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  • 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.

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

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人格障礙。心理學速成班#34 (Personality Disorders: Crash Course Psychology #34)

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    atina 發佈於 2021 年 01 月 14 日
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