Chapter 16: Personality Disorders Flashcards
Personality disorder patterns fall into two or more of the what areas?
- Distorted perceptions (of self, others, events)
- Affectivity (intense, labile, inappropriate)
- Interpersonal relationships (too clingy, push peeps away)
- Impulse control (difficulty controlling anger, immediate wants)
What is the DSM-V definition of personality disorders?
- PDs are patterns of maladaptive inner experiences and behavior
- Pattern is stable and of long duration
- Onset goes back to at least adolescence/early childhood
- Pattern is inflexible and pervasive across a broad range of situations
- Significant subjective distress or impairment from this pattern
- Pattern deviates markedly from the expectations of the individual’s culture
What did Sigmund Freud have to say about personality disorders?
- “Character disorders” not just patterns of “traits”, but the entire dynamic of personality
- Entails the defense mechanisms which are pretty much set by the end of adolescence
What is the problem of treating personality disorders?
Person must want to change and be treated
What are the 3 clusters of personality disorders according to the DSM-V?
- Odd, eccentric (weird)
- Dramatic, emotional (wild)
- Anxious, fearful (worried)
What are the 10 different personality disorders distinguished by the DSM-V? Which cluster does each fit in?
- Odd, eccentric = paranoid, schizoid, schizotypal
- Dramatic, emotional = antisocial, histrionic, narcissistic, borderline
- Anxious, fearful = avoidance, dependent, OCD
What are the problems with the DSM personality disorder model?
- Organization of PDs into distinct, discrete categories is misleading
- Even “normal” people have some symptoms
- Too much overlap among them –> comorbidity
- Most people fit characteristics of several personality disorders
What are the characteristics of paranoid PD?
- Suspects (w/o bias) that others are exploiting or deceiving him/her
- Can’t trust anybody, always doubts and anticipates deceit
- Bears grudges, is unforgiving, keeps score
- Is hypersensitive to remarks of others
- Always feel under attack and quickly gets angry
- Tends to be controlling
What are the characteristics of schizoid PD?
- Neither desires nor enjoys close relationships (including family)
- Lacks close friends or confidants
- Almost always chooses solitary activities
- Takes pleasure in few activities, if any
- Has little, if any, interest in having sexual experiences with another person
- Appears indifferent to both the praise and criticism of others
- Shows emotional coldness, detachment, or flattened affectivity
What are the characteristics of schizotypal personality disorder?
Poor interpersonal relationships:
-lack of close friend or confidants other than first-degree relatives
-Excessive social anxiety that doesn’t diminish w/ familiarity and tends to be associated w/ paranoid fears rather than negative judgment about self
-Inappropriate or constricted affect
Peculiar thoughts and behaviors:
-Odd thinking and speech
-Odd beliefs or magical thinking that influences behavior
-Unusual perceptual experiences
-Ideas of reference
What is the DSM-V criteria for antisocial PD?
- Not conforming to social norms
- Deceitful
- Impulsive
- Aggressive
- Reckless disregard for safety of self and others
- Consistently irresponsible
- Lack of remorse
- Evidence of “conduct disorder” before age 15
What are the social deviance characteristics of antisocial PD according to Robert Hare?
- Early behavioral problems
- Adult antisocial behavior
- Lack of responsibility
- Impulsivity
- Need for excitement
- Poor behavioral controls
What are the emotional-interpersonal characteristics of antisocial PD according to Robert Hare?
- Glib and superficially charming
- Shallow emotions
- Deceitful and manipulative
- Lack of empathy
- Lack of remorse and guilt
- Egocentric and grandiose
- Sense of entitlement
List the comorbidities of antisocial PD.
- Substance abuse disorders
- Other PDs
- ADHD
- Learning disabilities
- History of childhood abuse and neglect
- Reactive Attachment Disorder
When is the onset of antisocial PD?
By age 15 or earlier
Describe the course of antisocial PD.
- Chronic course that is difficult to change
- Some improvement in level of violence after age 40
What is the one year prevalence of antisocial PD?
3.5%
What is the gender ratio of antisocial PD?
4:1 (male: female)
What is the biological etiology of antisocial PD?
- Thrill seeking trait due to low arousal
- High pain threshold
- Low level of fear and anxiety
- Slow to classically condition
- Genetic factors
What are the environmental factors that contribute to antisocial PD?
- Inconsistent parenting style
- Fathers often antisocial; mothers have PDs
- Alcoholism and other substance abuse in family
- Poor role models, poverty, high crime neighborhood, bad schools, no jobs, etc.
What are the therapy treatment options for antisocial PD?
- Insight approaches
- Empathy training in peer group setting
- Operant conditioning in controlled environment
What are the medications that help treat antisocial PD?
- Anti-convulsants for aggression and anger
- SSRIs for impulse control problems
- Hormonal drugs to increase estrogen and decrease testosterone
What is the DSM-V criteria for histrionic PD?
- Needs to be center of attention
- Self dramatization and exaggerated emotions
- Sexually seductive
- Rapidly shifting and shallow emotions
- Speech is vague and lacks detail
- Very suggestible
- Exaggerate degree of intimacy w/ others
- Easily bored, impulsive
- Want their needs to be gratified immediately
What did Sigmund Freud call histrionic PD?
Hysterical
What is the DSM-V criteria for narcissistic PD?
- Grandiose sense of self-importance
- Requires excessive admiration
- Fantasies of success, brilliance, beauty, ideal love
- Believes to be special, unique
- Has a sense of entitlement
- Manipulative
- Lacks empathy
- Is often envious of others
- Arrogant, condescending, contemptuous
What is the DSM-V criteria for borderline PD?
- Affective instability (mood flips)
- Inappropriate intense anger
- Impulsivity in at least 2 areas that are potentially self-damaging
- Pattern of intense interpersonal relationships that are short-lived, and alternate between idealization and devaluation
- Frantic efforts to avoid real or imagined abandonment
- Suicidal behaviors, self mutilation
- Chronic feelings of emptiness
- Identity disturbance
- Transient psychotic states
What are the biological factors that contribute to borderline PD?
- Predisposition for modd instability
- Disregulated amygdala
What problems in early childhood contribute to borderline PD?
- Poor attachment
- Childhood abuse or neglect
List the comorbidities of borderline PD.
- Mood disorders
- PTSD
- Dissociative disorders
- Alcohol and drug abuse
- Eating disorders (esp. bulimia)
- Other PDs
When is the onset of borderline PD?
Childhood precursors w/ peak in adolescence/young childhood
What is the course of borderline PD?
Symptoms often lessen after age 40
What is the one year prevalence of borderline PD?
2%
What is the gender ratio of borderline PD?
3:! (female: male)
What is the psychotherapy treatment for borderline PD?
- Interpersonal psychodynamic therapy
- Cognitive-behavioral therapy
- Need for boundaries, structure, consistency
- Likely to be long-term therapy
What medications help treat borderline PD?
- SSRIs for impulse control and depression
- Anti-convulsants for mood swings and anger
- New psychotics for anger and paranoia
What kinds of meds are not recommended to treat borderline PD? Why?
Benzodiazepines b/c they further disinhibit impulses
What is the DSM-V criteria of avoidant PD?
- Fear of being criticized or rejected
- Views self as inferior
- Unwilling to get involved w/ people unless certain of being liked
- Restraint in intimate relationships
- Is inhibited in new relationships
- Doesn’t take personal risks
- Avoids occupational activities that involve interpersonal contact
List the comorbidities of avoidant personality disorder.
- Panic attacks
- Agoraphobia
- Depression
- Childhood abuse issues
- Substance abuse
How is avoidance personality disorder treated?
Similarly to generalized and chronic social phobia
What is the DSM-V criteria for dependent PD?
- Can’t make decisions w/o others’ advice
- Needs others to assume responsibility
- Difficulty expressing disagreement for fear of losing support
- Sense of helplessness
- Unrealistic fears of being left to care for self
- Immediately seeks new relationship when one relationship ends
List the comorbidities of dependent PD.
- Chronic mild to moderate depression (dysthymia)
- Anxiety disorder
- PTSD, ongoing domestic violence
- Substance abuse
- Somatization disorder
How is dependent PD treated?
Needs to include independence skills and help w/ building a support network
What is the DSM-V criteria for obsessive-compulsive PD?
- Preoccupied w/ details, rules, lists, order, organization
- Perfectionism at expense of task completion
- Excessive devotion to work
- Poor at team work
- Inflexible about morality, values
- Stubborn, rigid
- Stingy
- Hoarding behavior
Obsessive-compulsive PD is similar to what Sigmund Freud called what?
Anal Character
