Chapter 6: Personality Disorders Flashcards
Personality Disorders
types of enduring patterns of inner experience and behavior that deviate markedly from the expectations of the individual’s culture
are pervasive and inflexible, and leads to distress or impairment
Ego Syntonic
behavior or feelings that are perceived as natural or compatible parts of the self
Ego Dystonic
behavior or feelings that are perceived to be foreign or alien to one’s self-identity
Paranoid Personality Disorder
type of personality disorder characterized by persistent distrust and suspiciousness of the motives of others
Schizoid Personality Disorder
type of personality disorder characterized by detachment from social relationships and a restricted range of emotional expression
Schizotypal Personality Disorder
type of personality disorder characterized by acute discomfort in close relationships, cognitive, or perceptual distortions, and eccentricities of behavior
Ideas of Reference
form of delusional thinking in which a person reads personal meaning into the behavior of others or external events that are completely independent of the person
Antisocial Personality Disorder (APD)
type of personality disorder characterized by a chronic pattern of disregard for, and violation of, the rights of others
Psychopathy
type of personality pattern characterized by affective and interpersonal traits, such as shallow emotions, selfishness, arrogance, superficial charm, deceitfulness, manipulativeness, irresponsibility, sensation seeking, and a lack of empathy, anxiety, and remorse, combined with persistent violations of social norms, a socially deviant and nomadic lifestyle and impulsiveness
What are the factors associated with antisocial personality disorder?
lack of emotional responsiveness
the craving-for-stimulation-model
lack of restraint on impulsivity
limbic abnormalities
Optimum Level of Arousal
level of arousal associated with peak performance and maximum feelings of well-being
Borderline Personality Disorder (BPD)
type of personality disorder characterized by instability in interpersonal relationships, self-image, and affects and marked impulsivity
Splitting
term describing the inability of some people (especially people with borderline personalities) to reconcile the positive and negative aspects of themselves and others into a cohesive integration, resulting in sudden and radical shifts between strongly positive and strongly negative feelings
Histrionic Personality Disorder
type of personality disorder characterized by excessive need to be the center of attention and to receive reassurance, praise, and approval from others, such individuals often appear overly dramatic and emotional in their behavior
Narcissistic Personality Disorder
type of personality disorder characterized by grandiosity, need for admiration, and lack of empathy
Avoidant Personality Disorder
type of personality disorder characterized by avoidance of social relationships due to fears of rejection
Dependent Personality Disorder
type of personality disorder characterized by difficulties making independent decisions and by overly dependent behavior
Obsessive-Compulsive Personality Disorder
type of personality disorder characterized by rigid ways of relating to others, perfectionistic tendencies, lack of spontaneity, and excessive attention to details
Self Psychology
Heinz Kohut’s theory that describes processes that normally lead to the achievement of a cohesive sense of self or, in narcissistic personality disorder, to a grandiose but fragile sense of self
Symbiotic
(1) in biology, the living together of two different but interdependent organisms
(2) in Margaret Mahler’s object-relations theory, the term used to describe the state of oneness that normally exists between a mother and an infant in which the infant’s identity is fused with the mother’s
Separation-Individuation
in Margaret Mahler’s theory, the process by which young children come to separate psychologically from their mothers and to perceive themselves as separate and distinct persons
Problem-Solving Theory
form of therapy that focuses on helping people develop more effective problem solving skills
What are personality disorders?
all of us have particular styles of behavior and ways of relating to others
when these behavior patterns become so inflexible or maladaptive that they cause significant personal distress or impair functioning in the social or occupational realms, their behavior pattern may be diagnosed as a personality disorder
types of abnormal behavior patterns involving excessively rigid patterns of behavior or ways of relating to others that ultimately become self-defeating because their rigidity prevents adjustment to external demands
What are ego syntonic personality disorders?
behavior or feelings that are perceived as natural or compatible parts of the self
don’t care about other people’s negative reactions
largely agreeable or invisible to the person who has PD
most PDs
What are ego dystonic personality disorders?
behavior or feelings that are perceived to be foreign or alien to one’s self-identity
uncomfortable as a result
In what areas are the symptoms of personality disorder manifested in?
- cognition (i.e. ways of perceiving and interpreting self, other people, and events)
- affectivity (i.e. the range, intensity, lability, and appropriateness of emotional response)
- interpersonal functioning
- impulse control
What is the general DSM-5 criteria for personality disorders?
inflexible and pervasive
significant distress or impairment
stable and of long duration
not better accounted for as a manifestation or consequence of another mental disorder
not due to the effects of a substance
What are the characteristics of cluster A personality disorders?
odd, eccentric behavior “Mad”
paranoid, schizoid, schizotypal
What are the characteristics of cluster B personality disorders?
dramatic, emotional, impulsive, “bad”
borderline, antisocial, narcissistic, histrionic
What are the characteristics of cluster C personality disorders?
anxious, fearful, avoidant, “sad”
avoidant, dependent, obsessive-compulsive
What is paranoid personality disorder?
type of personality disorder characterized by persistent suspiciousness of the motives of others, but not to the point of holding clear-cut delusions
What are the core features of paranoid personality disorder?
suspiciousness without due cause
preoccupations with unfounded concerns over lack of loyalty of friends, spouse, and family
emotionally closed, reluctant to confide or “open up”
interpretive bias that promotes perception of innocuous content as threatening
grudging
What is schizoid personality disorders?
type of personality disorder characterized by a persistent lack of interest in social relationships, flattened affect, and social withdrawal
rarely express emotions and are distinct and aloof
but emotions of people with schizoid personalities are not as shallow or blunted as they are in people with schizophrenia
don’t have the positive symptoms of schizophrenia
What are the core features of schizoid personality disorders?
no interest in, or enjoyment of, close relationships
chronic loner
no interest in sex
seldom participates in recreational activities
unaffected by praise or criticism
emotionally cold, detached, flat
What is schizotypal personality disorder?
type of personality disorder characterized by eccentricities of oddities of thought and behavior but without clearly psychotic features
similar to schizophrenia in many respects but without the profound impairment in reality testing
abundance of positive symptoms
What are the core features of schizotypal personality disorder?
ideas of reference
odd beliefs or magical thinking (not just superstitions)
off perceptual experiences
peculiar thinking and speech
suspicious/paranoid
social isolation (other than family)
persistent social anxiety
What is antisocial personality disorder?
type of personality disorder characterized by a chronic pattern of antisocial and irresponsible behavior and lack of remorse
What are the core features of antisocial personality disorder?
failure to conform to social and legal norms
lying/conning
impulsivity and short sightedness in planning
irritability/aggressiveness, fighting
recklessness with self and others
irresponsibility
lack of remorse
note: MUST be 18 and have shown signs of conduct disorder before 15 years of age
What is psychopathy?
an extreme case of ASPD
type of personality pattern characterized by affective and interpersonal traits, such as shallow emotions, selfishness, arrogance, superficial charm, deceitfulness, manipulativeness, irresponsibility, sensation-seeking, and a lack of empathy, anxiety, and remorse, combined with persistent violations of social norms, a socially deviant and nomadic lifestyle, and impulsiveness
not all criminals show signs of psychopathy, and not all ASPD patients are psychopaths either
What is the psychopathy checklist?
describes behavior
score of 0 is not there, 1 is moderate, 2 is severe
cut off score is 30, normal score is 6
factor I: inter-personal/affective (lies, doesn’t care)
factor II: criminal behaviors (have they had charges in more than one type of crime), the manifestation of antisocial behaviors
What is the controversy surrounding the notion of a successful psychopath?
must distinguish between Factor I and Factor II PCL-R features
appreciate that one can have strong (Factor I) features without being a psychopath
may be nominally law-abiding and successful in their chosen occupations, but still show callous disregard for the interests and feelings of others
What is the relationship between race and ASPD?
antisocial personality disorder cuts across all racial and ethnic groups
researchers find no evidence of ethnic or racial differences in the rates of the disorder
What are the psychophysiological and biological factors that are related to antisocial personality and psychopathy?
lack of emotional responsiveness
the craving-for-stimulation model
lack of restraint on impulsivity
limbic abnormalities
aren’t born with a natural sense of right and wrong
psychopaths do not profit from experience (no learning)
brain regions (orbita-prefrontal cortex) aren’t as active in psychopathy
have and IQ that is 2/3 standard deviations lower than average
What is borderline personality disorder?
primarily characterized by a pervasive pattern of instability in relationships, self-image, and mood and a lack of control over impulses
people with BPD tend to be uncertain about their values, goals, loyalties, careers, choices of friends, and perhaps even sexual orientations
What are the three dialectical dilemmas associated with borderline personality disorder?
emotional vulnerability versus self-invalidation
active passivity versus apparent competence
unrelenting crisis versus inhibited grieving
What are the core features of borderline personality disorder?
works frantically avoid abandonment
intense and unstable relationships, view of others fluctuates between extremes
unstable self-image/self-concept
marked impulsivity
recurrent parasuicidal/self-harming behavior/threats
affective instability
feeling constantly empty
intense, frequently unwarranted, anger and difficulty controlling it
may show dissociative or paranoid symptoms
What is histrionic personality disorder?
type of personality disorder characterized by excessive need to be the center of attention and to receive reassurance, praise, and approval from other
such persons often appear overly dramatic and emotional in their behavior
What are the core features of histrionic personality disorder?
resents attention being directed to others
often seductive or provocative (just to prove they have the ability to draw people in)
emotionally shallow/variable
uses physical appearance (including mode of dress) to attract attention
rehearsed way of speaking with limited substance
dramatic, theatrical, emotionally flamboyant
highly suggestible
considers self to be “close friends: of mere acquaintances
What is narcissistic personality disorder?
type of personality disorder characterized by the adoption of an inflated self-image and demands for constant attention and admiration, among other features
What are the two main divisions of narcissistic personality disorder?
primary: genuinely believes they are special
compensatory: deep seeded sense of inadequacy covered up by narcissism
What are the core features of narcissistic personality disorder?
inflated sense of self-worth/self-importance
fantasizes about great power, wealth, desirability, success, etc.
feels special, entitled, above others, complex
demands admiration
exploitative of others
insensitive to the needs and feelings of others
arrogant, haughty
envious of others and resentful of their achievements, but may also think others envy them
What is avoidant personality disorder?
type of personality disorder characterized by avoidance of social relationships due to fears of rejection
What are the core features of avoidant personality disorder?
looks in some respects like schizoid PD, but the person really wants to have close relationships
hindered by strong fear of rejection or social inadequacy
avoids activities (including jobs) that require social contact
reluctant to take chances socially, deep sense of inadequacy
“up tight” (inhibited), even in established relationships
chronically fearful of criticism
sees self as socially inept and inferior
mortified by the prospect of embarrassment
What is dependent personality disorder?
type of personality disorder characterized by difficulties making independent decisions and by overly dependent behavior
What are the core features of dependent personality disorder?
can’t make decisions for themselves without seeking advice and reassurance
wants other to be responsible for them
avoids expressing dissent
lacks confidence in planning and initiating projects and activities
craves nurturance and support
feels vulnerable when alone
quickly finds a new relationship when another one ends
pre-occupied by fears of being alone
What is obsessive-compulsive personality disorder?
type of personality disorder characterized by rigid ways of relating to others, perfectionistic tendencies, lack of spontaneity, and excessive attention to details
What are the core features of obsessive-compulsive personality disorder?
highly concerned with rules, lists, details, procedures, etc.
interferes with completion of tasks
cannot complete task for fear that work is imperfect
neglects leisure and personal life to spend more time on work
inflexibly conscientious, moral, ethical
prone to hoarding as they hate to throw things out
doesn’t delegate well
miserly (very cheap)
stubborn and rigid with others
sometimes referred to as “anal retentive”
What are the problems with the classification of personality disorders?
undetermined reliability and validity
problems distinguishing from other types of disorders
overlap among disorders
difficulty in distinguishing between variations in normal and abnormal behavior
sexist biases
What are the proposed changes to the classification of personality disorders in the DSM-5?
reduction in diagnostic overlap
less arbitrary diagnostic threshold
movement from a categorical to dimensional conceptualization
recognition that symptom severity can fluctuate over time
alternatively, movement to a dimensional (trait) model
What are the areas of difficulty associated with personality disorders?
identity
self-direction
empathy
intimacy
What are the domains of personality associated with personality disorders?
negative affectivity (vs emotional stability)
detachment (vs extraversion)
antagonism (vs agreeableness)
disinhibition (vs conscientiousness)
psychoticism (vs lucidity)
What are the 6 personality disorders proposed for a future version of the DSM?
antisocial/psychopathic
avoidant
borderline
narcissistic
obsessive-compulsive
schizotypal
What are the psychodynamic perspectives on personality disorders?
Heinz Kohut: self psychology, mostly on narcissistic personality, lack of empathy development
Otto Kernberg: mostly re BPD, splitting, all good vs. all bad
Margaret Mahler: also emphasized BPD, symbiotic, separation-individuation
What are the learning perspectives on personality disorders?
reinforcement history
our personality is shaped by what behaviors were reinforced by our parents
What are the family perspectives on personality disorders?
parenting styles and personality
What are the cognitive-behavioral perspectives on personality disorders?
problem-solving therapy
teach practical problems solving skills
What are the biological perspectives on personality disorders?
genetic factors, twin studies
neuropsychological factors
What are the sociocultural views on personality disorders?
SES, trauma, parenting style, cultural norms
What is the treatment of personality disorders?
these conditions are highly refractory (don’t want to change after treatment, ingrained)
difficult for the patient to see, therefore limited insight
inherent stability of personality
treatment is different for various PDs
“stepped care” model
What are the psychodynamic approaches to the treatment of personality disorders?
insight re historical bias
insight re how their interpersonal conduct undermines relationships
minimally helpful
What are the cognitive behavioral approaches on personality disorders?
conceptual personality as persistent behavior patterns established and maintained by Rf contingencies
general strategy is to utilize modeling, Rf, and extinction to replace maladaptive behaviors
can utilize social skills training, identification of distorted beliefs, coaching family members
What are the biological approaches on personality disorders?
limited contribution
impulsiveness and low affect may reflect serotonin deficiencies, therefore try SSRIs
What is dialectical behavior therapy (DBT)?
developed primarily for BPD
BPD patients habitually “test” relationships: frequent crises, unscheduled phone calls, suicide threats/attempts, “splitting” professional teams and social groups, caregiver “burnout”
mindfulness techniques
distress tolerance
emotion regulation strategies
interpersonal effectiveness
usually team-delivered two full days/week
