HC.8 Flashcards
Name the DSM-5 criteria for narcissistic PD
- Grandiose sense of self
- Need for admiration
- Arrogant
- Entitled
- Fantasies of succes, power, etc.
- Envious of others
- Feels special all the time
- Lack of empathy
- Exploitative
Describe the prevalence of Narcissistic PD
- In community: 0%-6.2%
- In forensic studies: 27.2%
- The prevalence is higher in men than in women (50-75%)
Describe the 2 types of narcissistic PD
- Grandiose
- Dominance
- Self-assurance
- Immodesty
- Exhibitionism (center of attention)
- Aggression (in a way of doing things)
- more in line with the criteria of the DSM-5 for NPD - Vulnerable
- Introversion
- Negative emotions
- interpersonal coldness
- hostility
- need for recognition
- entitlement
- egocentricity
- more in line with the criteria for borderline of the DSM-5
People have a preference for 1 but they can switch in some situations
Explain the dimensional aspects of Narcissistic PD
- Identity
- Uses others for self-definition and self-esteem
- Exaggerated self-appraisal: They have an overly positive or negative self-image that does not correspond to reality.
- Emotion regulation fluctuates with self-esteem: Their ability to fluctuate emotions varies greatly depending on their self-esteem at that moment. - Self-direction
- Goal setting based on gaining approval: Their goals and ambitions are often focused on gaining approval and affirmation from others.
- High/low personal standards
- They are often unaware of the underlying motivations for their behavior. - Empathy
- Impared ability to recognise/ identify: Individuals with personality disorders have difficulty recognizing or identifying the feelings and needs of others.
- Excessively attentive to reactions of others (on the self): They are overly focused on how others react to them.
- Over- or underestimating own effect on others - Intimacy
- Superficial relationships
- Restrained mutuality (little genuine interest): They have difficulty with genuine reciprocity in relationships and show little genuine interest in others.
Describe the 2 pathways that people use to boost their selves
- Admiration (assertive self-enhancement; self-promotion)
- het individu werkt actief aan het verbeteren en promoten van een groots zelfbeeld.
- striving for uniqueness
- grandiose fantasies: Het individu heeft overdreven positieve en grootse ideeën over zichzelf.
- charmingness
- Social potency; Deze gedragingen leiden tot een verhoogde sociale status en invloed (ego boost). - Rivalry (antagonistic self-protection; self-defense)
- het individu zichzelf verdedigt en beschermt tegen bedreigingen die het groots zelfbeeld kunnen ondermijnen
- Devaluation: Het individu negeert of verlaagt de waarde van anderen om zichzelf beter te voelen.
- Aggressiveness
- Striving for supremacy: Het individu probeert anderen te domineren en te overtreffen.
- social conflict: Deze gedragingen leiden tot conflicten en vijandigheid in sociale interacties (ego threat).
Name the DSM-5 criteria for anti-social PD
Disregard for and violation of the rights of others starting since age 15
- Not conforming to social norms > repeated unlawful behavior
- Deceitfulness (lying, conning)
- Impulsivity
- Irritability and aggressiveness
- Reckless disregard for safety of self and others
- Consistent irresponsibility
- Lack of remorse
The diagnosis is later, not at the age of 15
Describe the prevalence of ASPD
- in community: 0.2%- 3.3%
- in forensic studies: higher prevalence (30%)
- there is a higher prevalence in men than in women
Describe the characteristics of psychopathy (how it first was seen)
- Superficial charm and good “intelligence”
- Absence of delusions and other signs of irrational thinking
- Unreliability
- Untruthfulness and insincerity
- Lack of remorse or shame
- Inadequately motivated antisocial behavior
- Poor judgement and failure to learn by experience
- Pathological egocentricity and incapacity for love
- General poverty in major affective reactions
- Specific loss of insight
- Unresponsiveness in general interpersonal relations
- Fantastic and uninviting behavior with drink and sometimes without
Describe the two main factors of psychopathy and other characteristics often associated with this personality disorder.
- Affective/ interpersonal
- Affective: lack of guilt/remorse, emotionally shallow, callous (lack of empathy), failure to accept responsibility for actions
- Interpersonal: glibness/superficial charm, grandiose, pathological lying, conning/manipulative - Antisocial/ lifestyle
- Antisocial: poor behavioral control, early behavioral problems, juvenile delinquency, revocation of conditional release, criminal versatility
- Lifestyle: need for stimulation, lack of realistic long term goals, parasitic lifestyle, impulsivity, irresponsibility - Other
- Promiscuous sexual behavior: mating with more than one partner in a relatively short-time period
- Many short-term relationships
- The relationships go very quickly; meeting>love>living together within a month
How do you diagnose these disorders?
- Often need for secondary source of information
- because they lie a lot and manipulate a lot
vb:
- file information from a criminal investigation
- Info from clinical/criminal records
- Info from family or other sources - Psychopathy Checklist - revised
- 20 items scored from 0 to 2
- Score > 26 or > 30 = psychopathy
- need for training
Explain the dimensional aspects of anti-social PD (and psychopathy)
- Identity
- Egocentrism
- Self-esteem derived from personal gain, power, or pleasure - Self-direction
- Based on personal gratification: Doelen en gedragingen zijn gericht op het behalen van persoonlijke voldoening.
- Absence of prosocial internal standards, normative ethical behavior: Gebrek aan interne normen die prosociaal (ten behoeve van anderen) en ethisch zijn. - Empathy
- Lack of concern for others: Weinig tot geen aandacht voor de gevoelens en behoeften van anderen.
- Lack of Remorse after hurting or mistreating another - Intimacy
- Incapacity for mutually intimate relationships
- Exploitation is used to relate to others
- use of dominance or intimidation
Pathologische Kenmerken (6/7):
- Manipulativiteit: Anderen op een slinkse of berekenende manier gebruiken voor persoonlijke voordelen.
- Kille gevoelloosheid: Gebrek aan medeleven en ongevoeligheid voor anderen.
- Bedrieglijkheid: Liegen en bedriegen om doelen te bereiken.
- Vijandigheid: Boosheid en agressie naar anderen.
- Risicogedrag: Zoeken naar gevaarlijke of risicovolle situaties voor opwinding.
- Impulsiviteit: Handelen zonder na te denken over de gevolgen.
-Onverantwoordelijkheid: Onverantwoord gedrag en het negeren van verplichtingen.
Specificatie voor Psychopathische Kenmerken:
- Gebrek aan angst/vrees: Weinig of geen negatieve emotionele reacties op gevaar of bedreiging (negatieve affectiviteit/detachment).
- Gedurfde interpersoonlijke stijl: Zelfverzekerde en risicovolle interacties met anderen.
- Hoge aandacht voor het zoeken: Actief zoeken naar aandacht en bevestiging van anderen.
Where do you see people with ASPD or psychopathy?
- usually not voluntarily in therapy, but by family, if they do come voluntarily, then they come often for a different problem
- in forensic settings
How do you recognise people with ASPD or psychopathy?
- They are charming/manipulative
- But they come across as normal
- They blame other people a lot
- NPD: subtle egocentric
- NPD: mephasizing own suffering
- NPD: Gaslighting
Why do you have to be careful diagnosing?
- Not everything they say is true
- some people show the narcissistic traits more in a physical way and some in a psychological way
- Narcissism is a spectrum
- Sometimes narcissism is used as a mask (for anxiety,
insecurity): Sometimes it is a mask to mask fear/anxiety. These people are aware of their motivations behind the narcissistic traits - ASPD/psychopathy diagnoses may be damaging: When you give them the diagnosis sometimes it gets worse becuase they carry it through
- Situational vs. Personality traits?: sometimes they can improve in a short time, and they did a bad thing out of desperation.
- There are cultural differences
e.g., macho culture, individualistic vs. collectivistic cultures - There are generational differences
e.g., the “selfie” generation
There are gender x culture differences
e.g., men might be expected/allowed to be more narcissistic
What are the consequences for people with these PDs?
- Involvement in criminal justice system
- Poor interpersonal relations
- Negative consequences for others (physical/emotional aggression)
In close relationships
In work settings - Poor personal outcomes (low quality of life)
