Chapter 13 Flashcards
What is personality?
A person’s typical way of thinking, feeling, and behaving—stable tendencies that influence how they respond to their environment.
What is a personality disorder?
*Three P’s pattern of behavior:
- Persistent (over time)
- Pervasive (over people and situations)
- Pathological (clearly odd; abnormal from cultural expectations)
->A persistent, pervasive, and pathological pattern of emotions, cognition, and behavior that deviates markedly from cultural expectations.
How do personality disorders impact daily life?
They cause emotional distress, affect work, and create difficulties in relationships.
What is considered a ‘normal’ personality according to Livesley?
Normal Personality is having adaptive solutions to life tasks.
What are Livesley’s three life tasks for a normal personality?
- Form stable, integrated representations of self and others. (to see your self and others as they really are)
- To develop capacity for intimacy (to have positive inter-relationships)
- To engage in pro-social and cooperative (to function adaptively in society)
When does a personality disorder develop according to Livesley?
Personality disorders occur when there is a failure to manage any one of these life tasks
What is the controversy surrounding personality disorder classification?
-> Categorical and Dimensional Models
-> Problems of kind vs. problems of degree
-> Low Stability of personality disorders diagnoses is a major criticism of categorical approach
-> (Cluster B disorders – highest stability over time)
Categorical Model (DSM-5): Disorders exist as distinct types.
Dimensional Model (Alternative Model - AMPD): Disorders exist on a continuum of traits.
What major change occurred in DSM-5 regarding personality disorders?
Axis II was eliminated (previously used for personality disorders in DSM-IV-TR).
What is the alternative dimensional model (AMPD) in DSM-5?
A proposed model where disordered personality reflects extreme levels of normal personality traits. It remains an alternative approach (not the main diagnostic method).
What are the two primary methods for assessing personality disorders?
- Clinical Interviews – the preferred method
->Often involve family informants for behavior - Psychological Tests – e.g., MMPI-2, Millon Clinical Multiaxial Inventory-IV.
What is the MMPI-2?
The Minnesota Multiphasic Personality Inventory-2 is a 567-item true-false test that assesses personality traits and psychopathology.
What is the Millon Clinical Multiaxial Inventory-IV?
the most widely used measure of personality disorder symptoms
195 true-false statements.
What are the five major personality traits in the Five-Factor Model?
- Extraversion (talkative, assertive, & active vs. silent, passive, & and reserved);
- Agreeableness (kind, trusting, and warm versus hostile, selfish, and mistrustful);
- Conscientiousness (organized, thorough, and reliable versus careless, negligent, and unreliable);
- Neuroticism (nervous, moody, and temperamental versus even-tempered); and
- Openness to experience (imaginative, curious, and creative versus shallow and imperceptive)
How does DSM-5 categorize personality disorders?
Into three clusters based on symptoms:
Cluster A – Odd/Eccentric
Cluster B – Dramatic/Erratic
Cluster C – Anxious/Fearful
What personality disorders belong to Cluster A (Odd/Eccentric)?
->Paranoid Personality Disorder
->Schizoid Personality Disorder
->Schizotypal Personality Disorder
What personality disorders belong to Cluster B (Dramatic/Erratic)?
->Antisocial Personality Disorder (APD)
->Borderline Personality Disorder (BPD)
->Histrionic Personality Disorder (HPD)
->Narcissistic Personality Disorder (NPD)
What personality disorders belong to Cluster C (Anxious/Fearful)?
->Avoidant Personality Disorder
->Dependent Personality Disorder
->Obsessive-Compulsive Personality Disorder (OCPD)
What is the estimated global prevalence of personality disorders?
7.8% (2020), with higher rates in high-income countries due to better diagnosis access.
Which personality disorders are more common in men vs. women?
Men: More likely diagnosed with Antisocial Personality Disorder (APD).
Women: More likely diagnosed with Borderline (BPD) and Histrionic (HPD).
What are the two types of gender bias in personality disorder diagnoses?
- Criterion gender bias
- the likelihood that men and women may exhibit the disorder differently because PD criteria include gender-related symptomatology
- Assessment gender bias
- Histrionic personality disorder biased against females & APD biased against males
Why is it difficult to diagnose a single personality disorder?
Many individuals exhibit traits from multiple disorders, leading to high comorbidity.
What is the main feature of Paranoid Personality Disorder (PPD)?
Unjustified suspicion and mistrust of others without reason.
What are common behaviors of individuals with PPD?
->Argumentative, hostile, or quiet and withdrawn
->Quick to blame others
->Can be extremely jealous
->Experience ideas of reference (mistaken belief that random events relate to them)
EX. Two people talking and you see one look at you and they keep talking = they must be talking about me
What disorders is Paranoid PD related to?
Paranoid Schizophrenia (but no hallucinations or full-blown delusions)
Delusional Disorder
-> Hallucinations and full-blown delusions are not present
-> Less impairment in social and occupational functioning than paranoid schizophrenia
Comorbid with Schizotypal and Avoidant Personality Disorders
What are possible causes of PPD?
Genetics: Slightly more common in relatives of people with schizophrenia
Childhood trauma/mistreatment (but memory bias may distort accuracy)
Cognitive factors: Mistaken assumptions like “I can’t trust anyone.”
Why is treatment difficult for PPD?
People with PPD mistrust therapists and struggle to form a therapeutic relationship.
What type of therapy is used for PPD?
Cognitive Therapy: Focus on restructuring mistaken assumptions about others.
What is the main feature of Schizoid Personality Disorder (SPD)?
Detachment from social relationships and a lack of interest in closeness with others.
What are common behaviors in people with Schizoid PD?
Cold, aloof, emotionally restricted
No desire for close relationships (including family, friends, intimacy)
NOT characterized by paranoia or psychotic symptoms (unlike Schizotypal)
How is Schizoid PD different from other disorders in Cluster A?
SPD lacks the unusual thought processes (e.g., magical thinking, ideas of reference)
What are some causes for Schizoid personality disorder?
- Very little research
- Childhood shyness (a precursor), abuse, neglect
- Low density of dopamine receptors (not much researcher)
What are some treatments for Schizoid PD?
- Rare to seek treatment (their family usually pushes them to get treatment)
- Therapy- Emphasis on the value in social relationships
- Social skills training
What are the core clinical features of Schizotypal Personality Disorder?
-Eccentric thinking
-social deficits
-psychotic-like symptoms
-cognitive impairment
-paranoid ideation
-suspiciousness
-Ideas of reference
-“Magical thinking” - unusual or irrational beliefs that events or thoughts can influence the world in supernatural or extraordinary ways
EX. reading other people’s minds; thinking objects have special powers (items of clothing may protect them)
- Odd speech (using words in unusual or unclear fashion)
EX. “What did you eat for lunch?” “I looked outside, it was a great day, I picked out my favorite spoon, I ate some cereal”
- Eccentric behavior and appearance
-> Hypersensitive to criticism as childrenEX. Even mild feedback or constructive criticism might cause intense feelings of sadness, shame, anger or anxiety in the child → with-drawl behaviors
What disorders is Schizotypal PD commonly comorbid with?
Borderline, avoidant, paranoid personality disorders, and (highly) major depressive disorder.
What are some biological causes of Schizotypal Personality Disorder (including the brain ares)?
Genetic links to schizophrenia, left hemisphere damage, enlarged ventricles, and reduced temporal lobe grey matter.
What treatments are used for Schizotypal Personality Disorder?
- Limited data on it’s effectiveness
- Antipsychotic medication, community treatment, social skills training, CBT
- Reduce symptoms or may postpone the onset of later schizophrenia (not everyone develops schizophrenia as they get older but some do)
What are key traits of someone with Histrionic Personality Disorder?
“Hysteria”
-Dramatic, attention-seeking, vain, impulsive, vague speech, sees things in black-and-white, self-centered.
- View situations in global, black-and-white terms (a person is bad or good etc.)
- Speech is often vague, lacking in detail
Why might HPD be overdiagnosed in women?
Because traits align with Western stereotypes of femininity (e.g., overdramatic, seductive).
What causes are proposed for HPD?
-Limited research
- psychoanalytic theory—parental seductiveness leading to emotionality and attention-seeking.
HPD is most often comorbid with what PD?
antisocial personality disorder
What is the treatment goal for HPD?
- Improving problematic interpersonal relationships
- Modification of interactional style - Teaching appropriate ways of negotiating their wants and needs (instead of manipulating others)
- Reducing attention seeking behaviors
What are the key traits of Narcissistic Personality Disorder?
- Unreasonable sense of self-importance, grandiosity, arrogance
- No compassion for others, envious, arrogant
- Frequently depressed because of high and unrealistic self expectations
What developmental factors contribute to NPD?
Lack of empathetic mirroring by parents and early invalidation.
EX. A child proudly shows an A grade and the parent simply says “oh good job” with no engagement.
What treatments are used for Narcissistic Personality Disorder?
CBT, relaxation training, learning to accept criticism, developing empathy, treating depression.
What are the hallmark features of Borderline Personality Disorder?
- Impulsivity and instability in relationships, mood, and self-image, fear abandonment, no control over emotions, self-mutilating and suicidal behaviors
- Argumentative, irritable, sarcastic, quick to take offence, black and white thinking (splitting - either bad or good no in-between)
What setting do we usually see people with Borderline PD in?
Clinical setting
What percentage of those with BPD die by suicide?
10%
What are common comorbidities with BPD?
Mood disorders, PTSD, substance abuse, eating disorders, and Cluster A PDs.
BPD is more common in men or women?
more common in women
When does BPD typically begin?
Begins in early adulthood
What are some causes of BPD?
- Still largely unknown
- Runs in families; Twin studies – Genetics
-Issues with the brain
-Early trauma (physical and sexual abuse) and biological predisposition
What brain abnormalities are linked to BPD?
Frontal lobe dysfunction (impulsivity), low glucose metabolism in the frontal lobes, and increased amygdala activity.
What is Linehan’s diathesis-stress theory of BPD?
Emotional dysregulation + invalidating environment → BPD.
->It’s a cycle reinforced by family response patterns.
EX. Emotional dysregulation in the child → child makes enormous demands on his or her family → Great demands on the family → Invalidation by parents ignoring the demands → Child suppressing emotions, only to have them build up to an explosion → Emotional outbursts by child to which parents attend → parents reinforce the very behaviors they find aversive → back to emotional dysregulation in the child
What are some treatment options for BPD?
- Antipsychotic and antidepressants, lithium
- Treatments similar to those with PTSD - feared situations are reexperiences to help extinguish the fear associated with them
- Dialectical behavior therapy (DBT)
What treatment is most effective for BPD?
- Dialectical behavior therapy (DBT)
- Effective in reducing suicide attempts
- Helps you regulate emotions by looking at them like a 3rd person and not immediately act on them
- When feel need to self harm hold ice cubes in your hands so you focus on something that hurts but isn’t physically harming you
- Type of CBT
- Has it’s roots in philosophy - doing two contradictory things then combining them (synthesizing them)
What are some older or alternative names for ASPD?
Mania without delirium, moral insanity, egopathy, sociopathy, psychopathy.
What is the connection between ASPD and the criminal justice system?
50% to 80% of male offenders are diagnosed with ASPD.
What childhood disorder is often a precursor to ASPD?
Conduct disorder.
What do twin and adoption studies say about ASPD?
They support a genetic influence on ASPD.
What is meant by gene–environment interaction in ASPD?
A genetic vulnerability combined with environmental stressors (e.g., poor caregiving) increases risk.
What cognitive deficits are associated with psychopathy in ASPD?
Deficits in executive function—problems with planning and inhibiting irrelevant information.
What brain areas show reduced gray matter in individuals with ASPD?
Paralimbic system (anterior cingulate cortex, orbitofrontal cortex, insular cortex).
->These areas influence impulse control, emotional regulation, evaluation of rewards/punishments, empathy.
What is the Under-arousal Hypothesis?
People with ASPD have chronically low arousal, leading to risk-taking behaviors to increase stimulation.
How does the Yerkes-Dodson Curve relate to ASPD?
Poor performance occurs at both low and high levels of arousal—ASPD individuals are typically under-aroused.
What kind of brain wave activity is seen in psychopaths when awake?
Excessive theta waves—typical in children, but abnormal in adults.
What is Hare’s Cortical Immaturity Hypothesis of Psychopathy?
Suggests psychopaths’ brains resemble those of children due to underdeveloped cortical functioning.
What is the Fearless Hypothesis?
Psychopaths have a higher threshold for fear, leading to more risk-taking and antisocial behavior.
How does an overactive reward system influence ASPD?
Failure to abandon an unattainable goal (May explain daring and reckless behaviors)
What’s the role of the family in ASPD?
- Aversive interactions with parents - coercive family process (Parents give in and children learn not giving up; + and - reinforcement)
- Parents’ inept monitoring of child’s activities
- Inconsistent parental discipline at home
- Childhood trauma - e.g., Experience of physical abuse - turn off emotions to cope
What is a primary goal in ASPD intervention?
Identify at-risk children before they reach adulthood.
What strategies are used to treat children with Conduct Disorder?
Parent training to reinforce prosocial behavior and ignore negative behavior (differential reinforcement).
What is a major challenge in preventing ASPD?
It’s difficult to predict which children will develop the disorder.
What are the key clinical features of Avoidant Personality Disorder?
Interpersonally anxious, fears rejection, and pessimistic about the future.
What did Millon suggest causes AvPD?
Difficult temperament + parental rejection or uncritical love → low self-esteem and lifelong social alienation.
What’s a possible issue with research on parental rejection in AvPD?
Studies are retrospective and may be influenced by memory bias.
How is AvPD similar to Social Anxiety Disorder (SAD)?
Both may involve an overactive behavioral inhibition system—perceiving too many stimuli as threatening.
What are some treatments for Avoidant Personality Disorder?
- Social skills training, specifically within a support group
- CBT: graduated exposure to feared situations
- Systematic desensitization: relaxing in the presence of feared situations
- Behavioral rehearsal: patients act out situations that cause anxiety
- Benzodiazepines, SSRIs
What are the clinical features of Dependent Personality Disorder?
Interpersonal dependence, fear of abandonment, submissive, timid, passive, sensitive to criticism, and clingy in relationships.
Feelings of inadequacy, sensitive to criticism, need reassurance, Cling to relationships
How does culture influence the perception of Dependent PD?
In collectivist cultures, submission and dependence may be seen as positive traits.
What causes are linked to Dependent Personality Disorder?
- Childhood disruptions (e.g., parental death, neglect, abuse)
- High sociotropy (focus on relationships)
- Low autonomy (focus on self-driven achievement)
What are key elements in treating Dependent PD?
Building confidence and interdependence
Guarding against overdependence on the therapist
Note: They may appear as ideal patients due to their submissiveness.
What are the core clinical features of OCPD?
Preoccupation with perfectionism and control
Fixation on doing things “the right way” → tasks often not completed
Rigidity in thinking and interpersonal issues
Egocentonic (they don’t see their behavior as problematic)
How is OCPD different from OCD?
OCPD is egosyntonic (seen as part of one’s identity), and more about perfectionism/control than intrusive thoughts and compulsions.
What are the causes and treatment strategies for OCPD?
Moderate genetic influence
Parental reinforcement for orderliness and conformity
CBT and relaxation techniques to challenge rigid thinking
