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PSY240 > Chapter 12: Personality Disorders > Flashcards

Chapter 12: Personality Disorders Flashcards

1
Q

What is personality?

A
  • all the ways we have of acting, thinking, believing, and feeling that make us unique
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2
Q

What is a personality trait?

A
  • complex pattern of behaviour, thought, and feeling that is stable across time and across many situations
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3
Q

What is a personality disorder?

A
  • personality styles characterized by inflexible and pervasive behavioural patterns
  • often cause serious personal and social difficulties and impair general functioning
  • onset in adolescence or early adulthood
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4
Q

What are the six criteria for personality disorders?

A 
A - pattern of behaviour must be manifested in at least TWO of the following areas:
→ cognition
→ emotions
→ interpersonal functioning
→ impulse control

B - enduring pattern of behaviour that is consistent across a broad range of situations

C - behaviour should lead to clinically significant distress in important areas of functioning

D - stability and long duration (onset of adolescence or earlier)

E - behaviour cannot be accounted for by another mental disorder

F - behavioural patterns are not result of substance use or another medical condition

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5
Q

Why is the pathologizing of personality disorders considered controversial?

A
  • controversial because the distress does not have to be felt by the person with the “disorder” but can also be people around them
    i. e. people with antisocial personality disorder probably don’t think there’s anything wrong with them but just ask the person they kicked in the head
  • psychologists don’t want to give someone the stigmatizing “personality disorder” label
  • this criteria ends up using circular logic to diagnose personality disorder
    → Why does he have borderline personality disorder? Because he has unusually unstable relationships.
    → Why are his relationships so unstable? Because he has borderline personality disorder.
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6
Q

What are the three broad clusters of personality disorders?

A
  • Cluster A: odd and eccentric disorders
  • Cluster B: dramatic, emotional, or erratic disorders
  • Cluster C: anxious and fearful disorders
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7
Q

Which personality disorders are in Cluster A?

A
  • paranoid, schizoid, and schizotypal
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8
Q

Which personality disorders are in Cluster B?

A
  • antisocial, borderline, histrionic, and narcissistic
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9
Q

Which personality disorders are in Cluster C?

A
  • avoidant, dependent, and obsessive compulsive
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10
Q

Other than the three broad clusters, what else does the DSM-5 classify under personality disorders?

A
  • personality change due to another medical condition and other specified personality disorder
  • other specified and unspecified personality disorder
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11
Q

What personality disorder would a change in personality due to a frontal lobe lesion fall under?

A
  • personality change due to another medical condition and other specified personality disorder
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12
Q

Which situations does the “other specified and unspecified personality disorder” category address?

A

1 - individual meets criteria for a general personality disorder and displays symptoms of several, but criteria isn’t met to qualify for specific disorder

2 - individual meets criteria for general personality disorder but their symptoms are not reflected in existing personality disorders

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13
Q

What is paranoid personality disorder?

A
  • pattern of distrust and suspiciousness such that others’ motives are interpreted as malevolent
  • unwarranted and unadaptive
  • hypervigilant as a result of their beliefs
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14
Q

What is schizoid personality disorder?

A
  • pattern of detachment from social relationships and a restricted range of emotional expression
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15
Q

What is schizotypal personality disorder?

A
  • pattern of acute discomfort in close relationships, cognitive or perceptual distortions, or eccentricity of behaviour
  • e.g. inhibited or inappropriate emotion, disorganized speech, superstitious in the extreme
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16
Q

What is characteristic of most Cluster A personality disorders?

A
  • symptoms similar to those of schizophrenia
    → inappropriate/flat affect, odd thought and speech patterns, paranoia
  • difference being they maintain grip on reality
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17
Q

What is antisocial personality disorder?

A
  • pattern of disregard for, and violation of, rights of others
  • pattern of criminal, impulsive, callous, or ruthless behaviour
  • no respect for social norms
  • one of the most common and most difficult to treat
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18
Q

What is borderline personality disorder?

A
  • pattern of instability in interpersonal relationships, self-image, and affects, and marked impulsivity
  • often alternate between idealization to devaluation
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19
Q

What is histrionic personality disorder?

A
  • pattern of excessive emotionality and attention seeking

- dramatic and seductive behaviour

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20
Q

What is narcissistic personality disorder?

A
  • pattern of grandiosity, need for admiration, and lack of empathy
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21
Q

What is avoidant personality disorder?

A
  • pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation
  • strong fear of rejection
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22
Q

What is dependent personality disorder?

A
  • pattern of submissive and clinging behaviour related to an excessive need to be taken care of
  • often involved in abusive relationships on either end
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23
Q

What is obsessive-compulsive personality disorder?

A
  • pattern of preoccupation with orderliness, perfectionism, and control
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24
Q

Why is assessment of personality disorders important in clinical and forensic settings?

A

Personality disorders can complicate treatment of other DSM mental disorders.

  • disrupts alliance between therapist and client
  • personality disorder can be mistaken for another mental disorder e.g., schizotypal personality disorder & schizophrenia
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25
Q

What is the general prevalence rate of personality disorders?

A
  • 6 to 9% of the entire population, including community, hospitalized, and outpatient sample, will have one or more personality disorders in their lifetime
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26
Q

Which populations are most at-risk of certain personality disorders?

A

Cluster A: men who never married

Cluster B: poorly educated men

Cluster C: unmarried high school graduates

♀ - avoidant, dependent, paranoid

♂ - antisocial

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27
Q

Compare egosyntonic and egodystonic.

A

EGOSYNTONIC
- mental disorder does not cause distress for the person who has it

EGODYSTONIC
- mental disorder causes distress and viewed as problematic by individual sufferers

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28
Q

What are the main reasons there are diagnostic issues with personality disorders?

A
  • poor reliability of diagnosis
  • lack of understanding of etiology
  • weak treatment efficacy
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29
Q

What are the two indices of reliability that are important to diagnosing personality disorders?

A

1 - Inter-rater reliability: agreement between two raters
→ ranges from 0.86 to 0.97

2 - Test-retest reliability: agreement in diagnosis over time
→ ranges from 0.11 to 0.57

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30
Q

What is characteristic of most Cluster B personality disorders?

A
  • manipulative, volatile, and uncaring in social relationships
  • impulsive, sometimes violent behaviour that show little regard for their own safety or the safety or needs of others
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31
Q

What is characteristic of most Cluster C personality disorders?

A
  • extremely concerned about being criticized or abandoned by others
  • dysfunctional relationships
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32
Q

What is the general criticism of the DSM’s definitions of personality disorder?

A
  • personality disorders are better viewed as constellations of traits lying along a continuum
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33
Q

What are the gender issues with the DSM’s definitions of personality disorder?

A
  • sex role stereotypes may influence clinician’s determination of the presence of personality disorders

→ e.g. males are rarely diagnosed with histrionic personality disorder, women are rarely considered to have antisocial personality disorder

34
Q

What are the cultural issues with the DSM’s definitions of personality disorder?

A
  • clinicians may misdiagnose if they don’t take care to determine whether certain attitudes and behaviours are appropriate for distinct cultures or societal subgroups
35
Q

Why are women so often underdiagnosed for antisocial personality disorder?

A
  • emphasis on physical aggression in diagnosis

- ignores that women might express aggression in different ways

36
Q

Why are women so often overdiagnosed for borderline personality disorder?

A
  • found that the criteria themselves are gender biased
  • men have different ways of expressing the same borderline features
    → men who are domestically abusive for example
  • still not corrected in DSM-5
37
Q

What attempts have been made to fix gender bias in diagnosing personality disorders?

A
  • hystrionic personality disorder renamed from “hysterical” personality disorder
    → “histrionic” meaning “overly theatrical”
  • not much difference made, though, since people tend to picture the criteria as inherently feminine
38
Q

What is comorbidity?

A
  • co-occurrence in the same person of two+ different disorders
39
Q

What is overlap?

A
  • similarity of symptoms in two or more different disorders (i.e., some of the same criteria apply to different diagnoses)
40
Q

What is an example of overlap in personality disorders?

A
  • narcissistic personality disorder and antisocial personality disorder are both associated with a lack of empathy or concern for others
  • borderline personality disorder overlaps with like everything
41
Q

What is the rate of comorbidity with personality disorders and another mental disorder?

A
  • over half (51.2%)
42
Q

What is a specific example of comorbidity with personality disorders and another mental disorder?

A
  • borderline personality disorder is comorbid with many mood disorders
43
Q

What is the “Dark Triad”?

A
  • constellation of personality traits that are deemed to be socially aversive
  • includes machiavellianism, subclinical narcissism, and subclinical psychopathy
44
Q

Who was first to describe antisocial behaviour?

A
  • Philippe Pinel
  • described it as “madness without delirium”
    e. g., he observed profound deficits in emotion but not in reasoning/intellectual dysfunction
45
Q

What term did James Pritchard coin to describe antisocial personality disorder?

A
  • “moral insanity”

- delineate a medical condition characterized by an absence in morality rather than “madness” of typical patients

46
Q

What term did Julius Ludwig Koch coin to describe antisocial personality disorder?

A
  • “psychopathic inferiority”

- stemmed from a type of biological abnormality that resulted in personality anomalies such as extreme selfishness

47
Q

How did Cleckley describe antisocial personality disorder?

A
  • included emotional, behavioural, and interpersonal elements
  • psychopaths were unresponsive to social control and behaved in a socially inappropriate manner
  • deep emotion and anxiety deficits
  • suggested it was this “emotional shallowness” that was the driving issue
48
Q

What is the psychodynamic view of personality disorders?

A
  • results from disturbances in parent-child relationship
    → separation-individuation: when a child begins to see themselves as an individual
    → difficulties in this process result in inadequate sense of self or problems in dealing with other people
  • risk factor of poor upbringing and childhood trauma lends credence to theory
49
Q

What is attachment theory?

A
  • children learn how to relate to others, especially in affectionate ways, by the way their parents relate to them
50
Q

What is the attachment theory of personality disorders?

A
  • poor parent-child bonding will result in difficulty in future relationships
    → e.g., clingy or afraid of rejection
  • personality disorders becoming obvious during adolescence when there are greater demands for social interaction seems to give attachment theory some weight
  • high prevalence of negative childhood experiences with personality disorder
51
Q

What is the cognitive-behavioural perspective of personality disorders?

A
  • people develop schemas (broad maladaptive themes that people hold about themselves or others) early in life that become rigid and inflexible
  • views of new events become distorted to maintain validity of schemas
  • coping mechanisms of childhood continue into adulthood
52
Q

How would modelling theory explain personality disorders?

A
  • parents model poor behaviour that their children then copy

- parents may reward or punish behaviours non-contigently i.e., without regard for how the child actually behaves

53
Q

Summarize the etiology of the broad clusters of personality disorder.

A

CLUSTER A

  • genetic links with schizophrenia and mood disorders
  • impaired eye-tracking show signs of biological basis

CLUSTER B

  • biological factors
  • attachment problems

CLUSTER C
- no conclusive evidence

54
Q

What is the difference between paranoid personality disorder and paranoid schizophrenia?

A
  • severity of paranoid belief
  • in schizophrenia the belief is sufficiently bizarre and ingrained that it counts as “psychotic”/”delusional”
    → e.g., aliens are trying to tap into their brain
  • in PPD the beliefs are non-bizarre and within realm of possibility, even if they’re wrong
    → e.g., my neighbours are stealing my mail
55
Q

What is the trouble with the diagnostic category of schizoid personality disorder?

A
  • very little methodologically sound research due to the difficulty to find research participants
  • schizoid and schizotypal are often confounded in studies
56
Q

What are the criticisms of the diagnostic category of schizotypal personality disorder?

A
  • too similar to schizophrenia; may in fact just be a milder form of it
  • overlaps with much of Cluster A and avoidant personality disorder
57
Q

What are the main traits of psychopaths?

A
  • predisposition via temperament to antisocial behaviour

- callous, grandiosity, and history of poor self-regulation

58
Q

What are the main traits of sociopaths?

A
  • normal temperament but weakly socialized because of environmental failures, including poor parenting, antisocial peers, and disorganized home and school experiences
59
Q

The criteria for the diagnosis of antisocial personality disorder includes the seven exemplars reflecting the violation of the rights of others. What are they?

A
  • nonconformity
  • callousness
  • deceitfulness
  • irresponsibility
  • impulsivity
  • aggressiveness
  • recklessness
60
Q

What is a polythetic approach?

A
  • only a subset of symptoms or behaviours is required for diagnosis
61
Q

What is the difference between antisocial personality disorder and psychopathy?

A
  • psychopathy incorporates richer set of emotional, interpersonal, and behavioural features than APD, which focuses on observable behaviour
  • psychopathy not even really in the DSM
62
Q

What is the lifetime prevalence of antisocial personality disorder?

A

0.02% - 3.3%

63
Q

How is psychopathy measured?

A
  • Psychopathy Check List - Revised (PCL-R)
64
Q

What is the fearlessness hypothesis?

A
  • proposed by Lykken
  • suggests that people with antisocial personality disorder have higher threshold for fear i.e., are essentially fearless
  • supported by evidence of attentional mechanism that reduces fear response in individuals with APD
65
Q

What are the main etiological factors of antisocial personality disorder?

A
  • many family systems approach used
    → people come from unstable households and unhappy childhoods
  • neuropsychological markers interact with specific environmental conditions (neglect, abuse, criminogenic environment, etc.) to create vulnerability to antisocial lifestyle
66
Q

What is oppositional behaviour?

A
  • deliberate flouting of others, even when or perhaps because it means certain punishment
67
Q

What is the responsivity factor?

A
  • treatment must be responsive (or matched) to a particular patient’s needs and interpersonal style
68
Q

What does the “borderline” of borderline personality disorder refer to?

A
  • individual is on the border between neurosis and psy`chosis
69
Q

What is the lifetime prevalence of borderline personality disorder?

A

2%

70
Q

What is the problem with the diagnostic criteria of borderline personal disorder?

A
  • too closely related to borderline schizophrenia

- inconsistent research based on how researchers interpret the criteria to begin with

71
Q

What are the etiological factors of borderline personality disorder?

A
  • disruptions in family, childhood abuse and neglect
  • anxious-ambivalent attachment
  • reduced volumes of right hippocampus and dorsolateral prefrontal cortex, which play core roles in controlling impulsive and aggressive behaviour
  • biosocial theories
72
Q

What is anxious ambivalent attachment?

A
  • interpersonal style of someone who strongly desires intimacy with others and persistently seeks out romantic partners but become anxious and back away before they get close
    → desire closeness but are also afraid of it
    → developed through poor parent-child attachments that fail to instill self-confidence and skills necessary for intimacy
73
Q

What is the biosocial theory of borderline personality disorder?

A
  • BPD is fundamentally a dysfunction of the emotion regulation system
  • individuals have biological difficulty in regulating emotions
    e. g., heightened emotions, take longer to get back to baseline emotional ground, very sensitive to emotional stimuli
  • vulnerability interacts with exposure to invalidating environment (minimizing their emotional experiences) this results in emotionall unregulated system
74
Q

Compare and contrast avoidant personality disorder and schizoid personality disorder.

A
  • both actively avoid intimacy with others, but avoidant personality types want intimacy and suffer from loneliness while schizoid types do not
75
Q

What are the two biggest factors that make personality disorders difficult to treat?

A

1 - patients are not themselves upset by their characteristic personality style and thus don’t seek treatment voluntarily

2 - dropout rate from treatment is incredibly high

76
Q

What are Sperry’s five basic premises for treating personality disorders?

A

1 - best conceptualized in a way that considers both biological and psychological factors

2 - assess individual’s amenability to treatment

3 - effective treatment is flexible and tailored to patient

4 - lower level treatability should combine several treatment approaches

5 - basic goal should be to move client from personality-disordered function to personality-styled functioning

77
Q

What are the three main approaches to treating personality disorders?

A

1 - object-relations therapy
2 - cognitive-behavioural approaches
3 - medications

78
Q

What is object-relations therapy?

A
  • treatment aimed at correcting flaws in the self that have resulted from unfortunate formative experiences
  • patient-therapist relationship is a vehicle for confronting patient’s defences and distortions
  • necessarily long-term
79
Q

What is cognitive restructuring?

A
  • technique used by cognitive-behavioural therapists to encourage clients to become aware of, and to question, their assumptions, expectations, attributions, and automatic thoughts
80
Q

What is cognitive-behavioural therapy?

A
  • form of psychotherapy that attempts to change maladaptive thoughts and behaviours
81
Q

What is dialectical behavioural therapy?

A
  • one of the cognitive-behavioural approaches to treatment of borderline personality disorder
  • main features is acceptance by therapist of the patient’s demanding and manipulative behaviours

PSY240 (16 decks)

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