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PSYC340 > Chapter 7 - Personality disorders > Flashcards

Chapter 7 - Personality disorders Flashcards

1
Q

Personality disorders

A

Heterogeneous group of disorders regarded as long standing, pervasive and inflexible patterns of behaviour that deviate from cultural expectations, cause impairment and emotional distress.

We all have those traits from time to time; the disorders are marked by EXTREME versions of those traits - inflexible traits

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2
Q

Egosyntonic disorders

A

Hard to notice; people wont usually come in FOR help with a personality disorder, since most people will not realize that they have one (called egosyntonic disorders) - they will seek help for other parallel problems, and discover this along the way

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3
Q

3 key factors for all personality disorders

A
  1. Rigid and inflexible behaviour
  2. Self-defeating behaviour that fosters vicious cycles
  3. Structural instability: fragility of the self that cracks under stress
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4
Q

Unable to do any of those tasks indicate a PD

A
  1. Form a clear view of the self
  2. Develop positive relationships with others
  3. Function in society (prosocial behaviours
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5
Q

Diagnosis challenges in PD

A
  • People are not aware of their disorders - their relatives see it differently
  • Most people are diagnosed with PD not otherwise specified (general PD)
  • Self-report measures are often used (recently MMPI and PSY-5)
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6
Q

History of PD

A

Started with Hippocrates humoral theory; first DSMs were very unreliable; DSM-III a bit more; in DSM-5 we now understand that episodic problems can be accompanied by a long term personality disorder

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7
Q

Reliability of PD

A

For many personality disorders, they do not test reliably over time
Except for anti-social, borderline, and OC

The type of assessment (dimensional or categorical) most likely plays a role in the reliability of the disorders

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8
Q

Name/ define the 3 clusters

A

A: odd, eccentric cluster (paranoid, schizoid, schizotypal)
B: dramatic, emotional, erratic cluster (anti-social, borderline, histrionic, narcissistic)
C: fearful (avoidant, dependent, OC)

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9
Q

Alternative Model for PD (AMPD)

A

Why is there no dimensional ratings in the DSM-5?
Instead they used the Alternative Model for PD (AMPD):
Critertion A: levels of personality functioning
Self
Interpersonal
Criterion B: rating across 5 trait dimensions
Negative affectivity,
Detachement,
Antagonism,
Disinhibition,
Psychoticism
This has clinical relevance, but a dimensional approach seems to be more fit to the data - personality disorders seem to be extreme version of traits everyone have
Personality scales (Big Five, HEXACO) can be useful dimensional tools to assess PD
Dimensional approach is best: that’s a fact, but WHICH dimensions are best? Still debated

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10
Q

Can people fit into a single personality disorder category?

A

It’s rare to have someone with 1 specific personality disorder; they are known to have elements from more than 1 disorder at the same time
That can explain why there is poor test-retest reliability
At time 1, they may see 1 aspect and see another after (depending on what they are going through at the moment, certain traits may be expressed more strongly at different times)
Need to keep in mind that being in a single category at all times is RARE

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11
Q

Characteristics - Paranoid PD

A 
Suspicious of others
Expect to be mistreated/exploited
Reluctant to confide
Tend to blame others
Extremely jealous 
No hallucinations nor delusions
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12
Q

Prevalence/comorbidity - Paranoid PD

A

about 1% prev.
Occurs + in men
Comorbid in schizotypal, borderline, avoidant PD

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13
Q

Characteristics - Schizoid PD

A

No desire for or enjoyment of social relationships
Appear dull, bland, aloof
Rarely report strong emotions (reflected in their facial expressions)
Have no interest in sex
Experience few pleasurable activities
Indifeerent to praise/criticism
May seem like they have issues and are avoidant of the world (similar to avoidant PD but not the same)

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14
Q

Prevalence/comorbidity - Schizoid PD

A

< 1% prev
+ common in men
Comorbid with schizotypal, avoidant, paranoid PD

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15
Q

Characteristics - Schizotypal PD

A

Noticeable oddness - may dress/act weird
Interpersonal difficulties of schizoid PD
High social anxiety
Eccentric symptoms like in pre and post phases of SZ
Odd beliefs/magical thinking
Recurrent illusions (ex: feeling ghost passing through them)
Odd speech
Ideas of reference (events have particular meaning)
Suspiciousness
Paranoid ideation
Eccentric behaviour/appearance
Constricted/flat affect
Cognitive impairments like in SZ

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16
Q

Dissociative experiences

A

(depersonalization and derealization) those in particular don’t have memory component (no memory loss, etc)

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17
Q

Depersonalization

A

you are doing something and you feel like you are no longer connected to your body and it seems like you are no longer controlling it, you are simply observing

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18
Q

Derealization

A

when you are doing something and everything around you seems surrealistic

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19
Q

Prevalence/comorbidity - Schizotypal PD

A

3% prev
+ frequent in men
Highest comorbidity of all
With borderline, avoidant, paranoid PD

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20
Q

Etiology - Schizotypal PD

A

Genetically linked to SZ
Maybe it’s a less severe form of it
Can be linked to history of PTSD/childhood trauma

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21
Q

Etiology of Cluster A

A

May all be genetically linked to SZ
The schizoid in particular seems to be the most related to schizophrenia, but they all are in this cluster
The family members of ppl with SZ seem to be more at risk for those PD, also the relatives of depressed people

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22
Q

Characteristics - Borderline PD

A

Core features are impulsivity and instability in relationships, mood and self-image
Attitudes and feelings toward others vary dramatically
Emotions are erratic and can shift abruptly (AKA emotional dysregulation)
Argumentative, irritable, sarcastic, quick to take offence, etc
High risk for suicide and self harm
Transient episodes of paranoia, dissociation
High neuroticism
Low on trust/compliance (agreeableness)
Dichotomous thinking (splitting)

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23
Q

Prevalence/comorbidity - Borderline PD

A

1-2% prev
+ common in women
Comorbid with mood disorders, substance abuse, PTSD, eating disorders, and cluster B PDs

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24
Q

3 main dimensions of borderline PD

A 
Affect instability (inappropriate anger, drastic mood shifts, reactive mood, feelings of emptiness)
Dysfunctional relationships (unstable/intense, efforts to avoid abandonment)
Impulsivity (self-damaging behaviours, attempts of self-harm/suicide)
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25
Q

Splitting

A

Black-and-white thinking: everything is GREAT or everything is AWFUL; they LOVE you or they HATE you
Can use splitting in all realms of their life

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26
Q

Etiology of borderline PD - biological

A

Strong genetic component in twins
Heritability of impulsivity and affective instability
Reduced response to serotonin in orbital, ventromedial and cingulate cortices linked to impulsive aggressivity
Increased noradrenergic responsiveness linked to affective instability

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27
Q

Etiology of borderline PD - psychosocial

A

negative experiences in childhood- abuse, neglect, separation, loss, trauma
Parental psychopathology

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28
Q

Etiology of borderline PD - Diathesis-stress

A

Genetic/biological diathesis: affective instaibility and impulsivity traits
Stress: trauma, parental failure or psychopathology, loss/rejections

29
Q

Etiology of BPD - object-relations theory

A

Neo-freudian theory
Premise: when you are a kid, you integrate and interject parts of significant people in our life (everyone does that)
When the signals by the caregivers are inconsistent, it results in an incohesive/fragmented sense of self - we integrate the mixed messages and we struggle to recognize our self
They have weak egos - ability to decide is weakened - links to splitting

30
Q

Etiology of BPD - Linehan’s diathesis-stress theory

A

Cycle of emotional dysregulation in child > demands on the family > invalidation from parents > emotional outbursts/dysregulation

Even if you are a well-intending parent, it is difficult to deal with the child, it can lead to this cycle
Difficult to tell what is the chicken / what is the egg
Linehan’s: trauma + invalidation = BPD

31
Q

Treatment - BPD (general + medication)

A

Have troubles estabilishing trust - idealize AND vilify their therapist (hardest to treat)
Medication: SSRIs, antipsychotic, mood stabilizers

32
Q

Treatment of BPD - dialectical behaviour therapy

A

Tolerance of negative affect, interpersonal skills, emotional regulation (combines client-centered acceptance with CBT
Therapy developped by Linehan to deal with this problem of idealize/vilification)

33
Q

Treatment of BPD - Object relation

A

strengthen ego, address direclty the splitting defense

34
Q

Characteristics - Histrionic PD

A

overly dramatic and attention-seeking
use physical appearance to draw attention
display emotion extravagantly
self-centered
overly concerned with their attractiveness
inappropriately sexually provocative and seductive
speech may be impressionistic (over the top) and lacking in detail

35
Q

Prevalence/comorbidity - Histrionic PD

A

2-3%
More common in women
Comorbid with depression and BPD

36
Q

Etiology - Histrionic PD

A

Unknown

A deep insecurity/need for approval seems to be underlying

37
Q

Characteristics - Narcissistic PD

A

grandiose view of own uniqueness and abilities
preoccupied with fantasies of great success
require almost constant attention/excessive admiration
lack empathy
envious of others
arrogant, exploitive, entitled
Likely to have other traits of the dark triad as well (psychopathy and machiavellism), dark tetrad - sadism

38
Q

Prevalence/comorbidity - Narcissistic PD

A

< 1% prev

Comorbid with BPD

39
Q

Etiology - Narcissistic PD

A

Product of our time/values?
Especially North America; individualistic/capitalist society makes it easier for narcissistic individuals to be accepted/to function
Theory: Self-psychology
Self: bi-polar scale with immature grandiosity at one pole and dependent overidealization of others at the other pole
Imbalance on the scale results from inadequate response of the parents to the child’s competency

40
Q

Characteristics - Antisocial PD

A

2 major components

  1. conduct disorder present before 15
  2. pattern of antisocial beahviour continues in adulthood (irresponsible, work only inconsistently, break laws, irritable, physically aggressive, impulsive/fail to plan ahead)

Sometimes people fill the requirements for #2, but we don’t know their history so it’s hard to establish - and they tend to lie a lot so it’s hard to determine

41
Q

Prevalence/comorbidity - Antisocial PD

A

3% of adult men, 1% women
3% in Canada
Comorbid with substance abuse

42
Q

Conduct disorder criteria

A 
Presence of at least 3 of:
aggression - people and animals
theft
vandalism
lying
bullying
run away
truancy or staying out all night before 13
43
Q

Problem with diagnosis of conduct disorder

A

Relies on patients reports on past life events, but they are often pathological liars
Many argue that a diagnostic concept in psychopathology should not be linked with criminality; conveys stereotypes, can lead to false/wrong associations/convictions

44
Q

Key characteristics - psychopathy

A

Lack of remorse
no shame
superficially shaming
manipulates other for personal gain
lack of anxiety (Important one: anxiety cannot guide us in situations where it can usually be useful
You react and deal with the world different way; you dont have a sense that you should be cautious about some things)
Poverty of emotions (both + and -)

45
Q

Differences/similarities between APD and Psychopathy

A

APD
20% also have psychopathy
75-80% felons meet criteria for APD
Lack of remorse not required

Psychopathy
All have ADP as well
15-25% felons meet criteria
Lack of remorse - core symptom
low fear disposition

Similarity factors:
Both are prone to suicide acts (psychopaths are not immune)
Both are prone to cognitive control deficits

46
Q

Cleckley’s definition of psychopathy

A 
Lack of remorse
Poverty of emotions (+/-)
Inadequate conscience development
Irresponsible/impulsive behaviour
Ability to impress/exploit others
Pathological liars
47
Q

Hare’s 2 factor checklist for psychopathy

A
  1. Affective/interpersonal (selfish, remorseless, inflated self-esteem, exploits others)
  2. Antisocial lifestyle/behaviour (marked by impulsivity and irresponsibility)
48
Q

Emotions of Psychopaths

A

Unresponsive to punishment/no conditioned fear response (low fear hypothesis)
Lower than normal levels of skin conductance at rest
Hear rate normal under rest, but high when anticipating intense/aversive stimuli (Indicates that psychopaths cannot be regarded as simply under-aroused; their increased heart rate indicates that they are tuning out the stimulus)

Some features of psychopaths might result from a lack of empathy (were less responsive to images of distress than controls in a study) - linked with brain dysfunctions

49
Q

Etiology of psychopathy - biological

A

Response modulation/impulsivity and psychopathy might arise from slow brain waves and spikes in temporal area, and less activity in the amygdala (involved in aversive conditioning) - reduced volume and response to negative stimuli

Reduction of grey matter observed in children

50
Q

Etiology of APD and psychopathology - heritability

A

Criminality/APD have genetic components
High concordance for MZ twins (DZ less but still)
Higher rates of antisocial behaviour in adopted children of biological parents with APD

51
Q

Etiology of APD and psychopathy - family environment

A

Lack of affection
Severe parental rejection
Physical abuse
Inconsistencies in disciplines (could be reaction to child’s behaviour) - That’s a theory
Failure to teach child responsibility towards others
Many individuals from those backgrounds do not become psychopaths
Fathers likely to have antisocial personalities

52
Q

Etiology of Psychopathy - stress reactivity theory

A

Convicted psychopaths usually found to have lowe autonomic stress reactions and lower resting state autonomic activity
Thought to play a role in development of psychopathology

53
Q

Successful vs unsuccessful psychopaths

A

Successful psychopath: have been diagnosed, but figured out a way to deal with the world without getting into trouble (adapted to society)
Baseline heart rate is even lower than control
Response is similar to the controls

Unsuccessful psychopath: were not able to adapt to society
Baseline heart rate is lower than control

54
Q

Etiology of psychopathy - frontal hypothesis

A

Executive functions deficits thought to underlie psychopathic features
studies supporting the theory mainly included violent offenders
no executive dysfunction was found in successful psychopaths

55
Q

Characteristics - Avoidant PD

A

Fearful in social situations
Keenly sensitive to criticism, rejection, disapproval
Reluctant to enter relationships unless sure they will be liked

56
Q

taijinkyoufu

A

extreme fear of how they appear to others, resulting in avoidance of social contacts like in avoidant PD and social anxiety (in Japan)

57
Q

Prevalence/comorbidity - Avoidant PD

A

1% prev

Comorbid with dependent PD, depression and generalized social phobia

58
Q

Difference between avoidant and dependent PD

A

Only difference between avoidant and dependent PD is that avoidant struggles to approach/initiate social relationships

59
Q

Characteristics - Dependent PD

A 
Lack self-reliance
overly dependent on others
intense need to be taken care of
uncomfortable when alone
subordinate own needs
60
Q

Prevalence/comorbidity - Dependent PD

A

1.5% prev
+ common in women
Comorbid with bipolar, depression, anxiety, bulimia

61
Q

World views on dependent PD

A

Maladjusted to the rest of the world; studies on DPD have been too focused on North America, where being dependent on others is a flaw; but in collectivistic cultures it can actually be ok

62
Q

Characteristics - Obsessive-Compulsive PD

A

Perfectionistic approach to life
Peroccupied with details, rules, schedules, etc
Serious, rigid, formal, inflexible
Unable to discard worn out and useless objects
Does not include obsessions/compulsions in OCD

63
Q

Prevalence/comorbidity of Obsessive-Compulsive PD

A

1% prev

Comorbid with OCD, panic disorder, depression, avoidant PD

64
Q

Etiology of cluster C

A

Unknown - little data

65
Q

Therapies for PDs

A

Not much research-based information
Object relations therapy for BPD
Dialectical therapy for BPD
Schema therapy: cognitive schemas that underlie PD can be corrected

66
Q

Treatment - Psychopathy

A

Virtually impossible to treat

Unable to form a trusting relationship with a therapist

67
Q

Where does the word dialectical come from (dialectical therapy)

A

Word dialectical comes from dialectics: worldview that holds that reality is an outcome of a constant tension between opposites (any event (thesis) generates a force opposite to it (antithesis), which is resolved by the creation of a new event (synthesis))
Therapists’ paradox: accepting the client as they are, yet helping them to change

68
Q

Carrers associated with PDs?

A

Antisocial: Computer science (don’t need to deal with ppl and follow rules)
Avoidant: accountant (no dealing with people)
Borderline: Acting, anything creative
Dependant: caretaker, personal assistant
Histrionic: wedding planner, waitress/bartender, also acting maybe but they are quite shallow
Narcissistic: politician, businessman, model, finance, job where they can show their charismatic personality and where they can be the boss of people
Obsessive compulsive: Pharmacist, doctor, librarian, wedding planner
Paranoid: bodyguard, detective
Schizoid: artistic, working from home
Schizotypal: fashion designer, author, fortune teller/psychic

PSYC340 (14 decks)

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