Chapter 11 in class notes Flashcards
What is personality?
Stable: thoughts, perceptions and interactions.
Personality Disorders (Overview)
- Pervasive and inflexible
- Causes distress
- High comorbidity (depression, anxiety, substance abuse)
- Poor prognosis - engrained, static way of interacting with world
- maladaptive/deficits (in at least 2 areas: emotions, behavior, thoughts, etc.)
Significant impairments in sense of self and relationships is likely due to
a personality disorder
What is the prevalence of personality disorders?
14.8% (one out of 6 people)
How many years of history does a person need to get diagnosis of a personality disorder?
5 years (and at least 22-25 years old)
A) What is Cluster A?
B) What disorders are in it?
A) Odd, eccentric personality disorder. Bizarre, wacky, quirky
B) Paranoid
Schizoid
Schizotypal
A) What is Cluster B?
B) What disorders are in it?
A) Dramatic-emotional, interpersonal
B) Borderline, Antisocial, Histrionic + Narcissistic
A) What is Cluster C?
B) What disorders are in it?
A) Anxious-Fearful
B) Avoidant, Dependent, Obsessive Compulsive
Paranoid PDO A) Prevalence B) Gender C) Symptoms D) Treatment E) Part of cluster _
A) 0.7-5.1% – 2% averaged
B) Males > Females. Males are belligerent/aggressive. Females caddy/behind scenes
C) Victim mentality - world is against me. Patterns of distrust and suspiciousness
D) poor. They don’t trust.
E) Cluster A (Odd, eccentric personality disorder. Bizarre, wacky, quirky)
Paranoid PDO patterns of distrust and suspiciousness
> Assume exploitation, harm or deception in any new relationship
Feelings of hurt + mistrust
Shocked by loyalty (but you did it because you want something from them)
Not confide in others so appear defensive/closed off
Mistakes are slights that are intentional and malicious (eg. wrong change by sales clerk)
Bear grudges and do not forgive
Feel anger and hostility for long periods after being slighted
Desire control to minimize betrayal
Paranoid PDO behavior expressions
> Sarcastic and blaming of others
Legal battles due to assigning fault
Thinly veiled grandiose ideas (you’re envious of me, that’s why you’re attacking me)
Prefer simple and straightforward situations and are wary of ambiguous situations (good/bad lumping)
Tend to seek out others who share the same paranoid thoughts
In frightful/scary situations what do paranoid PDO people do?
They’re belligerent and provocative (most people avoid scary situations, not them)
Schizoid PDO A) take away from the video watched in class B) Prevalence C) Gender D) Symptoms E) Part of cluster _
A) VERY difficult to keep a conversation going. afterwards exhausted
B) 0.8-1.7%
C) Males more than females
D) Detachment (lack of desire for social intimacy, indifferent to social situations or social cues, indifferent to criticism or praise)
Restricted affect
E) Cluster A (Odd, eccentric personality disorder. Bizarre, wacky, quirky)
Schizoid PDO - Restricted Affect
> Lack of pleasure from relationships + interactions
Lack of pleasure in sensory experiences (e.g. sex, walking, beach, sunshine)
No hobbies because no joy
Do not reciprocate smiles or eye contact or small nods to acknowledge others
May experience painful experiences under extreme circumstances (e.g. parent dies)
Seem to struggle in particular with the expression of anger
What are some forms of detachment for Schizoid PDO?
> lack of desire for social intimacy
Indifferent to social situations or social cues (i.e. sticking out hand for handshake)
Indifferent to criticism or praise
Schizoid people often live in _(A)___
Can develop (B)__ with extreme stress
They often appear to be __(C)__
What trait in childhood is most common? ___(D)
A) Isolation
B) psychosis
C) Without goals
D) Shyness
Schizotypal PDO A) Take away from the video watched in class B) Prevalence C) Gender D) Symptoms E) Part of cluster \_\_
A) He feels like an outsider - is aware of being different.
B) 3.9%
C) Males > Females
D) similar to SZ but mild.
E) Cluster A (Odd, eccentric personality disorder. Bizarre, wacky, quirky)
Symptoms of Schizotypal PDO
pervasive/chronic pattern of social and interpersonal deficit marked by:
> Acute discomfort in relationships (not apathetic like other DO)
> Cognitive and perceptual distortions (differ from paranoid bc not as intense about them)
> Eccentricities in behaviors (i.e. weather appropriate but not culturally appropriate dress)
Schizotypal can be comorbid with _____ (what __%)
Depression - 30-50% They still have emotions
Superstitions and Schizotypal disorder
> Reference - read magical meaning in unconnected events
Comply w/ magical rituals (e.g. walk past something 3X or something harmful will happen) This differs from OCD because OCD understands reality (that nothing bad will happen - they are doing things for anxiety)
Perceptual alterations (e.g. sensing that another person’s present or hearing their name murmured) not delusions or hallucinations
Odd things of Schizotypal
> Speech - tangential
Behaviors - strange gait (i.e. R foot has to go first)
Mannerism and dress
Borderline Personality Disorder A) Take away from the video watched in class B) Prevalence C) Gender D) Symptoms E) Part of cluster \_\_
A) They take cues from outside on how to be. They don’t know who they are. No sense of self.
B) 5.9% (6 of 100)
C) Females primarily (due to presentation. Males get categorized as antisocial)
D) Self harm. 2 groups of symptoms that shouldn’t coexist.
E) Cluster B (Dramatic-emotional, interpersonal)
[exam] What percentage of Borderline Personality Disorder people
A) attempt suicide?
B) commit suicide?
C) engage in self harm?
A) 75% attempt suicide
B) 10% commit suicide (some accidental with self harm)
C) 90-95% engage in self harm
Borderline Personality Disorder PSYCHOTIC SPECTRUM
1) Par_
2) Dist_
3) Biz__
4) Disconnect __
5) Disconnect __
1) Paranoid and a fierce need to defend ideas + thoughts
2) Distant, flat affect + apathy (think Schizoid)
3) Bizarre behaviors that are ritualized in some way (respond to internal stimulation)
4) Disconnect from reality
5) Disconnect between body and mind
Borderline Personality Disorder NEUROTIC SPECTRUM
1) Need ____
2) High ____
3) Im___
4) Hyper___
5) Intense __
1) need for relationships + dependent, need to have the approval of others
2) High emotionality, sensitive, unstable moods. Extreme anger to extreme happy to extreme sad
3) Impulsive behaviors and erratic behaviors (sex, drug use, reckless driving, bar fights)
4) Hyper-vigilant (awareness of how society views them)
5) Intense self-focus and self-criticism.
[exam]
A) How many symptoms are there for Borderline Personality Disorder?
B) How many symptoms are needed to diagnose?
C) what are the consequences of that?
A) 9 symptoms
B) 5 symptoms to diagnose
C) Can look vastly different between people
Why do Borderline PDO self harm?
> Numb in body yet high emotions, so cut to increase one (increase feeling in body) and decrease other (decrease emotion)
Focus on body pain instead of emotional pain
Attention - lonely, isolated, abandoned
Bc they dissociate - gets them back into body/back to reality
Every extreme with Borderline PDO is due to _____
Instability.
5 categories of diagnosis around instability for BPDO:
1) Self
2) Emotions
3) Cognitions
4) Relationships
5) Behaviors
1) lack of consistent identity and self-image, dissociation, extreme self doubts vs grandiose self. Rely on external environment to direct their behavior
2) Unstable and intense, lasts for minutes to days, emptiness, intense anger
3) Perceived abandonment and frantic efforts to stop it
4) Devalue and idealize. Once they have you they devalue you
5) self-harm, suicidal, impulsive sex, spending, etc.
Theories of BPDO:
A) Cognitive (Dialectical) theory
B) Neurobiological theory
A) childhood abuse/trauma, invalidation and subsequent emotion dysregulation and self-invalidation
B) amygdala overactive, hippocampus low memory of positive, prefrontal cortex - low functioning.
Treatments for BPDO:
A) D_
B) S
A) Dialectical behavioral therapy
B) Skills:
> Mindfulness (stay in present moment, notice environment)
> Interpersonal effectiveness (decrease relationship chaos)
> Emotion regulation skills (bucket of ice water - stick head in it - dive reflex - instantly feel calm. ice pack on back. really hot chili pepper)
> Distress tolerance (decrease impulsive behaviors)
Histrionic PDO A) Take away from the video watched in class B) Prevalence C) Gender D) Symptoms E) Part of cluster \_\_
A) very flirtatious. Needs to be desired/liked
B) 1.8%
C) Female
D) Need to be center of attention. Drama queen. Excessive emotionality.
E) Cluster B (Dramatic-emotional, interpersonal)
Histrionic PDO symptoms A) Need to be \_\_. And if not they feel \_\_\_\_ B) Excessive \_\_\_\_ (s\_\_\_ and \_\_\_) C) Sexually \_\_\_\_ D) Relationships E) Mannerism
A) center of attention. Anxiety
B) emotionality (shifting and shallow). They flip through emotions quickly
C) Sexually provocative. Very flirtatious and engaging, though they won’t have sex. Breathy
D) Relationships perception - tell you everything on first meeting. Think you’re BFFs. Burn through relationships.
E) extreme with all things. exaggerate needs and problems. Demanding + ego-centric.
Histrionic PDO is comorbid with
somatic disorders and anxiety
Etiology (the cause, set of causes, or manner of causation of a disease or condition)
of Histrionic
Largely unknown. Maybe reinforced behaviors.
Variant of antisocial personality?
Treatment options for Histrionic
Little evidence that treatment is effective
Focus on behavior change
Narcissistic PDO A) Prevalence B) Gender C) Symptoms D) Part of cluster \_\_
A) 7.7%
B) Males primarily
C) Grandiosity - “better than” … rules shouldn’t apply
D) Cluster B (Dramatic-emotional, interpersonal)
Symptoms of Narcissistic PDO
> Grandiosity: “better than” everyone else
Overestimate self/ability
Boastful (talk about self/achievements
Preoccupied with fantasy: saving the world, knowing famous people
need for admiration. Easily slighted if not complimented.
Entitlement “I deserve special treatment”
Lack of empathy
Exploitation - not trying to harm though.
Lack of understanding of lack of relationships. Why don’t people love me? I’m awesome.
Narcissistic PDO is comorbid with
histrionic and antisocial (lack of remorse)
Treatment for Narcissistic PDO is not effective because
they have a genuine lack of insight into their behavior.
Antisocial PDO A) Prevalence B) Gender C) Symptoms D) Part of cluster \_\_
A) 0.2 - 3.3%
B) Males primarily
C) lack of regard for society’s moral or legal standards.
D) Cluster B (Dramatic-emotional, interpersonal)
Antisocial PDO associated behaviors
> Failure to conform to social norms > Deceitfulness (lying, forging checks) > Impulsivity > Aggressiveness > Disregard for others > Irresponsibility > lack of remorse (they'll burn relationship. Money train runs out, exit relationship)
Conduct DO diagnosis prior to ___ years old
15
Conduct DO diagnosis
> Aggression, Destruction, deceitfulness
Violation of rules and nonconformity
Associated with callous-unemotional subtype of CDO (very small % of CDO people)
- they don’t steal because they want, they are motivated by wanting to hurt others.
- sexually active at young age. at 5 interested, at 7 touching/aggressive games.
To diagnose antisocial PDO one must rule out ___
manic episode or SZ/psychosis.
Antisocial PDO associated features A) S B) H C) A D) A E) I\_\_ P\_\_
A) Suicide B) Homicide - due to higher aggression C) Accidents (more reckless) D) Assaults E) Interpersonal problems (callous and disconnected)
Early risk factors of antisocial PDO
> Families with inconsistent parental discipline and support
Families often have histories of criminal and violent behavior
Family adversity - parents work a lot, kid comes home to empty house
Maternal difficulties - exp after birth - postpartum depression
Cognitive deficits - social stigma - bullied
Temper
Hyperactivity - ADHD
Rejection from peers - marginalized
Antisocial PDO - prevailing neurobiological theories
> Cortical immaturity hypothesis
> Fearlessness hypothesis - amygdala
Treatment for antisocial PDO
> burnout
> prison
Avoidant Personality disorder A) Prevalence B) Gender C) Symptoms D) Part of cluster \_\_
A) 2.4%
B) Females primarily
C) social inhibition, feelings of inadequacy, shy @ young age
D) Cluster C (Anxious-Fearful)
Symptoms of Avoidant personality disorder
A) Pattern of…
B) Early symptoms
A) > Social inhibition
> Feelings of inadequacy
> Hypersensitive to negative evaluation
B) Early symptoms:
> shyness at young age.
> More anxiety overall
> less eye contact
How is Avoidant PDO different from social anxiety?
They have these feelings regardless of who (even mother, siblings, etc.)
Causes of avoidant PDO
> Unknown. Possible reinforcement.
. High level of amygdala/fear activity
Treatment of avoidant PDO
Similar to Social Anxiety DO. Targets social skills and anxiety.
A) CBT
B) CB group treatment (CBGT) - $50-100/session - natural exposure, flooding, modeling. slowly easing in.
Most effective: CBGT
Causes of Social Anxiety Disorder
A)
B)
C)
A) Biological and evolutionary vulnerability (runs in family)
B) Learning and conditioning - avoiding eye contact perceived more negative
C) Cognitive perspective - depressive/negative triad
Psychological Treatment for Social Anxiety DO
A)
B)
C) Which is most effective?
A) CBT
B) CB group treatment (CBGT) - $50-100/session - natural exposure, flooding, modeling. slowly easing in.
C) CBGT
O-C Personality Disorder A) Prevalence B) Gender C) Symptoms D) Part of cluster \_\_
A) 7.9%
B) No difference M-F
C) Orderly and perfectionistic. Inflexible, rigid + emotionally blocked
D) Cluster C (Anxious-Fearful)
Symptoms of OCPD
> Orderly + perfectionistic
Inflexible, rigid and emotionally blocked. Things have to be a certain way. Can’t understand why people upset at them.
Controlling, dogmatic + stubborn. Stuck on beliefs
Lack of productivity.
How does OCPD differ from OCD?
OCD is across 1 or 2 things. OCPD is across everything
If OCPD affects self esteem what becomes comorbid?
Depression
Dependent personality disorder A) Prevalence B) Gender C) Symptoms D) Part of cluster \_\_
A) 0.49%
B) Females
C) Need to be cared for. Absorb into others.
D) Cluster C (Anxious-Fearful)
Symptoms of Dependent personality DO
> Need to be cared for
Deny all thoughts and actions that might displease others
Suppress own desires
Difficulty with everyday decisions. (Call up someone - what should I wear? should I bring a jacket?)
over-reliance on others
Relationship impairment
Treatment of cluster C PDOs
A) Particularly useful for ___
B) Not very effective for ___
C) Methods
A) Avoidant PDO
B) OCPD and Dependent
C) Cognitive + Behavioral Therapies. Graduated Exposure.
