Exam 4: Personality Disorders Flashcards
DSMV Diagnosis
enduring pattern of inner experience and behabior, pattern shown in 2+ areas: cognition, affectivity, interpersonal functioning, impulse control; often seek therapy for something other than personality disorder
Prevalence
9-13%
Inter-rater Reliability
.69-.97 depending on disorder; definitiosn got more specific and structured interviews were developed
Stability of Disorders
test-retest reliability varies; not as stable as DSM suggests
highly stable: antisocial
low: schizotypal
Comorbidity
50% qualify for another PD; 2/3 meet criteria for another disorder at somepoint in their lifetime
Cluster A
odd/eccentric behaviors, emotionally detatched, extreme forms overlap with psychotic disorders, more common in males, rarely seek treatment
Cluster B
dramatic/erratic behaviors, fragile ego/sense of self, attention-seeking
Cluster C
anxious/fearful behaviors
Paranoid
pervasive, unwanted suspiciousness, pathological jealousy, appear cold, serious and devious, lack tender feelings and sense of humor, do not have close relationships, often have difficulties working; Cluster A
Schizoid
withdrawn, detatched, reclusive, lacking humor, flat affect, indifferent to praise/criticism, little desire for relationships; Cluster A
Schizotypal
oddities of thought/speech/behavior/perception, loose associations, suspiciousness, lacking social skills, socially isolated, often seen as weak form of schizophrenia; Cluster A
Histronic
f>m, overly reactive/dramatic, intensely expressive, behaviors and relationships for attention rather than intimacy, seen as manipulative, often ends up in therapy; Cluster B
Narcissistic
extreme sense of self-importance and uniqueness, sense of entitlement, expect favors, constant need for attention, grandiose, might exploit others, not much empathy/concern for others, envious of others or thinks others are envious of them; Cluster B
Borderline Personality
f>m, (hispanics f=m and higher overall rate), instability in moods, self-image, impulsivity, relationship problems, percieved as manipulative, seems to wish for relationships but denies doing so, “you’re wonderful/you’re horrible” pattern, fear of abandonment, self-harm tendencies, some genetic component, Cluster B
Antisocial
m>f, associate with crime and violence, often violate other’s rights, long history of inappropriate behavior, often diagnosed with conduct disorder before 15, pathological lying, no remorse, do not care about others, difficulty maintaining job, careless with money, no sense of responsibility, reckless behavior, may mistreat/abuse others, manipulative, self-centered, relationship problems, rarely seek treatment; Cluster B
Avoidant
m=f, strong fear of rejection, desire intimacy but have few relationshis, need guarantee of unconditional acceptance, avoid social interaction, low-self esteem, anxious, sensitive, restrict activities; Cluster C
Dependent
f>m, clingy, obedient, fear of separation/abandonment, ongoing need to be taken care of, feel distressed, lonely, sad, lack of belief/confidence that they can function independently; Cluster C
Obsessive-Compulsive
m>f, intense focus on orderliness, perfectionism, control, no flexibility or openness, insist others do things their own way, do not seek treatment unless lifestyle is threatened; Cluster C
Seeking Treatment
many people with personality disorders do not seek treatment unless it is at someone else’s insistance - don’t believe they need to make changes
Paranoid: Psychodymanic Theory
demanding parents, distant/rigid father, over controlling/rejecting mothers. One view is that patients view environment as hostile as result of their parents’ persistently unreasonable demands
Paranoid: Cognitive Theory
hold broad maladaptive assumptions
Paranoid: Biological Theory
genetic cause. Twin studies in Australia, one twin suspicious, other twin had likelihood. But also could be caused by similar environment
Paranoid: Object Relations Treatment
work with patient’s deep wish for a satisfying relationship
Paranoid: Self-therapists
help clients reestablish self-cohesion
Paranoid: Behavioral Therapy
therapists help individual to master anxiety-reduction techniques and to improve skills at solving interpersonal problems
Paranoid: Cognitive Therapy
therapist guide to develop more realistic interpretations of other’s words/actions and to become aware of other’s points of view
Schizoid: Psychodymanic Theory
has roots in unsatisfied need for human contact, parents are unaccepting/abusive
Schizoid: Cognitive Theory
deficiencies in thinking. Thoughts are empty/vague/without meaning. Unable to pick up emotional cues and unable to process them. Children will develop language/motor skills slowly
Schizoid: CBT
Cognitive – present clients with list of emotions to think about/ remember pleasurable experience
Behavioral – teaching social skills using role play, exposure techniques, and homework assignments.
Also use group therapy
Schizotypal: Theories
family conflict, disorders in parents, deficits in attentions, short-term memory
Schizotypal: Biological Theory
high activity of NE, enlarged ventricles, smaller temporal lobes, loss of grey matter
Schizotypal: Comorbidity
MDD
Schizotypal: CBT
help client reconnect with world, recognize limits of thinking/powers. Increase social contacts
Cognitive – teach clients to evaluate unusual thoughts, perceptions objectively and try to ignore inappropriate ones.
Behavioral – speech lesson, social skills training, help clients blend in and feel more comfortable.
Histronic: Psychodymanic Theory
children experienced unhealthy relationships in which cold and controlling parents left the feeling unloved and afraid of abandonment. To defend against fears of loss, individuals learned to behave dramatically, inventing crises that would require others to act protectively
Histronic: Cognitive Theory
lack of substance and extreme suggestibility found in people with histrionic personality disorder. Individuals become less and less interested in knowing about the world at large because they are so self-focused. Rely on other people to provide them direction. Think they are helpless so rely on others to meet their needs
Histronic: Sociocultural Theory
produced by cultural norms/ expectations
Histronic: Therapy
cognitive and psychodynamic; try to change belief that they are helpless, push towards more deliberate ways of thinking. Try to make patients realize own excessive dependency; pretend to have a lot of symptoms to hard for therapists. They seek treatment on own (for attention). Therapists must remain objective.
Narcissistic: Psychodynamic
cold rejecting parents. spend lives defending against feelings unsatisfied, rejected, unworthy, wary of world. Believe that they are perfect to cope, while wanting admiration from others. Grandiose self-image as way to convince themselves they are self-sufficient without need of warm relationships with parents or anyone else.
Narcissistic: Cognitive/Behavioral Theory
people are treated too positively. Repeatedly reward themselves for minor accomplishments.
Narcissistic: Sociocultural Theory
family values/social ideals in certain societies periodically break down, producing generations of youth who are self-centered/materialistic.
Narcissistic: Psychodymanic Treatment
help people recognize and work through basic insecurities/ defenses
Narcissistic: Cognitive Therapy
redirect client’s focus to opinions of others, reach them to interpret criticism more rationally, increase ability to empathize.
Narcissistic: Treatment Success
No treatment has had much success, patients do not recognize need for treatment or value of treatment. Try to manipulate therapists.
Borderline: Psychodynamic Theory
early lack of acceptance by parents lead to loss of self-esteem, increased dependence, inability to cope with separation. Research indicates early sexual abuse.
Borderline: Biological Theory
overly reactive amygdala, underactive prefrontal cortex, lower serotonin activity (abnormality in 5-HTT gene).
Borderline: Biosocial (diathesis-stress)
combination of internal forces (difficulty identifying/controlling emotions/abnormal neurotransmitter) and external forces (environment in which child’s emotions are punished, ignored).
Borderline: Psychoanalytic Treatment
traditional doesn’t work because patients take it as insults, don’t think they have enough attention with free association. Relational psychoanalytic theory therapist take more supportive/egalitarian posture, they work to provide empathic setting within which patients can explore central relationship disturbance, poor sense of self, pervasive loneliness/emptiness.
Borderline: Dialectical Behavior Therapy
acceptance and change (that is: accepting yourself and that there is a reason for what you did, but that you need to change the behavior because it isn’t working well for you; starts by addressing harmful behaviors, then behaviors that interfere with therapy; based on cognitive/behavioral technique such as homework assignments, psych education, teaching of social skills, modeling, goal setting, reinforcements for appropriate behavior, collaborative examination of thinking with client and patient. Empathize with patients. Works in groups. Most supported treatment. Patients deal better with stress, more appropriate social skills. Fewer suicide symptoms/ hospitalization.
Borderline: Comorbidity
high comorbidity with with anxiety, PTSD, depression, eating disorder, substance abuse
Antisocial: Comorbidity
substance abuse
Antisocial: Psychodynamic Theory
absence of parental love during infancy, leading to lack of basic trust. Children become emotionally distant. Bond with others through use of destructiveness and power. Evidence is people who have it had family stress (violence, poverty, conflict, divorce)
Antisocial: Behavioral Theory
antisocial symptoms may be learned through modeling/imitation. Higher rate are found with people whose parents has it as well. Another theory, parents reward aggressive behavior.
Antisocial: Cognitive Theory
hold attitudes that trivialize importance of other people’s needs. Have genuine difficulty recognizing point of view of others.
Antisocial: Biological Theory
low serotonin level, deficient functioning in frontal lobe, people have less anxiety (vital for learning, people with disorder have low arousal in presence of stress, linked with tuning out threatening/emotional situations.)
Antisocial: Cognitive Treatment
teaches patients to think about moral issues and about the needs of other peoples; typically ineffective because patients do not want to change
Antisocial: Biological Treatment
atypical, antipsychotics drugs (not supported)
Avoidant: Psychodynamic Theory
focus on general sense of shame, early bowel/bladder incidents. If parents punish, child gets negative self-image, and will distrust love of others
Avoidant: Cognitive Theory
harsh criticism/ rejection I nearly childhood leads to think environment always judges and thinks badly of them. Individuals expect rejections, misinterpret positive feedback, fear social involvements
Avoidant: Behavioral Theory
fail to develop normal social skills, failure helps maintain disorder. Deficits result from avoiding social situations.
Avoidant: Psychodynamic Treatment
help clients recognize and resolve unconscious conflict that may be operating
Avoidant: Cognitive Treatment
help change distressing beliefs and thoughts, carry on in face of painful emotions, and improve self-image
Avoidant: Behavioral Treatment
provide social skills training as well as exposure treatments that require people to gradually increase social contact; group therapy is helpful
Avoidant: Biological Treatment
Antianxiety/antidepressants reduce social anxiety but symptoms may return when medication is stopped
Dependent: Psychodynamic Theory
unresolved conflicts during oral state gives rise to lifelong need for nurturance. Early parental loss. Rejection man prevent normal experience of attachment and separation. Some say parents are overprotective, so children become more dependent
Dependent: Behavioral Theory
parents unintentionally reward clinging behavior while pushing acts of independence away. Or Parents’ own dependent behavior modeled by kids.
Dependent: Cognitive Theory
two maladaptive thoughts: (1) inadequate and helpless to deal with world (2) must find person to provide protection so I can cope. Also (3) if I am to be dependent, I must be completely helpless.
Dependent: CBT
place all well-being on clinician. Must make clients accept responsibility; help take control of lives
Behavioral – therapists often provide assertiveness training
Cognitive – help clients challenge and change assumptions of incompetence and helplessness
Dependent: Drug Treatments
• Anti-depressants drug therapy good for personality disorder accompanied by depression
Dependent: Group Therapy
good for support from number of peers, can serve as models for each other
Obsessive-Compulsive: Psychodymanic Theory
anal regressive, overaly harsh toile training, become angry and get fixated. Struggles with parents over control and independent ignite aggressive impulses
Obsessive-Compulsive: Cognitive Theory
illogical thinking processes keep OCPD going. People with disorder tend to misread/ exaggerate potential outcomes of errors
Obsessive-Compulsive: Psychodynamic Treatment
help recognize and accept underlying feelings/insecurities
Obsessive-Compulsive: Cognitive Treatment
focus on changing “all-or-nothing” thinking, perfectionism, chronic worrying
Obsessive-Compulsive: Medication
Respond well to SSRIs but no research yet.
Personality Traits: The Big Five
Neuroticism Extroversion Openness to experience Agreeableness Conscientiousness
