Antisocial personalities & narcistic personalities

Question 1

wat is het spectrum van antisocial personalities

Answer 1

van antisocial behaviour in narcisists to pure psychopathy

Question 2

longitudinal studies show:

Answer 2

Longitudinal studies suggest that some individuals on this continuum may have
symptomatic improvement with aging, but the antisocial nature persists.

Question 3

why is diagnosis difficult

Answer 3

due to ubiquity of deception and misinfomation provided by the patient

Question 4

wat moet je als therapeut bij deze mensen doen

Answer 4

carefully monitor therapeutic relationship and consult with collegue

Question 5

hoe ziet antisocial behaviour er uit op 3 verschillende punten in het spectrum

Answer 5

1. antisocial behaviour in narcisists: they can be ruthlessly exploitative of others, but have the capacity to experience guilt and concern
2. malignant narcisists: with paranoid ideation and ego-syntonic sadism, but can have some loyalty or concern for others
3. true psychopathy, individuals cannot imagine altruism of any sort and are incapable of investing in nonexploitative relationships

Question 6

prevalence of aspd

Answer 6

3.6& lifetime prevalence in general population

Question 7

Many of those on the antisocial continuum will manifest a downward drift as they fail repeatedly, and some appear to “burn out” at some point in their lives. While many of these individuals have been debilitated by severe alcoholism or drug abuse, others have managed to thrive despite their dishonest behavior by moving from town to town or city to city as needed. Impulsivity may decrease with aging, but most continue to have struggles with work, parenting, and romantic partners.

Answer 7

oke

Question 8

male to female ratio

Answer 8

4:1

(maar kan door biases komen: manipulative and seductive woman who exhibits considerable antisocial activity is much more likely to be labeled histrionic or borderline than psychopathic.)

Question 9

wat is dus het ‘ergste’

Answer 9

Psychopathy is now regarded as much more severe, both in its clinical manifestations and in its treatment-resistance, compared to ASPD

Question 10

wat kan je zien in kinderen

Answer 10

Callous-unemotional traits are defined by reduced guilt and empathic concern, and fewer displays of appropriate emotion. These children and adolescents with callous-unemotional traits are typically viewed as less responsive to interventions than adolescents without such traits, perhaps reflecting a distinct neurobiology associated with callous-unemotional traits. There is generally a history that, as children, they showed a lack of fear of consequences for their actions and did not feel uncomfortable in any respect if they hurt someone or broke their parents’ rules. Individuals with callous-unemotional traits show reduced bonding with others and lack significant attachments.

-> callous lack of empathy, a tendency toward
conning and manipulation, and lack of remorse or guilt

Question 11

countertransferance reactions to antisocial patients

Answer 11

• have higher expectations of patients than are realistic (lie, steal, sexually exploit, smuggle drugs and alcohol into the hospital)
• tendency to regard themselves as able to treat the patient
• making SUD the primary diagnosis when it is actually ASPD

-> you need to accept that, most of the time, the client is playing you!

Question 12

treatment should focus on

Answer 12

faulty thought processes, holding the patient accountable for their actions

Question 13

14 time-honored principles of therapy with these patients

Answer 13

1. no legal complications
2. collega as consultant
3. should feel safe
4. must not have excessive expectations for improvement
5. therapist must be stable, persistent, incorruptible
6. monitor countertransferance
7. confront the patients denial and minimization of antisocial behaviour
8. must help patient connect actions with internal states of thoughts and feelings
9. confrontations of here and now behaviours are more likely to be effective than interpretations of unconscious material from the past
10. alert to comorbities
11. mentalization adn empathy should be promoted
12. cannot expect to maintain a neutral position regarding the patient’s antisocial activities (you should say you are shocked)
13. must be prepared that patient will quit
14. emphasize the need for honesty and the unacceptability of lying

Question 14

ppl with aspd may be unable to
work successfully because …

Answer 14

of their incapacity to be engaged, honest, and punctual.

Question 15

Clinicians must remember that attempted treatment strategies are unlikely to make major changes no matter how much patients may pretend that they are using the treatment or benefiting from it. There is no persuasive evidence that treatment is effective with patients in the antisocial spectrum, and more rigorous controlled studies are needed.

Answer 15

oke

Question 16

heterogeneity in narcisism

Answer 16

Individuals with narcissistic personality
disorder may be grandiose or self-loathing, extraverted or socially isolated, captains of industry or unable to maintain steady employment, model citizens or prone to antisocial activities.

Question 17

which core features of npd does the dsm criteria not include

Answer 17

• vulnerable self-esteem
• feelings of inferiority
• emptiness
• boredom
• affective reactivity
• distress

Question 18

proposed criteria for alternative DSM 5 model

Answer 18

A.
Moderate or greater impairment in personality functioning, manifested by
characteristic difficulties in two or more of the following four areas:
1. Identity: Excessive reference to others for self-definition and self-esteem regulation; exaggerated self-appraisal inflated or deflated, or vacillating between extremes; emotional regulation mirrors fluctuations in self-esteem.
2. Self-direction: Goal setting based on gaining approval from others; personal standards unreasonably high in order to see oneself as exceptional, or too low based on a sense of entitlement; often unaware of own motivations.
3. Empathy: Impaired ability to recognize or identify with the feelings and needs of others; excessively attuned to reactions of others, but only if perceived as relevant to self; over- or underestimate of own effect on others.
4. Intimacy: Relationships largely superficial and exist to serve self-esteem regulation; mutuality constrained by little genuine interest in others’ experiences and predominance of a need for personal gain.
B. Both of the following pathological personality traits:
1. Grandiosity (an aspect of Antagonism): Feelings of entitlement, either overt or covert; self-centeredness; firmly holding to the belief that one is better than others; condescension toward others.
2. Attention seeking (an aspect of Antagonism): Excessive attempts to attract and be the focus of the attention of others; admiration seeking.

Question 19

hoe ziet de vulnerable covert type van npd er uit

Answer 19

vulnerable, “fragile” or thin-skinned, covert subtype is inhibited, manifestly distressed, hypersensitive to the evaluations of others while chronically envious and evaluating themselves in relation to others. Shy, outwardly self-effacing, andhypersensitive to slights, while harboring secret grandiosity

Question 20

wat staat er in section III van DSM

Answer 20

identifies deficits in self-definition, self-esteem and affect regulation, and consolidationof internal goals and standards as core features of thedisorder; interpersonal relations are “functional,” serving to support the sense of self and/or to provide personal gain, and capacity for intimacy is lacking

Question 21

wat is volgens psychodynamische perspectieven de kern hiervan

Answer 21

From a psychodynamic perspective, a specific form of self or identity dynamic is at the core of narcissistic pathology (15). Rather than the flexible and reality-based self-experience that characterizes normal identity formation, the sense of self in narcissistic personality disorder is brittle and somewhat removed from reality; what characterizes narcissistic personality disorder across the spectrum is a more or less fragile sense of self that is predicated on maintaining a view of oneself as exceptional. This view is also present in those in the vulnerable subtype, where grandiosity is cloaked in feelings of inferiority and deficiency.

Question 22

hoe gaan mensen met npd met anderen om

Answer 22

On the one hand, individuals with narcissistic
personality disorder often have a profound need for others to support their sense of self and also to help with self-esteem regulation. On the other hand, genuine engagement with others can threaten the stability of the grandiose sense of self, by confronting the individual with the painful reality that others have attributes that they lack. As a result, those with more grandiose features tend to engage in superficial relationships organized to support self-esteem and self-definition, while those with more vulnerable features tend to withdraw from social situations; for both types, self-regulatory needs leave little roomfor genuine interest in the needs or feelings of others.