Understanding Abnormal Behavior
, Eighth Edition
Personality Disorders and Impulse Control Disorders
The personality disorders (p.
235) Personality disorders involve longstanding,
inflexible, and maladaptive behavior patterns that produce personal and social
difficulties, personal distress, or problems in functioning in society. They
account for about 5 to 15 percent of admissions to hospitals and outpatient
clinics; lifetime prevalence for all of them is 10 to 13 percent. Men are
more likely than women to be diagnosed with some of the personality disorders,
whereas women are more likely to be diagnosed with others. There are reasons
to suggest that the gender distribution may be due to bias in diagnosing.
Diagnosis is made on Axis II of the DSM, but diagnosis is difficult because
symptoms represent extremes of normal personality traits, are rarely stable
across situations, and may overlap with other disorders. Further, clinicians
often render diagnoses inconsistent with DSM criteria. To be considered disorders
personality patterns must cause significant impairment in functioning or subjective
distress, a constellation of characteristics must be found, the personality
pattern must characterize the persons current and long-term functioning,
and the pattern must not be limited to episodes of illness. Further, there
may be questions about the universality of these disorders and the cultural
validity of DSM-IV-TR personality disorders.
Etiological and treatment
considerations for personality disorders (p. 237) There is insufficient
empirical research pertaining to the personality disorders. Researchers have
found the five-factor model (FFM) may be a good way to describe personality
and personality disorders. The five factors are neuroticism, extraversion,
openness to experience, agreeableness, and conscientiousness. Personality
disorders may be exaggerations of these traits. Heredity partially explains
the development of personality styles, but family environment is also crucial.
As varied as the theories of cause may be, so are the treatment approaches.
Many people with personality disorders resist treatment, and there is little
research on success rates for the full range of disorders. DSM-IV-TR lists
ten personality disorders in three clusters: odd or eccentric behaviors; dramatic,
emotional, or erratic behaviors; and anxious or fearful behaviors.
by odd or eccentric behaviors (p. 238) Paranoid
personality disorder is characterized by suspiciousness, hypersensitivity,
and reluctance to trust others. DSM-IV-TR estimates the prevalence of paranoid
personality disorder as between 0.5 and 2.5 percent. Psychodynamic explanations
emphasize the role of projection in the disorder, Schizoid
personality disorder is marked by aloofness and voluntary social isolation.
To avoid conflicts and emotional involvements, these people withdraw from
others or comply superficially with requests from others. The relationship
between this disorder and schizophrenia is not clear. Schizotypal
personality disorder involves odd thoughts and actions, such as speech
oddities or beliefs in personal magical powers, and poor interpersonal relationships.
It occurs in approximately 3 percent of the population. Odd though their behaviors
are, individuals with this disorder are not as impaired as people with schizophrenia.
There is some evidence of genetic links between the two disorders.
by dramatic, emotional, or erratic behaviors (p. 243) Histrionic
personality disorder is marked by self-dramatization, exaggerated emotional
expression, and attention-seeking behaviors. It affects 1 to 3 percent of
the population. Biological factors, such as autonomic or emotional excitability,
and environmental factors, such as parental reinforcement of attention-seeking
behaviors, may influence the development of histrionic personality disorder. Narcissistic personality disorder involves an exaggerated
sense of self-importance, exploitative attitude, and lack of empathy. People
with this disorder may use denial to ward off feelings of inferiority. Prevalence
is about 1 percent. Antisocial personality disorder involves
exploitation of others, irresponsibility, and guiltlessness, and is far more
common in men than women. Borderline personality disorder is
characterized by extreme fluctuations in mood: friendly one day, hostile the
next. People with this disorder also lack identity, feel lost and empty; they
engage in self-destructive behaviors. The core aspects seem to be difficulty
in regulating emotions, and intense, unstable relationships. This disorder
is the most commonly diagnosed personality disorder and is estimated to occur
in 2 percent of the population, with females three times more likely to receive
the diagnosis than men. The disorder has been conceptualized from a psychodynamic
perspective (object splittingeither people are completely good or completely
bad), a social learning viewpoint (conflict between attachment to others and
avoidance of such engagement), and a cognitive approach (distorted attributions
and assumptions). There is much more theory than research evidence.
by anxious or fearful behaviors (p. 247) Individuals with avoidant
personality disorder desire interpersonal contact but fear social rejection;
they avoid situations that might lead to criticism. Their primary defense
mechanism is fantasy, and their social skills are weak. Prevalence is about
1 percent of the population, with no gender differences and there seems to
be disagreement about whether it is a separate diagnosis from social phobia
or an extension of that disorder. People with dependent
personality disorder are characterized by an extreme lack of self-confidence,
reliance on others for decisions, and an ingrained assumption that they are
inadequate and must be cared for by others. Prevalence of the disorder is
about 2.5 percent. Obsessive-compulsive personality disorder is
marked by excessive perfectionism, devotion to details, rigidity, and indecisiveness.
Unlike obsessive-compulsive disorder, there are no recurrent unwanted thoughts
or ritualistic actions. Prevalence is about 1 percent, with twice as many
males as females having the disorder.
disorder (p. 250) Other terms for this disorder are sociopathic and psychopathic personality. Cleckleys (1976) classic
description of antisocial personality disorder includes
superficial charm, shallow emotions and lack of guilt, unplanned actions,
failure to learn from experiences, absence of anxiety, and irresponsibility.
DSM-IV-TR criteria do not include lack of anxiety, shallow emotions, failure
to learn, and superficial charm. They do include being at least 18 years old,
having a history of breaking laws since age 15, aggressiveness, impulsivity,
and lack of remorse. Research by Hare et al. using their Psychopathic Checklist-Revised
(PCL-R), suggests three factors: arrogant and deceitful interpersonal style,
deficient affective experience, and impulsive and irresponsible behavioral
style. A subscale of the PCL-R is a good predictor of violence. Cleckleys
traits seem to be retained as psychopathic criminals age, the DSM-IV-TR characteristics
seem to decline with age. The prevalence in the United States is about 2 percent,
with three times more men than women being diagnosed. Although there are socioeconomic
differences, there are no racial differences in prevalence. Criminals are
not necessarily antisocial personalities; they often have a sense of loyalty
to others and feelings of guilt, which are missing in antisocial personalities. Primary psychopaths feel no guilt over antisocial behaviors, secondary psychopaths do.
Explanations of antisocial
personality disorder (p. 252) Psychoanalytic theory stresses a lack
of parental identification and consequent superego deficiency. Family and
socialization theory stresses parental reject ' ion and modeling of antisocial
behavior by fathers. Poor parental supervision predicts delinquency better
than poverty or divorce. Genetic influences are supported by evidence of MZ
twin concordance and greater likelihood of the disorder in the adoptees of
antisocial biological parents. Central nervous system theory maintains that
antisocial personalities have abnormal EEGs. Autonomic nervous system theory
stresses antisocial personalities low anxiety level and thrill seeking
to counteract general underarousal. Lykken and Farley suggest that psychopaths
and heroes have traits of fearlessness or thrill seeking in common (they are
called Big Ts). Little ts prefer
certainty and low conflict. Antisocial personalities are also influenced by
the kind and certainty of punishment (monetary loss is effective; shock and
verbal are not). Psychopaths may also have an emotional imagery deficit: they
have trouble forming associations between perceptual memory and responding.
Treatment of antisocial
personality disorder (p. 259) Owing to their lack of anxiety, antisocial
personalities are poorly motivated to change. Behavior modification and cognitive
therapies have been somewhat helpful, but effective treatments for antisocial
personality are rare. The focus might be placed on youths, who are more amenable
Disorders of impulse
control (p. 260) Impulse control disorders are
unrelated to personality disorders and are included in this chapter for the
sake of convenience. These disorders involve an inability to resist the temptation
to perform some act, a feeling of tension before the act, and a sense of excitement,
release, and sometimes guilt afterward. Intermittent explosive
disorder is marked by brief episodes of losing control, leading to
destruction of property or assaults on other people. Kleptomania involves
stealing, even when the article is not needed. It appears to be more common
in women than men. Pathological gambling involves
an inability to resist impulses to gamble and afflicts 1 to 3 percent of American
adults. Cognitive-behavioral approaches focus on the erroneous beliefs gamblers
have about their ability to influence outcomes that are governed by chance. Pyromaniacs repeatedly and deliberately set fires without
the motive of revenge. Children who are fire-setters are more often boys than
girls and have problems with impulsivity and hostility. Trichotillomania is
the inability to refrain from pulling out ones hair. It is probably
more common in women than men; about 1 percent of college students have a
past or current history of the disorder.
Etiology and treatment
of impulse control disorders (p. 265) Little research has been done
on the causes of these disorders. In some ways, impulse control disorders
are similar to obsessive compulsive, substance abuse, and sexual disorders.
Psychodynamic theory stresses sexual symbolism; behavioral theory focuses
on classical conditioning, reinforcement, and modeling; and biological theory
points out greater thrill seeking in pathological gamblers. Lesieur (1989)
notes two schools of thought: impulse control problems range on a continuum,
or they are disease-like (one either has the disorder or not). Behavioral
and cognitive treatments have had some success, as have insight therapies
and self-help groups such as Gamblers Anonymous.