In this video I describe the symptoms and prevalence of several disorders in the DSM-5 category of Personality Disorders. I also briefly discuss differences between antisocial personality disorder, psychopathy, and sociopathy and the Psychopathy Checklist created by Robert Hare.
The Psychopath Test: A Journey Through the Madness Industry – Jon Ronson (Amazon affiliate link)
Video Transcript
Hi, I’m Michael Corayer and this is Psych Exam Review. In this video we’re going to look at the category of personality disorders in the DSM-5. Now in most of the other videos in this unit I’ve talked about changes between the DSM-IV and the DSM-5 and what’s unique about this category is that we see it’s identical in the DSM-5 and in the DSM-IV. So this is not to suggest that everything is settled and there’s no debate or disagreement when it comes to personality disorders, in fact, some fairly large changes were proposed for this category but none of these changes were adopted and as a result we have the identical criteria that we had in the DSM-IV.
So what exactly do we mean by a personality disorder? This refers to a pattern of behavior beginning around adolescence or early adulthood which differs from cultural expectations for behavior and is resistant to change and seems to be stable over time and situations and which causes distress or impairment. So if a person has certain traits and behaviors that match that description then they might be diagnosed with a personality disorder. And in order to receive that diagnosis they need to be at least 18 years old. So personality is seen as a bit more malleable or changing before that time and so you wouldn’t get a diagnosis of a personality disorder in childhood. But after the age of 18 you might get this diagnosis and the diagnosis would then fall into one of three clusters; cluster A, cluster B, and cluster C. It is also possible, however, to get a personality disorder unspecified diagnosis and that means that the person has many of these symptoms and they have distress or impairment associated with certain personality traits and behaviors but none of these meet the full criteria for a particular disorder in this category. So that’s where they might get the unspecified label.
Okay so let’s take a brief look at the ten disorders that we find in this section. First we have cluster A, and this refers to personalities that are seen as odd or eccentric. So a paranoid personality disorder refers to a main symptom of distrust and suspicion of others, in schizoid personality disorder we have a main symptom of social detachment, so detachment from others and a reduced range of emotional expression, and lastly we have schizotypal personality disorder and this refers to acute discomfort in close relationships as well as perceptual or cognitive distortions and eccentricities of behavior.
Next we have cluster B and this refers to personalities that are dramatic, emotional, or erratic. And first we have antisocial personality disorder and the main symptom here is a disregard and violation of the rights of others, we have histrionic personality disorder, which refers to being excessively emotional or attention-seeking, we have narcissistic personality disorder which refers to grandiosity, a need for admiration from others, and a lack of empathy, and borderline personality disorder which refers to instability of one’s relationships and self-image and high impulsivity.
Okay next we have cluster C and this refers to personalities that are seen as anxious or fearful. So we have dependent personality disorder and this refers to a person who is overly submissive and shows clinging behavior and a need to be taken care of by others. We have avoidant personality disorder and this refers to social inhibition and feelings of inadequacy and sensitivity to negative evaluations. And lastly we have obsessive-compulsive personality disorder and this refers to a preoccupation with orderliness, perfectionism, and control. And it’s important to note that this is not the same criteria as for obsessive-compulsive disorder which is in a separate category and which I talked about in a previous video.
Ok, so one of the challenges of thinking about personality disorders is thinking about the challenges of personality. So if you watched my videos in the unit on personality then you’ve already seen how complex it is. It’s really hard to assess personality, to determine which traits are important for thinking about how people differ from one another. And we also have this challenge of knowing why these behaviors or traits differ. Is it something about the person, is that their disposition or is it these situations that the person is in? We have what’s called the person-situation controversy and this is a real challenge when it comes to assessing personality, even if we’re just trying to assess a personality in somebody who’s not showing distress or impairment.
So having the additional impairment or distress that’s involved makes this even more challenging and we might wonder just how well we can assess somebody and then determine whether or not they have a disorder. And related to that we have the problem if we’re defining certain aspects of personality as being symptomatic of disorder, we might wonder whether we’re just using this as a way to label people with the traits that we don’t like. There’s certain personality traits that we might find grating or we might dislike in others, and they might cause distress or impairment, but are we just labeling people this way? You know, at what point do we say that narcissism is just an annoying trait that somebody has versus when we think they actually have a disorder that might require that they be treated? And this is a big challenge for thinking about personality disorders.
We can also look at the prevalence of personality disorders and see for cluster A it’s about 5.7%, cluster B it’s about 1.5% and cluster C is about 6%. But the overall prevalence is about 9.1% and this brings back an important point that I talked about in a previous video which is that prevalence rates are not additive. So you might look at that initially and think that the total prevalence must be around 13%, but of course it’s a bit lower than that and the reason it’s a bit lower is that this includes co-occurrence, comorbidity, and that means that there are people who are receiving more than one personality disorder diagnosis. So somebody might be diagnosed with histrionic personality disorder as well as a narcissistic personality disorder and this might make us wonder are these really two disorders occurring in the same person? Or is it really one overall personality disorder that’s just sort of falling into these two different particular diagnoses?
Okay, and the last thing I’d like to talk about for this section is about antisocial personality disorder, psychopathy, and sociopathy. And this is because this is a question that students frequently ask and I’ve been asked many times before, what’s the difference between a psychopath and a sociopath? Or how does that relate to antisocial personality disorder? And so there’s a lot of confusion here and part of this confusion stems from the fact that the early editions of the DSM actually used the term psychopathy and it wasn’t until the DSM-III that the term antisocial personality disorder was introduced. And so that can be the cause of some of the confusion, that early use of the terms weren’t necessarily distinguished, or somebody looks back at earlier editions they might not know that there was a change in the term that the DSM uses.
And then we also have this term sociopathy which further complicates things because not everyone uses this in the same way. And so some psychiatrists and criminologists and forensic psychologists will use the term sociopathy and psychopathy interchangeably; they don’t see these as sufficiently different things that they need to distinguish and use one term or the other.
But others disagree and they try to differentiate using these two terms, saying someone’s a sociopath versus somebody’s a psychopath. And so in those who try to differentiate these terms they may use the term sociopath to refer to someone who shows less masking of their disregard, meaning that if somebody is violating the rights of others and not feeling any empathy or remorse some people might try to hide this and others may not. And so the idea is a sociopath is somebody who’s not trying to hide this; they’re sort of blatantly disregarding the societal expectations that they should, you know, pretend to feel remorse or something. Whereas a psychopath might be seen as more manipulative and deceitful and more willing to sort of pretend to be having certain sentiments or certain feelings, when in fact they actually aren’t. And so that’s one way that some people try to differentiate these terms.
And then another way is to think about whether the causes of these behaviors are related to genetic factors or are inherited or sort of more dispositional to the person versus are brought on by environmental factors; with the term sociopath potentially being used to differentiate those that come mostly from environmental factors rather than things that might be more inherited. But again there’s not full agreement on these terms and so that’s part of the reason for this confusion and so my answer is really that I don’t have a totally clear answer and it’s going to depend on who you ask. Some people will use them interchangeably and others won’t.
And lastly I’ll mention the diagnostic criteria, so for the diagnosis of antisocial personality disorder this would use the DSM-5 diagnostic criteria that I just talked about earlier in the video. But this is not what will be used to determine whether someone is a psychopath or not. For psychopathy what’s generally used is the psychopathy checklist revised which was created by Robert Hare. This is a 20-item checklist and for each item the person receives a score of 0, 1, or 2, so we have a total of 40 possible points and in the United States a score of 30 or higher is indicative of psychopathy. And this can have ramifications for the person’s sentencing when it comes to criminal behavior; the risk that it’s believed that they could be rehabilitated or not, whether they’re a risk to society after being released. And so this is an important part of this person’s assessment and there’s some criticism there where people are saying you know maybe there’s not enough research behind this checklist or exactly how it’s used and it’s having large effects on people’s lives. At the same time of course we want to have ways to assess whether people are a greater risk of repeat-offending of certain crimes, particularly violent crimes and assaults.
And if you want to learn more about psychopathy I can recommend a few books. I highly recommend “Without Conscience” which is by Robert Hare the creator of this checklist, as well as “The Psychopathy Test” by Jon Ronson and I’ll put links to those books in the description if you want to learn more about psychopathy or just have some fairly chilling reading.
And lastly I’ll say that it’s the case that most psychopaths will meet the criteria for antisocial personality disorder. Perhaps they haven’t gotten that diagnosis before but that would be fairly common, if you have somebody who scores highly on the psychopathy checklist. But it’s possible to have the antisocial personality disorder diagnosis and yet not meet the full criteria for being a psychopath using the psychopathy checklist. And we also see, I mentioned at the beginning of the video, that a personality disorder can only be diagnosed after the age of 18. So if in a child we see cruelty, we see violation of the rights of others, a lack of guilt, or a lack of empathy or remorse, then in this case a child can receive a diagnosis of conduct disorder. And this in many cases will be changed to a diagnosis of antisocial personality disorder after the age of 18. So it seems to be fairly stable so it’s not uncommon to see conduct disorder in children then being changed to antisocial personality disorder later in life.
Okay, so that’s the section of personality disorders in the DSM-5 and a little bit more detail on antisocial personality disorder, psychopathy, and sociopathy. I hope you found this helpful, if so, please like the video and subscribe to the channel for more.
