Chapter 15 - Personality Disorders Flashcards
What are the ABCs of psychological functioning?
- 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`
what is the most common personality disorder?
OCD
what are the most difficult psychological disorders to treat?
personality disorders
how many people in the US have personality disorders?
11%
how do you diagnose a personality disorder?
- 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
how does the DSM-5 classify personality disorders?
- 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
What are the Odd-Eccentric Personality Disorders?
Paranoid, Schizoid, Schizotypal
What is paranoid personality disorder?
- 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
what are the theoretical explanations for paranoid personality disorder?
- Psychodynamic: linked to patterns of early interactions with demanding parents
- Cognitive-behavioral: tied to broad maladaptive assumptions
- Biological: genetic causes
- Little systematic research
What are the treatments for paranoid personality disorder?
- 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
What is schizoid personality disorder?
- 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
What are the theoretical explanations for schizoid personality disorder?
- 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
What are the treatments for schizoid personality disorder?
- 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
What is schizotypal personality disorder?
- 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
What are the theoretical explanations for schizotypal personality disorder?
- Similar factors are at work in schizotypal personality disorder and schizophrenia and related disorders
- Links to mood disorders, especially depression, have been found
What are the treatments for schizotypal personality disorder?
- 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
What are the Emotional Dramatic Personality Disorders?
antisocial, borderline, histrionic, narcissistic
What is antisocial personality disorder?
- 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
What are the theoretical perspectives for antisocial personality disorder?
- 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
What are the treatments for antisocial personality disorder?
- Education; therapeutic community; psychotropic medication
- Typically ineffective due to lack of conscience and desire to change
What is borderline personality disorder?
- 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
What are the theoretical explanations for borderline personality disorder?
- 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
What are the integrative explanations for borderline personality disorder?
- 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
What are the treatments for borderline personality disorder?
- Psychodynamic: relational psychoanalytic therapy; dialectical behavioral therapy (DBT)
- Biological: antidepressant, antibipolar, antianxiety, or antipsychotic drugs as adjuncts to psychotherapy
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
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
What are the treatments for histrionic personality disorder?
- Cognitive-behavioral therapy
- Psychodynamic therapy
- Each approach is useful, though some are less useful
What is narcissistic personality disorder?
- Generally grandiose, need much admiration, and feel no empathy with others
- Up to 75% are men
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
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
What are the anxious-fearful personality disorders?
avoidant, dependent, OCD
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
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
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
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
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
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
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
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
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
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
what is the “big five” of personality?
neuroticism, extroversion, openness to experiences, agreeableness, and conscientiousness
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
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
