ANTISOCIAL NARCISSTIC PERSONALITY DISORDERS Tela Wilson Psy D

ANTISOCIAL & NARCISSTIC PERSONALITY DISORDERS Tela Wilson, Psy. D. , Psych II

Objectives § Identify specific personality disorders § Identify common characteristics of the psychopath

§ As a youth, he fought with other boys, stabbed animals with red hot irons, became a thief, spent time in a juvenile detention center. Became an assassin at 23, exiled to Syria and Egypt, before his rise to power. Reported that he shot and killed a member of his cabinet during a meeting. Caused the deaths of thousands. Who is he?

Cluster B Personality Disorders § People with Cluster B disorders tend to be dramatic, emotional, and attention-seeking. § They have intense interpersonal conflicts. § Personality disorders are characterized by inflexible long-standing and maladaptive personality traits that cause significant functional impairment or subjective distress. § § § Temperamental deficiencies Rigidity in dealing with life problems Defective perceptions of self and other

Antisocial personality disorder (301. 7) § Cluster B personality disorder § Pervasive pattern of disregard for, and violation of, the rights of others that begins in childhood or early adolescents and continues into adulthood. § Also referred to a psychopathy, sociopathy or dyssocial personality disorder § At least 18 years old § History of three or more symptoms of Conduct Disorder before age 15. § At least 4 antisocial symptoms as an adult § Fail to conform to social norms with respect to lawful behavior.

§ Irritable and aggressive § Get into fights or commit acts of physical assault. § Lack of empathy § Callous, cynical and contemptous of the feeling, rights and sufferings of others § Excessively opinionated, self-assured and cocky § Glib, superficial charm § Blame victim for being foolish

Psychopaths § Subcategory of APD § more severe § More intense § Cold, callous § Unemotional § White collar psychopaths § Able to control their criminality, but still act out in other ways.

Hare Psychopathy checklist revised § 3 factors § Arrogant & deceitful interpersonal style § Deficient affective experience § Impulsive & irresponsible interpersonal style § Doesn’t believe DSM-IV-TR captures “personality” aspect of the disorder § Overemphasizes behavioral manifestations and criminality

HISTORY § Phillipe Pinel- 1729 § Observed people with explosive & irrational violence. These patients seemed to understand their actions & surroundings, did not display delusions § Manie sans delire – mania without delirium

History continued § 1891 Koch introduced term psychopathic inferiority § attempted to define a physical basis rather than moral condemnation

Statistics § 2% US population § More frequent in urban environments § Lower socioeconomic groups § Rates comparable across ethnicities § 5 x more common among 1 st degree biological relatives of males § 10 x more common among 1 st degree relatives of females

Etiology § APD- brains mature abnormally slow rate § Similarities between the EEGs of adult psychopaths and normal adolescents § Egocentricity § Impulsivity § Selfishness § Unwillingness to delay gratification

§ Early brain damage in frontal cortex § Similarities § Poor long term planning § Low frustration tolerance § Shallow affect § Irritability & aggressiveness § Socially inappropriate behavior § impulsivity

Etiology continued § Prolonged separations from primary caregivers, desertion and divorce (not death) § Father’s antisocial or deviant behavior § Mother’s unaffectionate, neglectful care

Epidemiologic Catchment Area study § Study of psychiatric illnesses § 15, 000 people in 5 US cities § Did not include individuals in prison § Found: § 2 -4% men &. 5 -1% women antisocial § In the US this would mean approximately 7 million Americans antisocial

Treatment Options § Unfortunately, most APD/NPD don’t think § § § anything is wrong with them, referred because of others. Typically untreatable If going to treat, should be highly structured and secure inpatient setting. Use of psychotherapy § Is there capacity of patient to form attachments? § Can patient form genuine emotional relationship with therapist?

European Description of Dissocial Personality Disorder § ICD-10 Classification of Mental and Behavioral Disorders § Personality disorder, usually coming to attention because of a gross between behavior and the prevailing social norms, characterized by at least 3 of the following: § Callous unconcern for the feelings of others § Gross and persistent attitude of irresponsibility and disregard for social norms, rules and obligations § Incapacity to maintain enduring relationships, though having no difficulty in establishing them § Very low tolerance to frustration and low threshold for discharge of aggression, including violence § Incapacity to experience guilty and to profit from experience, especially punishment § Marked proneness to blame others, offer plausible rationalizations § Persistent irritability § Conduct disorder during childhood not always present

§C– §O§R§R§U§P§T- cannot follow the law obligations ignored remorselessness recklessness underhandedness planning deficit Temper

Were they?