L10: Cluster C PDs & Cognitive Models Flashcards
What are the Cluster C Disorders?
- avoidant PD
- dependent PD
- obsessive compulsive PD
What do cluster C disorders have in common?
- internalizing character hides underlying problems
- high mental health care use
What are the criteria for avoidant PD?
min 4:
1. avoiding occupational activities involving significant interpersonal contact
2. unwilling to get involved w ppl unless certain of acceptance
3. restraint within intimate relationships
4. preoccupied w fears of receiving criticisms or rejection in social situations
5. social inhibition new interpersonal situations
6. feelings of inferiority
7. reluctant to take personal risks or to engage in any new activities
What are the consequences of the avoidant Pd symptoms?
- High amounts of stress (depression, substance use, somatic symptoms, chronic mental health issues, sleep problems)
- Isolation from friends, colleagues and others (Lower social support)
- Negative impact on (academic) career
- Self-fulfilling prophecy?
What is the etiology of AVPD?
Low degree of (healthy) emotional expression in family
* Conflict avoidance in family
* Avoidant modeling by parents
* (preoccupied)-Avoidant attachment
* Ridicule by parents and rejection → Emotional abuse
Whats the similarities & differences between avoidant PD & social anxiety disorder?
similarities: both have intense fear about social situations due to fear of criticism/scrutiny, that are avoided
difference:
- AVD avoid all interpersonal situations while SAD fear/avoid performance related situations
- AVPD dont have situational fear response of SAD
- AVPD have feelings of inferiority (while in SAD the avoidance comes from specific attributes)
- AVPD more strongly related to introversion, openness, agreeableness
- AVPD earlier onset
- SAD: anxiety lessens as relationship develops
What are the 2 hypotheses regarding the relationship between AVPD & SAD?
- continuum hypothesis: avpd is a more severe form of generalized SAD which is a more severe form of nongeneralized SAD; they are all on one dimension
- there are 2 different diagnoses but there is just some overlap
-> evidence for both! - avoidant pd is also present in samples without SAD & the other way around
- other differences (avpd doent have situational fear response of SAD)
- treatment less effective for AVPD + SAD
-> SUPPORT FOR QUALITATIVE DIFFERENCES IN TRAITS & THESE DISORDERS
What are the criteria for Dependent PD?
meet min 5:
1. Difficulty making daily decisions without advice and reassurance
2. Needs someone else to take over major life areas
3. Difficulty disagreeing with others
4. Difficulty starting projects on their own
5. Go to great lengths to obtain support from others
6. Feeling uncomfortable or helpless when alone
7. Searches for new relationship after one ends
8. Unrealistic preoccupation with being left alone and unable to care for themselves
What are the 2 types of dependency?
- Functional dependency (Although can be active in certain situations, risk losing relationships) MAINLY THIS IN DPD
- Emotional dependency (Mainly seen in separation anxiety, BPD, depression)
What is the cognitive / interactionist model of DPD?
overprotective/authoritarian parenting, gender roles, cultural attitudes regarding achievement/relatedness -> cognitive consequences (schema of self as powerless & ineffectual) -> motivational effects (desire to obtain & maintain nurturant, supportive relationships) -> behaviour patterns (relationship facilitating self presentation strategies) + affective responses (performance anxiety, fear of abandoment & negative evaluation)
How are DPD patients experienced?
- score high on agreeableness
- viewed as passive
- but an be very pro active & aggressive/intimidating especially when fear of abandonment is triggered
What are the criteria for OCPD?
min 4
1. Preoccupation with details, rules, schedules, organization
2. Perfectionism that interferes with the task completion
3. Devotion to work and productivity to the exclusion of leisure activities and friendships
4. Is overconscientious, scrupulous, and inflexible about matters of morality, ethics, or values
5. Unable to discard worn-out or worthless objects
6. Reluctant to delegate tasks
7. A miserly spending style
8. Rigidity and stubbornness
What is the clinical presentation of OCPD?
- most common in general pop (more common in men)
- most “valued” in society cause they are extremely rational & workaholics
- relatively few patients seek help for it
- overlap/comorbidity w other PDs
- they overcompensate on coping by wanting to control everything
What is the OCPD etiology?
- Lack of emotional expression
- Lack of relaxation, fun, playtime
- Rigid rules, in exchange for love
- Punitive parenting style
- Overprotection
- Emphasis on achievements, rules, production
- Too much responsibility early in life - Parentification
What disorders have the most overlap with OCPD?
OCD
- symptoms overlap (orderliness, perfectionism, details)
- 25% of OCD has OCPD (distinct identities?)
- OCPD more likely in less severe OCD
- but egodystonic (while OCPD is egosyntoic)
- similar heritability
Hoarding disorder
- also rigid, perfectionistic, holding onto possessions
- but different reasons! sentimental reasons rather than practical/monetary reasons
What are the prevalences of each cluster C syndrome?
- avoidant: 2.5% healthy pop, 25% clinical pop; more in women & low SES
- dependent: 1% healthy pop, 15% clinical pop; more in women & low SES
- OCPD: 2% healthy pop, 10% clinical pop (low ratio); more in women & higher SES
What are schemas?
- knowledge representation of the self, others, the world (and relationships)
- can be explicit & implicit (unaware, like attachment representations)
- originate in childhood
- can be adaptive or maladaptive - Early Maladaptive Schemas (EMS, schemas that reflect your childhood environment if its abusive)
- so, our early experiences are the foundation of our general view of ourselves, others, and the world
What are the 3 types of cognitions that are part of the schemas we develop in childhood?
- core beliefs (i am…, others are…ex: i am bad, i am superior, others are irresponsible etc)
- conditional beliefs (if x, then y; ex: if i let ppl discover who i really am, they will reject me, if get attached to other ppl, they will abandon me)
- strategic (how to act to avoid bad things & acquire good things: find a strong person to make decisions, avoid emotions etc)
What is the core belief, conditional belief, and strategic belief of dependent PD?
core belief: I am weak & ignorant: others are strong, have knowledge and can help me
conditional belief: if i turn to someone else for help, he or she will solve it for me
strategic belief: let others decide; cling to other
What is the core belief, conditional belief, and strategic belief of Paranoid PD?
core: i am a target, ia m righteous; others are out to abuse me
conditional: if you let others know too much about you, they will use it against you
strategic: keep an eye on others; look for hidden intentions
What is the core belief, conditional belief, and strategic belief of borderline PD?
core: i am evil, victim, helpless, lost; others abuse or abandon you or reject you
conditional: if you let others get too close, they will abandon, abuse, or reject you
strategic: i need to find someone who will help me and never leave me
Why are schemas maintained?
- assimilation: inclusion of new knowledge in already existing schemas, sometimes adjusted (dominant process)
- accomodation: adjustment of scema according to new info (very difficult)
schemas influence info processing by: - attention & selection of info
- interpretation of info
- memory
How does the general PD cognitive model explain PDs?
- PDs are characterized by: specific sets of “beliefs”, specific cognitive biases (also implicit)
- schema scause cognitive processes & maintain PDs (no direct causal evidence yet)
- but cognitvie model useful for experimental research & translation to practice & treatment
How was interpretation bias in PDs studied?
- had different group of ppl with PDs (BPD, OCDP, DPD)
- 10 short stories presented
- first task: had to choose a response they thought fit w the story (out of 3 options where each fit one PD)
- 2nd task: open response to the short story
- 3rd task: had to rate how believable the story was
findings: - ppl w BPD & DPD selected the BPD forced response most often
- OCPD forced response was mostly selected by healthy population or those w mental syndromes not PDs -> unexpected
How do Early Maladaptive Schemas (EMS) relate to PDs?
- PD related schemas arise from experiences during early childhood when basic meets are not met
- tend to be less flexible & remain activated even when problematic in PDs
- lead to cognitive biases
- EMS not considered to be related to specific PDs, but some schemas sh+ow associatoins w specific PDs:
- abandonment: BPD
- subjugation & emotional inhibition w avoidant PD
- unrelenting standard: OCPD
- entitlement: narcissistic PD
- social insolation: schizoid & schizotypal PD
What are the EMS related coping styles?
- the way ppl deal w activation of a schema
- built on primitive responses that humans exhibit under high levels of threat: fight, flight, and freeze
- grouped into 3 clusters: overcompensation (related to fight), avoidance (related to flight), surrender (related to freewe)
What is the overcompensation coping style & its function & example?
person behaves & thinks in a way that is the opposite of the triggered EMS
- function of this is to fight the triggered EMS and keep it out of awareness
- ex: narcisstic person w underlying inferioirity & loneliness schemas, who acts as if they are superior & popular
What is the function of avoidance coping style & an example?
- function is to prevent triggering of EMSs, or when its already triggered, to avoid the emotions & thoughts that are aroused
ex: detachment from emotions & situational avoidance
What is the funciton of the surrender coping style?
to sruvive by submitting to what the EMSs dicatte
ex: someone who completely believes he or she is inferior and has given up any attempt to change these feelings
What is “schema mode”?
the emotional-cognitive-behavioural state of the person
- combo of activated specific EMS & specific coping style
- an assumptoin supported
ex: in BPD: abandoned & abused child mode, detached protector moode
- can have mode switches
- foundation of schema therapy for PDs
What are the main cognitive biases that result from maladaptive schemas in PDs?
- attentional bias
- interpretational bias
- evaluation bias
- response styles
- memory bias
What is the attentional bias like in PDs?
- they prioritize specific stimuli (often related to threats or rewards), influenced by schemas
ex: ppl w BPD are hypoervigilant to threats, which is dysfunctional & remains the disorder
What is the interpretational bias like in PDs?
- info is interpreted in line w existing schemas, leading to distorted interpretations
- implicit processes play big role here: automatic associations reveal underlying schemas
ex: ppl w AVPD see emotions as threating & themselves as inferior
ppl w BPD interpret others as rejecting
What is the evaluation bias like in PDs?
- evaluate info using extreme or negative info
ex: BPD patients often exhibit dichotomous thinking
What is the response styles bias in PDs?
- influenced by schemas
ex: AVPD tend to use avoidant strategies, OCPP use perfectionistic strategies, ASPD use aggression
What is the memory bias in PDs?
biased memory encoding & retrieval, favoring memories that fit their schemas
ex: BPD: difficulty forgetting negative stimuli
Do cognitive biases cause PDs/psychopathology? how do experiments show this
ex: training healthy pop to focus on or away from threat realted stimuli can create or reduce attentional biases which then affect fear & stress response
training to interpret ambiguous events in dysfunctional or functional ways can alter interpretational biases, influencing reactions to stress
- attentional & interpretational biases causally impact responses to stress
- reducing biases through psych treatment can help them recover
