L9 - Personality disorders Flashcards
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.
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.
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
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
What are the 3 subsections of Cluster A?
Cluster A: Odd, Eccentric
Schizoid
Schizotypal
Paranoid
What is schizoid personality characterised by?
Pervasive pattern of detachment from social relationships
Individuals don’t enjoy social relationships and have no close friends
What is schizotypal personality characterised by?
Similar to schizoid but with eccentric (strange) thoughts and behaviours, cognitive or perceptual distortions
What is paranoid personality characterised by?
pervasive distrust and suspiciousness of others
What are the 4 subsections of Cluster B?
Cluster B: Dramatic, Erratic, Emotional
Borderline
Histrionic
Narcissistic
Antisocial
What is borderline personality characterised by?
Instability of interpersonal relationships, self-image and affect + marked impulsivity
What is histrionic personality characterised by?
Excessive emotionality and attention-seeking
What is narcissistic personality characterised by?
Grandiosity, need for admiration and lack of empathy
What is antisocial personality characterised by?
Disregard for the rights of others, antisocial/ criminal behaviour
What are the 3 subsections of Cluster C?
Cluster C: anxious, fearful
Avoidant
Dependent
Obsessive-compulsive
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
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
