ANTISOCIAL & NARCISSTIC PERSONALITY DISORDERS

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

2. Objectives Identify specific personality disorders Identify common characteristics of the psychopath

3. 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?

5. 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

6. 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.

7. 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

8. 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.

10. 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

11. 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

12. History continued - • 1891 Koch introduced term psychopathic inferiority • attempted to define a physical basis rather than moral condemnation

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

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

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

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

17. 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

18. 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?

19. 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

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

21. Were they?