L9 - Personality disorders Flashcards by Anais Maynard

What are personality disorders?

Enduring/ long lasting patterns that influence how people perceive their surroundings, interact with others and think about themselves and their environment.

These are displayed across various social and personal situations.

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How does this differ from the DSM-5 definition?

Adds that the enduring patters deviate markedly from the norms and that they’re pervasive and inflexible which lead to distress or impairment for the individual.

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What is necessary in order for personality disorders to be diagnosed?

Thinking and/ or behaviour pattern manifested in AT LEAST 2 areas: cognition, affect, interpersonal functioning, or impulse control.

These thoughts/ behaviours need to be:

Inflexible and pervasive across a range of personal and social situations

Lead to clinically significant distress or impairment

stable and of long duration: onset can be traced to adolescence or early adulthood

Not be better explained as a manifestation of another mental disorder or medication

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According to the DSM-5 how many classifications of personality disorders are there and what are they?

Cluster A: Odd/ Eccentric

Cluster B: Dramatic/ Erratic

Cluster C: Anxious/ Fearful

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What are the 3 subsections of Cluster A?

Cluster A: Odd, Eccentric

Schizoid

Schizotypal

Paranoid

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What is schizoid personality characterised by?

Pervasive pattern of detachment from social relationships

Individuals don’t enjoy social relationships and have no close friends

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What is schizotypal personality characterised by?

Similar to schizoid but with eccentric (strange) thoughts and behaviours, cognitive or perceptual distortions

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What is paranoid personality characterised by?

pervasive distrust and suspiciousness of others

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What are the 4 subsections of Cluster B?

Cluster B: Dramatic, Erratic, Emotional

Borderline

Histrionic

Narcissistic

Antisocial

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What is borderline personality characterised by?

Instability of interpersonal relationships, self-image and affect + marked impulsivity

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What is histrionic personality characterised by?

Excessive emotionality and attention-seeking

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What is narcissistic personality characterised by?

Grandiosity, need for admiration and lack of empathy

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What is antisocial personality characterised by?

Disregard for the rights of others, antisocial/ criminal behaviour

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What are the 3 subsections of Cluster C?

Cluster C: anxious, fearful

Avoidant

Dependent

Obsessive-compulsive

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What is avoidant personality characterised by?

Social inhibition (withholding emotions/ behaviour in social situations to avoid disapproval), feelings of inadequacy and extreme sensitivity to criticism, fear of disapproval or rejection

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What is dependent personality characterised by?

Excessive need to be taken care of (i.e. submissive/ clingy), unable to function adequately without the help of others

What is obsessive-compulsive personality characterised by?

Preoccupation with orderliness, perfectionism and mental and interpersonal control (at the expense of flexibility, openness and efficiency)

According to an NIH survey of 43,000 American adults what is the estimated % of American adults meet the criteria of at least on personality disorders and what is the most common?

Estimated 14.8% (30.8 million)

with OCD being the most common

According to the DSM-5-TR what is Antisocial Personality Disorder?

A pervasive (widespread + happens often) pattern of disregard for and violation of the rights of others, occurring since age 15

According to the DSM-% what is the diagnostic criteria for Antisocial Personality Disorder?

Failure to conform to social norms, criminal behaviour(e.g., stealing, destroying property)

Deceitfulness (e.g., repeated lying, conning people for personal profit/ pleasure)

Impulsivity or failure to plan ahead

Irritability and aggressiveness (e.g., repeated physical fights/ assaults)

Reckless disregard for safety of self or others (e.g., DUI)

Consistent irresponsibility (e.g., failure to sustain stable work)

Lack of remorse, indifference or rationalising having hurt, mistreated, or stolen from another

What 2 factors are necessary for ASPD to be diagnosed?

Individual is at least 18 with evidence of conduct disorder before15

The occurrence of antisocial behaviour isn’t solely during the course of Sz or BPD

What is the prevalence of ASPD?

0.2-6.5%

More common in men - 3:1 to 8:1

Highest prevalence in men with alcohol use disorders and from substance abuse clinics, prisons or other forensic settings - Greater than 70%

What is the difference between ASPD and Psychopathy?

Psychopathy isn’t a diagnosable disorder

Psychopathy might involve ASPD behaviours; individuals are unable to process emotional information and show no regard for the emotions of others

How is Psychopathy measured?

Psychopathy Checklist - Revised (PCL-R) Hare (1991, 2003)

Semi-structured interview and file based info.

What is factor 1 of the PCL-R?

Interpersonal/ Affective Superficial charm Grandiose sense of self-worth Pathological lying/ lock of remorse Callous/ lack of empathy

What is factor 2 of the PCL-R?

Lifestyle/ antisocial Poor behavioural controls Impulsivity Irresponsibility Lack of realistic, long-term goals Parasitic lifestyle Proneness to boredom

What is the genetic basis of psychopathy?

Viding et al. (2005): 3687 twin children aged 7 Strong genetic influence for callous-unemotional (CU) traits Tuvbald et al. (2014): community sample of 14-15 year old twins (N=604) Genetic influences explained 69% of the variance in the psychopathic personality factor

What are the brain structure differences in psychopaths?

Reduction in prefrontal grey matter volume Grey matter loss in the right superior temporal gyrus (Gregory et al 2012) Amygdala volume loss A decrease in posterior hippocampal volume Exaggerated structural hippocampal asymmetry

Are these differences innate?

Blair 2003 - environmental factors e.g., drug use Gregory et al. 2012 - disagrees and argues that grey matter reductions aren't due to substance use disorders Rijsdijk et al. (2010) found moderate heritability estimates (37%-46%) for grey matter concentrations in the left posterior/ right dorsal anterior cingulate Common genes might explain the relationship between these regions and psychopathic traits

what is the prefrontal cortex (PFC) involved in?

social and affective decision-making, self-control

what is the anterior cingulate cortex (ACC) thought to be involved in?

Processing moral emotions (e.g., guilt), empathy, self-regulation of negative emotions

what is the amygdala involved in?

affective processes, responding to emotional stimuli

what is the striatum involved in?

modulating behaviour toward potentially rewarding stimuli

what is the anterior insula (AI) involved in?

sensory integration and interoceptive awareness

What is fear recognition in psychopathy

The ability/ difficulty psychopaths have in recognising and interpreting fears in others?

What studies provide evidence for fear recognition in psychopathy?

Meta-analysis of 20 studies - evidence of fearful recognition deficits among antisocial populations (Marsh and Blair 2008) Impaired processing of sad and fearful facial expression in children with psychopathic tendencies (Blair et all 2001) Psychopaths showed no activation of limbic-prefrontal circuit which is activated in healthy control during fear conditioning (Birbaumer et al 2005)

What are the treatments for ASPD?

Psychotherapy; CBT Moderate success especially in those who are motivated to change Medications: antipsychotics or antidepressants Limited effectiveness as medications target symptoms rather than the disorder Similar treatments are used to treat psychopathy