13 Flashcards
Personality disorder
A personality disorder is:
- Persistent pattern of emotions, cognitions, behaviour resulting in enduring emotional distress for affected person and others
- Distress may (or may not) be subjective
- Causes difficulties with work and relationships
- The DSM-5 lists 10 specific personality disorders
An issue that continues to be debated in the field is whether personality disorders are extreme versions of otherwise normal personality variations (dimensions) or ways of relating that are different from psychologically healthy behaviour (categories).
Category of personality disorders is controversial
Categorical and Dimensional Models
- Problems of kind vs. problems of degree
- Five-factor model of personality to be used as a meaningful way of measuring personality traits
— This model considered “normal,” universal
- Will give a better understanding of disorders
An issue that continues to be debated in the field is whether personality disorders are extreme versions of otherwise normal personality variations (dimensions) or ways of relating that are different from psychologically healthy behaviour (categories).
The five factors or dimensions are
Extraversion (talkative, assertive, and active versus silent, passive, and reserved);
Agreeableness (kind, trusting, and warm versus hostile, selfish, and mistrustful);
Conscientiousness (organized, thorough, and reliable versus careless, negligent, and unreliable);
Neuroticism (nervous, moody, and temperamental versus even-tempered); and
Openness to experience (imaginative, curious, and creative versus shallow and imperceptive; McCrae & Costa Jr., 2008).
On each dimension, people are rated high, low, or somewhere in between.
Personality Disorder Clusters
DSM-5 divides personality disorders into three groups (clusters)
Cluster A: odd or eccentric
Cluster B: dramatic, emotional, erratic
Cluster C: anxious, fearful
Statistics and Development
5.6% patients discharged from hospitals had mental health diagnosis in 2017–2018
- Personality disorders lead to life changes
Worldwide prevalence 7.8% (2019)
- More in high-income countries
- Same person can be diagnosed with different personality disorders at different times
Gender Differences
Criterion gender bias
Assessment gender bias
- Histrionic personality disorder biased against females
- Antisocial personality disorder biased against males
The criteria for a disorder may themselves be biased (criterion gender bias), or the assessment measures and the way they are used may be biased (assessment gender bias).
Statistics and Development
Comorbidity
Being diagnosed with more than one disorder, multiple diseases
A major concern with the personality disorders is that people tend to be diagnosed with more than one (comorbidity).
Paranoid Personality Disorder
Cluster A Disorder
Suspicious, mistrustful of others without justification
Clinical Description
- Argumentative, may complain, quiet, hostile toward others, suicidal
- Bears relationship to:
— Paranoid type of schizophrenia
— Delusional disorder
People with paranoid personality disorder are excessively mistrustful and suspicious of other people, without any justification. They tend not to confide in others and expect other people to do them harm.
Causes
- Genetics
- Relatives with schizophrenia
- Mistreatment or traumatic childhood experiences
- Cognitive cultural factors
Treatment
- Cognitive therapy to change mistaken assumptions about others
Bouchard and his colleagues concluded that cognitive restructuring could be helpful in reducing paranoid beliefs (Bouchard et al., 1996). An Australian survey of mental health professionals indicated that only 11 percent of therapists who treat paranoid personality disorder thought these individuals would continue in therapy long enough to be helped (Quality Assurance Project, 1990).
Schizoid Personality Disorder
Cluster A Disorder
Clinical Description
Detachment from social relationships, no desire to enjoy closeness with others, cold, aloof
Homelessness
Extreme social deficiencies
Social isolation, poor rapport, and constricted affect
Social deficits, psychotic-like symptoms, cognitive impairments/paranoia
“Magical thinking”
Report unusual perceptual experiences
Hypersensitive to criticism as children
Causes
Childhood shyness, abuse, neglect, low-density dopamine receptors
Genetics, prevalence of disorder in relatives
Left hemisphere damage; brain abnormalities
Abnormalities in semantic association abilities
- May be cause of magical ideation
Treatment
Social skills training
- Role-playing
Limited outcomes
Antipsychotic medication, community treatment, social skills training, CBT
People with schizoid personality disorder show a pattern of detachment from social relationships and a very limited range of emotions in interpersonal situations. They seem aloof, cold, and indifferent to other people.
People with schizoid personality disorder show a pattern of detachment from social relationships and a very limited range of emotions in interpersonal situations. They seem aloof, cold, and indifferent to other people.
It is possible that a biological dysfunction found in both autism and schizoid personality disorder combines with early learning or early problems with interpersonal relationships to produce the social deficits that define schizoid personality disorder (Hopwood & Thomas, 2012).
People with schizotypal personality disorder are typically socially isolated and behave in ways that would seem unusual to most of us. Additionally, they tend to be suspicious and have odd beliefs about the world.
Antisocial Personality Disorder
Cluster B Disorders
Clinical Description
Aggressive, lying, cheating, no remorse, substance abuse, unnatural death in boys with this disorder
Moral insanity, egopathy, sociopathy, and psychopathy
50% to 80% of male offenders diagnosed with this disorder
Conduct disorder in children
People with antisocial personality disorder have a history of failing to comply with social norms. They perform actions most of us would find unacceptable, such as stealing from friends and family. They also tend to be irresponsible, impulsive, and deceitful.
Having a higher IQ may help protect some people from developing more serious problems or may at least prevent them from being caught.
Genetic Influences
Gene–environment interaction
Chronic stress in family
Academic difficulty, peer problems, low family income, neglect and harsh discipline from parents
Underarousal of cortex, fearlessness
Treatment
Multifaceted, CBT, prevention better approach
Parent training for diagnosed children
Multifaceted for juvenile offenders
CBT
Neurobiological Influences
- Executive cognitive function deficits in psychopaths
—Underarousal hypothesis: abnormally low levels of cortical arousal, which causes fearlessness
—Fearlessness hypothesis: antisocial and risk-taking behaviours
- Insufficiently developed cortices
- Deficient MAOA due to defective gene producing it
Psychological and Social Dimensions
- Failure to abandon an unattainable goal
- Aversive interchange with parents
- Parents’ inept monitoring of child’s activities
- Inconsistent parental discipline at home
- Experience of physical abuse
An Integrative Model
Genetic vulnerability to antisocial behaviours and personality traits
- Leads to underarousal and fearlessness
- Weak inhibition systems and overactive reward system
- Differences in emotions and cognitions
Children with conduct disorder may become adults with antisocial personality disorder.
Prevention
Preschool program combining good parenting skills and family support
Borderline Personality Disorder
Cluster B disorder
Clinical Description
Turbulent relationships, fear abandonment, self-mutilating behaviours, no control over emotions
Often engage in suicidal or self-mutilating behaviours
Approximately 10% die by suicide
75% achieve remission six years after initial treatment
Causes
Genetics, related to mood disorders, early trauma
Memory bias (for negative cognitions typical of this disorder)
Childhood sexual abuse; similarities with PTSD
Early trauma and biological predisposition
Experienced rapid cultural changes
Treatment
Antipsychotic and antidepressants, dialectical behaviour therapy (DBT) (Effective in reducing suicide attempts)
Treatments similar to those with PTSD
Couples therapy for some
Dialectical behaviour therapy (DBT): involves helping people cope with the stressors that seem to trigger suicidal behaviours and other maladaptive responses
People with borderline personality disorder lack stability in their moods and in their relationships with other people, and they usually have very poor self-esteem. These individuals often feel empty and are at great risk of suicide.
People with this personality disorder are often very intense, going from anger to deep depression in a short time. They also are characterized by impulsivity; hence drug abuse, self-mutilation.
Depression and bipolar II, bulimia, anorexia, substance use are comorbid with this disorder.
Spousal abuse is high in men.
Borderline personality disorder is often accompanied by self-mutilation.
Histrionic Personality Disorder
Cluster B disorder
Clinical Description
Dramatic, theatrical, self-centred, vain, seek constant reassurance, impulsive
- View situations in global, black-and-white terms
- Speech is often vague, lacking in detail
Higher in women: may be overdiagnosed
- Western “stereotypical female”; overdramatic, vain, seductive, overconcerned with physical appearance
Causes
Co-occurs with antisocial personality disorder
Treatment
Improving problematic interpersonal relationships
Teaching appropriate ways of negotiating their wants and needs
Individuals with histrionic personality disorder tend to be overly dramatic and often appear almost to be acting; histrionic—which means theatrical in manner.
Narcissistic Personality Disorder
Cluster B disorder
Clinical Description
Unreasonable sense of self-importance, grandiosity
No compassion for others, envious, arrogant
Frequently depressed
Causes
Failure of empathetic “mirroring” from parents
Child remains fixated at self-centred, grandiose stage of development
Treatment
CBT, coping strategies (relaxation training, accepting criticism), empathizing, treatment for depression
People with narcissistic personality disorder think highly of themselves—beyond their real abilities. They consider themselves somehow different from others and deserving of special treatment.
In Greek mythology, Narcissus was a youth who spurned the love of Echo. So enamoured was he of his own beauty that he spent his days admiring his own image reflected in a pool of water.
People with narcissistic personality disorder think highly of themselves—beyond their real abilities. They consider themselves somehow different from others and deserving of special treatment.
In Greek mythology, Narcissus was a youth who spurned the love of Echo. So enamoured was he of his own beauty that he spent his days admiring his own image reflected in a pool of water.
In Greek mythology, Narcissus was so in love with his own image that he pined away and died of longing.
Avoidant Personality Disorder
Cluster C disorder
Clinical Description
Interpersonally anxious, fear rejection, pessimistic about their future
Causes
Born with difficult temperament, parental rejection, uncritical love
- Low self-esteem, social alienation persisting into adulthood
Overreactive behavioural inhibition system
Treatment
Social skills training
CBT: graduated exposure to feared situations
Systematic desensitization: relaxing in the presence of feared situations
Behavioural rehearsal: patients act out situations that cause anxiety
Treatment leads to modest improvements in behaviour
People with avoidant personality disorder are extremely sensitive to the opinions of others and therefore avoid social relationships. Their extremely low self-esteem, coupled with a fear of rejection, causes them to reject the attention others crave.
People with avoidant personality disorder are extremely sensitive to the opinions of others and therefore avoid social relationships. Their extremely low self-esteem, coupled with a fear of rejection, causes them to reject the attention others crave.
Dependent Personality Disorder
Cluster C disorder
Clinical Description
Interpersonally dependent, anxious
Submissive, timid, and passive
Feelings of inadequacy, sensitive to criticism, need reassurance
Cling to relationships
Causes
Disruptions in early childhood lead to fears of abandonment
High in sociotropic traits
Low on individualistic achievement traits
Treatment
Developing confidence; ensuring patient does not overdepend on therapist
Individuals with dependent personality disorder rely on others to the extent of letting them make everyday decisions as well as major ones; this results in an unreasonable fear of being abandoned.
Sociotropy refers to a personality orientation involving a strong investment in positive social interactions, whereas autonomy refers to a personality style involving a strong investment in independence from others, mobility, and freedom of choice (Beck, 1983, 1987).
Obsessive-Compulsive Personality Disorder
Cluster C disorder
Clinical Description
Rigidity, poor interpersonal relationships, quest for perfectionism
Causes and Treatment
Genetics
Relaxation techniques, CBT to reframe compulsive thoughts
People who have obsessive-compulsive personality disorder are characterized by a fixation on things being done “the right way.” This preoccupation with details prevents them from actually completing much of anything.
Not to be confused with OCD
