L9 - Personality disorders

Question 1

What are personality disorders?

Answer 1

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.

Question 2

How does this differ from the DSM-5 definition?

Answer 2

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.

Question 3

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

Answer 3

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

Question 4

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

Answer 4

Cluster A: Odd/ Eccentric

Cluster B: Dramatic/ Erratic

Cluster C: Anxious/ Fearful

Question 5

What are the 3 subsections of Cluster A?

Answer 5

Cluster A: Odd, Eccentric

Schizoid

Schizotypal

Paranoid

Question 6

What is schizoid personality characterised by?

Answer 6

Pervasive pattern of detachment from social relationships

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

Question 7

What is schizotypal personality characterised by?

Answer 7

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

Question 8

What is paranoid personality characterised by?

Answer 8

pervasive distrust and suspiciousness of others

Question 9

What are the 4 subsections of Cluster B?

Answer 9

Cluster B: Dramatic, Erratic, Emotional

Borderline

Histrionic

Narcissistic

Antisocial

Question 10

What is borderline personality characterised by?

Answer 10

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

Question 11

What is histrionic personality characterised by?

Answer 11

Excessive emotionality and attention-seeking

Question 12

What is narcissistic personality characterised by?

Answer 12

Grandiosity, need for admiration and lack of empathy

Question 13

What is antisocial personality characterised by?

Answer 13

Disregard for the rights of others, antisocial/ criminal behaviour

Question 14

What are the 3 subsections of Cluster C?

Answer 14

Cluster C: anxious, fearful

Avoidant

Dependent

Obsessive-compulsive

Question 15

What is avoidant personality characterised by?

Answer 15

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

Question 16

What is dependent personality characterised by?

Answer 16

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

Question 17

What is obsessive-compulsive personality characterised by?

Answer 17

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

Question 18

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?

Answer 18

Estimated 14.8% (30.8 million)

with OCD being the most common

Question 19

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

Answer 19

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

Question 20

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

Answer 20

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

Question 21

What 2 factors are necessary for ASPD to be diagnosed?

Answer 21

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

Question 22

What is the prevalence of ASPD?

Answer 22

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%

Question 23

What is the difference between ASPD and Psychopathy?

Answer 23

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

Question 24

How is Psychopathy measured?

Answer 24

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

Semi-structured interview and file based info.

Question 25

What is factor 1 of the PCL-R?

Answer 25

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

Question 26

What is factor 2 of the PCL-R?

Answer 26

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

Question 27

What is the genetic basis of psychopathy?

Answer 27

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

Question 28

What are the brain structure differences in psychopaths?

Answer 28

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

Question 29

Are these differences innate?

Answer 29

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

Question 30

what is the prefrontal cortex (PFC) involved in?

Answer 30

social and affective decision-making, self-control

Question 31

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

Answer 31

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

Question 32

what is the amygdala involved in?

Answer 32

affective processes, responding to emotional stimuli

Question 33

what is the striatum involved in?

Answer 33

modulating behaviour toward potentially rewarding stimuli

Question 34

what is the anterior insula (AI) involved in?

Answer 34

sensory integration and interoceptive awareness

Question 35

What is fear recognition in psychopathy

Answer 35

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

Question 36

What studies provide evidence for fear recognition in psychopathy?

Answer 36

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)

Question 37

What are the treatments for ASPD?

Answer 37

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