13 | P a , 9-08 2020-0 P . P | a . , 9 -0 8 2020-0 a C a O A O Ca P Sa G C P P a P C P a D D a a P P P P C D a D a D a D a D CD A D Ob P a P a P -C a D a D P a D Ab A a P a P . D S V a D :G , 9 -0 8 2020-0 a /A a S P P a a BD A B H Na , 9-08 2020-0 . , 08 A D 020-092 Pa a S S . a M C D b a C P a a D D a D a . P I a P 386 a , 9-08 2020-0 a .a Wa a ....I ba a Ja , 9-08 2020-0 a , M Ma G ....I b a a a a :aC . M P a B D NEL Co igh 2021 Nel on Ed ca ion L d. All Righ Re e ed. Ma no be co ied, canned, o d lica ed, in hole o in a . D e o elec onic igh , ome hi d a con en ma be e ed f om he eBook and/o eCha e ( ). Nel on Ed ca ion e e e he igh o emo e addi ional con en a an ime if b e en igh e ic ion e i e i . S P U ,d O -08 a 2020-09 b a d a a c c E a b D c b a b a : a d ca : a a d c . CO S* ❯ Id ( . ., : a d d c ❯D c a c P P NEL d c d ab P a c b aPa G a a d aPa S a db d a a c b b c d a ❯C (APA SLO 1.3c) -ba d ❯D *P ba c b ca , c , b a ca P O c a c d ,d -0 8 0-0c 9 c 02 ca a a (2013) 2 c b da c a a (APA SLO 1.3a) ca , a d c a c a a d a d , a d a dc a d d ca c d c . ac ca a d b b a a a a a ) (APA SLO 2.1a) (APA SLO 2.3A) a a d ca ad a a c c a c ca c .C a c a (S O). We all think we know what a personality is. It s all the characteristic ways a person behaves and thinks: Michael tends to be shy ; Mindy likes to be very dramatic ; Juan is always suspicious of others ; Annette is very outgoing ; Ahmed seems to be very sensitive and gets upset very easily over minor things ; Sean has the personality of an eggplant! We tend to type people as behaving in one way in many different situations. For example, like Michael, many of us are shy with people we don t know, but we aren t shy around our friends. A truly shy person is shy even among people he or she has known for some time. The shyness is part of the way the person behaves in most situations. We have all probably behaved in all the ways noted here (dramatic, suspi. d ccharacteristics cious, outgoing, easily upset). When personality interfere with relationships with others, cause the person distress, ,d or in a general disrupt activities of daily living, however, we 8 -09-0 disorders. In this chapter, we consider these to2be personality 020 look at characteristic ways of behaving in relation to a number of specific personality disorders. First, we examine in some detail how we conceptuali e personality disorders and the issues related to them; then we describe the disorders themselves. may distress the affected person. Some individuals with personality disorders may not feel any subjective distress, however; indeed, it may in fact be acutely felt by others because of the c . actions of the person with the disorder. As noted by d forensic psychologist Robert Hare, professor emeritus at the University of ,d British Columbia, this distress is particularly common with anti8 a 0 social 20-09the- individual may show a P personality disorder, 20because blatant disregard for the rights of others yet exhibit no remorse (Hare, 1993). In certain cases, someone other than the person with the personality disorder must decide whether the disorder is causing significant functional impairment, because the affected person often cannot make such a judgment. The DSM-5 lists 10 specific personality disorders. Unfortunately, as we see later, many people who have personality disorders in addition to other psychological problems tend to do poorly in treatment. Data from several studies show that people who are depressed have a worse outcome in treatment if they also have a personality disorder (Sanderson & Clarkin, 1994; Shea et al., 1990). Michael Vallis and Janice Howes have suggested, however, that there are grounds to be cautiously optimistic about the potential uses of cognitive therapy in individuals with personality . c 2000). disorders (Vallisdet al., A OV V , d Before the DSM-5, most of the disorders we discuss in this a 08 were in Axis I of the DSM-IV-TR, which included the tradi-book P of thinking and 2behaving 020-09 tional disorders. The personality disorders were included in a What if a person s characteristic ways cause significant distress to the self or others? What if the person separate axis, Axis II, because as a group they were seen as can t change this way of relating to the world and is unhappy? We distinct. It was thought that the characteristic traits were more might consider this person to have a personality disorder. ingrained and inflexible in people who have personality disorders, Unlike many of the disorders we have already discussed, personand the disorders themselves were less likely to be successfully ality disorders are chronic; they do not come and go but originate modified. With the changes made with the DSM-5, these separate c . in childhood and continue throughout adulthood (Widiger, 2012). axes were eliminated and now the personality disordersdare listed These chronic problems pervade every aspect of a person s life. If with the rest of the DSM-5 disorders , d(American Psychiatric Assoa man is overly suspicious, for example (a sign of a possible paraciation, 2013). a -08 09the 20-that P may be surprised2to0learn noid personality disorder), this trait will affect almost everything You category of personality he does, including his employment (he may change jobs frequently disorders is controversial, because it involves several unresolved if he believes co-workers conspire against him), his relationships issues. Examining these issues can help us understand all the (he may not be able to sustain a lasting relationship if he can t disorders described in this book. trust anyone), and even where he lives (he may move often if he suspects his landlord is out to get him). Ca a d d a d d cof.emotions, Ca A personality disorder is a persistent pattern cognitions, and behaviour , d that results in enduring emotional Most of us are sometimes suspicious of others and a little paradistressafor the person affected -08and for others and may cause noid, or overly dramatic, or too self-involved, or reclusive. Fortu-09relationships 020and difficulties with2work (American Psychiatric nately, these characteristics do not last long or are not overly Association, 2013). The DSM-5 notes that having this disorder intense; they don t significantly impair how we live and work. A O Copyright 2021 Nelson Education Ltd. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Nelson Education reserves the right to remove additional content at any time if subsequent rights restrictions require it. 387 . People with personalit disorders, however, displa problem in the section on emerging measures and models in the DSM-5 , characteristics over e tended periods and in man situations, that is included for further stud (American Ps chiatric Associaa great emotional 08them, for others, or for tion, 2013). This model focuses on a continuum of disturbances 9 which can cause pain for 0 0 2 P 20 difficult , then, can be seen as one of of self (i.e., how ou view ourself and our abilit to be selfboth (Widiger, 2012). Their degree rather than kind; in other words, the problems of people directed) and interpersonal functioning (i.e., our abilit to empawith personalit disorders ma just be e treme versions of the thi e and be intimate with others). It remains to be seen how this problems man of us e perience on a temporar basis, such as alternative model will be used in the future. being sh or suspicious. Although no general consensus e ists about what the basic The distinction between problems of degree and problems of personalit dimensions might .be, there are several contenders kind is usuall described in terms of dimensions and categories. (South et al., 2011). One of the more widel accepted models is , the Big Five or the five-factor model of personalit , and called The issue that continues to be debated in the field is whether a -08from work on normal personalit (Hopwood & personalit disorders are e treme versions 20it-is09taken P of otherwise t pical 0 2 Thomas, 2012; McCrae & Costa Jr., 2008). In this model, people personalit variations (dimensions) or wa s of relating that are can be rated on a series of personalit dimensions, and the combidifferent from ps chologicall health behaviour (categories; nation of five components describes wh people are so different. Skodol, 2012). You can see the difference between dimensions The five factors or dimensions are e traversion (talkative, asserand categories in ever da life. For e ample, we tend to look at tive, and active versus silent, passive, and reserved); agreeablegender categoricall . Societ generall views us as being in one categor female or the other male. Yet man believe it ness (kind, trusting, and warm versus hostile, selfish, and mistrustful); conscientiousness (organi ed, thorough, and reliable is more accurate to look at gender in terms of dimensions. For , neuroticism (nervous, versus careless, negligent, and unreliable); e ample, we know that male and female ma describe a a 08 mood , andPtemperamental versus even-tempered); range of choices in gender e pression (e.g., personal grooming, 20-09- and openness 0 2 attire, use of makeup, and other bod modifications). We could to e perience (imaginative, curious, and creative versus shallow and imperceptive; McCrae & Costa Jr., 2008). On each dimenjust as easil place people along a continuum of maleness and sion, people are rated high, low, or somewhere in between. femaleness rather than in the absolute categories of male or Cross-cultural research establishes the relativel universal female. We also often label people s height categoricall , as tall, nature of the five dimensions although there are individual average, or short. But height, too, can be viewed dimensionall , . differences across cultures (Carlo, Knight, Roesch et al., 2014; in inches or centimetres. Valchev et al., 2013). One stud e amined the Big Five traits in Most people in the field see personalit disorders as e tremes , high school students across si different cultures and found, for on one or more personalit dimensions. Yet because of the wa 8 a 0 personalit disorders -the 9 0 e ample, that oung adults in Turke reported higher levels of people the DSM, 0 2 P are diagnosed with 20 conscientiousness and e traversion than those in China, whereas like most of the other disorders end up being viewed in categostudents in Taiwan reported about as much openness as those in ries. You have two options either ou do or ou do not have a Slovenia (Va son i et al., 2015). A number of researchers are disorder. For e ample, either ou have antisocial personalit tr ing to determine whether people with personalit disorders can disorder or ou don t. The DSM doesn t rate how obsessive or also be rated in a meaningful wa along the Big Five dimensions compulsive ou are; if ou meet the criteria, ou are labelled as . us better understand these disorand whether the s stem will help having obsessive-compulsive personalit disorder. No in-between ders (Bagb et al., 2005; Costa & McCrae, 2013), as outlined in is possible when it comes to personalit disorders. Using categor, Table 13.1.8 ical models of behaviour has advantages, the most important a 9 -0 being convenience. With simplification, however, P come problems. 2020-0 One is that the mere act of using categories leads clinicians to P a C reif the disorders, that is, to view disorders as real things, comparable to the realness of an infection or a broken arm. Some The DSM-5 divides the personalit disorders into three groups, or argue that personalit disorders are not things that e ist but points clusters ; this will probabl continue until a strong scientific at which societ decides a particular wa of relating to the world basis is established for viewing them differentl (American has become a problem. Ps chiatric Association, 2013). The cluster division is based on Some had proposed that the DSM-IV-TR personalit disorders resemblance (see Table 13.1). Cluster A, is called the odd or section be replaced or at least supplemented b a dimensional eccentric cluster; it aincludes paranoid, schi0oid, 9- 8 and schi omodel in which individuals would not onl be given categorical t pal personalit disorders. Cluster P 2020-B0 is the dramatic, diagnoses but also would be rated on a series of personalit emotional, or erratic cluster; it consists of antisocial, borderdimensions. Widiger and colleagues (Widiger, 2011; Widiger & line, histrionic, and narcissistic personalit disorders. Montr al Simonsen, 2005; Widiger & Trull, 2007) have argued for decades researchers Karl Looper and Joel Paris (2000) have found that all that such a s stem would have at least three advantages over a four disorders in this cluster are characteri ed b elevated impulpurel categorical s stem: (1) It would retain more information sivit . Cluster C is the an ious or fearful cluster; it includes . about each individual, (2) it would be more fle ible because it avoidant, dependent, and obsessive-compulsive personalit disorwould permit both categorical ,and dimensional differentiations ders. Research b Michael Bagb and his colleagues in Toronto among individuals, avoid the often arbitrar deci(Bagb et al., 1993) and b Birendra Sinha and David Watson 8 a and (3) it would 0 -09- to a diagnostic categor . (2004) in Edmonton supports the e istence of these three clusters. sions P involved in assigning 202a0person Currentl , an alternative model of personalit disorders is included More recent work shows, however, that the proposed three-cluster 388 C a 13 P a NEL Cop right 2021 Nelson Education Ltd. All Rights Reserved. Ma not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third part content ma be suppressed from the eBook and/or eChapter(s). Nelson Education reserves the right to remove additional content at an time if subsequent rights restrictions require it. . . . disorder to be 9.1 percent (2.1 percent for an disorders in Cluster A, 5.5 percent for an disorders in Cluster B, and 2.3 percent for an disorders in Cluster C). All ten personalit -F disorders ere associated ith substance use problems. Ha ing F -F M P T an of the ten diagnoses as associated ith more suicide attempts, more trouble at ork, being separated or di orced, N E O A C D ha ing problems ith friends and relati es, and ha ing problems C A ith the la . In a re ie of studies orld ide, Quirk et al. (2016) . B diagnoses ere associated ith arifound that Clusters A and P * ous ph sical diseases, such as cardio ascular diseases and arthri, tis. Clearl , people diagnosed ith personalit disorders S * 08 20-09-e perience significant life challenges. P 0 2 S * * * In another U.S. sur e (Len en eger et al., 2007), this time of nearl 10 000 adults, the pre alence of an DSM-IV-TR personalC B it disorders as 11.9 percent (6.2 percent for Cluster A, 2.3 percent for Cluster B, and 6.8 percent for Cluster C). As ou B * can see, numbers can ar from stud to stud , but both major . N * sur e s sho personalit disorders to be quite pre alent (at around 10 percent). In the Len en eger et al. (2007) sur e , all , H * * * personalit disorders ere comorbid ith most other t pes of 08 9 0 ps chological disorders. 0 2 P A * * 20 The pre alence of personalit disorders aries across countries. Winsper et al. (2019) reported a orld ide pre alence of C C 7.8 percent, ith some countries ha ing near ero pre alence D * * (e.g., China) and others ha ing a pre alence of near one in fi e (e.g., Australia). Winsper et al. found that, o erall, high-income A * * . countries had higher pre alences of personalit disorders, for reasons that are not quite clear et. O * , Personalit disorders ere once thought to originate in child8 -,0O = 9 0 hood or adolescence and continue into the adult ears (Cloninger & 0 2 :N= , E = , A = N 20 . A ,C= S akic, 2009). More sophisticated anal ses suggest that personalit ; .B disorders can remit o er time; ho e er, the ma be replaced b . other personalit disorders (Torgersen, 2012; Zanarini et al., 2014). W . (1994). S :A In other ords, a person could recei e a diagnosis of one personalit disorder at one point in time but ears later no longer meet the . problem and no ha e characteristics criteria for his or her original structure holds onl hen the personalit disorders are assessed a second (or third) personalit disorder. Our relati e lack of , of b clinicians, and not hen the are assessed ia patient selfinformation about such important features of personalit disorders 8 -as0their de elopmental 9 0 reports (Yang et al., 2002). We follo in 0 course is a repeating theme. The gaps in our 2 P this three-cluster2order 0 our re ie . kno ledge of the course of about half these disorders are isible in Table 13.2. One reason for this dearth of research is that man indi iduals do not seek treatment in the earl de elopmental phases C P of their disorder, but onl after ears of distress. This dela makes Data on the pre alence of personalit disorders in Canada are it difficult to stud people ith personalit disorders from the . lacking, so e report on sur e s conducted in the United States beginning, although a fe research studies ha e helped us underand else here (see Table 13.2). The Canadian Institute for Health stand the de elopment of se eral, disorders (Kasen et al., 1999; Information (CIHI, 2019), ho e er, records information on Hecht et al., 2014). 08 hospitali ation as a function of different ps chological disorders People ith borderline 20-09-disorder are characteri ed P 20personalit in Canada. For 2017 2018, in general hospitals, 5.6 percent of b their olatile and unstable relationships; the tend to ha e patients discharged ith a mental health diagnosis had a personalpersistent problems in earl adulthood, ith frequent hospitali ait disorder. This as the second-lo est rate, after an iet disortions, unstable personal relationships, depression, and suicidal ders at 4.4 percent, and far belo the highest: mood disorders at gestures. Suicide attempts are e tremel common, affecting more 28.4 percent. In ps chiatric hospitals, 7.8 percent of discharged than 80 percent of indi iduals in some studies (e.g., Soloff et al., patients had a personalit disorder, ith the lo est .rate being 2000), though onl about 10 percent of these attempts are again an iet disorders at 2.0 percent, and the highest this time completed (Paris, 2014). On the bright side, their s mptoms , being schi ophrenia and other ps 8 chotic disorders at 31.4 percent. graduall impro e if the sur i e into their 30s (Zanarini et al., 0 An impressi e20 sur20 e -0 of9o er 40 000 American adults (Trull 2014), although seniors ma still e perience higher than a erage et al., 2010) found a pre alence of an DSM-IV-TR personalit interpersonal difficulties (Po ers et al., 2013). People ith T P P P 13.1 P F NEL , C -08 9 0 P 0 2 20 A O Cop right 2021 Nelson Education Ltd. All Rights Reser ed. Ma not be copied, scanned, or duplicated, in hole or in part. Due to electronic rights, some third part content ma be suppressed from the eBook and/or eChapter(s). Nelson Education reser es the right to remo e additional content at an time if subsequent rights restrictions require it. 389 rep do not , l n o al use 9-08 Person 2020-0 . roduce a ca a a b a a , a c c .F c ac , , a a (T c a a c a ac ; a a a b a c a c , a a c a ca a ., 2013). A a a a (Vac b a , ac , 2012). e c du . o ot repr n o d , onl gender8diFFerenCes al use n 9 -0 o s r e P 2020-0 maureen rigdon/Shutterstock.com A c a t re , do no l n o e al us 9-08 Person 2020-0 13.2, a a a .N a ba c , , a a c .M b a a a a (10.3 c . 8.0 c T a ., 2010 ), a c a a du ro - ce ca a . A a ocnot repa ,d C C se, bonl 9-08 c u l a n o a . T Paers b 20.c20-0 a D a ca c b a c a ba c c c c a c , ba a c ca a a ? Ta , a , a b F a W (1989), c ca c ca c a . O ca c b a a ca a , c c a ac b b a c b a a a a a ; ca c b a c a , c c a ac b c a a a a a a . T a a a e. produc Personalit disorders tend to begin in childhood. Table 13.2 Disorder Tab oduce. r p e r t no statistics and development of Personalit ,disorders onl do 8 e s u l Gender0 Differences* Course 9 -0 ersona PPrevalence* 202 -0 Paranoid personalit disorder 1.9% F>M Insufficient information Schi oid personalit disorder 0.6% M>F Insufficient information Schi ot pal personalit disorder 0.6% M=F Chronic: some go on to develop schi ophrenia Antisocial personalit disorder 3.8% M>F Borderline personalit disorder 2.7 % F>M Histrionic personalit disorder 0.3% F>M Narcissistic personalit disorder 1.0% M>F Ma improve over time (Cooper & Ronningstam, 1992; Gunderson et al., 1991) Avoidant personalit disorder 1.2% F>M Insufficient information . roduce p e r t o n survive into S mptoms graduall improve l , difoindividuals on1993) their 30s (Dulit et al., e s u l a 0 9- 8 on PersChronic 2020-0 Ma dissipate after age 40 (Hare et al., 1988) . Insufficient information roduce p e r t o n Obsessive-compulsive personalit disorder F>M Insufficient information onl , do 81.9% e s u l a 0 *Based on 9- et al., 2010). on of 40 000 American -0(Trull rsa surve 20adults PePopulation 20data data and gender reported in Epidemiolog , b S. Torgersen, in T. A. Widiger (Ed.), The Oxford Handbook of Personalit Source: Dependent personalit disorder 0.3% F>M Disorders (pp. 186 205), 2012, Oxford Universit Press. 390 Chapter 13 Personalit C a b 2021 N E ca B NEL L .A R a / C a R ( ). N . Ma b c E ca , ca , ca a , a c a .D a a c b c , c a c . . A A P 80 P.D. , 9-08 2020-0 H Remember, however, that just because certain disorders are observed more in men or in women doesn t necessarily indicate bias (Lilienfeld et al., 1986). And when it is present, bias can occur at different stages of the diagnostic process. The criteria for the disorder may themselves be biased (criterion gender bias), or the assessment measures and the way they are used may be biased (assessment gender bias; Widiger & Spitzer, 1991). In general, the criteria themselves do not appear to have . et al., 2007), although there may be strong gender bias (Jane some tendency for clinicians to have their own bias when using , the criteria and therefore diagnose males and females differ9-08 (Oltmanns & Powers, 2012). As studies continue, 2020-0 ently researchers will try to make the diagnosis of personality disorders more accurate with respect to gender and more useful to clinicians. P.D. H 70 60 50 40 P P 30 20 L 10 0 , disorders is that people tend A major concern with the personality to be diagnosed with more than one. -08The term comorbidity P 020-0in9which a person has multiple F 13.1 G historically describes the 2 condition . D diseases (Caron & Rutter, 1991). A fair amount of disagreement , exists about whether the term should be used with psychological . disorders because of the frequent overlap of different disorders S :A AD DSM-III-R DSM-I P D (e.g., Nurnberg et al., 1991). In just one example, Morey (1988) F -F M P , , ,C ., S, 2 - , conducted a study of 291 persons who were diagnosed with C ,P D F -F M P personality disorder and found considerable overlap. In the far P .C A. (E ). 2002 A , P A . left column of Table 13.3 is the primary diagnosis, and across the 8 0 table are the percentages of people who also meet the criteria for 9 0 2020other disorders. For example, a person identified with borderline personality disorder also has a 32 percent likelihood (i.e., almost male in some versions and as female in others, although everya one in three chance) of fitting the definition of another supposthing else was identical. As the graph in Figure 13.1 shows, edly different personality disorder paranoid personality disorwhen the antisocial personality disorder case was labelled male, der (Grove & Tellegen, 1991). most psychologists gave the correct diagnosis. When the same Do people really tend. to have more than one personality disorcase was labelled female, however, most psychologists diagnosed der? Are the ways we define these disorders inaccurate, and do we it as histrionic personality disorder rather than antisocial person, need to improve our definitions so they do not overlap? Or did we ality disorder. This finding of an underdiagnosis of antisocial 08 the disorders in the wrong way to begin with and need to personality disorder in female clients 20-09-divide P was replicated in2a0similar rethink the categories? Complicating this issue is the phenomestudy conducted in Toronto with psychiatry residents (Belitsky et non that people will change diagnoses over time (Torgersen, al., 1996). In the original Ford and Widiger study, being labelled 2012). Such questions about comorbidity are just a few of the a woman increased the likelihood of a diagnosis of histrionic important issues faced by researchers who study personality personality disorder. disorders. Gender differences in diagnoses have been criticized by C P P . C M F M F D several authors. For example, some have argued that histrionic personality disorder, like several of the other personality disorders, is biased against females. Many of the features of histrionic personality disorder, such as overdramatization, vanity, seductiveness, and overconcern with physical appearance, are characteristic of the Western stereotypical female (Kaplan, 1983). This disorder may simply be the embodiment of extremely feminine traits (Chodoff, 1982); branding such an individual as having a mental illness, according to Kaplan, reflects society s . personinherent bias against females. Interestingly, the macho ality (Mosher & Sirkin, , 1984; Pantony & Caplan, 1991), in which the individual possesses stereotypically traits, is 9-08What do youmasculine -0DSM. nowhere to be found think the sex ratio 202in0the would be for people diagnosed with this personality disorder ? NEL . CPS P , -08 A D SO2D 020-S09 P Although it is probably very adaptive to be a little wary of other people and their motives, being too distrustful can interfere with making friends, working with others, and getting through daily interactions in a functional way. People with paranoid personality disorder are excessively mistrustful and suspicious of others, without any justification. They assume other people are out to harm or trick them, and therefore they tend not to confide in others. Consider the case of Jake. C AD Copyright 2021 Nelson Education Ltd. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Nelson Education reserves the right to remove additional content at any time if subsequent rights restrictions require it. 391 rep do not , ly n o al use 9-08 Person 2020-0 . roduce rep do not , ly n o al use 9 -0 8 Person 2020-0 . roduce sturti/iStock rep do not , ly n o al use 9-08 Person 2020-0 roduce . Gender bias may affect the diagnosis of clinicians who associate certain behavioural characteristics with one sex or the other. u ce . reprod t o n o ,d se only 9-08 u l a n o Pers 2020-0 Table 13.3 diagnostic overlap of Personality disorders Odds Ratio* of People Qualifying for Other Personality Disorder Diagnoses ObsessiveDiagnosis Paranoid Schizoid Schizotypal Antisocial Borderline Histrionic Narcissistic Avoidant Dependent Compulsive Paranoid 2.1 Schizoid 2.1 Schizotypal 37.3* 19.2 8.7* ro not rep o d , ly on 1.1 -08 1.7 nal use2.0 20-03.9 9 Perso2.7 20 15.2* 9.4 11.0 2.6 12.3* 0.9 37.3* 19.2 Antisocial 2.6 1.1 2.7 Borderline 12.3* 2.0 15.2* 9.5* Histrionic 0.9 3.9 9.4 8.1* 2.8 Narcissistic 8.7* 1.7 11.0 14.0* 7.1* 13.2* Avoidant 4.0* 12.3* 3.9* 0.9 2.5* 0.3 Dependent 0.9 2.9 7.0 5.6 7.3* Obsessivecompulsive 5.2* 5.5* 7.1 0.2 2.0 9.5* . duce4.0* 0.9 5.2* 12.3* 2.9 5.5* 3.9* 7.0 7.1 8.1* 14.0* 0.9 5.6 0.2 2.8 7.1* 2.5* 7.3* 2.0 . 1.3 roduce p e r t o n 0.3 nly4.0 o , do 8 3.7* e s u l a 0 9- 2.7 son Per0.3 20202.0-0 13.2 0.3 9.5 4.0 2.0 1.3 2.0 2.7 9.5 0.9 0.9 . roduce p e r t o n only, do 8 e s u l a 0 Source: Reprinted, permission, from Zimmerman, M., Rothschild, L., & Chelminski, I. (2005). The prevalence of DSM-IV personality disorders in psychiatric outpatients. 09-Reprinted sonofwith 0-1918. PerJournal 021911 American Psychiatry,2 162, with permission from the American Journal of Psychiatry (Copyright 2005). American Psychiatric Association. All *The odds ratio indicates how likely it is that a person would have both disorders. The odds ratios with an asterisk (*) indicate that, statistically, people are likely to be diagnosed with both disorders with a higher number meaning people are more likely to have both. Some higher odds ratios are not statistically significant because the number of people with the disorder in this study was relatively small. Rights Reserved. 392 Chapter 13 Personality NEL Co igh 2021 Nel on Ed ca ion L d. All Righ Re e ed. Ma no be co ied, canned, o d lica ed, in hole o in a . D e o elec onic igh , ome hi d a con en ma be e ed f om he eBook and/o eCha e ( ). Nel on Ed ca ion e e e he igh o emo e addi ional con en a an ime if b e en igh e ic ion e i e i . e. produc e r t o n , do JaKel uVictim oflyConspiracy? se on 8 a n o 0-09-0 PersJake grew up in20a 2 middle-class neighbourhood, and DSM-5 Table 13.1 Diagnostic Criteria for Paranoid Personality Disorder A. A pervasive distrust and suspiciousness of others such that their although he never got into serious trouble, he had a motives are interpreted as malevolent, beginning by early adultreputation in high school for arguing with teachers and hood and present in a variety of contexts, as indicated by four (or more) of the following: classmates. After high school he enrolled in the local 1. Suspects, without sufficient basis, that others are exploiting, community college but flunked out after the first year. harming, or deceiving him or her. Jake’s lack of success in school was in part attributable to e. 2. Is preoccupied producwith unjustified doubts about the loyalty or e his failure to take responsibility for his poor grades. He r t o n trustworthiness of friends or associates. began to develop conspiracy theories about fellow students only, do 8 3. Is reluctant to confide in others because of unwarranted fear e s u l and professors, believing they worked 9-0 that the information will be used maliciously against him or her. ona to see him Perstogether 2020-0 fail. Jake bounced from job to job, each time complaining 4. Reads hidden demeaning or threatening meanings into benign that his employer was spying on him. His parents brought remarks or events. him to a psychologist, and he was diagnosed with paranoid 5. Persistently bears grudges (i.e., is unforgiving of insults, injuries, or slights). personality disorder. Clinical Description 6. Perceives attacks on his or her character or reputation that are not apparent to others and is quick to react angrily or to counterattack. 7. Has recurrent suspicions, without justification, regarding fidelity of spouse or sexual partner. B. Does not occur exclusively during the course of schizophrenia, a bipolar disorder or depressive disorder with psychotic features, or another psychotic disorder and is not attributable to the physiological effects of another medical condition. Note: If criteria are met prior to the onset of schizophrenia, add “premorbid, i.e., “paranoid personality disorder (premorbid). rep do not , ly n o al use 9-08 Person 2020-0 roduce . The defining characteristic of people with paranoid personality disorder is a pervasive unjustified distrust. Certainly, there may be times when someone is deceitful and out to get you; however, people with paranoid personality disorder are suspicious in situations in which most other people would agree that their suspicions are unfounded. Even events that have nothing to do with e. would Source: Reprinted with permission from the Diagnostic and Statistical Manual of them are interpreted as personal attacks. These ucpeople eprodairline t Mental Disorders, Fifth Edition (Copyright © 2013). American Psychiatric Association. view a neighbour’s barking o dognor ardelayed flight as a o ,d All Rights Reserved. otonly deliberate u attempt annoy them. Unfortunately, such mistrust e s l 8 a -0to them and makes meaningful 9 0 sonextends to people close 0 2 Peroften 20 relationships very difficult. Imagine what a lonely existence this must be. Suspiciousness and mistrust can show themselves in many ways. People with paranoid personality disorder may be in paranoid personality disorder (Kendler et al., 2015). As you argumentative, may complain, or may be quiet, but they are obviwill see later with the other odd or eccentric personality disorders ously hostile toward others. These individuals are very sensitive in Cluster A, there seems to be some relationship with schizophree. causing some to suggest eliminating to criticism and have an excessive need for autonomy. Having nia (Bolinskeyoet al.,c2014), du r p e r t oa separate disorder from the DSM (Triebwasser et al., 2012). this disorder increases the risk of suicide attempts and violent do itnas , onoflylife behaviour, and is related to having a poor overalluquality contributions to this disorder are even less e s l 8 0 Psychological -certain, na are outlined 9 0 (Hopwood & Thomas, 2012). TheP in although some interesting speculations have been made. DSM-5 0 ersocriteria 2 20 DSM Table 13.1. Retrospective research—asking people with this disorder to recall Paranoid personality disorder bears relationship to two disorevents from their childhood—suggests that early mistreatment or ders we will discuss in more detail in Chapter 14: (1) the paratraumatic childhood experiences may play a role in the developnoid type of schizophrenia and (2) delusional disorder. Both of ment of paranoid personality disorder (Iacovino, 2014). Caution the latter disorders involve delusions—persistent beliefs that are is warranted when interpreting these results because, clearly, . ceare out of touch with reality. Although individuals with paranoid there may be strong bias in the recall of these individuals, roduwho p e r t o personality disorder are very suspicious of others, their suspialready prone to viewing the worlddas nthreat. ly, otoathe ondirectly e ciousness does not reach delusional proportions. Another differSome psychologists point thoughts (also referred s u l a 0 9- 8personality disorder as 0 rson ) of people 0 ence between the paranoid type of schizophrenia and paranoid to as with paranoid 2 Peschemas 0 2 personality disorder is that the former also involves other a way of explaining their behaviour. One view is that people with psychotic symptoms like hallucinations (e.g., hearing voices), this disorder have the following basic mistaken assumptions whereas paranoid personality disorder does not (see Chapter 14). about others: People are malevolent and deceptive, They’ll attack you if they get the chance, and You can be OK only if Causes you stay on your toes (Lobbestael & Arntz, 2012). This is a . cepersonality u maladaptive way to view the world, yet it seems to pervade every Evidence for biological contributions to paranoid d o r p t re the disorder may be aspect of the lives of these individuals. Although we don’t know osuggests n disorder is limited. Some, d research o e onlyamong-0 why they develop these perceptions, some speculation is that the slightlyamore the8relatives of people who have uscommon l n 9 association o 0 s 0 roots are in their early upbringing. Their parents may teach them the does not seem to be 2 Perschizophrenia, although 0 2 to be careful about making mistakes and to impress on them that strong (Tienari et al., 2003). Genetics appears to have a strong role NEL Cluster A Disorders Copyright 2021 Nelson Education Ltd. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Nelson Education reserves the right to remove additional content at any time if subsequent rights restrictions require it. 393 . the are different from other people. This vigilance causes them personal situations. The seem aloof, cold, and indifferent to to see signs that other people are, deceptive and malicious (Triebother people (see DSM Table 13.2). The term schi oid is rela08people are not alwa s tivel old, having been used b Bleuler (1924) to describe people 9 wasser, 2013). It is certainl20true that 0 P 20and our interactions are sometimes who have a tendenc to turn inward and awa from the outside benevolent and sincere, ambiguous enough to make other people s intentions unclear. world. These people were said to lack emotional expressiveness Looking too closel at what other people sa and do can someand pursued vague interests. Consider the case of Mr. Z. times lead to misinterpretation. Cultural factors have also been implicated in paranoid person. alit disorder. Certain groups of people such as prisoners, refugees, people with hearing impairments, and the elderl are 13.2 D C , DSM-5 thought to be particularl susceptible because of their unique S P D 8 0 9 experiences (Iacovino et al., 2014; Ra a, P DeMarce, et al., 2014; 20-0 20 A. A R der et al., 2015). Imagine how ou might view other people if ou were an immigrant who had difficult with the language and , the customs of our new culture. Such innocuous things as other , ( ) : people laughing or talking quietl might be interpreted as some1. N , how directed at ou. We have seen how someone could misinter. pret ambiguous situations as malevolent. Therefore, cognitive and 2. A . cultural factors ma interact to produce the suspiciousness 3. H , , , observed in some people with paranoid personalit disorder. . 4. 5. L P , , 2020.-0 9-08 - - Because people with paranoid personalit disorder are mistrustful . of ever one, the are unlikel to seek professional help when the 6. A . need it, and the have difficult developing the trusting relation7. S , , . ships necessar for successful therap (Sarkar & Adshead, 2012; B. D , . Skodol & Gunderson, 2008). Establishing a meaningful therapeu, tic alliance between the client and the therapist therefore becomes , , an important first step (Bender, 2005). When the do seek ther-08lives or other problems . apP , the trigger is usuall 0 a crisis 20-0in9their 2 N :I , such as anxiet or depression, and not necessaril their personal, . ., ( ). it disorder (Kell et al., 2007). Therapists tr to provide an atmosphere conducive to developS :R D S M ing a sense of trust (Bender, 2005). The often use cognitive M D ,F E (C 2013). A P A A R R . therap to counter the person s mistaken assumptions about . others, focusing on changing the person s beliefs that all people are malevolent and most people cannot be trusted (Beck et al., , 2015). Be forewarned, however, that to date there are no confirmed 08 demonstrations that an form of treatment P can significantl2020-09improve the lives of people with paranoid personalit disorder MR. . A H O (Bateman et al., 2015). Nonetheless, a review of the literature b A 39- ear-old scientist was referred after he returned from Qu bec researcher Stephane Bouchard and his colleagues being stationed in Baffin Island where he had stopped concluded that cognitive restructuring could be helpful in reduccooperating with others, had withdrawn to his room, and ing paranoid beliefs (Bouchard et al., 1996). An Australian surve begun drinking on his own. Mr. Z. was orphaned at age of mental health professionals indicated that onl 11 percent of four, raised b an aunt until nine, and ,subsequentl looked therapists who treat paranoid personalit disorder thought these after b an aloof housekeeper. At universit he8 excelled at individuals would continue in therap long enough to be helped 9-0 ph sics, P but chess was his onl2contact others. (Qualit Assurance Project, 1990). 020-0with Throughout his subsequent life, he made no close friends and engaged primaril in solitar activities. Until his move C P to Baffin Island, he had been quite successful in his research work in ph sics. He was now, some months after Do ou know someone who is a loner ? Someone who would his return, drinking at least a bottle of Schnapps each da choose a solitar walk over an invitation to a part ? A person who . and his work had continued to deteriorate. He presented as comes to class alone, sits alone, and leaves alone? Now, magnif self-contained and unobtrusive, and he was difficult to this preference for isolation man times over and ou can begin , disorder. People engage effectivel . He was at a loss to explain his to grasp the impact of schi oid personalit 8 0 0-09a -pattern of detachment from colleagues anger at his aloofness in Baffin Island and with P this personalit disorder 202show social relationships and a ver limited range of emotions in inter- 394 C 13 P . . . NEL Cop right 2021 Nelson Education Ltd. All Rights Reserved. Ma not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third part content ma be suppressed from the eBook and/or eChapter(s). Nelson Education reserves the right to remove additional content at an time if subsequent rights restrictions require it. e. prod c e r o n do appeared indifferent of him. He did not e onl to, their-opinion l a 08 relations. n 9 appear to req ire an interpersonal o 0 r 0 e 2 P 20 decades point to biological ca ses of a tism (a disorder e disc ss in more detail in Chapter 15), and research demonstrates significant o erlap in the occ rrence of a tism spectr m disorder and schi oid personalit disorder (L gneg rd et al., 2012; So rce: Q alit Ass rance Project, Treatment O tlines for Paranoid, H mmelen et al., 2014; Coolidge et al., 2013; Vann cchi et al., Schi ot pal and Schi oid Personalit Disorders, A stralian & 2014). It is possible that a biological d sf nction fo nd in both Ne Zealand Jo rnal of Ps chiatr , 24(3), 339 350. 1990, a tism and schi oid personalit disorder combines ith earl Sage P blications. learning or earl problems ith interpersonal relationships to prod ce the social deficits ce. that define schi oid personalit disorro&d Thomas, pood e r der (Hop 2012). For e ample, research on the o n do ne rochemical dopamine s ggests , l n As described in the book The Stranger in the Woods (Finkel, that people ith a lo er densit o e 08 onli aingl in a tent 2017), Christopher Knight spent P 27erears in0-a09-of dopamine receptors scored higher on a meas re of detachment 2 20 forest and not seeing an one. He did it b choice and greatl (Farde et al., 1997). It ma be that dopamine ( hich seems to be missed his time there after he ret rned to societ (he as ca ght in ol ed ith schi ophrenia as ell) ma contrib te to the social stealing food). Altho gh he has not been formall diagnosed, his aloofness of people ith schi oid personalit disorder. choice and description of his life is consistent ith some of the Trea men feat res of schi oid personalit disorder. It is rare for a person ith this disorder to req estdtreatment ce. Clinical De crip ion repro or losing e cept in response to a crisis s ch as o e treme depression o n l , d often begin treatment b Indi id als ith schi oid personalit disorder seem neither to a job (Kell et al., 2007). e onTherapists l a n o desire nor enjo closeness ith others, incl ding romantic or pointing -09-08 The person ith the 20relationships. Pero t the al e in 2social 0 se al relationships. As a res lt the appear cold, aloof, and disorder ma e en need to be ta ght the emotions felt b others detached (Lo a & Hanna, 2006) and do not seem affected b to learn empath (Skodol & G nderson, 2008). Beca se their praise or criticism. Unfort natel , homelessness appears to be social skills ere ne er established or ha e atrophied thro gh pre alent among people ith this personalit disorder, perhaps as lack of se, people ith schi oid personalit disorder often a res lt of their lack of close friendships and lack of dissatisfacrecei e social skills training. The therapist takes the part of a e. (Ro ff, friend or significant other in a techniq e kno n as role-pla ing tion abo t not ha ing a relationship ith another person c d o r 2000; Angstman & Rasm ssen, o rep and helps the patient practise establishing and maintaining social o n2011). nl , ofdpeople o The social deficiencies ith schi oid personalit disor(Skodol & G nderson, 2008). This t pe of social e l 8 -0 ith paranoid personalit disorder, relationships nasimilar to those2of0-people 9 0 skills training is helped b identif ing a social net ork a person Perderoare 20 altho gh the deficiencies are e treme. As Beck and Freeman (1990) or people ho ill be s pporti e (Bender, 2005). O tcome p t it, the consider themsel es to be obser ers rather than particiresearch on this t pe of approach is nfort natel q ite limited, pants in the orld aro nd them (p. 125). The do not seem to ha e so e m st be ca tio s in e al ating the effecti eness of treatthe er n s al tho ght processes that characteri e the other disorment for people ith schi oid personalit disorder. ders in Cl ster A (Kal s et al., 1993). For e ample, people ith ce. onali di order paranoid and schi ot pal personalit disorders often ha e ideas of od Per r Chi o Pal p e r reference, mistaken beliefs that meaningless e ents relate j st to do no , People ith schi ot pal personalit disorder are t picall onl the them. In contrast, those ith schi oid personalit ldisorder e share a -0 8 n o r social isolation, poor rapport, and affect 2 (sho Peconstricted 020ing-09 sociall isolated, like those ith schi oid personalit disorder. In neither positi e nor negati e emotion) seen in people ith paranoid addition, the also beha e in a s that o ld seem n s al to personalit disorder. We see in Chapter 14 that this distinction man of s, and the tend to be s spicio s and to ha e odd beliefs among ps chotic-like s mptoms is important to nderstanding (Chemerenski et al., 2013; Rosell et al., 2014). Schi ot pal people ith schi ophrenia, some of hom sho the positi e personalit disorder is considered b some to be on a contin m s mptoms (acti el n s al beha io rs, s ch as ideas of reference) (i.e., on the same spectr m) ith schi ophrenia the se ere e. and others onl the negati e s mptoms (the more passi e manidisorder e disc ss in Chapter 14 b t itho t some roofdthecmore p e r o n and del sions. In festations of social isolation or poor rapport ith others). debilitating s mptoms, s ch as ,hall nl docinations oconnection, e fact, beca se ofalthis close 0 9- the8 DSM-5 incl des this on both the heading Ca e disorder Per nder 2020-0of a personalit disorder and E tensi e research on the genetic, ne robiological, and ps chosonder the heading of a schi ophrenia spectr m disorder (Americial contrib tions to schi oid personalit disorder remains to be can Ps chiatric Association, 2013). Consider the case of Mr. S. cond cted. In fact, er little empirical research has been p blished on the nat re and ca ses of this disorder (Trieb asser et al., 2012). Childhood sh ness is reported as a prec rsor to later ad lt MR. . Man i h a Mi ion ce . schi oid personalit disorder. It ma be that trait d personalit rothis p e r o n determinant in the de elopis inherited and ser es as,andimportant Mr. S. as a 35- ear-old chronicall nemplo ed man ho onl Ab seo and8neglect in childhood are also e ment of this disorder. had been referred b a ph sician beca se of a itamin l a 0 9on among 0indi deficienc . This problem as tho ght to ha e e ent ated Perreported 2 20id-0als ith this disorder (Lobbestael et al., 2010; Carr et al., 2015). Research o er the past se eral NEL Cl er A Di order Cop right 2021 Nelson Ed cation Ltd. All Rights Reser ed. Ma not be copied, scanned, or d plicated, in hole or in part. D e to electronic rights, some third part content ma be s ppressed from the eBook and/or eChapter(s). Nelson Ed cation reser es the right to remo e additional content at an time if s bseq ent rights restrictions req ire it. 395 . personalit disorder found that the tend to be passi e and unen, that could ha e been because Mr. S. a oided an foods gaged and are h persensiti e to criticism (Olin et al., 1997; see 8 to de elop 0begun 9 contaminated b a machine.0He had DSM Table 13.3). 0 2 P 0 alternati e ideas about2diet in his 20s and soon left his Because persons ith schi ot pal personalit disorder often famil and began to stud an Eastern religion. It opened ha e beliefs around religious or spiritual themes (Bennett et al., m third e e; corruption is all about, he said. 2013), clinicians must be a are that different cultural beliefs or He li ed b himself on a small farm in British Columbia, practices ma lead to a mistaken diagnosis of this disorder. For attempting to gro his o n food, bartering for items he e ample, some people ho practise certain religious rituals . could not gro himself. He spent his da s and e enings such as speaking in tongues, practising oodoo, or mind reading researching the origins and mechanisms of food ma do so ith such obsessi eness as to make them seem contamination and, because of this kno ledge, had e, tremel unusual, thus leading to a misdiagnosis (American 9-08Association, 2013). Mental health orkers ha e to be de eloped a small band that follo ed his ideas. He had 20Ps-0chiatric P 0 2 ne er married and maintained little contact ith his famil : particularl sensiti e to cultural practices that ma differ from I e ne er been close to m father. I m a egetarian. their o n and can distort their ie of certain seemingl unusual He said he intended to take a herbalism course to impro e beha iours. his diet before returning to his life on the farm. He had refused medication from the ph sician and became uneas C hen the facts of his deficienc ere discussed ith him. Historicall , the ord schi ot pe as used to describe people ho ere predisposed to de elop schi ophrenia Source: Qualit Assurance Project, Treatment Outlines for Paranoid, , (Meehl, 1962; Rado, Schi ot pal and Schi oid Personalit Disorders, Australian & 1962). Schi ot pal personalit disorder is 9 -0ed8b some to be 0 ieRecall Ne Zealand Journal of Ps chiatr , 24(3), 339 350. 1990, -pe. 0 2 P 0 one phenot pe of a schi ophrenia genot that a pheno2 Sage Publications. t pe is one a a person s genetics are e pressed. Your genot pe is the gene or genes that make up a particular disorder. Depending on a ariet of other influences, ho e er, the a ou turn C . D , 13.3 D C People gi en a diagnosis of schi ot pal personalit disorder ha e DSM-5 -08 (such as belie ing S P D 0 ps P chotic-like (but not ps0chotic) s9mptoms 0 2 2 e er thing relates to them personall ), social deficits, and someA. A times cogniti e impairments or paranoia (K apil & Barrantes, , , Vidal, 2012). These indi iduals are often considered odd or , bi arre b others because of ho the relate to other people, ho , ( ) the think and beha e, and e en ho the dress. The ha e ideas 1. I ( . of reference for e ample, the ma belie e that someho e er 2. O one on a passing cit bus is talking about them, et the ma be , ( . ., able to ackno ledge this is unlikel (Rosell et al., 2014). Again, 8 , , ; 0 9 0 as e see in Chapter 14, some people Pith schi ophrenia also , 2020ha e ideas of reference, but the are usuall not able to test realit 3. , or see the illogic of their ideas. 4. O ( . ., , Indi iduals ith schi ot pal personalit disorder also ha e , , ). odd beliefs or engage in magical thinking, belie ing, for e ample, 5. S . that the are clair o ant or telepathic (Furnham & Crump, 2014). 6. I . In addition, the report unusual perceptual e periences, including 7. B , , such illusions as feeling the presence of another person hen the , 8. L are alone. Notice the subtle but important difference bet een 9-08 . 0 0 feeling as if someone else is in the room, and the more e treme 2 P 0 2 9. E perceptual distortion in people ith schi ophrenia ho might report there is someone else in the room hen there isn t. Onl a . small proportion of indi iduals ith schi ot pal personalit B. D disorder go on to de elop schi ophrenia (Wolff et al., 1991). , Unlike people ho simpl ha e unusual interests or beliefs, those . N :I ith schi ot pal personalit disorder tend to be suspicious and , . ., ( ha e paranoid thoughts, e press, little emotion, and ma dress or beha e in unusual a s (e.g., ear man 8 la ers of clothing in the 0 D S summertime or mumble2 to0themsel 20-09es;- Chemerinski et al., 2013). SM :DR , F E (C P 2013). A P Prospecti e research on children ho later de elop schi ot pal A R R . 396 C . 13 P : ). , ). . - , . . - , , . , ). M A . NEL Cop right 2021 Nelson Education Ltd. All Rights Reser ed. Ma not be copied, scanned, or duplicated, in hole or in part. Due to electronic rights, some third part content ma be suppressed from the eBook and/or eChapter(s). Nelson Education reser es the right to remo e additional content at an time if subsequent rights restrictions require it. o d ce . eother people s phenot pe, professionals pro iding therapeutic ser ices), and social skills out our phenot pe ma arno o from nl , dgenetic e en if the haee o a similar makeup to ours. Some people training, to treat the s mptoms e perienced b indi iduals ith al to ha e schi 08genes (the genot pe) and et, this disorder. Researchers found that this combination of n 9 areothought ophrenia 0 0 e 2 P because of the relati 20 e lack of biological influences (e.g., prenatal approaches either reduced their s mptoms or postponed the onset illnesses) or en ironmental stresses (e.g., po ert , maltreatment), of later schi ophrenia. The idea of treating ounger persons ho some ill ha e the less se ere schi ot pal personalit disorder ha e s mptoms of schi ot pal personalit disorder ith some (the phenot pe). combination of antips chotic medication, cogniti e beha iour The idea of a relationship bet een schi ot pal personalit therap and social skills training in order to a oid the onset of disorder and schi ophrenia arises in part from the a people schi ophrenia ma ce.e to be a promising pre ention strateg d pro e etoal., ith the disorders beha e. Man characteristics of schi ot pal o (Nordentoft 2015; Graff et al., 2014; Correll et al., 2010; o n d personalit disorder, including ideas of reference, illusions, 2011). e onland, -Weiser, l a 08 n 9 o 0 paranoid thinking, are similar but milder forms of beha iours 0 e 2 P 20 obser ed among people ith schi ophrenia. Genetic research also seems to support a relationship. Famil , t in, and adoption studCl S e B DiSO De S ies, largel conducted in Nor a , ha e sho n an increased pre aan i oCial Pe onali di o de lence of schi ot pal personalit disorder among relati es of people ith schi ophrenia ho do not also ha e schi ophrenia People ith antisocial personalit disorder are among the most . themsel es (Sie er & Da is, 2004). These studies also tell us, d ceand dramatic of the indi iduals a clinician ill see e in a o practice ho e er, that the en ironment can strongl influence schi ot pal o n are characteri ed as ha ing n a l histor , doof failing to compl ith personalit disorder. For e ample, research from the United e o actions social norms. The perform l a -08of us ould find unacn o Kingdom suggests that a oman s e posure to influen a in preg-09most 20friends Pe such as stealing2from 0 ceptable, and famil . The also tend nanc ma increase the chance of schi ot pal personalit disorto be irresponsible, impulsi e, and deceitful (Widiger & Corbitt, der in her children (Venables, 1996). It ma be that a subgroup of 1995). Robert Hare (1993), a pioneer in the stud of people ith people ith schi ot pal personalit disorder has a similar genetic ps chopath (a group of persons ith antisocial personalit makeup hen compared ith people ith schi ophrenia. disorder), describes them as Biological theories of schi ot pal personalit disorder are . ceeassessment social predators ho charm, manipulate, and ruthlessl plo their recei ing empirical support. For e ample, cogniti emildotod moderate decreo a through life, lea ing a broad trail of broken hearts, shattered of persons ith this disorder point to n o d on tests in ol ing memor and onlto ,perform e pectations, and empt allets. Completel lacking in conscience ments in their e abilit l 8 0 ona suggesting -09-damage and empath , the selfishl take hat the ant and do as the in the left hemisphere Pe learning, 2020some ( Voglmaier et al., 2000). Research b Roger Gra es, professor please, iolating social norms and e pectations ithout the emeritus at the Uni ersit of Victoria, suggests that abnormalities slightest sense of guilt or regret. (p. i) in semantic association abilities ma contribute to the thinking The Trull et al. (2010) population stud reported a pre alence oddities displa ed b schi ot pal indi iduals. Gra es and his of 5.7 percent for adult males. Ne male inmates in the Correccolleagues e amined people ith high le els of magical ideation tional Ser ice of Canada ha e a much higher rate of antice. s stem (MI) a thinking st le similar to that of schi ot pal patients. od disorder: social personalit 44 percent o erall, 36 percent in e High-MI participants ere found to consider unrelated ords asdo no , Ontario, 54 percent in the Atlantic region, 40 percent in the Prainl for o e more closel associated than lo -MI participants. Thus, al 08 and 64 percent in the Pacific region (Beaudette et al., 2015). schi ot pal people, loose associations after 20all-09-ries,Although Pe maonnot be loose20 first identified as a medical problem b Philippe (Mohr et al., 2001). Other research using magnetic resonance Pinel at the start of the 19th centur (1801/1962), descriptions of imaging (MRI) points to generali ed brain abnormalities in indi iduals ith these antisocial tendencies can be found in patients ith schi ot pal personalit disorder (Lener et al., 2015). ancient stone te ts from Mesopotamia dating as far back as 670 BCE (Abdul-Hamid & Stein, 2012). Just ho are these T ea men people ith antisocial personalit disorder? Consider thece case . People ith schi ot pal personalit disorder ho request clinical od e of R an. o n help often seek assistance for an iet or depression (American onl , do 8 e Ps chiatric Association, 2013). Relatedl , the presence of schi ol a 0 9t pal personalit disorder significantl increases the risk for Pe on 2020-0 de eloping major depressi e disorder e en ears later (Skodol R an The Th ill Seeke et al., 2011). Treatment includes some of the medical and ps choI first met R an on his 17th birthda . Unfortunatel , he as logical treatments for depression (Cloninger & S akic, 2009; celebrating the e ent in a ps chiatric hospital. He had been Mulder et al., 2009). truant from school for se eral months and had gotten into Controlled studies of attempts to treat groups of people ith . e some trouble; the local judge ho heard his case had c schi ot pal personalit disorder are fe . There is no gro ing d ee er, obecause recommended ps chiatric e aluation one more time, though o n interest in treating this ,disorder, ho it is being o d l n o R an had been hospitali ed si pre ious times, all for e ie edaas (McClure et al., 2010). l a precursor to-0schi 8 0ophrenia problems related to drug use and truanc . He as a eteran 20 9- of approaches, including antiPe Oneonstud used a0combination 2 ps chotic medication, communit treatment (a team of support NEL Cl e B Di o de Cop right 2021 Nelson Education Ltd. All Rights Reser ed. Ma not be copied, scanned, or duplicated, in hole or in part. Due to electronic rights, some third part content ma be suppressed from the eBook and/or eChapter(s). Nelson Education reser es the right to remo e additional content at an time if subsequent rights restrictions require it. 397 . , most of the staff. I of the system and already knew for curing their son. When Ryan finished talking, I smiled, 08admitted this time interviewed him to assess why he9was applauded, told him it was the best performance I had 0 0 2 P 20 and to recommend treatment. ever seen. His parents turned on me in anger. Ryan paused My first impression was that Ryan was cooperative and for a second, then he too smiled and said, It was worth a pleasant. He pointed out a tattoo on his arm that he had shot! Ryan s parents were astounded that he had once made himself, saying that it was a stupid thing to have again tricked them into believing him; he hadn t meant a done and that he now regretted it. In fact, he regretted many word of what he had just said. Ryan was eventually . things and was looking forward to moving on with his life. discharged to a drug rehabilitation program. Within four I later found out that he was never truly remorseful for weeks, he had convinced his parents to take him home, , and within two days he had stolen all their cash and anything. Our second interview was quite different. During those 09-08 he apparently went back to his friends and to 20-disappeared; P 0 2 48 hours, Ryan had done several things that showed why he drugs. needed a great deal of help. The most serious incident When he was in his 20s, after one of his many arrests for involved a 15-year-old girl named Ann who attended class theft, Ryan was diagnosed as having antisocial personality with Ryan in the hospital school. Ryan had told her that he disorder. His parents never summoned the courage to turn was going to get himself discharged, get in trouble, and be him in or refuse him money, and he continues to con them sent to the same correctional facility Ann s father was in, into providing him with a means of buying more drugs. where he would rape her father. Ryan s threat so upset Ann , that she hit her teacher and several of the staff. When I 08 spoke to Ryan about this, he smiled slightly and said he was 20-09P 0 2 bored and that it was fun to upset Ann. When I asked C D whether it bothered him that his behaviour might extend her stay in the hospital, he looked puzzled and said, Why Individuals with antisocial personality disorder tend to have should it bother me? She s the one who ll have to stay in long histories of violating the rights of others. They are often this hellhole! described as being aggressive because they take what they want, Just before Ryan s admittance, a teenager in his town . indifferent to the concerns of other people. Lying and cheating was murdered. A group of teens went to the local graveyard seem to be second nature to them, and often they appear unable , at night to perform satanic rituals, and a young man was to tell the difference between the truth and the lies they make up 8 0 purchase. Ryan -drug 9 0 stabbed to death, apparently over a to further their own goals. They show no remorse or concern 0 2 P 20 was in the group, although he did not stab the boy. He told over the sometimes devastating effects of their actions. Substance me that they occasionally dug up graves to get skulls for abuse is common, occurring in 60 percent of people with antitheir parties; not because they really believed in the devil, social personality disorder; this appears to be a lifelong pattern but because it was fun and it scared the younger kids. I among these individuals, who are also at increased risk for abusasked, What if this was the grave of someone you knew, a ing multiple substances (Skodol et al., 2014; Taylor & Lang, 2006). The long-term outcome .for people with antisocial personrelative or a friend? Would it bother you that strangers were ality disorder is usually poor, regardless of gender (Colman digging up the remains? He shook his head. They re , et al., 2009). One longitudinal study, for example, found that dead, man; they don t care. Why should I? -09-08boys were more than twice as likely to die an unnatuRyan told me he loved PCP, or angel P dust, and that he 2020antisocial ral death (e.g., accident, suicide, homicide) as their nonwould rather be dusted than anything else. He routinely antisocial peers, which may be attributed to factors such as made the two-hour trip to Toronto to buy drugs in a alcohol abuse and poor self-care (e.g., reckless behaviour; Laub particularly dangerous neighbourhood. He denied that he & Vaillant, 2000). was ever nervous. This wasn t machismo; he really seemed Antisocial personality disorder has had a number of names unconcerned. over the years. Philippe Pinel (1801/1962) identified what he Ryan made little progress. I discussed his future in called manie sans delire (mania without delirium) to describe family therapy sessions and we talked about his pattern of , people with unusual emotional responses and impulsive showing supposed regret and remorse, and then stealing -08 rages but no deficitsPin reasoning ability2(Charland, money from his parents and going back onto the street. In 020-092010). Other labels have included moral insanity, egopathy, sociopathy, and psychopfact, most of our discussions centred on trying to give his athy. There continues to be debate in the field about whether parents the courage to say no to him and not to believe his antisocial personality disorder and psychopathy really are two lies. distinct disorders (Douglas et al., 2015; Wall, 2015; Werner, One evening, after many sessions, Ryan said he had 2015; Anderson, 2014; Venables, 2014). The diagnostic criteria seen the error of his ways and that he felt bad that he for antisocial personality disorder are more liberal than those for had hurt his parents. If they would only take him home . psychopathy because in Canadian prisons and secure hospitals, this one last time, he would be the son he should have , 50 to 80 percent of male offenders are diagnosed with antisocial been all these years. His speech moved his parents to 8 0 -09- as if to thank me personality disorder (see DSM Table 13.4), but only 15 to tears, P and they looked2at02me0gratefully 25 percent are diagnosed as psychopaths (Hare, 2003). 398 C 13 P NEL Copyright 2021 Nelson Education Ltd. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Nelson Education reserves the right to remove additional content at any time if subsequent rights restrictions require it. . . . DSM-5 P A. A , 13.4 D A 9-0P8 2020-0 , 15 ) C D , : 1. F , . 2. D , , . 3. I P 4. I . , . 5. R . 6. C , . 7. L , , B. , 18 . C. . D. . S M A R P P :R D R ,F . E (C D 2013). A S P The presence of antisocial traits among the criminal population seems to have important implications for predicting their future criminal behaviour (Vitacco et al., 2014). One study conducted in British Columbia by psychologist James Ogloff and ( his colleagues found that criminals who scored high on a measure of psychopathy put in less effort and showed fewer improvements in a therapy program than did criminals who were not psychopaths (Ogloff, 1990). Other studies have shown that psychopathic . than nonpsychopathic criminals to criminals are more likely , repeat their criminal offences, especially those that are violent or , sexual in nature (Langton et al., 2006; Nicholls et al., 2004; 9-08 2006; Olver & Wong, 2006; Valliant et al., 1999). 202- 0-0 Ogloff, It is important to note the developmental nature of antisocial behaviours and traits. The DSM-5 provides a separate diagnosis for children who engage in behaviours that violate society s norms: conduct disorder (CD; DSM Table 13.5). It provides for the designation of two subtypes: childhood-onset type (the onset of at least one criterion characteristic of CD before age ten) .or . adolescent-onset type (the absence of any criteria characteristic of , subtype, new to the DSM-5, is CD before age ten). An additional -08 15 called (Barry et al., 20-09presentation P with a callous-unemotional 0 2 2012). This designation is an indication that the young person presents in a way that suggests personality characteristics similar to an adult with psychopathy. Some children with CD do feel remorseful about their behaviour, hence the qualifier with a M A . callous-unemotional presentation to better differentiate these . two groups. , 8 for antisocial personality 9-0criteria Earlier versions0of the-0 DSM 2 20 13.5 D C focused almost entirely on observable behaviours (e.g., impulDSM-5 C D sively and repeatedly changes employment, residence, or sexual partners ). The framers of the previous DSM criteria felt that A. A trying to assess a personality trait—for example, whether some, one was manipulative—would be more difficult than determining . 15 12 whether the person engaged in certain behaviours, such as , repeated fighting. The DSM-5, however, moved closer to the trait, : based criteria and includes such language as deceitfulness, impul8 A P A 0 9 0 sivity, and lack of remorse). Unfortunately, research on identifying P 20201. O , , . persons with antisocial personality disorder suggests that this new 2. O . definition reduces the reliability of the diagnosis (Regier et al., 3. H 2013). Additional work will be needed to improve the reliability ( . ., , , , , ). of this diagnosis while maintaining the core traits that character4. H . ize these individuals. 5. H . Some people with antisocial personality traits manage to not get in trouble with the law. What separates many in this group 6. H ( . ., , , from those who get into trouble with the law may be IQ, along , , ). 8 0 9- . with other factors. In a prospective, longitudinal study, White, P7. H 2020-0 Moffit, and Silva (1989) followed almost 1000 children, beginD P ning at age five, to see what predicted antisocial behaviour at 8. H age 15. They found that of the five-year-olds determined to be at . high risk for later delinquent behaviour, 16 percent did indeed 9. H ( ). have run-ins with the law by the age of 15 and 84 percent did not. . D What distinguished these two groups? In general, the at-risk children with lower IQs were the ones who got in trouble. This find10. H , , . , ing suggests that having a higher IQ may help protect some 8 11. O 0 09-serious problems or may at least people from developing ( . ., ). 2020-more prevent them from being caught. NEL C BD Copyright 2021 Nelson Education Ltd. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Nelson Education reserves the right to remove additional content at any time if subsequent rights restrictions require it. 6 . 399 . , 9-08 2020-0 12. H ( . ., ). PS , ; R 13. O , 13 - . 14. H , . 15. I , 13 . - B. Data from long-term follow-up research indicate that many adults with antisocial personality disorder or psychopathy had CD as children (Davidson, 2014; Kasen et al., 2014; Robins, 1978; Salekin, 2006); the likelihood increases if the child has both CD and attention-deficit/hyper-activity disorder (Lynam, 1996). There is a tremendous amount of interest in studying a group that causes a great deal of harm to society. Research has been conducted for many years, and so we know a great deal . disorder than about the other more about antisocial personality personality disorders. , G-09-0I8 2020Family, C. I 18 , P twin, and adoption studies all suggest a genetic influence . on both antisocial personality disorder and criminality (Checknita S : et al., 2015; Delisi & Vaughn, 2015; Ficks & Waldman, 2014; C :I Kendler et al., 2015; Reichborn-Kjennerud et al., 2015). For 10 . example, Crowe (1974) examined adopted-away children of A :I mothers who were felons and compared them with adopted-away 10 . children of noncriminal mothers. All were separated from their :C , mothers as newborns, minimi ing the ,possibility that environ-08responsible for mental factors families 20-09were P from their biological 0 2 10 . the results. Crowe found that the adopted-away offspring of S : felons had significantly higher rates of arrests, conviction, and M :F antisocial personality than did the adopted-away offspring of , noncriminal mothers, which suggests at least some genetic influ( . ., , , , ). ence on criminality and antisocial behaviour. . M : Crowe (1974) also found something else quite interesting, however: the adopted children of felons who themselves later , ( . ., , ). became criminals had spent more time in interim orphanages than 8 0 S :M 9 0 either the adopted children of felons who did not become crimi0 2 P 20 , nals or the adopted children of noncriminal mothers. As Crowe ( . ., , , points out, this suggests a gene environment interaction; in other , , ). words, genetic factors may be important only in the presence of certain environmental influences (alternatively, certain environS :R D S M mental influences are important only in the presence of certain ,F E (C 2013). A P A . M D . factors may present a vulneragenetic predispositions). Genetic A R R . bility, but actual development of criminality may require environ, mental factors, such as a deficit in early, high-quality contact with -or08parent-surrogates. 9 0 0 parents 2 P 20 Many children with conduct disorder most often diagnosed This gene environment interaction was demonstrated most in boys become juvenile offenders and tend to become involved clearly by Cadoret, Yates, Troughton, Woodworth, and Stewart with drugs (Durand, 2014). Ryan fits in this category. More (1995), who studied adopted children and their likelihood of develimportant, the research of Richard Tremblay and his colleagues at oping conduct problems. If the children s biological parents had a the Universit de Montr al supports a stable, lifelong pattern of history of antisocial personality disorder and their adoptive famiantisocial behaviour in a subgroup of antisocial children. Specifilies exposed them to chronic stress through marital, legal, or cally, a group of young children who display antisocial behaviour psychiatric problems, the children were at , greater risk for conduct has been shown to likely continue these behaviours as the problems. Again, research shows that genetic influence 8 does not 0-09-0Genetic research members grow older, while many others desist (Charlebois et al., necessarilyP mean certain disorders are2inevitable. 20 1993). Some more recent longitudinal research from Tremblay on CD points to an interaction between genetic and environmental and his colleagues shows that personality traits distinguish boys influences, such as academic difficulty, peer problems, low family who show this stable pattern of antisocial behaviour over time. income, neglect and harsh discipline from parents (Beaver et al., The most important personality characteristic that distinguished 2011; Kendler et al., 2013; Knopik et al. 2014; Silberg et al., 2012). the boys who showed a stable and persistent pattern of physical . N I aggression, theft, and vandalism, was psychoticism (Carrasco et al., 2006). Not to be confused,with the psychotic disorders, like A great deal of research has focused on neurobiological influschi ophrenia discussed in Chapter 14,0psychoticism is an older ences that may be specific to antisocial personality disorder. 9- 8 label P for a personality characteri 2020-0ed by high impulsivity and low Some researchers have used neuropsychological tests to deterempathy (Carrasco et al., 2006). mine if there are specific cognitive deficits that might contribute , 400 C , 13 P . NEL Copyright 2021 Nelson Education Ltd. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Nelson Education reserves the right to remove additional content at any time if subsequent rights restrictions require it. . . c . h pothesis of ps chopath . Hare s theor holds that the cerebral cortex of a ps chopaths is at a relativel primitive P a D :G stage of development. This h pothesis ma help explain wh the behaviour of I have hatred inside me. I don t care how much I beat ps chopaths is often childlike and somebod . . . . The more I hear somebod , the more anger impulsive: their cerebral cortices, I get inside me. . . . I used drugs when I was . . . probabl which pla such a ke role in the inhinine or ten ears old . . . smoked marijuana. . . . First time c .bition and control of impulses, ma be insufficientl developed. But remember I drank some alcohol I think I was probabl about three , that man ps chopaths are also quite ears old. . . . I assaulted a woman. . . . I 0 had 8 so much a 9 0 planful, as indicated b the research of 0 2 20 . . . It s just ticking . . . anger. P . . . I was just like a bomb. investigators like Adelle Forth and and the wa I m going, that bomb was going to blow up in Stephen Porter (Brown & Forth, 1997; Woodworth & Porter, 2002). me. I wouldn t be able to get awa from it . . . going to be The data on theta waves are open to a lot of people hurt. . . . I m not going out without taking an alternative and perhaps simpler explasomebod with me. . nation. Because theta waves alsocindiV .c / a M Ta . E cate states such as drowsiness or O Acc C ca c .I a , ps chopaths higher levels of boredom, c ca , ca c a a acc aa 08 simpl reflect their theta waves -09-ma NELSONb a .c . 20 P 0 2 relative lack of concern regarding being hooked up to ps choph siological equipment! Picture ourself having our to antisocial personalit disorder or ps chopath . For example, a brain waves measured. You sit next to the intimidating pol graph stud b Thierr Pham at the Pinel Institute in Montr al looked at machine, attached to a number of electrodes and wires. How will the neurops chological function of ps chopathscand. did find ou react? As a nonps chopath, ou will probabl feel anxiet evidence of differences between the executive functions and and apprehension. In contrast, a ps chopath, who is low in anxiattention-related abilities, of incarcerated ps chopaths and incar, will probabl be bored, apathetic, and unresponsive. The -08Specificall , Pham et al. (2003) etexcessive 9 0 ceratedanonps chopathic patients. theta waves of ps chopaths ma simpl reflect their 0 2 20 found that, relative to others, ps chopaths evidenced deficits in relative absence of anxiet . their abilities to maintain a plan and to inhibit irrelevant informaAccording to the fearlessness h pothesis, ps chopaths tion. Similar results have been obtained b Blair et al. (2006), possess a higher threshold for experiencing fear than most other suggesting executive cognitive function deficits in ps chopaths. individuals (L kken, 1957, 1982). In other words, things that Two major neurobiological theories have attracted a great deal greatl frighten the rest of us have little or no effect on the c .et al., 2013). Remember that R an was of attention in the area of antisocial personalit and ps chopath : ps chopath (S ngelaki (1) the underarousal h pothesis and (2) the fearlessness h pothof going alone to , unafraid esis. According to the underarousal h pothesis, ps chopaths have dangerous neighbourhoods 8 a 9-to0 bu drugs. According to 0 abnormall low levels of corticalParousal (S lvers et al.,02009). 0 2 2 There appears to be an inverted U-shaped relation between arousal proponents of this h potheand performance, the Yerkes-Dodson curve, which suggests that sis, the fearlessness of the people with either ver high or ver low levels of arousal tend to ps chopath gives rise to all experience negative affect and perform poorl in man situations, the other major features of whereas individuals with intermediate levels of arousal tend to be the s ndrome. c . relativel content and perform satisfactoril in most situations. Earl evidence for the According to the underarousal h pothesis, the abnormall low fearlessness h pothesis came , levels of cortical arousal characteristic of ps chopaths are the from a series a of studies b 9-08 primar cause of their antisocial and risk-taking behaviours; the L kken P (1957) using prison 2020-0 seek stimulation to boost their chronicall low levels of arousal. inmates. In one such stud , This means that R an lied, took drugs, and dug up graves to L kken constructed a classiachieve the same level of arousal we might get from talking on cal conditioning task involvthe phone with a good friend or watching television. ing painful electric shock. His Low-frequenc theta waves are found in brain wave measures dependent measure . specific primar of children and largel disappear in adulthood; ctheir was galvanic skin response purpose is unknown. Evidence suggests that man ps chopaths (GSR), a reaction marked b Ma a , have excessive theta waves when the are awake. This finding an increase in palmar sweat- b a a 8 a 0 9 0 led Robert Hare2(1970) , a c 020 to generate another theor related to ing and t picall interpreted c arousal levels, sometimes referred to as the cortical immaturit a b c . as a sign of autonomic P NEL C BD Cop right 2021 Nelson Education Ltd. All Rights Reserved. Ma not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third part content ma be suppressed from the eBook and/or eChapter(s). Nelson Education reserves the right to remove additional content at an time if subsequent rights restrictions require it. 401 I a aG R c /L P V a J C a L a P ,c 9-08c a 2020-0a A P G Ab o d ce . pr arousal. L kken repeatedl paired a tone stimuA subsequent stud confirmed that MAOA is deficient onl in o(thereconditioned n o d , l n lus) with electric shock to the participants fingertips (the uncondithe affected males (Brunner et al., 1993). The possible genetic o se he presented al Then, 08the tone (conditioned vulnerabilit to react violentl , in combination with certain n 9 o tioned stimulus). 0 s r 0 e 2 P 20occasions. Nonps chopaths showed a stressors, ma result in aggression. But remember that this stimulus) alone on multiple predictable and understandable pattern: when the heard the tone, defect, to date, has been found onl in one famil . It is unlikel their palms began to sweat, signalling that the e pected the shock that all or even most aggressive behaviour will be traced to the to come ne t. Moreover, their GSRs were quite slow to e tinguish. same cause. Finall , social, economic, and cultural factors deterIn contrast, ps chopaths showed a striking pattern: in most cases, mine the t pe and severit of stresses. What this research the e hibited ver weak GSRs to the tones alone, and their GSRs suggests, however, is that just e.the right (or wrong) combination prod c and ps chosocial contributions e r tended to e tinguish rapidl . of genetic, neuro-biological, o n , do This stud b L kken has important implications, suggesting to create devastating outcomes in one Dutch se onl came9together l a 08 n o 0 that ps chopaths ma have difficult associating certain cues or famil . s r 0 e 2 P 20 A stud b Caspi and colleagues (2002) in the United Kingdom signals with impending punishment or danger, much as children are sociali ed to inhibit their behaviour. Most parents do not found evidence suggesting that genetics ma pla a role in punish their children directl on ever occasion for harmful or e plaining wh some males who are maltreated as children grow inappropriate behaviour, but instead rel on cues such as no or up to displa antisocial behaviour, whereas others do not. There, even a threatening stare to inhibit inappropriate behaviour. researchers studied a large sample of male children from birth to Largel because of classical conditioning, such cues tend to be adulthood. Once again, the genetic defect studied in this group d reprowho quite effective substitutes for direct punishment. But if the have involves the gene that produces the en me MAOA. o Children n o d , onl high levels little or no impact on the preps chopathic child, he or she will were maltreated but had the gene of MAOA se conferring 8 buildup al were -0have 9 0 probabl not acquire a well-developed capacit for impulse e pression P (meaning less likel to of 0 ersonthe 2 20 control. certain neurotransmitters during stress and thus better able to Scientific research suggests the possibilit that there ma be a handle stress) were less likel to develop antisocial problems genetic component to one important aspect of ps chopath than maltreated children without this genot pe. The authors aggression. Researchers in the Netherlands are cautiousl opticlaim that their findings ma help e plain wh some but not all mistic after discovering that a gene mutation found in a large victims of abuse grow up to victimi e others (Caspi et al., 2002). e. c Dutch famil ma cause aggression (Brunner et al.,o 1993). Their findings also once again show how genetic and environmend r p how genes The reabout stud is important because it ma dtell usomore tal factors can interact in the development of various forms n o , affect behaviour. Brunner universit of ps chopatholog antisocial personalit in this case (Caspi se onandl his 9colleagues l 8 of atonethefamil a -0males n o 0 hospital tracked the since et al., 2002). 0 2 Persin Nijmegen have 20 1978. Some of the men are prone to particularl violent outbursts. Ps chological and Social Dimensions One raped his sister, two others were arsonists, and still another tried to run over his boss after being told his work wasn t good What goes on in the mind of someone diagnosed with antisocial enough. None of the women in the famil are given to violent personalit disorder or someone with the closel related condioutbursts. tion called ps chopath ? In one of several studies of how ps choce. The evidence for a genetic e planation of these behaviours is paths process reward Newman, Patterson, and d punishment, oand r p e r o impressive. The observation that the condition occurs onl in the Kosson (1987) set up a card-pla ing task on a computer; the n o , d five-cent rewards and fines for correct onl provided e males indicates the gene is probabl on the X chromosome. and incorrect s l 8 -0to ps chopathic and nonps chopathic criminal na bad or 20answers 9 0 Because men have onl one X chromosome, offenders. Persoan 20 mutated gene will show up. Because women have two X chromoThe game was constructed so at first the were rewarded about somes, the tend to have a good or normal gene to balance the 90 percent of the time and fined onl about 10 percent of the time. bad one. Graduall , the odds changed until the probabilit of getting a To further narrow the location of the mutated gene, Brunner reward was 0 percent. Despite feedback that reward was no longer and his colleagues conducted a linkage stud . As ou ma rememforthcoming, the ps chopaths continued to pla and lose. As a ber from Chapter 4, such studies tr to identif marker genes that result of this and other studies, the researchers h pothesiped that d re areroless o n are inherited along with the gene ou are tr ing to locate. Because once ps chopaths set their sights on a reward goal, the o d , l n odeterred we alread know where the marker genes are, we can get a good likel than nonps chopaths despite that the nal tosebe(Dvorak-Bertscha 9-08signs ersoachievable idea of the appro imate location of the mutated gene. goal is noPlonger et al., 2009). 0 2 20-0 Based on the linkage stud and biochemical anal ses, Brunner Again, considering the reckless and daring behaviour of some and his fellow researchers believe the defect involves the gene ps chopaths (robbing banks without a mask and being caught that produces monoamine o idase A, or MAOA. MAOA is an immediatel ), failure to abandon an unattainable goal fits the en me that helps break down neurotransmitters, specificall overall picture. those involved in our fight-or-flight responses to threats and other The influence of the famil has also been of great interest to ce. If researchers. Gerald Patterson s influential work suggests that stresses; the include serotonin, dopamine, and noradrenaline. d o r p re neurotransmit- aggression in children ma escalate in part because of their interthe MAOA en me isn t working o no, these , dproperl l n o e ters ma build sand the affected 8 will have trouble actions with their parents (Granic & Patterson, 2006; Patterson, 9-0people onalupsituations. handling Persstressful 2020For-0e ample, after the deaths of 1982). He found that the parents often give in to the problems close relatives, the two arsonists in the Dutch famil set fires. displa ed b their children. For e ample, parents ask their son to 402 Chap er 13 Personali NEL Cop right 2021 Nelson Education Ltd. All Rights Reserved. Ma not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third part content ma be suppressed from the eBook and/or eChapter(s). Nelson Education reserves the right to remove additional content at an time if subsequent rights restrictions require it. ce. ce. o d ce . make his bed and he refuses. One oparentepells at the bo . He ells incarcerated adolescent offenders. Porter s (1996) intriguing do n , l n back and becomes abusive. At some point his interchange h pothesis is thus deserving of further stud . o e 8 stops fighting and walks al so aversive 0parent n 9 o becomes that the 0 0 e 2 P awa , thereb ending 20 the fight but also letting the son not make An In eg a i e Model his bed. Giving in to these problems results in short-term gains How can we put all this information together to get a better underfor both the parent (calm is restored in the house) and the child standing of people with antisocial personalit disorder? Remem(he gets what he wants), but it results in continuing problems. The ber that research in each area ma involve people labelled as child has learned to continue fighting and not give up, and the having antisocial personalit disorder, people labelled as ps choparent learns that the onl wa to win is to withdraw all pathic, or criminals. the label, it appears these people e. d cWhatever ep ovulnerabilit demands. This coercive famil process combines with other o have a genetic to antisocial behaviours and persono n d factors, such as genetic influences, parents inept monitoring traits. Perhaps this vulnerabilit results in underarousal or e onl of, -alit l a 08 n o their child s activities and less P parental The genetic inheritance might be the propensit for 0-09 fearlessness. e involvement,20to2help maintain the aggressive behaviours (Chronis et al., 2007; Patterweak inhibition s stems and overactive reward s stems that could son et al., 1989; Sansbur & Wahler, 1992). Coercive parenting partiall account for the evidence of differences in cognitions and along with genetics appears to be at least modestl involved emotions (Newman & Wallace, 1993). with the callous-unemotional traits that seem related to later In a famil that ma alread be under stress because of divorce ps chopath (Waller et al., 2014). or substance abuse (Hetherington et al., 1989; Patterson et al., e. Although little is known about which environmental factors 1989), there ma be an interaction st le that actuall encourages p od cet al., pla a direct role in causing antisocial personalit disorder and antisocial behaviour on the part ofothe childe(Wootton o n d ps chopath , evidence from adoption studies strongl suggests 1997). The child s antisocial behaviour alienates e onland, impulsive l a 08 and attracts others n 9 o 0 that shared environmental factors that tend to make famil other children who might be good role models 0 e 2 P 20 members similar are important to the etiolog of criminalit who encourage antisocial behaviour (Vuchinich et al., 1992). and to perhaps antisocial personalit disorder. For example, in the These behaviours ma also result in the child s dropping out of Swedish adoption stud b Sigvardsson, Cloninger, Bohman, and school and a poor occupational histor in adulthood, which help von Knorring (1982), low social status of the adoptive parents create increasingl frustrating life circumstances that further increased the risk of nonviolent criminalit among females. Like incite acts against societ (Caspi et al., 1987). e. disorc children with CDs, individuals with antisocial personalit This is, admittedl , an abbreviated version of a complex and d o p eparental o der come from homes withdinconsistent discipline (e.g., still incomplete scenario. Somehow, biological, ps chological, n o , Robins, 1966).e onl cultural factors combine in intricate wa s to create someone l a -08at the social environment and and n 9 o 0 stud looked like R an. 0 2 Pe One interesting 20 attitudes of neighbourhoods and their effect on violent crime. T ea men Sampson, Raudenbush, and Earls (1997) asked members of cit neighbourhoods questions about the willingness of local residents One of the major problems with treating people in this group is to intervene for the common good, for example, whether neight pical of numerous personalit disorders: these people rarel bours would intervene if children were skipping school and hangidentif themselves as needing treatment. Because of this, and e. manipulative even with their therapists, ing out on the street. The researchers found that the degree of because the can odbecver p e mutual trust and solidarit in a neighbourhood was inversel do most no clinicians are pessimistic about the outcome of treatment for nl , adults who have antisocial personalit disorder, and there are few ooutside e related to violent crime. This stud points out that factors l 9 -0 8 ona with antisocial the famil can influence behaviours Pe associated 2020-0 documented success stories (National Collaborating Centre for personalit disorder. Mental Health, 2009). Antisocial behaviour is predictive of poor A final factor that has been implicated in antisocial personalit prognosis even in childhood (Ka din & Ma urick, 1994). Clinidisorder is the role of stress. One stud found that trauma associcians encourage identification of high-risk children so treatment ated with combat ma increase the likelihood of antisocial behavcan be attempted before the become adults (National Collaboratiour. In this stud , more than 2000 arm veterans of the Vietnam ing Centre for Mental Health, 2009; Patterson, 1982; Thomas, e. War were studied (Barrett et al., 1996). Even after adjusting for 2009). One large stud with violent offenders found d ccogniothat p e o histories of childhood problems, the researchers found that those tive behaviour therap could reduce of violence l , doetthenal.,likelihood on(Olver e who had been exposed to the most traumatic events were most five ears after treatment 2013). Importantl , l 8 a 0 on success0was -09- correlated with ratings likel to engage in violence, illegal activities, l ing, and the use however, Pe treatment 2 20negativel of aliases. Stephen Porter has h pothesi ed that childhood trauma of the ps chopath trait of selfish, callous, and remorseless use ma pla a role in the development of ps chopath . Specificall , of others. In other words, the higher the score on this trait, the when certain individuals are severel traumati ed b loved ones, less successful this group was in refraining from violence after over time the might learn to turn off their emotions as a wa their treatment. of coping. The use of this coping skill could contribute to the The most common treatment strateg for children involves e. result in parent training (Scott et al., 2014; Patterson, 1986; Presnall et al., emotional differences observed in ps chopaths andceven d o p e no (Porter, a ps chopathic personalit 1996). Consistent 2014). Parents are taught how to recogni e behaviour problems , dodisorder l n o e with this possibilit , Campbell,0Porter, and Santor (2004) found earl and how to use praise and privileges to reduce problem l 8 a 09- were associated with the experi- behaviour and encourage prosocial behaviours. Treatment studies Pe thatonhigher ps chopath 2020-scores ence of ph sical abuse in a large sample of male and female t picall show that these t pes of programs can significantl NEL Cl e B Di o de Cop right 2021 Nelson Education Ltd. All Rights Reserved. Ma not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third part content ma be suppressed from the eBook and/or eChapter(s). Nelson Education reserves the right to remove additional content at an time if subsequent rights restrictions require it. 403 Pe al d e l , -08 9 2020-0 e d ce . disorder (Ingoldsb et al., 2012). Given the lo effectiveness of treatment for adults, ho ever, prevention ma be the best approach to this problem. b Pe ali di de People ith borderline personalit disorder lead tumultuous lives. Their moods and relationships are unstable, and usuall the have a ver poor self-image. d ce. The often feel empt and are at great risk of e d ing b their o n hands. Consider the case of ,d l Claire. e 9 -0 8 2020-0 ClaiRe ck.c g a /Sh e Ta g Sakda al de li e Pe A S a ge a gU I have kno n Claire for more than 40 ears and have atched her through the good but mostl bad times of her d e often shak and erratic life as a person ith borderline dschool together , l personalit disorder. Claire and I ent to 8 in touch al e and -0kept from Grade e ve 20-09 Pe8 through high school, 0 2 periodicall . M earliest memor of her is of her hair, hich as cut short and rather unevenl . She told me that Child e i h c d c di de a bec e ad l i h a i cial hen things ere not going ell she cut her o n hair e ali di de . severel , hich helped to fill the void. I later found out that the long sleeves she usuall ore hid scars and cuts improve the behaviours of man children ho displa dantisocial ce . that she had made herself. e Group, 2010; behaviours (Conduct Problems Prevention Research Claire as the first of our friends to smoke. What as l et, d Fleischman, 1981; Patterson al., 1982; Webster-Stratton & unusual about this and her later drug use as not that the e l 8 a 09-0ho ever, put families at Hammond, occurred (this as in the 1960s!) or that the began earl ; it 0-factors, Pe 1997). A number 202of risk for either not succeeding in treatment or for dropping out as that she didn t seem to use them to get attention, like earl ; these include cases ith a high degree of famil d sfuncever one else. Claire as also one of the first hose parents tion, socioeconomic disadvantage, high famil stress, parent s divorced, and both of them seemed to abandon her histor of antisocial behaviour, and severe CD on the part of the emotionall . She later told me that her father as an child (Dumas & Wahler, 1983; Kaminski et al., 2008; Ka din alcoholic ho had regularl beaten her and her mother. She et al., 1993). did poorl in school and d chade.ver lo self-esteem. She e Some researchers are no e amining ho a multifaceted said she as stupid and ugl , et she as d , frequentl approach to treatment can help reduce delinquent behaviour on l obviousl8 neither. e l a 9 -0 the part of juvenile offenders. Programs that Pecombine the behav2020-0 Throughout our school ears, Claire left to n ioural approaches just described ith efforts to improve famil periodicall , ithout an e planation. I learned man ears relationships and provide services to the famil...
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