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
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)
3
Q
Cluster A of pds
A
- paranoid, schizoid, schizotypal
- males overrepresented
4
Q
Cluster B of pds
A
- histrionic, narcissistic, antisocial, borderline
- very dramatic PDs
5
Q
Cluster C of pds
A
avoidant, dependent, obsessive-compulsive
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)
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
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
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
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
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
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
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
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
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
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
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
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)
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
Core belief - Schizotypal
It's better to be isolated from others
26
Core belief - Histrionic
People are there to serve or admire me
27
Core belief - Narcissistic
Since I am special, I deserve special rules
28
Core belief - Antisocial
I am entitled to break rules
29
Core belief - Borderline
I deserve to be punished
30
Core belief - Avoidant
If people knew the 'real' me, they would reject me
31
Core belief - Dependent
I need people to survive/be happy
32
Core belief - Obsessive-Compulsive
People should do better, try harder
33
Dialectical Behavior Therapy
- 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
Transference-focused psychotherapy
- 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
Mentalization
- treatment for BPD
- uses therapeutic relationship to help patients develop skills needed to accurately understand own/others' feelings/emotions
36
Biological treatments of BPD
- 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
Treating personality disorders in clusters A and B
- 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
Treating Cluster C PDs
- 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
Psychopathy
- 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
Dimensions of psychopathy
(need to know for exam)
- 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
Criticisms of antisocial PD
- 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
Clinical picture in psychopathy
(need to know for exam)
- 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
Psychopathy in children
- high emotional reactivity OR fearlessness and low anxiety
44
Most likely comorbid disorder of psychopathy
substance-abuse disorders
45
Genetic causes in psychopathy
- 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
Fearlessness and Impaired Fear Conditioning in Psychopathy
- 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
Treatment/Outcomes in Psychopathic Personality
- 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
