they have different theoretical underpinnings, their effectiveness is comparable. This led to the extraction of the characteristics identified in all major evidence-based treatments for borderline personality disorder. There is evidence that treatments for borderline personality disorder do not need to be carried out by specialist psychologists in all cases. A generalist approach has been designed for use by clinicians who have not done extensive training and who are not committed to becoming borderline personality disorder specialists. Patients who fail to respond to a generalist approach might then be referred for the more intensive and borderline personality disorder-specific, evidence-based treatments. Drugs are used very frequently in the treatment of borderline personality disorder despite the scarcity of evidence for their use. It has been stated that if patients have no comorbid illness, efforts should be made to reduce or stop pharmacotherapy. This is because there is limited evidence for the effectiveness of drugs, and those drugs tend to come with long-term risks. Some restricted evidence exists for the effectiveness of cognitive behavioral therapy in various settings, with the best evid ence for the therapy delivered in a group format for people with antisocial personality disorder and substance misuse problems. It has been suggested that pharmacological interventions should not be routinely used for the treatment of antisocial persona lity disorder or its associated behaviors. Still, pharmacological interventions can be used for comorbid mental disorders. Cluster C personality disorders Personality Page 8 Cluster C personality disorders Both psychodynamic and cognitive therapy have been shown to have medium to large positive effects for cluster C personality d isorders. Psychodynamic therapy has been shown to be more effective for reducing distress. CBT has been shown to be more effective in people with avoidant personality disorder. There are no drug trials for cluster C personality disorders. However, antidepressants are effective for social phobia, which suggests that these drugs may be effective in patients with avoidant personality disorder. Do bad guys get ahead or fall behind? Relationships of the dark triad of personality with objective and subjective career success - Spurk article Introduction The aim of the present study is to test whether narcissism, psychopathy, and Machiavellianism differentially (negatively and positively) predict objective (i.e., salary and status in terms of leadership position) and subjective career success (i.e., career satisfaction). Narcissism and career success The authors assume that narcissism is positively related to both objective & subjective career success because of motivationa l tendencies to get ahead and to be successful and because of a high self-worth. Some components of narcissism are positively related to achievement orientation, which is positively associated with upward career goals. Within success-related situations, narcissists show strong emotional reactions and use them as a further source of self-enhancement. Narcissists perform well in impression management, especially in selection contexts that might help them obtain more prestigious jobs. Because narcissists are assumed to have higher levels of objective career success, and objective career success is assumed to be a precursor of subjective career success, they should also be subjectively more successful with their career. Hypothesis 1: Narcissism is positively related to (a) objective and (b) subjective career success. Psychopathy and career success Due to psychopathic attributes such as impulsivity, emotional shallowness, and lack of remorse, psychopaths have diminished levels of corporate responsibility and can adversely affect productivity. Psychopathy is, for example, positively related to severe forms of counterproductive work behavior and is the strongest (negative) predictor of job performance among the Dark Triad traits. Individuals high in psychopathy apply hard and aggressive manipulation tactics (e.g., threat of appeal and threat of punishment), which suggest that they face strong occupational socialization problems. However, people high in psychopathy may use extroverted charm to convey charisma or may fit well with some workplace demands in leadership positions. Still, the authors argue that in sum, there are stronger arguments for psychopaths to experience less objective & subjective career success, because of their impulsivity, negative affectivity, and social malfunctioning. Hypothesis 2: Psychopathy is negatively related to (a) objective and (b) subjective career success. Machiavellianism and career success Although it was shown that Machiavellianism is associated with diminished organizational, supervisor, and team commitment, along with a tendency to be perceived as abusive by subordinates, Machiavellianism is beneficial for attaining leadership positions. This could also possibly be because individuals high in Machiavellianism make occupational choices associated with legal and management careers. They also tend to focus on maintaining and broadening power, strive for control, and have a desire for status. Machiavellianism is positively related to political skills and need for achievement, which are both positively related to objective career success. Compared to individuals high in psychopathy, individuals high in Machiavellianism more often apply soft manipulation tactics (e.g., charm, appearance, joking, compromise, exchange of a favor, alliances, and offering compliments) that are socially acceptable and therefore do not backfire in the mid- to long term Individuals high in Machiavellianism might feel successful in their careers because of their powerful, prestigious positions, despite striving for even more influence. Hypothesis 3: Machiavellianism is positively related to (a) objective and (b) subjective career success. Method Surveys including a dark triad measure, objective career success measures (salary + leadership position), a subjective career success measure & control variables measures (gender, age, working hours, occupational education, job tenure in years) were administered. Results Narcissism was significantly positively correlated with salary, but not with leadership position or career satisfaction (1a confirmed, 1b rejected). Psychopathy was negatively related to salary, leadership responsibility and career satisfaction (2a & 2b confirmed). Machiavellianism was positively correlated with leadership position and marginally significantly positively related to career satisfaction (3a partially Personality Page 9 Machiavellianism was positively correlated with leadership position and marginally significantly positively related to career satisfaction (3a partially confirmed, 3b confirmed). Combined, the dark triad explained 1.5% - 2% of variance in the analyzed career success indicator beyond control variables. Discussion Results provided support for the assumptions that narcissism and Machiavellianism are positively related to objective career success (i.e., salary and status, respectively), that Machiavellianism is positively related to career satisfaction, and that psychopathy is negatively related to all analyzed indicators of objective and subjective career success. Hence, whether bad guys get ahead or fall behind seems to depend on the type of dark trait. One of the most consistent findings of past research was that agreeableness is negatively related to objective career success. This parallels the findings that narcissism and Machiavellianism are positively related to objective career success because these persons usually also show lower levels of agreeableness. However, although psychopaths also show lower levels of agreeableness, they were less successful within this study. ○ This could be because they express their low agreeableness in a different way compared to people high in narcissism and Machi avellianism. ○ Psychopathy is also related to lower levels of conscientiousness compared to narcissism and Machiavellianism, which is anothe r possible explanation for the differential and negative relations of psychopathy. The dirty dozen: a concise measure of the dark triad - Jonason article The dark triad is inefficient for researchers to measure, because it is measured with 90 items spread across 3 scales. In this article, the authors develop and test the psychometric properties of an efficient, 12-item version of the Dark Triad called the Dirty Dozen. The standard scales also have problems such as dichotomous questions and being faked easily (e.g. by high-narcissism people who tend to manage impressions). More, empirical evidence suggests that narcissism, psychopathy, and Machiavellianism measure a single, latent construct that accounts for approximately 50% of the variance associated with the three scales. Thus, it is important that any concise measure of the Dark Triad incorporate the flexibility of being scored as either three related subscales or as a single, composite scale. The authors expect that if the dirty dozen scale is valid: It will correlate with the longer, original measures of the Dark Triad. It will correlate negatively with agreeableness and positively with a short-term mating strategy & aggressiveness. Men will have higher scores than men. I skip the studies' specific details because I don't think this will be part of the exam, and the general discussion goes is enough. General discussion In 4 studies, the authors developed & validated the Dirty Dozen - a concise measure of the dark triad. The Dirty Dozen had reasonable psychometric properties, showed acceptable convergent (e.g., NPI, Big Five, mating, aggression ) and discriminant validity (e.g., self-esteem) with other examined measures and proved to be reliable over time and across a number of tests (e.g., corrected test –retest reliability). The Dirty Dozen showed a consistent pattern of disagreeableness and short-term mating across two studies and conscientiousness, which may relate to a fast life strategy that underlies the nature of the Dark Triad in study 2. The Dirty Dozen measures are negatively correlated with neuroticism and positively correlated with openness; both findings ar e consistent with work that suggests the Dark Triad reflects a latent dimension of social exploitation, where this profile of lower order personality traits is expected. In Study 3, correlations between measures of self-esteem and the Dirty Dozen were some of the weakest reported. However, such evidence is inconsistent with research suggesting a possible link between the instability of self-esteem and narcissism. It may be that the reduction of items from the 40-item Narcissistic Personality Inventory to the four items we used to measure narcissism caused one or more specific aspects of narcissism that relate to self-esteem instability to be lost (e.g., entitlement, grandiosity, superiority). The Dirty Dozen measures showed some sex differences across all studies, confirming that men tend to be more socially exploit ive than women are through personality traits like the Dark Triad. Exploiting others may come at a higher cost for women than for men, because women are more dependent on social networks than men are on average. From an evolutionary perspective, men should benefit more from social exploitation and therefore should have higher scores on personality traits that reflect social exploitation. Personality Page 10