Personality Disorders

I) Anti-social

II) Paranoid

III) Borderline





I) Anti-social personality disorder’s

Researchers today don’t know what causes antisocial personality disorder. There are many theories, however, about the possible causes of antisocial personality disorder. Most professionals subscribe to a biopsychosocial model of causation — that is, the causes of are likely due to biological and genetic factors, social factors (such as how a person interacts in their early development with their family and friends and other children), and psychological factors (the individual’s personality and temperament, shaped by their environment and learned coping skills to deal with stress). This suggests that no single factor is responsible — rather, it is the complex and likely intertwined nature of all three factors that are important. If a person has this personality disorder, research suggests that there is a slightly increased risk for this disorder to be “passed down” to their children.


Anti-social personality disorder is a pervasive pattern of disregard for, and violation of, the rights of others that begins in childhood or early adolescence and continues into adulthood.


The term anti-social behaviour covers a wide range of unacceptable activity that blights the lives of many people on a daily basis. It often leaves victims feeling helpless, desperate and with a seriously reduced quality of life. Terms such as ‘nuisance’, ‘disorder’ and ‘harassment’ are also often used to describe this type of behaviour.

To be classified as having an anti-social personality disorder you must be at least 18 years of age, must have had a history of symptoms before 15 years of age, occurrences of antisocial behaviour is not exclusively during the course of schizophrenia or a manic episode.


Antisocial personality disorder is said to be genetically based but typically has environmental factors, such as family relations, that trigger its onset. It also appears to be associated with low economic status and urban settings. Traumatic events can lead to a disruption of the standard development of the central nervous system, which can generate a release of hormones that can change normal patterns of development. One of the neurotransmitters that have been discussed in individuals with ASPD is serotonin.

Serotonin is a hormone in the human brain which regulates a variety of complex brain functions such as sexual arousal and anxiety.


Subtypes:

Subtype
Features

Nomadic (including schizoid and avoidant features)

Feels jinxed, ill-fated, doomed, and cast aside; peripheral, drifters; gypsy-like roamers, vagrants; dropouts and misfits; tramps, wanderers; impulsively not benign. (This is a person who feels out of place in the world and has no need for extrinsic communication.)

Malevolent (including sadistic and paranoid features)

Belligerent, mordant, rancorous, vicious, malignant, brutal, resentful; anticipates betrayal and punishment; desires revenge; truculent, callous, fearless; guiltless. (This is a person who is very aggressive and thinks everyone is out to get them; will do anything to prevent them or achieve revenge.)

Covetous (variant of "pure" pattern)

Feels intentionally denied and deprived; rapacious, begrudging, discontentedly yearning; envious, seeks retribution, and avariciously greedy; pleasure more in taking than in having. (This is a very selfish person who is not satisfied unless he or she is receiving more than giving.)

Risk-taking (including histrionic features)

Dauntless, venturesome, intrepid, bold, audacious, daring; reckless, foolhardy, impulsive, heedless; unbalanced by hazard; pursues perilous ventures. (This is a person who feels the need to live on the edge every moment of his or her life.)

Reputation-defending (including narcissistic features)

Needs to be thought of as unflawed, unbreakable, invincible, indomitable; formidable, inviolable; intransigent when status is questioned; over reactive to slights. (This is a person who believes him/herself to be near godlike and is willing to commit anything for others to believe so.)

A generic symptom of almost all ASPD’s is lack of remorse and empathy.

The following conditions commonly coexist with antisocial personality disorder:

Anxiety disorders: A persistent pattern of unpleasant inner turmoil.

Depressive disorder: A state of low mood and aversion.

Impulse-control disorders: A person fails to resist a temptation, urge or impulse that may be harmful.

Substance-related disorders: A severe addiction to harmful substances; such as drugs, alcohol and women.

Somatization disorder: A condition in which a person has multi-organ pain symptoms but no physical cause can be found.

Attention deficit hyperactivity disorder: A person having difficulty concentrating and behaving appropriately.

Narcissistic personality disorder: A person is preoccupied with issues of personal prestige, power and vanity.

Sadistic personality disorder: A person enjoys causing harm to themselves or others.

risks of developing the disorder include:

  • Diagnosis of childhood conduct disorder

  • Family history of antisocial personality disorder or other personality disorders or mental illness

  • Being subjected to verbal, physical or sexual abuse during childhood

  • Unstable or chaotic family life during childhood

  • Loss of parents through traumatic divorce during childhood

  • History of substance abuse in parents or other family members

The overall prevalence of anti-social personality disorders in community samples is about 3% in males and 1% in females. Within a clinical setting percentages vary from 3% - 30% for both sexes.

Treatment: Anti-social personality disorders are considered to be the most difficult of personality disorders to treat. Because people with ASPD’s are so manipulating, dishonest, aggressive and lack sufficient motivation to change; treatment is often extremely difficult to even begin. Outpatient success in treating this personality disorder is next to 0%. Inpatient success rates are also not very high due to the fact that schema and multi-systemic therapies are the only currently available treatments for anti-social personality disorders. The success rates in these therapies are not very high because they are both highly dependent on the patients and the patients’ families’ full co-operation/ participation.





In the Ted Bundy movie Michael Reilly Burke playing ted displayed many Malevolent ASPD traits throughout the movie.

II) Paranoid personality disorder

How is Paranoid Personality Disorder Diagnosed?

Personality disorders such as paranoid personality disorder are typically diagnosed by a trained mental health professional, such as a psychologist or psychiatrist. Family physicians and general practitioners are generally not trained or well-equipped to make this type of psychological diagnosis. So while you can initially consult a family physician about this problem, they should refer you to a mental health professional for diagnosis and treatment. There are no laboratory, blood or genetic tests that are used to diagnose paranoid personality disorder.

Paranoid personality disorder (PPD) is a mental disorder characterized by paranoia and a pervasive, long-standing suspiciousness and generalized mistrust of others. People who have this disorder believe that others will exploit, harm or deceive them, even though there is no evidence to support this expectation. They do not believe loyalty showed by an associated person because of unreasonable doubts. Members of minority groups, immigrants, political and economic refugees or of different ethnic backgrounds are most prone to defensive behaviours. This disorder may be fist apparent in childhood and adolescence. In clinical samples this disorder appears to be more commonly diagnosed in males.

The prevalence of paranoid personality disorder has been reported to be 0.5%-2.5% in the general population, 10%-30% among those in in-patient psychiatric settings and 2%-10% among those in out-patient clinics.

It is caused by faulty genetics inherited from parents or unhappy/rough upbringing which causes mistrust. Biologically, the disorder may be caused by excessive levels of cortisol (a hormone), brain injuries and use of narcotics (e.g. cocaine or amphetamines)

PPD is characterized by at least three of the following:

1. Excessive sensitivity to setbacks and rebuffs.

2. Tendency to bear grudges persistently, i.e. refusal to forgive insults and injuries or slights.

3. Suspiciousness and a pervasive tendency to distort experience by misconstruing the neutral or friendly actions of others as hostile.

4. A combative and tenacious sense of personal rights out of keeping with the actual situation.

5. Recurrent suspicions, without justification, regarding sexual fidelity of spouse or sexual partner.

6. Tendency to experience excessive self-importance, manifest in a persistent self-referential attitude.

7. Preoccupation with unsubstantiated "conspiratorial" explanations of events both immediate to the patient and in the world at large.

Subtypes:

Various researchers and clinicians may propose varieties and subsets or dimensions of personality related to the official diagnoses. Psychologist Theodore Millon has proposed five subtypes of paranoid personality:

Subtype
Features

Obdurate (including compulsive features)

Self-assertive, unyielding, stubborn, steely, implacable, unrelenting, dyspeptic, peevish, and cranky stance; legalistic and self-righteous; discharges previously restrained hostility; renounces self-other conflict. (This person is easily annoyed by others, and never respects others` opinions.)

Fanatic (including narcissistic features)

Grandiose delusions are irrational and flimsy; pretentious, expensive supercilious contempt and arrogance toward others; lost pride re-established with extravagant claims and fantasies. (This person loves him/herself and are so overconfident that he/she despises others. They do not feel the need for others or their opinions.)

Querulous (including negativistic features)

Contentious, caviling, fractious, argumentative, faultfinding, unaccommodating, resentful, choleric, jealous, peevish, sullen, endless wrangles, whiny, waspish, snappish. (This is a person who is always complaining.)

Insular (including avoidant features)

Reclusive, self-sequestered, hermitical; self-protectively secluded from omnipresent threats and destructive forces; hyper vigilant and defensive against imagined dangers. (This is a person who is very protective over themselves and isolates him or herself from the rest of the world.)

Malignant (including sadistic features)

Belligerent, cantankerous, intimidating, vengeful, callous, and tyrannical; hostility vented primarily in fantasy; projects own venomous outlook onto others; persecutory delusions. (This is the worst PPD to have; people having it are hostile to a point of being dangerous to everyone around them and trust no one.)



Treatment: It is very challenging to treat PPD due to the low levels of trust that the patient will display throughout treatment until solution has been found. However psychotherapy, anti-depressants, anti-psychotics and anti-anxiety medications can play a certain role. Cognitive-behavioural therapy is effective in helping individuals adjust distorted thought patterns and behaviours. Medications listed above are often accompanied by this therapy.




The woman in this video displayed common PPD symptoms under the sub-type Insular: suspicion, imagined occurrences and hyper-vigilant.



III) Borderline personality disorder


Borderline personality disorder (BPD) is a pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity that begins at early adulthood. It is present in a variety of contexts. People with this disorder are extremely afraid of abandonment; therefore make frantic efforts to avoid it, whether it is real or imagined. People with BPD often engage in idealization and devaluation of themselves and of others, alternating between high positive regard and heavy disappointment or dislike (e.g. the individual will give up on an achievable goal when it is nearly completed; such as dropping out of high school a month before graduating). Self-harm and suicidal behaviors are common with BPD and may require inpatient psychiatric care. When this disorder is accompanied by Mood Disorders or Substance-Related Disorders, the suicide rate increase drastically. Recurrent job loses, interrupted education, and broken marriages are also common. Impulsive behaviors are common, including: substance or alcohol abuse, eating disorders, unprotected sex or sex with multiple partners, and reckless driving. Physical and sexual abuse, neglect, hostile conflict and early parental loss are great contributors to BPD.

BPD is diagnosed predominantly (about 75%) in females. The prevalence of BPD is estimated to 2% of the general population, about 10% among individuals seen in out-patient mental health clinics and about 20% psychiatric in-patients. It ranges from 30% to 60% among clinical populations with personality disorders. Border-line personality disorder is about 5 times more common among 1st degree biological relatives of those the disorder than in the general population.

At least 2 of the following symptoms must be detected in the individuals, for BPD to be diagnosed:

1. Disturbances in and uncertainty about self-image, aims, and internal preferences.

2. Liability to become involved in intense and unstable relationships, often leading to emotional crisis.

3. Excessive efforts to avoid abandonment.

4. Recurrent threats or acts of self-harm.

5. Chronic feelings of emptiness.

6. Demonstrates impulsive behavior, e.g., speeding, substance abuse.

Subtypes:

Theodore Millon has proposed four subtypes of BPD. He suggests that an individual diagnosed with BPD may exhibit none, one, or more of the following.

Subtype
Features

Discouraged (including avoidant features)

Pliant, submissive, loyal, humble; feels vulnerable and in constant jeopardy; feels hopeless, depressed, helpless, and powerless. (This person easily loses heart when they compare themselves to others or when they face difficult situations.)

Petulant (including negativistic features)

Negativistic, impatient, restless, as well as stubborn defiant, sullen, pessimistic, and resentful; easily slighted and quickly disillusioned. (This person has very negative thoughts about themselves and others; starts things but hardly finish them.)

Impulsive (including histrionic or antisocial features)

Capricious, superficial, flighty, distractible, frenetic, and seductive; fearing loss, becomes agitated, and gloomy and irritable; potentially suicidal. (This person is quick to make poor choices due to uncontrollable impulses and has fears about losses, especially those of friendships.)

Self-destructive (including depressive or masochistic features)

Inward-turning, easily angered over acute triggers; conforming, deferential, and ingratiating behaviors have deteriorated; increasingly high-strung and moody; possible suicide. (This person is highly dangerous to themselves as well as others due to destructive thoughts. This is the worst sub type of BPD.)

Treatment: Like ASPD and PPD, board-line personality disorder is extremely difficult to treat. Psychotherapists are using DBT (Dialectical Behaviour Treatment) as the most useful strategy to help patients suffering from the disorder. DBT involves educating patients to control their impulsive thoughts, outrageous imaginations. Support from family and friends is extremely crucial to the well-being and advance of the person under treatment. It should be emphasised that mood swings occur very often, and cause great hardships for both the patient and the helpers.




The woman in this video suffers from classic symptoms of a petulant BPD.









References:

http://content.met.police.uk/Article/What-is-antisocial-behaviour/1400022084553/1400022084553
https://www.youtube.com/watch?v=izMrZcE30X4
https://www.youtube.com/watch?v=URVhqbdHeRQ
https://www.youtube.com/watch?v=dBvsfansgnY
http://psychcentral.com/disorders/antisocial-personality-disorder-symptoms/
http://www.mayoclinic.org/diseases-conditions/antisocial-personality-disorder/basics/risk-factors/con-20027920
http://psychcentral.com/disorders/paranoid-personality-disorder-symptoms/

www.wikipedia.com

www.NIH.com

www.mayoclinic.com

www.cmha.ca

DSM 4th edition

Psych 20