Personality Disorders: Crash Course Psychology #34

Summary

This script delves into the complexities of personality disorders, distinguishing between ego-dystonic and ego-syntonic disorders. It outlines the three clusters from the DSM-5, highlighting disorders from eccentric behaviors to dramatic and impulsive traits. The video explores the challenges in diagnosis and the roots of disorders like Borderline and Antisocial Personality Disorders, emphasizing the importance of early intervention and the potential for treatment through understanding the bio-psycho-social factors involved.

Takeaways

• 🗣️ Personality disorders are psychological conditions characterized by inflexible, disruptive, and enduring behavior patterns that impair social functioning.
• 🤔 Ego-dystonic disorders are recognized as problematic by the individual, whereas ego-syntonic disorders, like personality disorders, are not necessarily recognized as problematic by the individual.
• 📚 The concept of personality disorders is relatively new, with modern classifications based on the work of Kurt Schneider, who published a treatise on psychopathy in 1923.
• 📈 The DSM-5 categorizes personality disorders into three clusters: A (odd/eccentric), B (dramatic/impulsive), and C (anxious/fearful).
• 🔍 The most commonly diagnosed personality disorder is 'Personality Disorder Not Otherwise Specified' (PDNOS), indicating the complexity and overlap in diagnosing specific disorders.
• 🧬 The Dimensional Model proposes a shift from discrete disorders to a spectrum of personality traits, assessing individuals on various dimensions rather than specific diagnoses.
• 🤯 Borderline Personality Disorder (BPD) is a complex set of learned behaviors and emotional responses to traumatic or neglectful environments, particularly in childhood.
• 😈 Antisocial Personality Disorder is associated with a lack of conscience and can manifest in various forms, from criminal behavior to successful but ruthless individuals.
• 🧠 Research suggests that Antisocial Personality Disorder may have biological roots, including genetic predispositions and differences in brain structure and function.
• 👶 Early intervention and prevention are key in addressing the development of Antisocial Personality Disorder, focusing on children and adolescents who show warning signs.
• 🌟 The script emphasizes the importance of understanding the diverse factors that contribute to personality disorders and the ongoing efforts to refine diagnostic criteria and treatment approaches.

Q & A

What is the Self-Assessment measure for Personality Disorders?

The Self-Assessment measure for Personality Disorders is a tool that allows patients to describe themselves by ranking statements according to how accurate they believe them to be in relation to their own behavior and feelings.

Why can't self-reporting be fully relied upon to assess certain personality disorders?

Self-reporting can't be fully relied upon because some individuals, particularly those with certain personality disorders, may not acknowledge their issues or may even believe the problem lies with others, leading to inaccurate self-assessment.

What does 'ego-dystonic' mean in the context of psychological disorders?

'Ego-dystonic' refers to psychological disorders where the affected individuals are aware that they have a problem and are generally distressed by their symptoms, such as in Bipolar Disorder or OCD.

What is the difference between 'ego-dystonic' and 'ego-syntonic' disorders?

In 'ego-dystonic' disorders, individuals recognize their issues and are distressed by them. In contrast, 'ego-syntonic' disorders are those where the individual does not perceive a problem with themselves and may even blame others, such as in certain personality disorders.

What are the three clusters of personality disorders according to the DSM 5?

The DSM 5 categorizes personality disorders into three clusters: Cluster A (odd/eccentric), Cluster B (dramatic/emotional/impulsive), and Cluster C (anxious/fearful/avoidant).

Why are personality disorders often considered to be chronic and enduring syndromes?

Personality disorders are considered chronic and enduring because they create noticeable problems in an individual's life, often persisting over time and causing consistent impairment in social and other functioning.

What is the Dimensional Model proposed as an alternative for diagnosing personality disorders?

The Dimensional Model proposes replacing the concept of discrete personality disorders with a range of personality traits or symptoms, assessing each person on a spectrum of these traits rather than diagnosing specific disorders.

What is Borderline Personality Disorder (BPD) and how is it typically misunderstood?

Borderline Personality Disorder (BPD) is a complex set of learned behaviors and emotional responses often linked to traumatic or neglectful environments, particularly in childhood. It was once commonly misunderstood as 'difficult' or 'attention-seeking' behavior by clinicians.

What is Antisocial Personality Disorder and what are some common misconceptions about it?

Antisocial Personality Disorder is characterized by a lack of conscience for wrongdoing and can manifest in various behaviors, from criminal activities to manipulative tendencies in high positions. Misconceptions include equating it with all criminal behavior, whereas not all criminals have this disorder.

How might early signs of psychopathic features be detected in children?

Early signs of psychopathic features in children can be detected as young as age three or four, often manifesting as an impairment in fear conditioning, such as a lower than normal response to typically startling or frightening stimuli.

What are some biological factors linked to Antisocial Personality Disorder?

Biological factors linked to Antisocial Personality Disorder include genetic predispositions, abnormalities in brain structures related to impulse control and empathy, and an overly reactive dopamine reward system influencing impulsive behaviors.

What interventions are suggested for preventing the development of Antisocial Personality Disorder in at-risk children?

Interventions for at-risk children include early identification of warning signs, working with children and families to correct behavior, and removing negative influences, potentially channeling impulsiveness into healthier directions such as athleticism or adventure.

Outlines

00:00

🤔 Understanding Personality Disorders

This paragraph introduces the concept of personality disorders, distinguishing them as 'ego-syntonic' or 'ego-dystonic'. It explains that while some disorders cause distress to the individual, others like personality disorders may not be recognized by the sufferer. The paragraph outlines the chronic nature of these disorders and their impact on social functioning. It also introduces the Self-Assessment measure for Personality Disorders, highlighting the range of behaviors from narcissism to a lack of empathy. Historical context is provided with the work of Kurt Schneider and the current classification in the DSM 5, which divides personality disorders into three clusters: A (odd/eccentric), B (dramatic/impulsive), and C (anxious/fearful). The paragraph concludes by discussing the challenges in diagnosing these disorders and the proposed Dimensional Model as an alternative approach.

05:01

🧐 Delving into Borderline and Antisocial Personality Disorders

The second paragraph delves into two specific personality disorders: Borderline Personality Disorder (BPD) and Antisocial Personality Disorder (ASPD). It describes BPD as a set of learned behaviors and emotional responses to early life trauma, which can manifest in dysfunctional ways such as rage or self-harm. The paragraph acknowledges the progress in psychotherapies that have helped BPD patients, even those with severe symptoms. Moving on to ASPD, the paragraph discusses its more infamous synonyms, 'psychopathy' and 'sociopathy', and describes the typical behaviors of individuals with this disorder, including a lack of conscience and early signs of psychopathic tendencies. It also touches on the prevalence of ASPD in the incarcerated population and explores the potential biological and environmental causes, including genetic factors, early behavioral signs, and neural responses to distressing stimuli.

10:06

📚 Conclusion and Acknowledgments

The final paragraph serves as a conclusion to the video, summarizing the key points discussed about personality disorders, including the distinction between ego-dystonic and ego-syntonic disorders, the three DSM V clusters, and the overlapping symptoms. It also provides a brief overview of the bio-psycho-social roots of Borderline and Antisocial Personality Disorders. The paragraph concludes with acknowledgments to the Crash Course team, including the writer, editor, consultant, and production crew, and an invitation for viewers to support the channel through Subbable.com.

Keywords

💡Personality Disorders

Personality disorders are psychological conditions characterized by enduring patterns of behavior, cognition, and inner experience that deviate from the norms of an individual's culture, are inflexible, and cause distress or impairment. In the video, they are discussed as either 'ego-dystonic' or 'ego-syntonic,' with the latter not necessarily being recognized as problematic by the individual. The script delves into the chronic and enduring nature of these disorders, their impact on social functioning, and their range from narcissism to a lack of empathy.

💡Ego-Dystonic

Ego-dystonic refers to a condition where an individual is aware of their psychological problem and is distressed by it. The video explains that many disorders, such as Bipolar Disorder or OCD, are ego-dystonic, meaning the person recognizes their condition and does not like its effects. This contrasts with ego-syntonic disorders, which are not necessarily recognized as problematic by the individual experiencing them.

💡Ego-Syntonic

Ego-syntonic disorders are those where the individual does not perceive their condition as problematic and may even believe that the problem lies with others. The video script highlights that personality disorders fall into this category, and this lack of self-awareness can make diagnosis and treatment more challenging.

💡DSM 5

The DSM 5, or the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, is the standard classification of mental disorders used by mental health professionals. The video mentions that it contains ten distinct personality disorder diagnoses, grouped into three clusters, which helps in the diagnosis and understanding of these conditions.

💡Cluster A

Cluster A in the DSM 5 refers to a group of personality disorders characterized as 'odd' or 'eccentric.' The video script describes disorders like paranoid personality disorder and schizoid personality disorder as part of this cluster, which are marked by pervasive distrust and aloofness, respectively.

💡Cluster B

Cluster B includes personality disorders characterized by dramatic, emotional, or impulsive behaviors. The video provides examples such as narcissistic personality disorder, with its display of self-importance, and histrionic personality disorder, which involves attention-seeking behaviors that can be self-destructive.

💡Cluster C

Cluster C in the DSM 5 classification refers to personality disorders with anxious, fearful, or avoidant traits. The video script mentions avoidant and dependent personality disorders as part of this cluster, where individuals may avoid social interactions and show a lack of confidence or fear of abandonment.

💡Dimensional Model

The Dimensional Model is an alternative approach to diagnosing personality disorders that focuses on a spectrum of personality traits rather than discrete categories. The video script discusses this model as a work in progress that may evolve the clinical definition of personality disorders, moving away from specific diagnoses to a range of symptoms and traits.

💡Borderline Personality Disorder (BPD)

Borderline Personality Disorder is a specific type of personality disorder that the video script describes in detail. It is characterized by unstable relationships, self-image, and emotions, as well as impulsive behavior. The script explains that individuals with BPD have learned dysfunctional ways to meet their psychological needs, such as love and validation, and that therapies have been effective in helping even the most severely affected patients.

💡Antisocial Personality Disorder

Antisocial Personality Disorder is a personality disorder characterized by a lack of conscience for wrongdoing and a disregard for the rights of others. The video script discusses this disorder in the context of its potential roots in biological, psychological, and environmental factors, and its association with criminal behavior, although not all individuals with this disorder are criminals.

💡Conduct Disorder

Conduct Disorder is a diagnosis typically given to children and adolescents that involves a repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated. The video script mentions it as a precursor to Antisocial Personality Disorder, indicating that early intervention is crucial in preventing the development of this disorder in adulthood.

Highlights

The Self-Assessment measure for Personality Disorders allows patients to rank statements about themselves in terms of accuracy.

Some people with overconfidence or deceitful tendencies may not admit to such traits in self-reporting measures.

Personality disorders are categorized as 'ego-dystonic' or 'ego-syntonic', with the latter not recognizing their issues.

Personality disorders are chronic, enduring syndromes causing significant life problems, ranging from narcissism to lack of empathy.

Psychopathy and sociopathy are severe personality disorders associated with serial killers and mob bosses.

Modern classifications of personality disorders are based on the work of Kurt Schneider, dating back to 1923.

The DSM 5 outlines ten distinct personality disorder diagnoses, grouped into three clusters.

Cluster A personality disorders are characterized as 'odd' or 'eccentric', such as paranoid and schizoid personality disorders.

Cluster B includes dramatic and impulsive characteristics like narcissistic and histrionic personality disorders.

Cluster C involves anxious, fearful, or avoidant traits, such as avoidant and dependent personality disorders.

The Dimensional Model proposes a range of personality traits instead of discrete disorders, assessing each person on various dimensions.

Borderline Personality Disorder (BPD) is a complex set of learned behaviors and emotional responses to trauma.

Antisocial Personality Disorder is associated with a lack of conscience and can lead to criminal behavior or manipulative success.

Causes of Antisocial Personality Disorder likely involve a mix of genetic and environmental factors, including fear conditioning impairments.

Neural studies show reduced activity in the frontal lobe of individuals with psychopathic features, linked to impulse control.

Early interventions and behavior corrections can help prevent the development of Antisocial Personality Disorder in at-risk children.

Personality disorders are a diverse group of conditions with overlapping symptoms and various underlying factors.

Transcripts

I can be smooth and charming and slick. I can make a very confident impression and

it's hard to leave me at a loss for words.

Sometimes I find myself fantasizing about unlimited success and power, and beauty.

I have repeatedly used deceit to cheat, con, or defraud others for my personal gain. To

be honest, I don't have much concern for the feelings of other people, or their suffering.

Doesn't sound like the Hank you know, does it?

These are all statements from the Self-Assessment measure for Personality Disorders, that lets

patients describe themselves, ranking each statement in terms of how accurate they think it is.

To be honest, you can't rely too much on this kind of self-reporting to assess what we are

talking about today because while some people who are over-confident or obsessed with power

or downright deceitful might tell you that they are, there is a certain subset that won't.

Many of the disorders that we have talked about so far are considered, "ego-dystonic"

meaning that people who have them are aware that they have a problem and tend to be

distressed by their symptoms.

Like a person with Bipolar Disorder or OCD generally knows that they have a psychological

condition and they don't like what it does to them.

But some disorders are trickier then that. They are "ego-syntonic," the person experiencing

them doesn't necessarily think that they have a problem and sometimes, they think the problem

is with everyone else.

Personality disorders fall into this category. These are psychological disorders marked by

inflexible, disruptive, and enduring behavior patterns that impair social and other functioning

-- whether the sufferer recognizes that or not.

Unlike many other conditions that we've talked about, personality disorders are often considered

to be chronic and enduring syndromes that create noticeable problems in life.

And as you can tell from these self assessment statements, they can range from relatively

harmless displays of narcissism, to a true and troubling lack of empathy for other people.

Not only can personality disorders be difficult to diagnose and understand, they can also

be downright scary. Most of the extreme and severe disorders go by names that you probably

recognize: psychopathy and sociopathy. I'm talking, like, serial killers here, mob bosses, Vlad the Impaler.

Cultures have been studying human personality characteristics for thousands of years, but

the concept of personality disorders is a much newer idea.

Much of our modern classifications of these disorders are based on the work of German

psychiatrist, Kurt Schneider, who was one of the earliest researchers into what was

then known as psychopathy and published a treatise on the study in 1923.

Today, the DSM 5 contains ten distinct personality disorder diagnoses, grouped into three clusters.

The first cluster, cluster A, includes what are often labeled simply as "odd" or "eccentric"

personality characteristics. For example, someone with paranoid personality disorder

may feel a pervasive distrust of others and be constantly guarded and suspicious while

a person with a schizoid personality disorder would seem overly aloof and indifferent, showing

no interest in relationships and few emotional responses.

Cluster B encompasses dramatic emotional or impulsive personality characteristics. For

example, a narcissistic personality can display a selfish grandiose sense of self-importance

and entitlement. Meanwhile, a histrionic personality might seem like they're acting a part to get

attention, even putting themselves at risk with dramatic, dangerous, and even suicidal

gestures. The behavior of Cluster B can be truly self-destructive and frightening, and

these disorders are often associated with frequent hospitalization.

Finally, Cluster C encompasses anxious, fearful, or avoidant personality traits. For example,

those with avoidant and dependent personality disorders often avoid meeting new people or

taking risks and show a lack of confidence, an excessive need to be taken care of, and

a tremendous fear of being abandoned. Now, in the past, and, to a great extent, today,

some of these categories have been controversial. Many researchers argue that some of these

conditions overlap with each other so much that it can be impossible to tease them apart.

Narcissistic personality disorder, for example, has many traits that resemble histrionic personality

disorder. And because of this gray area, the most commonly diagnosed personality disorder

is actually personality disorder not otherwise specified or PDNOS. The prevalence of this

diagnosis suggests that while clinicians can identify a personality disorder in a patient,

figuring out the details of the condition can be messy and difficult.

One proposed alternative for diagnosing these disorders is the Dimensional Model, which,

in essence, gets rid of discrete disorders and replaces them with a range of personality

traits or symptoms, rating each person on each dimension. So the Dimensional Model would

assess a patient not with the aim of diagnosing one disorder or another, but instead, simply

finding out that they rank high on say, narcissism and avoidance. It's a work in progress, so

with another generation, the clinical definition of "personality disorder" may evolve pretty radically.

One of the best-studied personality disorders right now is Borderline Personality Disorder,

or BPD. Borderline makes it sounds like patients are like, pretty close to being healthy, but

not quite, but that is not at all the case. BPD sufferers have often learned to use dysfunctional,

unhealthy ways to get their basic psychological needs met, like love and validation, by using

things like outbursts of rage, or on the other end of the spectrum, self-injury behaviors

like cutting or worse. People with BPD were once commonly maligned by clinicians as 'difficult'

or 'attention-seeking', but we now understand BPD as a complicated set of learned behaviors

and emotional responses to traumatic or neglectful environments, particularly in childhood. In

a sense, people with this disorder learn that rage or self-harm helped them cope with traumatic

situations, but as a result, they also end up using them in non-traumatic situations.

Although challenging for patients and clinicians alike, the good news is that some psychotherapies

have helped even the most severely suffering, repeatedly hospitalized BPD patients.

But probably the most famous well-established, and frankly, troubling personality disorder

is Antisocial Personality Disorder. Now, you've heard of this before, but maybe by one of its now

somewhat out of vogue synonyms, "psychopathy" or "sociopathy." People with Antisocial Personality

Disorder, usually men, exhibit a lack of conscience for wrongdoing, even towards friends and family

members. Their destructive behavior surfaces in childhood or adolescence, beginning with

excessive lying, fighting, stealing, violence, or manipulation. As adults, people with this

disorder are thought to generally end up in one of two situations: either they are unable

to keep a job and engage in violent criminal or similarly dysfunctional behavior; or they

become clever, charming con-artists, or ruthless executives who make their way to positions

of power. Tony Soprano would have qualified for a diagnosis, even if he wasn't nearly

as bad as, say, serial killer Ted Bundy or Vlad the Impaler, the infamous 15th century

Romanian prince who personally watched about 100,000 people get impaled or have the skin

of their feet licked off by goats.

Yeah. That happened.

Despite this classic remorselessness, lack of empathy, and sometimes criminal behavior,

criminality is not always a component of antisocial behavior. Certainly many people with criminal

records don't fit that psychopathic profile. Most show remorse, love, and concern for friends

and family. But still, although anti-social personalities make up just about 1% of the

general population, they were estimated in one study to constitute about 16% of the incarcerated population.

So, how might someone end up with such a disturbing disorder? Well, as you might expect, the causes

are probably a tangled combination of biological and psychological threads, both genetic and environmental.

Although no one has found a single genetic predictor of Antisocial Personality Disorder,

twin and adoption studies do show that relatives of those with psychopathic features do have

a higher likelihood of engaging in psychopathic behavior themselves. And early signs are sometimes

detected as young as age three or four, often as an impairment in fear conditioning, in

other words, lower than normal response to things that typically startle or frighten

children like loud and unpleasant noises. Most kids only need to get burned by a hot

dish once to know to stay away, but kids who end up displaying Antisocial Personalities

as adults don't necessarily connect or care about the learned consequences when they're little.

From there, like we've seen in other disorders, genetic and biological influences can intersect

with an abusive or neglectful environment to help wire the personality in a peculiar

and damaged way. While the vast majority of traumatized people don't grow up to be killers

or con-artists, genes do seem to predispose some people to be more sensitive to abuse or trauma.

Meanwhile, studies exploring the neural basis of Antisocial Disorder have revealed that

when shown evocative photographs, like a child being hit or a woman with a knife at her throat,

those with psychopathic personality features showed little change in heart rate and perspiration,

as compared to control groups.

And the classic antisocial lack of impulse control and other symptoms have also been

linked to deficits in certain brain structures. One study compared PET scans from 41 people

convicted of murder to those of non-criminals and found that the convicted killers had greatly

reduced activity in the frontal lobe, an area associated with impulse control and keeping

aggressive behavior in check. In fact, violent repeat offenders had as much as 11% less frontal

lobe tissue than the average brain. Their brains also responded less to facial displays

of stress or anguish, something that's also observed in childhood, so it's possible that

some antisocial personalities lack empathy because they simply don't or can't register

others' feelings. Research has also suggested an overly reactive dopamine reward system,

suggesting that the drive to act on an impulse to gain stimulation or short-term rewards

regardless of the consequences may be more intense than the average person's.

As we mentioned before, because personality disorders are pretty much egosyntonic by definition,

people don't often acknowledge that they have a problem or a need for treatment - and in

the case of Antisocial Personality Disorder, even if they did, there aren't many specific

treatments available, at least not for adults.

But there are some promising interventions for kids and adolescents whose minds and brains

are more plastic and adaptable. In this way, the best way to treat Antisocial Personality

Disorder may be in trying to prevent it. According to American psychiatrist Donald W. Black,

among others, many kids diagnosed with Conduct Disorder, the diagnostic precursor to Antisocial

Disorder, are at high-risk for developing Antisocial Personalities as adults. But by

identifying warning signs early on and by working with these kids and families to correct

their behavior and remove negative influences, some of that impulse fearlessness could be

channeled into healthier directions, like to reward promoting athleticism, or a spirit

of adventure. It's important to remember that Antisocial Personality Disorder is only one

type of personality disorder. This is a diverse family of psychological conditions determined

by many different factors and we're still in the early stages of diagnosing and understanding

the mechanisms behind them.

Today, you learned about personality disorders and the difference between ego-dystonic and

ego-syntonic disorders. We looked at the three clusters of personality disorder, according

to the DSM V, and how personality disorder symptoms often overlap. We also took a look

at Borderline and Antisocial Personality Disorders, including their potential bio-psycho-social roots.

Thank you for watching, especially to all of our Subbable subscribers, without whom

we could not make Crash Course. To find out how you can become a supporter, just go to

Subbable.com/CrashCourse.

This episode was written by Kathleen Yale, edited by Blake de Pastino, and our consultant

is Dr. Ranjit Bhagwat. Our director and editor is Nicholas Jenkins, the script supervisor

and sound designer is Michael Aranda, and the graphics team is Thought Cafe.