READ: Personality Disorders

Mental Disorders

Mental disorders sometimes play a part in why someone commits a crime. There are many different types of mental disorders and many of them are not usually associated with crime. In this course we will focus on personality disorders because they are more commonly associated with crime.

Before we learn more about this topic, keep in mind that many people are affected by mental disorders. Possibly yourself, or someone you know may have a personality disorder. Just because someone has a mental disorder does not mean that the person is a criminal, or that they are likely to commit a crime. Many people are able to live healthy lives despite having a mental disorder.

The purpose of this section is to point out that sometimes people commit crimes because they are not mentally sound. It is the job of forensic psychologists to determine if a suspect suffers from a mental disorder that could have contributed to the crime they committed. Some examples of this would be mass shooters or serial killers. When these type of criminals are tried in court, their mental state often comes into question. It is not hard to see that a person who decides that it would be okay to kill many people is often not in a good mental state.

The following pages include some general information about personality disorders and how they are diagnosed by psychologists.

Diagnosing Mental Disorders

Diagnosing Mental Disorders

When a psychologist is brought in to help assess the mental state of a suspect, they use what is known as psychotherapy and the DSM to analyze the mental health of the suspect. Psychotherapy basically means that they talk to the suspect and ask specific questions to get a better sense of their mental health. The DSM is a manual that helps psychologists come to a diagnosis. Both are described in more detail below.

Defining Psychotherapy

Psychotherapy is a term that describes many forms of talk therapy, all of which aim to explore distressing thoughts, feelings and behaviors.Psychotherapy is an umbrella term that describes a number of different forms of talk therapy. Other terms that can be used more or less interchangeably with the term psychotherapy include counseling and therapy. Psychotherapy is defined by the interaction or treatment between a trained professional and a client, patient, family, couple, or group. The problems addressed are psychological in nature and can vary in terms of causes, influences, triggers, and resolutions.

What Is The DSM?

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is the standard classification of mental disorders used by mental health professionals in the United States.The DSM is the manual that guides diagnoses of psychological disorders; ithas been revised many times, and is both praised and criticized. It contains lists of diagnostic criteria for every psychiatric disorder recognized by the U.S. healthcare system. The current edition is used by professionals in a wide array of contexts, including psychiatrists, physicians, psychologists, social workers, nurses, occupational and rehabilitation therapists, and counselors. The DSM is often considered a "necessary evil", having many flaws but being the only widely accepted method of diagnosing mental disorders.

Personality Disorders

Personality Disorders

Personality, defined psychologically, is the set of enduring behavioral and mental traits that distinguish human beings. Hence, personality disorders are defined by experiences and behaviors that differ from societal norms and expectations. Those diagnosed with a personality disorder may experience difficulties in cognition, emotiveness, interpersonal functioning or control of impulses. These disorders are characterized by enduring maladaptive patterns of behavior, cognition and inner experience, exhibited across many contexts and deviating significantly from cultural norms.

Patterns within personality disorders develop early and are inflexible. Though personality disorders are typically associated with significant distress or disability, they are ego-syntonic, which means that individuals do not feel as though their values, thoughts and behaviors are out of place or unacceptable; in other words, they are consistent with their own ideal self-image.

Boundless Psychology Textbook, CC-BY-SA 3.0

Antisocial Personality Disorder

Antisocial Personality Disorder

Antisocial personality disorder (ASPD) is characterized by a pervasive pattern of disregard for (or violation of) the rights of others. There may be a poor moral sense or conscience, and a history of crime, legal problems, impulsivity, and aggressive behavior. One of the most important features of ASPD is the individual's lack of remorse or guilt for the acts they have committed. While many individuals break the law and engage in antisocial behavior, it is not appropriate to assume that antisocial behaviors indicate the antisocial personality disorder. Individuals with ASPD do not feel as though they are doing anything wrong, necessarily, and are able to internally justify all of their behaviors and actions. Antisocial personality disorder is sometimes referred to as psychopathy or sociopathy, though the criteria might be slightly different depending on the method of diagnosis.

Though the word "antisocial" is often used to indicate someone who does not like interacting with others, or may be shy or reserved, these characteristics have little to nothing to do with ASPD, and should not necessarily be associated.

Symptoms and Diagnosis

The DSM describes ASPD as a pervasive pattern of disregard for, and violation of, the rights of others occurring since age 15, as indicated by three (or more) of the following:

• Failure to conform to social norms with respect to lawful behaviors, as indicated by repeatedly performing acts that are grounds for arrest;

• Deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure;

• Impulsivity or failure to plan ahead;

• Irritability and aggressiveness, as indicated by repeated physical fights or assaults;

• Reckless disregard for safety of one's self or others;

• Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations; and

• Lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another.

• The individual must be at least 18 years old, there must be evidence of Conduct Disorder  with onset before age 15, and the occurrence of antisocial behavior must not exclusively be during the course of Schizophrenia or a Manic Episode.

Conduct Disorder

Features of conduct disorder (CD) are necessary for a diagnosis of ASPD. CD is childhood behavior disorder characterized by aggressive and destructive activities that violate social norms and the rights of others.

Causes and Prevalence

ASPD seems to be caused by a combination of both genetic and environmental influences. Genetic influences draw on the temperament and the kind of personality a person is born with, and environmental influences include the way in which a person grows up, and the experiences they have had. Traumatic events can lead to a disruption of the standard development of the central nervous system, which can generate a release of hormones that can change normal patterns of development. One of the neurotransmitters that have been discussed in individuals with ASPD is serotonin.

ASPD is seen in up to 30% of psychiatric outpatients. The prevalence of the disorder is even higher in selected populations, like prisons, where there is a preponderance of violent offenders. Approximately 47% of male prisoners and 21% of female prisoners have ASPD. Similarly, the prevalence of ASPD is higher among patients in alcohol or other drug abuse treatment programs, than in the general population. Furthermore, ASPD is diagnosed three times more frequently in men than in women.

Boundless Psychology Textbook, CC-BY-SA 3.0

Other Personality Disorders

Other Personality Disorders in the DSM

There are 10 personality disorders in the DSM, each defined by experiences and behaviors that differ from societal norms and expectations.

Clusters and Characteristics of Personality Disorders

TheDSM-5 lists ten personality disorders, grouped into three clusters based on common features. Personality disorders are often researched in these "clusters", since they all exhibit common disturbances.

Cluster A (odd and eccentric)

• Paranoid: Characterized by a pattern of irrational suspicion and mistrust of others, and the interpretation of motivations as malevolent. The person is guarded, defensive, distrustful, suspicious, and always seeking confirmatory evidence of hidden schemes .

• Schizoid: Lack of interest and detachment from social relationships, and restricted emotional expression. The individual is apathetic, indifferent, remote, solitary, distant, and humorless. They neither desire, nor need, human attachments, and withdraw from relationships and prefers to be alone.

• Schizotypal: A pattern of extreme discomfort interacting socially, and distorted cognitions and perceptions.  One is eccentric, self-estranged, bizarre, absent, and exhibits magical thinking and strange beliefs.

Cluster B (dramatic, emotional, or erratic)

• Antisocial: A pervasive pattern of disregard for, and violation of, the rights of others, and a lack of empathy. One is Impulsive, irresponsible, deviant, unruly, inconsiderate, sometimes violent, and meets social obligations only when self-serving.

• Borderline: A pervasive pattern of instability in relationships, self-image, identity, behavior and affect, often leading to self-harm and impulsivity. One is unpredictable, manipulative, unstable, and frantically fears abandonment and isolation. One shifts rapidly between loving and hating.

• Histrionic: A pervasive pattern of attention-seeking behavior and excessiveemotions. One is dramatic, seductive, shallow, stimulus-seeking, and vain. One overreacts to minor events and is exhibitionistic.

• Narcissistic: A pervasive pattern of grandiosity, need for admiration, and a lack of empathy.

Cluster C (anxious or fearful)

• Avoidant: Pervasive feelings of social inhibition and inadequacy, and extreme sensitivity to negative evaluation. One is hesitant, self-conscious, embarrassed, anxious, and sees self as inept, inferior, or unappealing.

• Dependent: A pervasive psychological need to be cared for by other people. One is helpless, incompetent, submissive, immature, and sees self as weak or fragile.

• Obsessive-compulsive (not the same as obsessive-compulsive disorder): Characterized by a rigid conformity to rules, perfectionism, and control. One maintains a rule-bound lifestyle, adheres closely to social conventions, sees the world in terms of regulations and hierarchies, and often follows directions and rules to the point of missing the purpose of the task.

Boundless Psychology Textbook, CC-BY-SA 3.0

Challenges

Challenges

Management and treatment of personality disorders can be a challenging and controversial area, since symptoms are enduring and affect multiple areas of functioning. Community mental health services may view individuals with personality disorders as too complex or difficult, and may directly or indirectly exclude individuals with such diagnoses or associated behaviors. The disruptive nature of individuals with personality disorders makes them, quite possibly, the most challenging group of conditions to manage.

Additionally, an individual may not consider their personality to be a disorder, or the cause of problems. This may be the patient's lack of insight into their own condition, an ego-syntonic perception of the problems with their personality that prevents them from experiencing it as being in conflict with their goals and self-image, or by the simple fact that there is no distinct or objective boundary between 'normal' and 'abnormal' personalities. Unfortunately, there is substantial social stigma and discrimination related to the diagnoses.

Boundless Psychology Textbook, CC-BY-SA 3.0