Ch15 (lesson 18): personality disorders Flashcards
DSM-5 clusters of personality disorders
- Cluster A (odd/eccentric)
- Cluster B (Dramatic/ Erratic)
- Cluster C (Anxious/Fearful)
Cluster A (Odd/eccentric)
- Paranoid Personality Disorder
- Schizoid Personality Disorder
- Schizotypal Personality Disorder
Cluster B (Dramatic/Erratic)
- Antisocial Personality Disorder
- Borderline Personality Disorder
- Histrionic Personality Disorder
- Narcissistic Personality Disorder
Cluster C (Anxious/Fearful)
- Avoidant Personality Disorder
- Dependent Personality Disorder
- Obsessive Compulsive Personality Disorder
Personality Disorders (PD)
- Longstanding, pervasive, Inflexible, extreme, and persistent patterns of behavior/ inner experience
- unstable positive sense of self
- unable to sustain close relationships
reasons for considering changes to PD criteria
- High comorbidity- Half who met criteria for one DSM-IV-TR Personality Disorder met diagnostic criteria for another Personality Disorder
- some of the DSM-IV-TR Personality Disorders are rare (<2%)
- Many ppl w serious personality probs don’t fit any of Personality Disorder diagnoses
- Ppl w a Personality Disorder can vary from one another in nature of personality traits and severity of condition
- to capture subsyndromal symptoms better
Alternative DSM-5 Model for Personality Disorders
includes 6 distinct diagnoses
- Borderline Personality Disorder
- Obsessive-Compulsive Personality Disorder
- Avoidant Personality Disorder
- Schizotypal Personality Disorder
- Antisocial Personality Disorder
- Narcissistic Personality Disorder
location in DSM-5- Alt model for Personality Disorders
- Working Group recommended this model
- lack of consensus resulted in move to Section III- Emerging Measures and Models
- Better aligns w Personality Theory (Big Five)
- in the alt model, Personality Disorders are considered when person shows persistent and pervasive impairments in func from early adulthood
- two types of dimensional personality scores:
- 5 personality trait domains
- 25 (more specific) personality trait facets)
test-retest stability for personality disorders and Major Depressive Disorder
- although definition suggests should be stable over time, they appear to increase into adolescence and decline over time
- many still have symptoms after remission, symptoms wax and wane
- baseline diagnosis predicts lower func and more depression even 10-15 yrs later
Paranoid Personality Disorder
Presence of 4+ signs of distrust/suspiciousness beginning in early adulthood in mult contexts:
- Pervasive unjustified suspiciousness of being harmed/deceived, exploited
- unwarranted doubts about loyalty/trustworthiness of friends/associates
- reluctance to confide in others due to suspiciousness
- tendency to read hidden meanings into begnin actions of others
- angry reactions to perceived attacks of character/ reputation
- unwarranted suspiciousness of fidelity of partner
Schizoid Personality Disorder
4+ signs of interpersonal detachment and restricted emotions from early adulthood:
- lack of desire for/ enjoyment of close relationships
- prefers solitude
- little interest in sex
- few/no pleasurable activities
- lack of friends
- indifference to praise/criticism
- flat affect, emotional detachment
Schizotypal Personality Disorder
- ppl with Schizotypal Personality Disorder show problems similar to schizophrenia
- eccentric thoughts and behaviors, interpersonal detachment, suspiciousness
- Highly heritable (60%)
- cog and neuropsychological deficits
- enlarged ventricles
- less temporal gray matter
DSM-5 criteria of Schizotypal Personality Disorder
- Ideas of reference
- Peculiar beliefs or magical thinking (eg: belief in extrasensory perception)
- unusual perceptions (eg: disorted feelings about body)
- peculiar patterns of thought and speech
- suspiciousness/ paranoia
- innapropriate/ restricted affect
- odd/eccentric behavior/appearance
- anxiety around other people, doesn’t diminish w familiarity
Antisocial Personality Disorder
- Atleast 18
- Evidence of conduct disorder before 15
- perasive pattern of disregard for rights of others since 15 shown by 3+:
- repeated law breaking
- deceitfulness/lying
- irritability/ aggressiveness
- reckless disregard for own/others safety
- irresponsibility as seen in unreliable employment/financial history
- lack of remorse
Etiology of Antisocial Personality disorder- research issues
- problems w research
- conducted w mostly criminals
- different measurements (APD vs psychopathy)
Genetics- etiology of APD
- heritable 40-50%
- genetic risk for APD, psychopathy, conduct disorder, and substance abuse related
family enviro- etiology off APD
- lack of warmth, highly neg, parental inconsistency predict APD
- Poverty, exposure to violence
- Family enviro interacts w genetics
Characteristics- Etiology of Antisocial Personality disorder
- Fearlessness
- lack of fear/anxiety
- low baseline levels of skin conductance; less reactive to aversive stimuli
- Impulsivity
- Lack of response to threat when pursuing rewards
- Deficits in empathy
- not in tune w emotional reactions of others
- Prevalence greater in men
- comorbid substance abuse v common
ASD vs Psychopathy- 2 differences
- PCL-R covers many of the criteria for APD, but differs in that it includes more affective symptoms (shallow affect, lack of empathy)
- differs in requirement that person develop symptoms before 15
Borderline Personality Disorder
5+ in many contexts, beginning in early adulthood:
- frantic efforts to avoid abandonment
- unstable interpersonal relationships in which others are idealized or devalued
- unstable sense of self
- Self-damaging, impulsive behaviors in areas such as spending, sex, reckless driving, binge eating
- recurrent suicidal behavior/gestures/ injurious behavior
- chronic feeling of emptiness
- recurrent bouts of intense/poorly controlled anger
- during stress, tendency to experience transient paranoid thoughts and dissociative symptoms
prevalence and comorbidty of BPD
- later in life, most no longer meet diagnostic criteria
- comorbidity high w PTSD, MDD, Substance use, eating disorders, and schizotypal PD
- comorbidity predicts less chance of remission
Etiology of BPD- neurobiological
- Genetic component
- highly heritable (60%)
- may play role in impulsivity and emotional dysregulation
- decreased functioning of serotonin system
- increased activation of amygdala
Etiology of BPD- Social Environmental Factors
- Parental separation, verbal and emotional abuse during childhood
- Linehan’s Diathesis-Stress Theory
- ppl w BPD have difficulty controlling emotions (emotional dysregulation)
- possible biological diathesis
- family invalidates or discounts emo experiences and expression
- interaction btwn extreme emotional reactivity and invalidating family –> BPD
- ppl w BPD have difficulty controlling emotions (emotional dysregulation)
Histrionic Personality Disorder
5+ signs of excessive emotionality/attention seeking:
- Strong need to be center of attention
- Inappropriate sexually seductive behavior
- Rapidly shifting expression of emotions
- Use of physical appearance to draw attention to self
- speech that is excessively impressionistic and lacking in detail
- exaggerated, theatrical emotional expression
- overly suggestible
- misreads relationships as more intimate than they are
Narcissistic Personality disorder
5+ shown in early adulthood in many contexts:
- grandiose view of one’s importance
- preoccupation w one’s success, brilliance, beauty
- belief that one is special and can be understood only by other high-status people
- extreme need for admiration
- tendency to exploit others
- lack of empathy
- envious of others
- arrogant behavior or attitudes
Etiology of Narcissitic Personality disorder- 2 models
- Kohut’s Self-Psychology Model
- Social Cognitive model
Etiology of NPD- Kohut’s Self-Psychology model, and parenting
parenting:
- in childhood, narcissist valued as a means to increase parent’s own self-esteem
- not valued for his or her own competency/self worth
- Parental emotional coldness and overemphasis on child’s achievements reported by narcissists
Kohuts model:
- projects self-importance, self-obsorbtion on the surface
- masks fragile self esteem
- get sense of self-worth f through quests for respect of others
- inflated self-worth and denigration of others are defenses against shame
Etiology of NPD- Social Cognitive model
- Narcissist has low self-esteem
- Interpersonal relationships are a way to bolster sagging self-esteem rather than increase closeness to others
- lab studies reveal cog biases that maintain narcissism
- exclusion activated neural regions sensitive to pain
fragile self esteem in narcissistic personality disorder
- debate as to whether it is core to the diagnosis
- might be present only for subset of those w disorder
- the more fragile self-worth, higher level of neuroticism and depression
Avoidant Personality disorder
pervasive pattern of social inhibition, feelings of inadequacy, hypersensitivity to criticism shown by 4+ starting in early adulthood, many contexts
- avoidance of occupational activities that might involve sig interpersonal contact, bc fears of criticism/disapproval
- unwilling to get involved w ppl unless certain of being liked
- restrained in intimate relationships bc fear of being shamed/ridiculed
- preoccupation w being criticized or rejected
- inhibited in new interpersonal situations bc feelings of inadequacy
- views self as socially inept or inferior
- unusually reluctant to try new activities bc may be embarrassing
Etiology of Avoidant Personality Disorder (comorbidity)
- High comorbidity w social anxiety disorder
- related to Japanese syndrom claled tijin kyofusho (“interpersonal fear”)
- high comorbidity w major depression
Dependent Personality Disorder
excessive need to be taken care of, atleast 5+ beginning in early adulthood,
- difficulty making decisions w/out excessive advice and reassurance from others
- need for others to take responsibility for most major areas of life
- Difficulty disagreeing w others for fear of losing support
- difficulty doing things on own/starting projects due to lack of self-confidence
- doing unpleasant things to obtain approval/support of others
- feelings of helplessness when alone bc of fear of being unable to care for self
- urgently seeking new relationship when one ends
- preocc w fears of having to take care of self
Obsessive-Compulsive personality disorder
Intense need for order and control shown by 4+ beginning in early adulthood in many contexts:
- Preocc w rules, details, organization to extent that the point of an activity is lost
- excessive devotion to work w exclusion of leisure and friendships
- inflexibility about morals and values
- difficulty discarding worthless items
- reluctance to delegate unless others conform to ones standards
- miserliness
- rigidity and stubbornness
Etiology of Obsessive-Compulsive Personality Disorder (comorbidity, difference btwn OCD)
- OCPD differs from OCD
- doesn’t have obsessions/compulsions
- Most freq comorbid w avoidant PD
- also can be comorbid w OCD, has some genetic vulnerability in common
- less intp difficulties than other personality disorders
- little research on etiology
why might people w personality disorders seek treatment
- for conditions other than their personality disorder
- BPD may come in for substance abuse
- Dependent Personality disorder may come in for Depression
- Personality disorders predict slower improvement in psychotherapy
treatment of choice for Personality disorders
- psychotherapy- personality traits can be changed
- focus on maladaptive cognitions
- often supplemented w medication to quel impulsive or depressive symptoms
some maladaptive cognitions of personality disorders
Avoidant- if people know the real me, they will reject me
Obsessive-compulsive personality- people should do better and try harder
narcissistic: I am better than others
antisocial: I am entitled to break rules
treatment of Schizotypal PD
- antipsychotic and antidepressent meds
avoidant pd treatment
- same treatment as social anxiety disorder
- antidepressent meds
- social skills training
- cog behavioral
- exposure
antisocial/ psychopathy treatment
- CBT or psychodynamic
treatment of Borderline PD
- Difficult to treat
- intp probs play out in therapy
- attempts to manipulate therapist
- Medications
- Dialectical Behavioral therapy
- Transference- focused therapy
- mentalization therapy
- schema-focused cognitive therapy
transference-focused therapy
(treatment of BPD)
- emphasis on relationship to therapist, powerful feelings clients may develop towards therapist
- consider parallels btwn response to therapist and other relationships
mentalization therapy
(treatment of BPD)
- focuses on helping client be more reflective about their own feelings + those of others
- avoid acting automatically w/out thinking when emotions/intp stressors occur
Dialectical Behavioral Therapy
- acceptance and empathy plus CBT
- emotion-regulation techniques
- social skills training
concept of dialectics refers to tension between a phenomenon (thesis) and its opposite (antithesis), resolved by creating a new phenomenon (synthesis)
- dialectical tension btwn accepting client as is and helping them change
four stages for dbt for BPD
- first stage: addressing dangerously impulsive behaviors (suicidal)
- second stage: modulating extreme emotionality and coaching client to tolerate emotional distress
- stage three: improving relationships and self-esteem
- promote connectedness and happiness
medications- treating BPD
- antidepressants
- mood stabilizers
schema-focused cognitive therapy
identify maladaptive assumptions that underlie cognitions
