Chapter 12 - Personality Disorders Flashcards
Describe personality traits
- stable over time, consistent across situations
- psychological characteristics: cognitions, emotions, behaviours, way of interactions
How are personality disorders conceptualized?
- maladaptive, inflexible, pervasive
- disorders of “reputation”, how others experience the traits as problematic
- not a manifestation of another mental disorder, or due to effects of drugs, or general medical condition
Name two areas manifested in
- cognition, affectivity, interpersonal functioning, impulse control
Example of how perfectionism is a continuum
Adaptive: pride
Excessive: until I get right
Problematic: must be perfect, even if more than required
Dysfunctional: nothing ever good enough, never finish anything
Why should personality disorders be diagnosed at all?
- ego-syntonic: trait in line w self-perception, thus resist change
- better understanding of comorbid disorders
- important implications in planning treatment
Prevalence of diagnosable in gen pop
6-9%
How are PDs organized in DSM5
10 disorders in 3 clusters
Define cluster A
WEIRD - odd, eccentric behaviour
- Paranoid
- Schizoid
- Schizotypal
Define cluster B
WILD - dramatic, emotional, erratic
- Antisocial
- Borderline
- Histrionic
- Narcissistic
Define Cluster C
WITHDRAWN - anxious, fearful behaviour
- Avoidant
- Dependent
- Obsessive-compulsive
Describe paranoid PD
Core Cognition: Other people can never be trusted
- suspicion
- prevalence: <1%
- pervasive mistrust
- motives perceived as malevolent
- sees hidden meaning behind remarks
- bears grudges, unforgiving
- jealousy, suspicion
- not severe enough to be delusional (not as rigid or well defined)
Describe schizoid PD
Core Cognition: I don’t need other people
- low emotional responsiveness
- prevalence: women
- poss related more to asocial disorders (i.e. Aspergers)
Describe schizotypal PD
Core Cognition: world is bizarre place
- eccentric beh & thought
- prevalence: 3% of gen pop
- men = women
- genetic
- more frequent in relatives of schiz
- odd, peculiar ideation & beh
- magical thinking, supersititious beliefs,
- ideas of reference, unusual perceptual experiences
- odd speech: vague, overelaborate, stereotyped
- interpersonal challenges
- related to schiz, on schizophrenic spectrum
Describe Histrionic PD
Core Cognition: I need to impress others to be acceptable
- prevalence: 3% of gen pop
- 10-15% in clinical settings
- Women > men (diagnosed)
- excessive emotionality, attention-seeking
- dramatic, exaggerated, but shallow emotions
- shallow, stormy relationships
- related to low-self esteem
Describe Narcissistic PD
Core Cognition: I am special & unique, not like others
- prevalence: women
- grandiose self-importance
- fantasies of success, power, brilliance, beauty
- entitlement, need for admiration
- lack empathy, exploit others
- unstable, tenuous self-esteem
- Narcissistic injury: deflated if something really negative happens
Describe Borderline PD
Core Cognition: If someone doesn’t care for me, I am nothing
- prevalence: 1-2% gen pop; 10-20% clinical pop
- women > men
- borderline: between neurotic and psychotic
- unstable interpersonal relationships (really close then really angry/reject). intense, chaotic
- fluctuating self-esteem
- impulsive, risky, self-descructive beh
- feeling empty, fear abandonment
- intense anger
Etiology of BPD
- childhood abuse & neglect
- high incidence of sex abuse
- anxious/ambivalent attachment
- intense feelings of abandonment
- “splitting” - idealization, devaluation (all good or bad)
Typical comorbid w BPD
- mood disorders, substance abuse
- eating disorders, PTSD, DID
Treatment issues w BPD
- chaotic, intense interpersonal patterns play out
- long-term intensive treatment
Describe Antisocial PD
Core Cognition: People are there to be used - get others before they get you
- Prevalence: 3% (higher in prisions)
- men > women (2:1 - 7:1)
- “psychopath” concept
- disregard for others, aggressive, fights, assaults
- reckless beh, impulsive,
- fail to plan ahead
- deceitful, irresponsible
What is Antisocial PD diagnosed as in adolescents
Conduct disorder before age 15
- aggression to others, animals, cruelty, deceitfulness
Describe Avoidant PD
Core Cognition: I need to be careful not to be hurt by others
- prevalence: 1%
- men = women
- anxious, fearful, much like anxiety disorders
- social inhibit, fear rejection
- hypersensitive to neg eval
- avoid trying new things, fear of embarrassment
- similar and often comorbid to social phobia
Describe Dependent PD
Core Cognition: I am helpless. I need someone to take care of me
- prevalence: 2% (v common in clinical settings)
- women > men
- submissive, dependent, clinging
- need to be taken care of
- seeking advice, reassurance
- fear of being alone, helpless
- comorbid: depression, panic disorder
Describe Obsessive-compulsive PD
Core Cognition: errors are bad. I must not make a mistake
- prevalence: 2%
- men > women
- preoccupied w orderliness, perfectionism, control
- excessive devotion to work, inflexible, no down time
- rigid, stubborn, miserliness, hoarding
- control freak
Difference between OCPD and OCD
OCD: ego-dystonic
OCPD: ego-syntonic
- OCPD no obsessions or compulsions
Name the CBT approach to treating personality disorders
- Schema Therapy
- treats early maladaptive schemas
Describe how Early Maladaptive schemas may have occurred
- schemas develop early in life
- when childhood needs are not met
- tend to be self-perpetuating, resistant to change
- information is distorted to fit schema
- unconditional beliefs about self, others (simlar to self/world/future)
- defensiveness, incompetence, entitlement, etc
- automatic thoughts (activated by environment events)
- produce strong emotional reactions, malad beh
Describe Early Maladaptive schemas core childhood needs
- love, nurturing, attention
- acceptance, praise
- stable base, predictible, safety
- empathy
- guidance, protection, limit-setting
- validation of feelings, needs
Unique challenges to treating PDs
- resistant to change, rigid
- less co-operative, less motivated
- cognitions less conscious, accessible
- more focus needed on the thera relationship, early experience key
- can’t diagnose before age 18
Issues in psychotherapy
GOAL: restructuring personality
- change perception & understanding of interpersonal events
- anticipating consequences of actions
- develop realistic & stable self
- find mutuality & intimacy in relationships
- thera reln’ is most important
Is Psychodynamic or schema therapy more effective for PBD
schema therapy by far
5 formal criteria to diagnose PD
Criterion A: pattern of beh in two: cognition, emotions, interpersonal, impulse control
Criterion B: pattern rigid & consistent across personal & social
Criterion C: clin sig distress
Criterion D: stable and long duration of symptoms, adolescence or earlier
Criterion E: not accounted by other disorder
DSM 5 PDs going away
paranoid, schizoid, histrionic, dependent
avg duration of hospital stay due to PD
9.5 days
Most common cluster for suicide
Cluster B most common in suicide
Cluster commonality in married/education
Cluster A: never married men
Cluster B: poorly educated men
Cluster C: graduated highschool but never married
Most common cluster to seek treatment
Cluster B, then Cluster C, then A
Key research focus for PD (reliability)
- inter-rater reliability
- test-retest reliability
Common pair of PD
- borderline & schizotypal
Comorbid rates w Axis I
about half w PD also have Axis I disorder
Describe Dark triad
Machiavellanism + subclinical narcissism + subclinical psychopathy
Progress of naming psychopathy
- manie san deliere (madness w/out delirium)
- moral insanity
- psychopathic inferiority
- sociopath
Etiology of clusters (bio vs env)
Cluster A: genetic
Cluster B: bio + attachment
Cluster C: not yet
Difference between paranoid personality & paranoid schizophrenia
- severity
Schizo: a delusion, ingreained
Paranoid PD: non-bizarre, general suspicion
Difference between APD and psychopathy
- most psychopaths are APD, but only some APD are psychopaths
- psychopathy includes emotional, interpersonal and beh features
Fearlessness hypothesis
- higher threshold for feeling fear than do other people
- learned to be indifferent to physical punishment or oppositional attempts to control
- update: differentially responsive (not fear physical, but do respond when money is at stake)
Burnout factor relates to which PD
Antisocial beh
Selective impulsivity theory
- psychopaths aren’t out of control, just can quickly weigh pros and cons.
- will act impulsively if worth it
Affected Brain parts in psychopaths
- PFC, hippocampus, angular gyrus, basal ganglia, amygdala
- amygdala: use cognitive means to compensate for missing limbic input
Two pathways to psychopathy
Fundamental: biological hinders affective bonds
Secondary: neg env experiences in childhood. unable to detach frm emotions
Biosocial theory of BPD
- bio predisposed to unable regulate own emotions
- experience emo reactions more strongly, longer to recover
Makes avoidant unique
feeling lonely
Relatives disorders related to panic
Relatives of male dependent PD: depression
Relatives of female dependent PD: panic disorder
DBT
- therapist accepts demanding beh
- exposure treatment, skills training, contingency mgmt, cog restructuring
