chapter 15 Flashcards
Personality Disorders
Involve problems in thinking, affect, impulse control and interpersonal functioning
Persist for years and influence many domains of life
DSM-5 provides criteria for personality disorder in general as well as 10 specific personality disorders
The 10 personality disorders are classified into 3 clusters:
The 10 personality disorders are classified into 3 clusters:
Odd/Eccentric (cluster A)
Dramatic/Erratic (cluster B)
Anxious/Fearful (cluster c)
General Personality Disorder
An inflexible pattern of inner experience and Behavior that is distinct from CULTURAL EXPECTATIONS, and influences at least two of the following:
- Cognition about the self and others
- Affect
- Interpersonal functioning
- Impulse control
*The pattern
Causes significant distress or impairment
Is inflexible
Is pervasive across situations
*Onset by early adulthood and persistence for a long duration
Not explained by another mental disorder, by a substance, or by a medical condition
Personality Disorders: Prevalence
About 1 out of 10 people meet diagnostic criteria for a personality disorder
Important to consider whether patterns of Behavior are unusual for a person’s cultural background
Tend to co-occur with psychological disorders
Commonly encountered in treatment settings
40% of outpatients meet criteria for a personality disorder
Associated with more severe symptoms
Personality disorders are not stable over time
About half of people achieve remission 2 years later
99% remit when re-assessed after 16 years
People may still have some symptoms after remission
Many will relapse
Personality disorders are highly comorbid
More than 50% meet criteria for another personality disorder
High rates of over overlap in symptoms and concerns
Test-Retest Stability of Personality Disorders
-for depression (without personality disorder) low Test-Retest 6 months, 12 months and 24 months
slide 13
What are the two criticisms of the current DSM classification of PD’s?
-based on western values (maybe idk)
Common Risk Factors of personality disoders
Personality disorders tend to co-occur and share genetic vulnerability
Environmental factors
Early adversity
Childhood abuse or neglect
Aversive or unaffectionate parental style
Odd/Eccentric Cluster
Cluster A
Paranoid Personality Disorder
Schizoid Personality Disorder
Schizotypal Personality Disorder
Paranoid Personality Disorder
Suspicious of others
Strangers, casual acquaintances, family members
Expectation for mistreatment or exploitation
Secretive and continually on the lookout for signs of trickery and abuse
Hostile and angry in response to perceived insults
Seen as difficult and critical
Social world filled with conflict, which perpetuates paranoia
(Cluster A)
DSM-5 Criteria:Paranoid Personality Disorder
Presence of 4 or more of the following signs of distrust and suspiciousness from early adulthood across many contexts:
Unjustified suspiciousness of being harmed, deceived, or exploited
Unwarranted doubts about the loyalty or trustworthiness of friends or associates
Reluctance to confide in others because of suspiciousness
The tendency to read hidden meanings into the benign actions of others
Bears grudges for perceived wrongs
Angry reactions to perceived attacks on character or reputation
Unwarranted suspiciousness of the partner’s fidelity
Schizoid Personality Disorder
Do not desire or enjoy social relationships
No close friends
Aloof and show no warm, tender feelings when interacting with others
Rarely experience strong emotions
No interest in sex
Enjoy few activities
Indifferent to praise or criticism
DSM-5 Criteria: Schizoid Personality Disorder
Presence of 4 or more of the following signs of aloofness and flat affect from early adulthood across many contexts:
Lack of desire for or enjoyment of close relationships
Almost always prefers solitude to companionship
Little interest in sex
Few or no pleasurable activities
Lack of friends
Indifference to praise or criticism
Flat affect, emotional detachment, or coldness
Presence of 5 or more of the following signs of unusual thinking, eccentric Behavior, and interpersonal deficits from early adulthood across many contexts:
Ideas of reference
Odd beliefs or magical thinking, e.g., belief in extrasensory perception
Unusual perceptions
Odd thought and speech
Suspiciousness or paranoia
Inappropriate or restricted affect
Odd or eccentric behavior or appearance
Lack of close friends
Social anxiety and interpersonal fears that do not diminish with familiarity
Schizotypal Personality Disorder
Eccentric thoughts and Behavior, interpersonal detachment, and suspiciousness
Some develop more severe psychotic symptoms over time, and a small proportion develop schizophrenia
Similarities with schizophrenia - Schizotypal Personality Disorder
Similarities with schizophrenia Genetic vulnerability Deficits in cognitive and neuropsychological functioning Enlarged ventricles Less temporal lobe gray matter Neurotransmitter dysregulation
DSM Criteria: Schizotypal Personality Disorder
Presence of 5 or more of the following signs of unusual thinking, eccentric Behavior, and interpersonal deficits from early adulthood across many contexts:
- Ideas of reference
- Odd beliefs or magical thinking, e.g., belief in extrasensory perception
- Unusual perceptions
- Odd thought and speech
- Suspiciousness or paranoia
- Inappropriate or restricted affect
- Odd or eccentric behavior or appearance
- Lack of close friends
- Social anxiety and interpersonal fears that do not diminish with familiarity
Dramatic/Erratic Cluster
Cluster B Antisocial Personality Disorder Borderline Personality Disorder Histrionic Personality Disorder Narcissistic Personality Disorder
Antisocial Personality Disorder
Pervasive disregard for the rights of others
Aggressive, impulsive, and callous traits
Pattern of irresponsible Behaviors
Working inconsistently, breaking laws, being irritable and physically aggressive, defaulting on debts, being reckless and impulsive, neglecting to plan ahead
Little regard for truth and little remorse for misdeeds
5x more common in men
75% also meet criteria for another disorder
Substance use is very common
Psychopathy
Focuses on internal thoughts and feelings
Poverty of emotion
Negative emotions
Lacks shame, remorse and anxiety; does not learn from mistakes
Positive emotions
Merely an act used to manipulate others; superficially charming
Impulsivity
Behave irresponsibly for thrills
*Psychopathy Checklist – revised (Hare, 2003)
*Compared to Antisocial Personality Disorder:
Does not require symptoms before age 15
Includes more affective symptoms (e.g., lack of empathy)
DSM-5 Criteria:Antisocial Personality Disorder
Age at least 18
Evidence of conduct disorder before age 15
Pervasive pattern of disregard for the rights of others since the age of 15 as shown by at least three of the following:
Repeated law breaking
Deceitfulness, lying
Impulsivity
Irritability and aggressiveness
Reckless disregard for own safety and that of others
Irresponsibility as seen in unreliable employment or financial history
Lack of remorse
Etiology of Antisocial Personality Disorder
Problems with research
Differences in diagnosis (APD vs. psychopathy)
Conducted mostly with criminals
Interactions of genes and the social environment
Genetic, Behavioral, and family influences are very hard to disentangle
*Social environment
Poverty, exposure to violence
*Family environment interacts with genetics
-Polymorphism of the MAO-A gene predicts psychopathy among males who had experienced childhood physical or sexual abuse or maternal rejection