Chapter 10 – Personality Disorders Flashcards
Identify problems associated with diagnosis of personality disorders
There are substantial limitations to the category and cluster designations of the DSM. One of the primary issues is that there are simply too many overlapping features across both categories and clusters.
More misdiagnoses probably occur here than in any other category of disorder. Reasons include that diagnostic criteria are not as sharply defined as they are for most axis I diagnostic categories so they are often not very precise or easy to follow in practice. Because the criteria are defined by inferred traits or consistent patterns of behaviour rather than buy more objective behavioural standards, the clinician must exercise more judgement in making the diagnosis that is the case for many Axis I disorders.
The development of semistructured interviews and self-report inventories has increased certain aspects of diagnostic reliability. However, the agreement between the diagnoses made on the basis of different structured interviews or self-report inventories is often rather low and there are still substantial problems with the reliability and validity of these diagnoses.
What does cluster A of the personality disorders include?
Paranoid, schizoid, and schizotypal personality disorders.
People with these disorders often seem odd or eccentric, with unusual behaviour ranging from distrust and suspiciousness to social detachment.
What do cluster B personality disorders include?
Histrionic, narcissistic, antisocial, and borderline personality disorders.
Individuals share a tendency to be dramatic, emotional, and erratic
What disorders are included in cluster C personality disorders?
Avoidant, dependent, and obsessive-compulsive personality disorders
Often show anxiety and fearfulness
Discuss the difficulties in studying the causes of personality disorders
Little is known partly because such disorders have received consistent attention by researchers only since DSM – I I I was published in 1980 and partly because they are less amenable to thorough study. One major problem in studying the causes a personality disorder stems from the high level of comorbidity among them.
Another problem is that most research is retrospective instead of the more valuable prospective research.
Biological factors seem to be the infants temperament or inborn disposition to react affectively to environmental stimuli which predisposes them to the development of particular personality traits and disorders.
There is also increasing evidence for genetic contributions.
When it comes to psychological factors, psychodynamic theories originally attributed great importance in the development of character disorders to an infant getting excessive versus insufficient gratification of his or her impulses in the first few years of life. Learning based habit patterns and maladaptive cognitive styles have received more attention as possible cause of factors recently.
May also originate in disturbed parent-child attachment relationships. Parental psychopathology and ineffective parenting practises have also been implicated. Early emotional, physical, and sexual abuse may also be important factors.
A personality disorder characterized by pervasive suspiciousness and distrust of others.
Tend to see themselves as blameless, instead blaming others for their own mistakes and failures even to the point of ascribing evil motives to others. Are chronically tens and en garde, constantly expecting trickery and looking for clues to validate their expectations while disregarding all evidence to the contrary. Preoccupied with doubts about the loyalty of friends and our hence reluctant to confide in others. Commonly bear grudges, refuse to forgive pereceived insults and slights, and are quick to react with anger and sometimes violent behavior.
They are not usually psychotic; that is, most of the time they are in clear contact with reality, although they may experience transient psychotic symptoms during periods of stress. Share some symptoms found in paranoid personality, but they have any additional problems including more persistent loss of contact with reality, delusions, and hallucinations. Do appear to be at elevated liability for schizophrenia
Paranoid personality disorder
A personality disorder characterized by the inability to form social relationships or express feelings and lack of interest in doing so.
Consequently, they typically do not have good friends, with the possible exception of a close relative. Unable to express their feelings and are seen by others as cold and distant. Often lack social skills and can be classified as loaners or introverts, with solitary interests and occupations. Tend not to take pleasure in many activities, including sexual activity, and rarely marry. Are not very emotionally reactive, rarely experiencing strong positive or negative emotions, but rather a generally apathetic mood.
Schizoid personality disorder
A personality disorder characterized by excessive introversion, pervasive social interpersonal deficits, cognitive and perceptual distortions, and eccentricities in communication and behaviour.
Although contact with reality is usually maintained, highly personalized and superstitious thinking is characteristic, and under extreme stress they may experience transient psychotic symptoms. Often believe they have magical powers and may engage in magical rituals. Other cognitive-perceptual problems include ideas of reference – the belief that conversations or gestures of others have special meaning or personal significance –, odd speech, and paranoid beliefs. Oddities in thinking, speech, and other behaviours are the most stable characteristics and are similar to those often seen in schizophrenic patients.
Schizotypal personality disorder
Causal factors: several studies have shown the same deficit in the ability to track a moving target visually that is common in schizophrenia. Also show numerous other mild impairment in cognitive functioning including deficits in their ability to sustain attention, working memory, both of which are common in schizophrenia. Also show deficits in their ability to inhibit attention to a second stimulus that rapidly follows presentation of a first stimulus similar to schizophrenia.
Associated with elevated exposure to stressful life events and low family socioeconomic status.
A personality disorder characterized by excessive attention seeking, emotional instability, and self-dramatization.
Tend to feel unappreciated if they are not the centre of attention; their life we, dramatic, and excessively extroverted styles often ensure that they can charm others into attending to them. But these qualities do not need to stable and satisfying relationships because others tire of providing this level of attention. Their appearance and behaviour are often quite theatrical and emotional as well as sexually provocative and seductive. May attempt to control their partners through seductive behaviour and emotional manipulation but they also show a good deal of dependence. Speech is often vague and impressionistic, and they are usually considered self-centered, vain, and excessively concerned about the approval of others, who see them as overly reactive, shallow, and insincere
Histrionic personality disorder
A personality disorder characterized by an exaggerated sense of self importance, preoccupation with being admired, and lack of empathy for the feelings of others.
Subtypes: grandiose and vulnerable.
Grandiose presentation is manifested by trace related to grandiosity, aggression, and dominance. Reflected in a strong tendency to overestimate their abilities and accomplishments while underestimating the abilities and accomplishments of others. Sense of entitlement is frequently a source of astonishments to others, although they themselves seem to regard there lavish expectations as merely what they deserve. Behave in stereotypical ways to gain the acclaim and recognition they crave. Because they believe they are so special, they often think they can be understood only by other high status people or that they should associate only with such people. Their sense of entitlement is also associated with their unwillingness to forgive others for perceived slights, and they easily take offense.
Vulnerable presentation have a very fragile and unstable sense of self-esteem, and for these individuals, arrogance and condescension is merely a façade for intense shame and hypersensitivity to rejection and criticism. May become completely absorbed and preoccupied with fantasies of outstanding achievement but at the same time experience for found shame about their ambitions. May avoid interpersonal relationships due to fear of rejection or criticism.
Unwilling or unable to take the perspective of others, to see things other than through their own eyes. If they do not receive the validation or assistance they desire, they are inclined to be hypercritical and retaliatory.
Narcissistic personality disorder
A personality disorder characterized by impulsivity and instability in interpersonal relationships, self-image, and moods.
Affective instability – manifested by unusually intense emotional responses to environmental triggers, with the lead recovery to a baseline emotional state.
Highly unstable self image – impoverished and/or fragmented.
Impulsivity – rapid responding to environmental triggers without thinking or caring about long-term consequences. Often leads to erratic,, self-destructive behaviours such as gambling sprees or reckless driving.
Self-mutilation – such as repetitive cutting behaviour associated with relief from anxiety or dysphoria and to communicate the person’s level of distress to others.
Borderline personality disorder
A personality disorder characterized by extreme social inhibition and introversion, hypersensitivity to criticism and rejection, limited social relationships, and low self-esteem.
They do not seek out other people, yet they desire affection and are often lonely and bored. Unlike skis avoid personalities, they do not enjoy their aloneness; their inability to relate comfortably to other people cause acute anxiety and is accompanied by low self-esteem and excessive self-consciousness, which in turn are often associated with depression. The two most prevalent and stable features are feeling inept and socially inadequate.
Avoidant personality disorder
The key difference between the loner with schizoid personality disorder and the loner who is avoidant is that the one with an avoidant personality is shy, insecure, and hypersensitive to criticism, whereas the one with the schizoid personality is aloof, cold, and relatively indifferent to criticism. The avoidant personality also desires interpersonal contact but avoids it for fear of rejection, whereas the schizoid lacks the desire or ability to form social relationships.
A less clear distinction is that between avoidant personality disorder and generalized social phobia. There is substantial overlap leading some investigators to conclude that avoidant personality disorder may simply be a somewhat more severe manifestation of generalized social phobia.
A personality disorder characterized by extreme dependence on others, particularly the need to be taken care of, leading to clinging and submissive behaviour.
Usually build their lives around other people and the board made their own needs and views to keep these people involved with them. Maybe indiscriminate in their selection of meats. Often fail to get appropriately angry with others because of a fear of losing their support, which means that people may remain in psychologically or physically abusive relationships. Difficulty making even simple, every day decisions without a great deal of advice and reassurance because they lack self-confidence and feel helpless even when they actually develop the good work skills or other competencies. May function well as long as they are not required to be on their own.
Dependent personality disorder
Some features overlap with those of borderline, histrionic, and avoidant personality disorder’s, but there are also differences. For example, both borderline personalities and dependent fear abandonment however, the borderline who usually has intense and stormy relationships, reacts with feelings of emptiness or rage if abandonment occurs, whereas the dependent personality reacts initially with submissiveness and appeasement and then finally with an urgent seeking of a new relationship. Histrionic and dependent personalities both have strong need for reassurance and approval, but the histrionic personality is much more gregarious, flamboyant, and actively demanding of attention, whereas the dependent personality is more docile and self-effacing. It can also be hard to distinguish between dependent and avoidant personality’s. Dependent personalities have great difficulty separating in relationships because they feel incompetent on their own and have a need to be taken care of, whereas avoidant personalities have trouble initiating relationships because they fear criticism or rejection, which will be humiliating.
This personality disorder is characterized by perfectionism and excessive concern with maintaining order, control, and adherence to rules.
They are very careful in what they do so as not to make mistakes, but because the details there preoccupied with are often trivial they use their time poorly and have a difficult time seeing the larger picture. This perfectionism is often quite dysfunctional in that it can result in their never finishing projects. They also tend to be devoted to work to the exclusion of leisure activities and may have difficulty relaxing or doing anything just for fun. On an interpersonal level, they have difficulty delegating tasks to others and are quite rigid, stubborn, and cold, which is how others tend to view them. Rigidity, stubbornness, and perfectionism, as well as reluctance to delegate, are the most prevalent and stable features.
Obsessive compulsive personality disorder or OCPD
Do not have true obsessions or compulsive rituals that are the source of extreme anxiety or distress. Instead they have lifestyles characterized by over conscientiousness, inflexibility, and perfectionism but without the presence of true obsessions or compulsive rituals.
Some features overlap with features of narcissistic, antisocial, and schizoid personality disorders but there are distinguishing factors. For example, individuals with narcissistic and antisocial personality disorder is me share the lack of generosity toward others that characterizes OC PD, but the former tends to indulge themselves, where as those with OC PD are equally unwilling to be generous with themselves. In addition, both the skids the Wade and the obsessive-compulsive personalities may have a certain amount of formality and social attachment, but only this giveaway personality lacks the capacity for close relationships. The person with OC PD has difficulty in interpersonal relationships because of excessive devotion to work and great difficulty expressing emotions.
Describe general socio-cultural causal factors for personality disorders
Not well understood. The incidence and particular features of personality disorders vary somewhat with time and place, although not as much as one might guess. There is less variance across cultures then within cultures. This may be related to findings that all cultures share the same five basic personality traits, and their patterns of covariation also seem universal.
