Chapter 15 - Personality Disorders Flashcards
1
Q
What are the ABCs of psychological functioning?
A
- Affect: range, intensity, and changeability of emotions and emotional responsiveness
- Behavior: ability to control impulses and interactions with others
- Cognition: perceptions and interpretations of events, other people, and oneself`
2
Q
what is the most common personality disorder?
A
OCD
3
Q
what are the most difficult psychological disorders to treat?
A
personality disorders
4
Q
how many people in the US have personality disorders?
A
11%
5
Q
how do you diagnose a personality disorder?
A
- The individual displays a long-term, rigid, and wide-ranging pattern of inner experience and behavior that leads to dysfunction in at least two of the following realms: cognition, emotion, social interactions, impulsivity
- The individual’s pattern is significantly different from ones usually found in individual’s culture
- The individual experiences significant distress or impairment
6
Q
how does the DSM-5 classify personality disorders?
A
- DSM-5 has a categorical approach
- Some theorists prefer dimensional approach
- Cluster A: Odd-Eccentric personality disorders, Cluster B: Dramatic Emotional personality disorders, Cluster C: Anxious-Fearful personality disorders
7
Q
What are the Odd-Eccentric Personality Disorders?
A
Paranoid, Schizoid, Schizotypal
8
Q
What is paranoid personality disorder?
A
- deep distrust and suspicion of others
- Limited close relationships; cold & distant affect
- Excessive trust in own ideas and abilities; critical of weakness and fault in others
- More common in men than in women
9
Q
what are the theoretical explanations for paranoid personality disorder?
A
- Psychodynamic: linked to patterns of early interactions with demanding parents
- Cognitive-behavioral: tied to broad maladaptive assumptions
- Biological: genetic causes
- Little systematic research
10
Q
What are the treatments for paranoid personality disorder?
A
- Psychodynamic: object relations therapists; self therapists
- Behavioral: anxiety reduction and interpersonal problem-solving improvement
- Cognitive: development of more realistic interpretations of words and actions of others
- Biological: antipsychotic drug therapy
11
Q
What is schizoid personality disorder?
A
- Persistent avoidance of social relationships; little demonstration of emotions
- Individual focuses primarily on self and is generally unaffected by praise or concern
- Preference for being alone; weak social skills
- Lack of intimacy interest; often marital or family problems
- Slightly more common in men than in women
12
Q
What are the theoretical explanations for schizoid personality disorder?
A
- Psychodynamic: rooted in unsatisfied need for human contact; unaccepting and/or abusive parents; objects relations theory
- Cognitive-behavioral: tied to deficiencies in thinking; inability to pick up emotional cues; language and motor skills delays
13
Q
What are the treatments for schizoid personality disorder?
A
- Psychodynamic: object relations therapists; self therapists
- Behavioral: social skills education; role-playing, exposure techniques; group therapy
- Cognitive: presenting and evoking memories of pleasurable experiences
- Biological: drug therapy provides limited help
14
Q
What is schizotypal personality disorder?
A
- A range of interpersonal problems, marked by extreme discomfort in close relationships, odd (even bizarre) ways of thinking, and behavioral eccentricities
- Individuals believe unrelated events pertain to them in important ways; bodily illusions
- Demonstrate difficulty keeping attention focused; conversation is typically digressive and vague, even sprinkled with loose associations
- Slightly more males than females
15
Q
What are the theoretical explanations for schizotypal personality disorder?
A
- Similar factors are at work in schizotypal personality disorder and schizophrenia and related disorders
- Links to mood disorders, especially depression, have been found
16
Q
What are the treatments for schizotypal personality disorder?
A
- Behavioral: help the client reconnect to world and recognize thinking limits
- Cognitive-behavioral: recognize unusual thoughts and magical prediction; speech lessons, social skills training, appropriate dress and manners recognition
- Biological: some patients benefit from low-dose antipsychotic drugs
17
Q
What are the Emotional Dramatic Personality Disorders?
A
antisocial, borderline, histrionic, narcissistic
18
Q
What is antisocial personality disorder?
A
- Sociopaths and psychopaths
- Persistently disregard and violate others’ rights
- Person must be at least 18 years of age to receive this diagnosis (DSM-5)
- Lie repeatedly, reckless, and impulsive
- Little regard for other individuals, and can be cruel, sadistic, aggressive, and violent
- Higher rate of alcoholism, substance use disorder, or childhood conduct disorder and ADHD
- 4x more common in men than in women
19
Q
What are the theoretical perspectives for antisocial personality disorder?
A
- Psychodynamic theorists: absence of parental love leads to lack of basic trust; research links to childhood stress
- Behavioral: antisocial symptoms learned through operant conditioning, modeling, imitation
- Cognitive: difficulty recognizing others’ viewpoints or feelings
- Biological: biological predisposition; lower serotonin activity; dysfunctional brain circuits
20
Q
What are the treatments for antisocial personality disorder?
A
- Education; therapeutic community; psychotropic medication
- Typically ineffective due to lack of conscience and desire to change
21
Q
What is borderline personality disorder?
A
- Characterized by instability, including major shifts in mood, unstable self-image, and impulsivity
- Unstable interpersonal relationships
- Prone to bouts of anger, which sometimes result in physical aggression and violence; also may direct impulsive anger inward and harm themselves
- 75% are women
22
Q
What are the theoretical explanations for borderline personality disorder?
A
- Psychodynamic: early parental relationships
- Object relations theory: lack of early acceptance or abuse/neglect by parents (some research support)
- Biological: genetic predisposition; lower brain serotonin activity, abnormal brain structure/circuit activity and anatomy
- Sociocultural: impact of rapidly changing cultures
23
Q
What are the integrative explanations for borderline personality disorder?
A
- Biosocial: combination of internal and external forces
- Children have intrinsic difficulty identifying and controlling emotions; parents teach them to ignore their feelings
- Developmental psychopathology: childhood traumas and dysfunctional parental attachments lead to flawed capacity for healthy relationships; positive factors can counter
- Mentalization deficits
24
Q
What are the treatments for borderline personality disorder?
A
- Psychodynamic: relational psychoanalytic therapy; dialectical behavioral therapy (DBT)
- Biological: antidepressant, antibipolar, antianxiety, or antipsychotic drugs as adjuncts to psychotherapy
25
What is histrionic personality disorder?
- Individuals are extremely emotional and continually seek to be the center of attention
- Engagement in attention-getting behaviors and always on stage
- Approval and praise are lifeblood
- Vain, self-centered, and demanding
- Some make suicide attempts, often to manipulate others
- Females diagnosed more frequently
26
What are the theoretical perspectives for histrionic personality disorder?
- Psychodynamic: unhealthy relationships with cold, controlling parents in childhood; feelings of being unloved and fear of abandonment; dramatic crisis invented for protection
- Cognitive-behavioral: lack of substance and extreme suggestibility tied to self-focused and emotional behavior; search for others to meet needs related to sense of helplessness
- Sociocultural/multicultural: partially influenced by cultural norms and expectations
27
What are the treatments for histrionic personality disorder?
- Cognitive-behavioral therapy
- Psychodynamic therapy
- Each approach is useful, though some are less useful
28
What is narcissistic personality disorder?
- Generally grandiose, need much admiration, and feel no empathy with others
- Up to 75% are men
29
What are the theoretical perspectives on narcissistic personality disorder?
- Psychodynamic: focus on cold, rejecting parents
- Object relations: focus on grandiose self-presentation; self-sufficiency replaces warm relationships
- Cognitive-behavioral: propose narcissistic personality disorder may develop when people are treated too positively rather than too negatively in early life; overvalue self-worth
- Sociocultural: see a link between narcissistic personality disorder and eras of narcissism in society
30
What are the treatments for narcissistic personality disorder?
- One of the most difficult personality patterns to treat
- Clients consult therapists usually because of a related disorder, most commonly depression
- Individuals may try to manipulate therapists to support their sense of superiority; a love-hate relationship may evolve
- Psychodynamic: recognize and work through basic insecurities and defenses
- Cognitive-behavioral: focus on self-centered thinking and redirection
- No major treatment approaches have had much success
31
What are the anxious-fearful personality disorders?
avoidant, dependent, OCD
32
What is avoidant personality disorder?
- Pervasive anxiety, a sense of inadequacy, and a fear of being criticized, which leads to the avoidance of social interactions and nervousness
- Characterized by consistent discomfort and restraint in social situations, overwhelming feelings of inadequacy, and extreme sensitivity to negative evaluation
- Social avoidant personality disorder: fear of close social relationships; Social anxiety disorder: fear of social circumstances; the two disorders may reflect core psychopathology; should be combined
- Men have it as frequently as women
33
What are the theoretical perspectives for avoidant personality disorder?
- Theorists often assume avoidant personality disorder has the same causes as anxiety disorder; no clear research ties the two together
- Psychodynamic: focus on shame and insecurity traced to childhood experiences
- Cognitive-behavioral: harsh criticism in early childhood leads to expected rejection; failure to develop effective social skills
- Biological: arousal
34
What are the treatments for avoidant personality disorder?
- Therapy often sought for acceptance and affection
- The therapist gains the individual’s trust and tends to treat the disorder in the same way as social phobia and anxiety
- Cognitive-behavioral: group therapy provides practice in social interations
- Antianxiety and antidepressant drugs are sometimes useful, symptoms return when medication is stopped
35
What is dependent personality disorder?
- Individuals have a pervasive, excessive need to be cared for
- Clinging and obedient; fear separation from loved ones; distressed, lonely, sad, and prone to self-dislike
- Reliance on others so the smallest decision cannot be mde
- Difficulty with separation is central feature
- Equal incidence among males and females
35
What are the theoretical perspectives on dependent personality disorder?
- Psychodynamic: similar to depression; overinvolvement or overprotection
- Freudian: unresolved conflicts during oral stage
- Object relations theory: early parental loss or rejection prevents normal attachment and separation
- Behavioral: unintentional clinging and loyal behavior rewarded by dependent parents
- Cognitive: maladaptive behaviors; inadequate and helpless to deal with world; need to find person to provide protecton
36
What are the treatments for dependent personality disorder?
- Psychodynamic: transference of dependency needs
- Cognitive-behavioral: often combines interventions
- Behavioral: assertiveness training to cope
- Cognitive: challenge and change incompetence and helplessness assumptions
- Biological: antidepressant drug therapy, when disorder is comorbid with depression
- Group therapy format
37
What is obsessive-compulsive personality disorder?
- Intense focus on orderliness, perfectionism, and control and resulting loss of flexibility, openness, and efficiency
- Unreasonably high standards for self and others and, fearing a mistake, may be afraid to make decisions
- Tendency to be rigid and stubborn
- Difficulty expressing affection; relationships are often stiff and superficial
- Men are twice as likely as women to display disorder
38
What are the theoretical perspectives on obsessive-compulsive personality disorder?
- Freudian: overly harsh toilet training during anal stage; anal retentive and fixated
- Cognitive-behavioral: illogical thinking processes
39
What are the treatments for obsessive-compulsive personality disorder?
- People with obsessive-compulsive personality disorder do not usually believe there is anything wrong with them
- Individuals often respond well to psychodynamic or cognitive therapy
- A number of clinicians report success with SSRIs
40
what are the multicultural factors of personality disorder
- According to DSM-5, a pattern diagnosed as a personality disorder must “deviate markedly from the expectations of a person’s culture”
- Lack of multicultural research is of special concern regarding borderline personality disorder
- Clinical theorists have suspicions, but no compelling evidence, that cultural differences exist
41
what is the "big five" of personality?
neuroticism, extroversion, openness to experiences, agreeableness, and conscientiousness
42
what does a categorical approach assume?
- Problematic personality traits are either present or absent
- Personality disorder is either displayed or not displayed
- A person who suffers from a personality disorder is not markedly troubled by personality traits outside of the disorder
43
What is the alternative dimensional approach for possible use in future DSM?
5 groups of problematic traits would be eligible for a diagnosis of PDTS: negative affectivity, detachment, antagonism, disinhibition, psychoticism
