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PSYC 337 > Chapter 10 > Flashcards

Chapter 10 Flashcards

1
Q

Clinical features of personality disorders

A
  • 1 in 10 people have a personality disorder
  • chronic interpersonal difficulties, problems w identity/sense of self, inability to function adequately in society
  • diagnosed when pervasive and inflexible, as well as stable and of long duration
  • clinically significant distress/impairment in functioning in 2+ of cognition, affectivity, interpersonal functioning, or impulse control
  • not stress induced; gradual development
  • often cause at least as much difficulty in lives of others
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2
Q

____% of people meet criteria for at least one personality disorder for behavior in last 2-5 years

A

10-12% (Cluster C > Cluster A > Cluster B)

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3
Q

Cluster A of pds

A
  • paranoid, schizoid, schizotypal
  • males overrepresented
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4
Q

Cluster B of pds

A
  • histrionic, narcissistic, antisocial, borderline
  • very dramatic PDs
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5
Q

Cluster C of pds

A

avoidant, dependent, obsessive-compulsive

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6
Q

Core feature of personality disorders

A

rigidity! (inflexibility in orientation to world; problem bc we live in a changing world w changing demands)

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7
Q

Paranoid PD

A
  • Hitler
  • Cluster A
  • suspiciousness, mistrust of others, see self as blameless, on guard
  • quick to anger; interpersonal difficulties
  • elevated liability for schizophrenia
  • modest genetic liability; parental neglect/abuse; exposure to violent adults
  • symptoms increase after TBI, are high in chronic cocaine users
  • 1.5% point prevalence
  • males = females
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8
Q

Schizoid PD

A
  • impaired social relationships
  • Cluster A
  • inability/lack of desire to form attachment to others
  • not very emotionally reactive
  • low E, low O, low nAch
  • high heritability
  • might precede psychotic illness; links to ASD
  • 1.2% point prevalence
  • males > females
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9
Q

Schizotypal PD

A
  • Kramer, Doc Brown
  • Cluster A
  • can be thought of as an attenuated form of schizophrenia; not adequately explained by 5FM
  • involves cognitive problems
  • peculiar thought patterns, oddities of perception and speech that interfere w communication/social interaction
  • may experience transient psychotic symptoms/believe they have magic powers
  • moderately heritable, often in relatives of someone w schizophrenia
  • 1.1% point prevalence
  • males > females
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10
Q

Histrionic PD

A
  • Paris Hilton
  • Cluster B
  • lively, dramatic, excessively extraverted
  • need to be center of attention
  • self-dramatization, overconcern w attractiveness, tendency to irritability if attention seeking is frustrated
  • extreme E and N
  • comorbid w borderline, antisocial, narcissistic, and dependent personality disorder diagnoses
  • might be underlying genetic predisposition that links to antisocial (men) and histrionic (women)
  • 1.2% point prevalence (decreasing)
  • females > males (might be biased)
  • was recommended to be removed in DSM5
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11
Q

Narcissistic PD

A
  • Trump
  • Cluster B
  • 2 subtypes: grandiose and vulnerable
  • grandiosity, attention-seeking, self-promoting, lack of empathy
  • point prevalence under 1%
  • males > females
  • least likely to come to therapy bc they think they are god’s gift to the world and don’t need to change
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12
Q

Antisocial PD

A
  • Joker
  • Cluster B
  • lack of moral/ethical development, deceitfulness, manipulation, history of conduct problems as child
  • need to be 18+ for diagnosis, but shown symptoms of conduct disorder before 15 (younger the start, higher the risk)
  • ADHD can be a precursor (ADHD + conduct disorder is highest risk group)
  • moderate heritability, gene might also link to alcoholism
  • environment interacts w genetic predisposition
  • point prevalence 1% females, 3% males
  • males > females
  • over 80% of incarcerated populations
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13
Q

Borderline PD

A
  • Cluster B
  • impulsiveness, inappropriate anger, drastic mood shifts, chronic feelings of boredom, attempts at SH or suicide (1/4), fear of abandonment
  • good at detecting anger on faces, also detect anger in neutral faces
  • associated w major depressive disorder, mania, panic disorder, agoraphobia, GAD, and PTSD
  • high N, low A, low C
  • runs in families, genes account for 40% BUT environmental factors more important
  • 1.4% point prevalence
  • females = males
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14
Q

Avoidant PD

A
  • Michael Jackson
  • Cluster C
  • hypersensitivity to rejection, shyness, insecurity in social interactions/initiating relationships
  • want social connection but feel insecure (diff from schizoid)
  • almost all cases have comorbid social anxiety disorder (might be severe form of social AD)
  • might be linked to inhibited temperament (diathesis?)
  • 2.5% point prevalence
  • females > males
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15
Q

Dependent PD

A
  • Buster
  • Cluster C
  • difficulty in separating in relationships, discomfort at being alone, subordination of needs to keep others in relationship, indecisiveness
  • high N, high A
  • comorbid w mood disorders, anxiety disorders, eating disorders, somatic symptom disorders, schizoid, avoidant, borderline, and histrionic personality disorders
  • diff. from BPD bc they react w submissiveness and appeasement if abandonment occurs and immediately seek out a new relationship
  • 30-60% of variance attributable to genetics
  • 1% point prevalence
  • females > males
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16
Q

Obsessive Compulsive PD

A
  • Steve Jobs
  • Cluster C
  • excessive concern w order/rules/details, perfectionistic, lack of expressiveness/warmth, difficulty relaxing
  • high C
  • modest genetic influence
  • 2.1 point prevalence
  • males (slightly) > females
  • not true compulsions/obsessions/rituals like in OCD
  • 20% of OCD patients have OCPD
  • 20-61% of people with anorexia nervosa have OCPD
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17
Q

Difficulties in diagnosing PDs

A
  • criteria not as sharply defined
  • reliability and validity low despite use of semi-structured interview and self-reports
  • no unified dimensional classification
  • focus on dev. approach to integrate many existing approaches; five-factor model most influential
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18
Q

5-Factor Model - Dimensional approaches to diagnosing PDs

A
  • negative affectivity (extreme neuroticism)
  • detachment (extreme introversion)
  • antagonism (extremely low agreeableness)
  • disinhibition (extremely low conscientiousness)
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19
Q

Sociocultural causal factors of PDs

A
  • less variance across cultures than within cultures
  • narcissistic PD more common in Western cultures
  • histrionic personality less common in Asian cultures, more common in Hispanic cultures(and maybe African American women)
  • increases in emotion dysregulation and impulsive behaviors may be related to increases in the prevalence of borderline and ASPDs
20
Q

Causes of PDs

A
  • difficulties in studying the causes of PDs
  • high comorbidity among disorders
  • biological: temperament might predispose us to traits/disorders
  • psychodynamic: excessive/insufficient gratification of impulses in first years of life
  • learning based: habit patterns; maladaptive cognitive styles
21
Q

Treatment Outcomes for PDs

A
  • hard to treat, don’t want to change
  • goals include reducing subjective distress (esp. BPD), changing dysfunctional behaviors/structure of personality
  • often go to treatment bc someone made them
  • might have hard time forming therapeutic relationship (esp. for Cluster A or B)
22
Q

Adaption of Therapeutic Techniques for PDs

A
  • individual therapy might encourage dependence if already dependent
  • anxious/fearful Cluster C patients might be hypersensitive to perceived criticism from therapist
  • cognitive therapy increasingly used
23
Q

Core belief - Paranoid

A

I cannot trust people

24
Q

Core belief - Schizoid

A

Relationships are messy, undesirable

25
Q

Core belief - Schizotypal

A

It’s better to be isolated from others

26
Q

Core belief - Histrionic

A

People are there to serve or admire me

27
Q

Core belief - Narcissistic

A

Since I am special, I deserve special rules

28
Q

Core belief - Antisocial

A

I am entitled to break rules

29
Q

Core belief - Borderline

A

I deserve to be punished

30
Q

Core belief - Avoidant

A

If people knew the ‘real’ me, they would reject me

31
Q

Core belief - Dependent

A

I need people to survive/be happy

32
Q

Core belief - Obsessive-Compulsive

A

People should do better, try harder

33
Q

Dialectical Behavior Therapy

A
  • CBT adapted for BPD
  • dominant psychotherapeutic approach
  • encourages patients to accept negative affect w/o engaging in maladaptive behaviors
  • problem-focussed and based on clear hierarchy of goals
  • important mindfulness aspect
  • prioritizes decreasing SH/suicidal behaviors and increasing coping skills
  • combines individual and group components
34
Q

Transference-focused psychotherapy

A
  • treatment for BPD
  • variant of psychodynamic psychotherapy
  • strengthens weak ego w particular focus on primitive primary defense mechanism of splitting
  • helps patients see the shades of gray between extremes and integrate positive and negative views of themselves and others into more nuanced views
  • expensive and time consuming, but shown to be as effective as DBT
35
Q

Mentalization

A
  • treatment for BPD
  • uses therapeutic relationship to help patients develop skills needed to accurately understand own/others’ feelings/emotions
36
Q

Biological treatments of BPD

A
  • drugs often used, but little evidence supports this
  • antidepressants (mostly SSRIs) widely used, more appropriate when client has comorbid mood disorder
  • some second-gen antipsychotic meds and mood stabilizers can reduce symptoms in short-term
37
Q

Treating personality disorders in clusters A and B

A
  • treatment of cluster A and other cluster B PDs doesn’t have as many promising advances as w BPD
  • schizotypal PD: low doses of antipsychotics have modest results, SSRIs may be useful
  • no controlled studies on treating paranoid, schizoid, narcissistic, histrionic
38
Q

Treating Cluster C PDs

A
  • treatment of some, esp dependent and avoidant appears promising
  • active/confrontational short-term therapy shows improvement (need to develop therapeutic alliance first)
  • CBT/psychodynamic therapies also have significant lasting treatment gains
  • antidepressants from MAOI and SSRI categories might help w avoidant PD (and social anxiety!)
39
Q

Psychopathy

A
  • antisocial PD dates back to 1980 in DSM-III
  • sociopathic personality now called psychopathy
  • psychopathy not same as antisocial PD
  • prevalence unknown, estimated 1-2% men in North America (much lower in women)
  • psychopathy diagnosis is single best predictor of violence and recidivism
40
Q

Dimensions of psychopathy
(need to know for exam)

A
  • Robert Hare developed 20-item checklist (PCL-R); includes detailed interview and checking of past school, police, prison records; uses Cleckley criteria for diagnosis
  • 4 dimensions: interpersonal(charming/dynamic), affective (lack of remorse/guilt), lifestyle (risk taking), antisocial (disregard for rules/laws)
  • lifestyle+antisocial most linked to Antisocial PD in DSM
41
Q

Criticisms of antisocial PD

A
  • essentially describes a criminal
  • high prevalence in those who are incarcerated
  • there are some successful psychopaths who don’t get caught! (have affective and interpersonal dimensions that help them)
42
Q

Clinical picture in psychopathy
(need to know for exam)

A
  • Inadequate conscience development (severely retarded or nonexistent)
  • appear unable to understand and accept ethical values (except on verbal level)
  • may claim to adhere to high moral standards but no connection to behavior
  • lack of guilt
  • irresponsible and impulsive; take rather than earn
  • prone to thrill-seeking, often break law
  • higher rates of substance abuse/dependence disorder
  • superficially charming/likable, cannot understand love
  • manipulative, exploitative, coercive
43
Q

Psychopathy in children

A
  • high emotional reactivity OR fearlessness and low anxiety
44
Q

Most likely comorbid disorder of psychopathy

A

substance-abuse disorders

45
Q

Genetic causes in psychopathy

A
  • considerable heritability (twin studies)
  • genetic factors account for about 43-56% of variance in dimensions of psychopathy
  • remaining variance best explained by nonshared env.
46
Q

Fearlessness and Impaired Fear Conditioning in Psychopathy

A
  • psychopaths who are high on first-factor dimensions + egocentric, callous, exploitative have low trait anxiety and poor conditioning of fear
  • Lykken: study found psychopaths dont respond to negative reinforcement (ie shocks); fail to acquire conditioned responses essential for normal human functioning (eg conscience, socialization)
  • show deficient fear-potentiated startle
47
Q

Treatment/Outcomes in Psychopathic Personality

A
  • experience little personal distress, don’t seek treatment
  • punishment ineffective, being incarcerated doesn’t deter future behavior
  • biological treatments not systemically studied, little evidence such approaches have much impact
  • CBT: greatest promise, but still only modest results; try to increase self-control/social perspective taking/anger management (helps reduce inmate antisocial behavior but results do not carry over to real world on release)
  • social skills training increases re-offense rates

PSYC 337 (15 decks)

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