chapter 9: personality disorder

Question 1

define personality

Answer 1

pattern of perceiving, feeling, and thinking about relating to oneself and the environment

Question 2

personality trait

Answer 2

pretty consistent aspect of personality that is seen across environments and time (could be outgoing, sky, angry, etc.)

Question 3

five-factor model

Answer 3

theory that everyone’s personality is organized around five broad traits
- negative emotionality, extraversion, openness to experience, agreeableness, and conscientiousness

Question 4

what are the current ways we define personality disorder ith DSM-5

Answer 4

• current in clinical setting use first model that defines 10 different PDs with distinct criteria
• alternative model looks at it as normal and abnormal personalities fall on continuum of personality with personality disorder representing the extreme maladaptive variants

Question 5

personality disorder cluster a

Answer 5

odd/ eccentric thinking or behaviors called paranoid, schizoid, and schizotypal
- odd speech patterns
- inappropriate or flat affect
- thought to be below threshold for schizophrenia (for schizotypal)
- usually seen in people who have first-degree relatives with schizophrenia or delusional disorder (for schizotypal)

Question 5

define personality disorder

Answer 5

pattern deviate significantly from expectations of their culture shown through thinking of oneself, others, event emotional experience and expression, interpersonal functioning, and/or impulse control
- has to present during adolescent/ early adulthood
- if under 18 the symptoms must have been present for 1 yr

Question 6

PD cluster B

Answer 6

dramatic, erratic emotional behavior and interpersonal relationships
- antisocial, histrionic, borderline, narcissistic
- tend to be manipulative, volatile, and uncaring in social relationships
- little regard for safety of themselves and others

Question 7

PD cluster C

Answer 7

anxious and fearful emotions and chronic self-doubt
- dependent, avoidant, compulsive
- have little self confidence and difficulty in relationships

Question 8

paranoid personality disorder

Answer 8

pattern of suspicion of others actions and motives and being afraid to be victimized or mistreated
- see events as highly meaningful and trying to decipher clues to others true intentions
- different from schizophrenia because their suspicious beliefs can be somewhat plausible and retain some degree of reality

Question 9

stats of paranoid personality disorder

Answer 9

• 1.21-4.4% of people in general population but in clinical population thought to be around 25%
• in clinical setting this is the strongest predictor of aggressive behavior
• can be very debilitating and cause many people to have unstable relationships and quit work
• associated with violence, stalking, and excessive litigation
• increased risk for major depression, anxiety, substance abuse, and psychotic episodes,
  -impaired vocational functioning
• more common in families with members who have unipolar depression
• higher in african americans

Question 10

theories around Paranoid personality disorder

Answer 10

• cognitive: from belief that other people are deceptive combine with own lack of self-confidence about being able to defend themselves
• more likely to hold others responsible for their life circumstances

Question 11

treatment for paranoid personality disorder

Answer 11

• because they are so distrusting, usually only seek help when they are in crisis and this has caused small amount of individuals with this disorder to have psych help
• no FDA approved meds and limited knowledge for best therapy
• cognitive therapy focuses on increasing self-efficacy, dealing with difficult situations to all decrease fear and hostility toward others
• therapists must be calm, respectful, and extremely straightforward

Question 12

schizoid personality disorder

Answer 12

abnormally detached from social relationships and emotional expression
- higher levels of mental pain and recurrent depression large risk factor for depression
- inescapable loneliness and social withdrawal
- highly treatment resistant which impairs several important functional areas
- view relationship with others as messy, intrusive, unrewarding, etc
- 0.8-2.8% of adults manifesting disorder sometime throughout life and 5% in general population
- somewhat more often in men
- can still function in society and hold jobs, usually ones that do not require frequent interpersonal interactions
- social detachment not anxious avoidant

Question 13

what is alexithymia

Answer 13

impaired ability to recognize and express emotions - have problems deciphering external emotions that can lead to emotional dysregulation, suicidal ideation, and comorbidity with other major psych disorders

Question 14

theories of schizoid personality disorder

Answer 14

• thought possible inheritability

Question 15

treatment for schizoid personality disorder

Answer 15

-interpersonal relationship like therapy may be seen as stressful instead of supportive
- psychosocial focuses on increasing personal awareness of their own feelings, social skills, and social contacts
- possible group therapy

Question 16

schizotypal personality disorder

Answer 16

only personality disorder on schizophrenia spectrum because they display similar symptoms
- longlong pattern of odd behavior/appearance that impact interpersonal function, thinking, and behavior
- understudied, misdiagnosed, challenging to treat, and has significant functional impairment
- usually have odd preoccupation with bizarre fantasies and magical thinking, view others as deceitful and hostile

Question 17

stats of schizotypal personality disorder

Answer 17

prevalence: 0.6% in Norwegian sample and 4.6% in American but less frequent in clinical setting
- men more effected then women (greater among black women, those in low income, separated, divorced, or widowed)
- lowest among asian men
- relationship with bipolar 1,2 PTSD, BPD, and narcissistic personality disorder

Question 18

theories of schizotypal personality disorder

Answer 18

• thought to have a genetic component possible the
  -gene that regulated NMDA receptor system
• dysregulation of neurotransmitter dopamine (high levels in striatal and cortical region)
• less grey matter in temporal lobe
• usually have experienced childhood trauma and can have diminished cognitive functioning in areas of working memory, visual learning, verbal fluency, etc
• sexual abuse associated with odd belief, magical thinking
• severe emotional neglect: interpersonal dysfunction

Question 19

treatment of schizotypal personality disorder

Answer 19

• usually use same drugs as schizophrenia: neuroleptics and antipsychotics, sometimes antidepressants
• therapy can help with social contact and learn socially appropriate behaviors
• cognitive therapy focuses on teaching individuals to challenge their thoughts and find evidence in real world situations to back their bizarre thoughts

Question 20

what are the personality disorders associated with cluster B

Answer 20

borderline, histrionic, antisocial, and narcissistic

Question 21

borderline personality disorder

Answer 21

instability of emotions, relationships, that impact function. they have trouble regulating and can have intense bouts of anger, depression, anxiety that could be hours or days
- usually emerges early in puberty and impacts variety of areas of life, can reduce social learning and healthy peer environment
- hypersensitivity to abandonment
- practice parasuicidal actions of self-harm without the intention of dying
- 70-75% of those with borderline disorder have done self-harm
- highest odds to have anxiety disorder too and lowest is eating disorder

Question 22

stats of borderline personality disorder

Answer 22

1.7% in general population but closer to 15-28% in clinical setting
- in clinical more women are diagnosed
- Hispanic origins most likely compared to tother ethnicity

Question 23

theories of borderline personality disorder

Answer 23

usually seen most during during adolescences and young adults (challenging time of time)
- remission is difficult and relapse very likely especially
- in social and professional disability
- have a more negative emotional baseline, emotional variability, and harding time returning to baseline
- compared to other disorders, individuals with this disorder have background of instability, neglect, and parental psychopathology
- dont have self confidence to ask for help in mature / effective way
- splitting: only see people as all good or bad and switch back and forth
- smaller hippocampus and amygdala
- structural and metabolic difference in prefrontal cortex

Question 24

treatment for borderline personality disorder

Answer 24

• dialectical behavior therapy: has most data for lowing self-injury, hospitalization, and anger. helps teach more realistic positive sense of self, learn adaptive skills for problem solving, regulating emotions, and correct dichotomous thinking
• cognitive therapy: use STEPPS program
• transference- focused therapy: use relationship with therapist to help patients create more realistic relationships
• mentalization-based treatment: helps relationships and understand mental states of themselves and other because of their traumatic childhood and poor attachment
• meds: possible mood stabilizers

Question 25

histrionic personality disorder

Answer 25

share features of borderline including shifting emotions, unstable relationships, dramatic, volatile, etc. but also have:
- self-destructiveness, angry disruption, inner emptiness and what to find ways to draw attention to themselves
- use excessive emotionality and provocative behavior to get attention from others
- others seem them as self-centered, demanding, overly dependent, etc
- impacts 1-3% and 2x likely to women than men
-increased risk of depression and substance use disorders
- unclear if this has genetic traits associated with

Question 26

treatment for histrionic personality disorder

Answer 26

• psychodynamic: uncover repressed emotions and help them express themselves more appropriately
• cognitive therapy: help them function better on their own and create goals and plan that do not rely on approval from others
• dont recommend group/ family therapy because they dont want the distraction of being “center of attention:

Question 27

narcissistic personality disorder

Answer 27

similar to histrionic but dont look for approval of others, they see themselves as superior to others and expect others to recognize this.
- preoccupied with thoughts of self-importance and fantasies of power and success
- talk about their actions as “perfect” or “the best”
- dont have abandonment concerns
- can be the workaholics or feel extreme distress when their perfectionism falls short and can alienate their relationships
- 6.2% prevalence and presents higher in men is increasing because culture is moving towards self-focused individualism (more in black men and women, hispanic women

Question 28

theories of narcissistic personality disorder

Answer 28

rely on praise and domination of others for their self-esteem
- develop belief they are unique as defense against rejection unmet basic emotional needs by important people in their lives

Question 29

two subtypes of narcissistic personality

Answer 29

• grandiose: engage in grandiose fantasies arrogant, entitled, manipulative, aggressive
• vulnerable: copes with difficulties in self-esteem with fantasies to stop intense shame

Question 30

treatment of narcissistic personality disorder

Answer 30

• not a lot seek help they see problems as weakness and due to others
• cognitive therapy is used to help teach them to challenge self-aggrandizing ways and be more sensitive to others

Question 31

what are the cluster C personality disorders

Answer 31

avoidant, dependent, obsessive compulsive feel chronic anxiety or fearfulness and have behaviors intended to ward off feared situations

Question 32

avoidant personality disorder

Answer 32

fueled by feelings of inadequacy and fear of criticism and rejection
- personality traits of negative affectivity and detachment
- 1.5-2.5% slightly higher in women can be comorbid with major depression and substance abuse
- more chronic and severe anxiety in social situations than social anxiety
- if diagnosed with this, more likely to also go through postpartum depression

Question 33

theories of avoidant personality disorder

Answer 33

• no relationship to sexual or physical abuse growing up like other disorders but can have emotional neglect
• cognitive: create dysfunctional beliefs due to rejection by other important people in their lives
• dont believe positive feedback from others, saying they are just trying to be nice

Question 34

treatment for avoidant personality disorder

Answer 34

• important to have intervention because this is a lifelong challenge
• cognitive and behavioral therapy help graduate exposure to social settings, skills. training, and challenge automatic negative assumptions
• meds: serotonin re-uptake inhibitors to reduce social anxiety

Question 35

dependent personality disorder

Answer 35

excessive pathological need to be taken care of by others, will overly accommodate others to obtain their support and relationship
- 0.78% prevalence
- comorbid with depression and anxiety disorder
- children with separation anxiety or chronic physical illness are more prone

Question 36

theories of dependent personality disorder

Answer 36

-behavioral and cognitive perspectives say this is learned behavior, that when they were children they learn to act in way to get desired response
- cognitive: concrete belief about themselves that they are weak and needy
- anxious-insecure attachment style
- big five personality: high anxiety and insecurity and low risk taking and perceived competence

Question 37

treatment of dependent personality disorder

Answer 37

• unlike other disorders in this chapter, they do seek help frequently
• focus on learning self confidence and appropriate independence skills
• psychodynamic: learn about early attachment through relationship with therapist
• cognitive-behavioral: increase assertive behaviors and decrease anxiety

Question 38

obsessive-compulsive personality disorder

Answer 38

perfectionistic, dogmatic, emotionally blocked, inflexibility
- will persist in a task even when their approach is failing
- this is more generalized to how they approach life rather than a specific obsessive though or compulsive behavior like OCD
- also see their actions as part of their personality unlike OCD where they are unwanted actions or thoughts so people with OCPD are less likely to seek help as compared to those with OCD
- people can have both OCD and OCPD

Question 39

stats on Obsessive compulsive personality disorder (OCPD)

Answer 39

• most prevalent personality disorder 2-8% in the US
• some studies find 2x men more likely and others say equal likelihood between genders
• usually diagnosed during adulthood after 30
• prone to depression, anxiety, eating disorder

Question 40

theories around obsessive-compulsive personality disorder

Answer 40

• slightly higher record of physical neglect than other disorders
• belief that flaws, defects, mistakes are intolerable
• more common if relative has OCD
• reduced grey matter in prefrontal cortex, cingulate, insula
• possible spontaneous neural activity which could be linked with excessive self-control, and low levels of empathy

Question 41

treatment for OCPD

Answer 41

• supportive therapy: overcoming crises
• behavioral therapy: decrease compulsive behavior

Question 42

DSM critiques of defining personality disorder

Answer 42

1. 10 separate PDs but have large overlap in diagnostic criteria
2. people seem to go in and out of a diagnosis throughout life because symptoms come and go
3. did not reflect literature across cultures

Question 43

the alternative model (combines continuum and categorical approach)

Answer 43

define PD in terms of functioning and pathological traits
1. determine function level in sense of self and relationships with others
2. determine pathological personality traits
- neuroticism: how able are you to handle stress and be calm (negative affectivity)
- detachment
- antagonism (honesty)
- disinhibition (tendency to be responsible, organized to impulsive)
- psychoticism (unusual beliefs)
3. do they meet requirements of any of the six specific disorder

Question 44

what PDs are recognized by the alternative DSM model

Answer 44

antisocial, avoidant, borderline, narcissistic, obsessive-compulsive, schizotypal