Chapter 12: Personality Disorders and Impulse-Control Disorders

Question 1

The description/definition of personality disorders

Answer 1

Overly rigid and maladaptive patterns of behavior and ways of relating to others.

Question 2

How do those with personality disorders view themselves, and how does this impact participation in treatment?

Answer 2

Fail to see how their behaviors are maladaptive

Do not feel a need for change

Ego syntonic
- Behaviors or feelings that are perceived as natural parts of self.

Question 3

Cluster A

Answer 3

Perceived as odd or eccentric

• Paranoid
• Schizoid
• Schizotypal

Question 4

Cluster B

Answer 4

Overly dramatic, emotional, erratic

• Antisocial
• Borderline
• Histrionic
• Narcissistic

Question 5

Cluster C

Answer 5

Appear persistently anxious or fearful

• Avoidant
• Dependent
• Obsessive-compulsive

Question 6

Psychodynamic perspectives

Answer 6

In general, most psychodynamic perspectives entail an analysis of a patient’s early experiences with relationships, and what instances may have included profound rejection and abandonment.

Greater feeling of rejection/abandonment = Increased capacity to manage relationships in a non-cohesive manner.

Question 7

Family perspectives

Answer 7

Disturbances in family relationships underlie the development of personality disorders:

• Overcontrolling parents
• Lack of parental nurturing
• Childhood physical or sexual abuse
• Childhood neglect
• Parental overprotection and authoritarianism

Question 8

Biological perspectives

Genetic factors

Answer 8

Personality traits thought to represent interactions of genetic factors and life experience.

Of the several personality disorders, antisocial, narcissistic, paranoid, and borderline types considered to relatively more genetic influences versus other PD’s

Question 9

Biological perspectives

Lack of emotional responsiveness

Answer 9

People with antisocial personalities
- Can maintain their composure in stressful situations that would induce anxiety in most people

Lack of anxiety in threatening situations

Question 10

Biological perspectives

The craving-for-stimulation model

Answer 10

People with antisocial personalities

• Tend to crave excitement or stimulation
• They may need more stimulation that other people to maintain interest and function normally

Question 11

Biological perspectives

Brain abnormalities

Answer 11

Most directly implicated are the prefrontal cortex and deeper brain structures in the limbic system.

Brain imaging links borderline and antisocial personality disorder to dysfunctions in parts of the brain involved in regulating emotions and restraining impulsive behaviors.

Examples – amygdala and hippocampus (associated with memory and fear responses).

Question 12

Sociocultural perspectives

Answer 12

Social conditions may contribute to the development of personality disorders.

Stressors encountered by disadvantaged/impoverished families may contribute to antisocial behavior patterns
- Antisocial personality disorder is reported frequently among people from lower socioeconomic classes.

Children reared in poverty more likely to be exposed to deviant role models.

Maladjustment in school may lead to alienation and frustration in larger society.
- Leading to antisocial behavior

Question 13

What are some of the criticisms behind the classification of personality disorders?

Answer 13

Major concerns:

Personality disorders: categories or dimensions?

Problems distinguishing from other clinical syndromes.

Overlap among many disorders.

Difficulty in distinguishing between normal and abnormal behavior.

Confusing labels with explanations

Question 14

Sexist biases

Answer 14

Certain behaviors classified as feminine are seen as pathological more often than stereotyped masculine behaviors.

Question 15

What are the general perspectives on psychiatric medications for personality disorders?

Answer 15

Drug therapy does not directly treat personality disorders. However:

Antidepressants or antianxiety are used to treat immediate symptoms related to depression/anxiety.

Atypical antipsychotics

• Used to target aggressive/self-destructive behaviors (especially with severe cases of borderline personality disorder).
• The effects are modest.
• The drugs carry serious potential side effects (as mentioned during topic on schizophrenia and related disorders).

Question 16

What is noted as the primary challenge with effectively treating individuals with personality disorders?

Answer 16

People with personality disorders usually see their behaviors, even maladaptive, self-defeating behaviors, as natural parts of themselves.

Unlikely to perceive their own behavior as cause of unhappiness or distress.

Question 17

Kleptomania

Answer 17

Repeated acts of compulsive stealing.

Stolen objects are typically of little value or use to the person

Typically not motivated by anger or vengeance

Experience pleasurable excitement or gratification when they engage in compulsive stealing

Question 18

Intermittent explosive disorder

Answer 18

Repeated episodes of impulsive, uncontrollable aggression in which people strike out at others or destroy property.

Episodes of violent rage and loss of control.

State of tension before their violent outbursts.

Sense of relief after outbursts.

Justify behavior.

Feel remorse or regret.
- This is a key difference from conduct disorder, which is only diagnosed during childhood/adolescence.

Question 19

Pyromania

Answer 19

Characterized by repeated acts of compulsive fire setting in response to irresistible urges.

Rare disorder and not well understood.

Most common motive is anger or revenge.

Feel a sense of psychological/emotional relief when setting fires.
- With conduct disorder, setting fires would be seen as a pattern of intentionally cruel and harmful behavior.

May feel sense of empowerment.

Question 20

Which disorder is often associated with intermittent explosive disorder but includes a feature that distinguishes one disorder from the other?

Answer 20

Conduct disorder

Feel remorse or regret.
- This is a key difference from conduct disorder, which is only diagnosed during childhood/adolescence.

Question 21

With pyromania, why is the feature of psychological/emotional relief with setting fires an important feature and in contrast to patterns related to conduct disorder?

Answer 21

They set the fires to feel the relief from the urge while children and adolescence set fires to be cruel and harmful