Lecture 1 Flashcards
What is the definition of a personality disorder according to the DSM-5 ?
An enduring pattern of inner experience and behavior that deviates from cultural expectations, is pervasive and inflexible, begins in adolescence or early adulthood, and leads to distress or impairment
What are the three key characteristics of personality disorders (the “3 Ps”) ?
- Pervasive
- Persistent
- Pathological
How are personality disorders different from clinical disorders like anxiety or depression ?
- Personality disorders = egosyntonic (the person does not see their traits as problematic)
- Clinical disorders = egodystonic (the person recognizes them as distressing)
What are the general criteria for a personality disorder according to the DSM-5 ?
- Enduring pattern deviating from cultural norms in cognition, affectivity, interpersonal functioning, or impulse control
- Inflexible and pervasive across situations
- Causes distress or impairment
- Stable and long-lasting, beginning in adolescence or early adulthood.
- Not better explained by another mental disorder
- Not caused by substances or medical conditions
What are the two exclusion criteria for diagnosing a personality disorder ?
The symptoms cannot be:
1. A manifestation of another mental disorder
2. Attributable to substance use or a medical condition
What is the estimated prevalence of personality disorders in the general population ?
10.5 – 12%
What are the three clusters of personality disorders in DSM-5 ?
- Cluster A (“Odd/Eccentric”): Paranoid, Schizoid, Schizotypal
- Cluster B (“Dramatic/Emotional/Erratic”): Antisocial, Borderline, Histrionic, Narcissistic
- Cluster C (“Anxious/Fearful”): Avoidant, Dependent, Obsessive-Compulsive
What is the main characteristic of Cluster A personality disorders ?
Odd, eccentric thinking or behavior, often with social withdrawal
What are the three personality disorders in Cluster A ?
- Paranoid
- Schizoid
- Schizotypal
What are key symptoms of Paranoid Personality Disorder ?
- Distrust & suspicion of others
- Reads hidden meanings into benign remarks
- Bears grudges, quick to anger
- Suspects partner of infidelity without justification
How does Schizoid Personality Disorder manifest ?
- Detached from social relationships
- Prefers solitary activities
- Emotionally cold, indifferent to praise or criticism
What are the characteristics of Schizotypal Personality Disorder ?
- Social deficits with discomfort in relationships
- Odd beliefs (e.g., magical thinking).
- Unusual perceptual experiences
- Eccentric behavior and speech
What is the main characteristic of Cluster B personality disorders ?
Dramatic, emotional, or erratic behaviors, often with impulse control and emotional regulation issues
What are the four personality disorders in Cluster B ?
- Antisocial
- Borderline
- Histrionic
- Narcissistic
What are the diagnostic criteria for Antisocial Personality Disorder ?
- Disregard for others’ rights
- Deceitfulness and manipulativeness
- Lack of remorse
- Aggressive or reckless behavior
At what age can Antisocial Personality Disorder be diagnosed ?
18 years old, with evidence of conduct disorder before age 15
What are the symptoms of Borderline Personality Disorder ?
- Intense, unstable relationships
- Fear of abandonment
- Impulsivity (e.g., reckless spending, substance abuse)
- Chronic feelings of emptiness
- Self-harm or suicidal behavior
What are the key traits of Histrionic Personality Disorder ?
- Attention-seeking behavior
- Inappropriate seductive behavior
- Exaggerated emotions and theatricality
- Considers relationships to be more intimate than they are
What are the core characteristics of Narcissistic Personality Disorder ?
- Grandiosity and sense of entitlement
- Need for excessive admiration
- Lack of empathy
- Exploits others for personal gain
What is the main characteristic of Cluster C personality disorders ?
Fearfulness and anxiety, leading to avoidance, dependency, or rigidity
What are the three personality disorders in Cluster C ?
- Avoidant
- Dependent
- Obsessive-Compulsive
How does Avoidant Personality Disorder manifest ?
- Fear of criticism and rejection
- Social inhibition
- Feelings of inadequacy
- Avoids social situations unless certain of being liked
What are the symptoms of Dependent Personality Disorder ?
- Excessive need to be taken care of
- Clingy and submissive behavior
- Fear of abandonment
- Difficulty making decisions alone
How does Obsessive-Compulsive Personality Disorder (OCPD) differ from OCD ?
- OCPD: Personality-based rigidity, perfectionism, and control (egosyntonic)
- OCD: Anxiety-driven compulsions and obsessions (egodystonic)
What are common traits of OCPD ?
- Perfectionism interfering with task completion
- Excessive devotion to work
- Reluctance to delegate tasks
- Stubbornness and rigidity
What was the main research agenda for DSM-V regarding personality disorders ?
- Clinicians and researchers suggested that psychiatric symptoms are better represented by dimensions rather than categories
- A hybrid model was developed in 2011 but was ultimately placed in Section III of DSM-5 due to insufficient validation
What are the primary propositions of the Alternative Model for Personality Disorders ?
- Retain 6 of 10 PDs with most empirical evidence
- Remove Paranoid PD, Schizoid PD, Histrionic PD, and Dependent PD
- Revise general PD criteria to focus on impairments in self and interpersonal functioning
- Assess severity levels of impairment
Identify underlying pathological personality traits - Use BIG-FIVE traits: Negative Affectivity, Detachment, Antagonism, Disinhibition, Psychoticism
- Allow for PD diagnosis as “trait-specified”
Why was an Alternative Model for PDs necessary ?
- Limited empirical evidence for some PD types
- Lack of specificity in general PD definitions
- Inadequate representation of PD severity
- Heterogeneity within types
- Arbitrary diagnostic thresholds
- Excessive comorbidity among PDs
- Instability of categorical PD criteria
Which PDs were retained in the Alternative Model ?
- Antisocial
- Avoidant
- Borderline
- Narcissistic
- Obsessive-Compulsive
- Schizotypal
What are the key general criteria for PDs in the Alternative Model ?
A. Moderate or greater impairment in personality functioning (self and interpersonal)
B. One or more pathological personality traits
C. Traits must be inflexible and pervasive
D. Traits must be stable over time
E. Not better explained by another mental disorder
F. Not due to substance effects or medical conditions
G. Not a normal variation based on development or culture
What is Criterion A in the Alternative Model for PDs ?
Criterion A focuses on impairments in personality functioning in self (identity, self-direction) and interpersonal (empathy, intimacy) domains. Severity is assessed on a 0-4 scale using the Level of Personality Functioning Scale
What is Criterion B in the Alternative Model for PDs ?
Criterion B identifies pathological personality traits categorized under the BIG-FIVE domains:
- Negative Affectivity
- Detachment
- Antagonism
- Disinhibition
- Psychoticism
What are common issues with the DSM-IV-TR’s general criteria for PDs ?
- Not empirically based
- Too broad, potentially overlapping with other disorders
- Do not emphasize core impairments in self and interpersonal functioning
How does the Alternative Model address PD severity ?
The Alternative Model includes severity levels, recognizing that PD symptoms exist on a spectrum, which helps guide treatment intensity and type
What are common issues with comorbidity among PDs ?
Many individuals receive multiple PD diagnoses, with excessive overlap between disorders. For example, in clinical and prisoner samples, over 30-70% had more than one PD diagnosis
What are the core characteristics of Antisocial Personality Disorder in the Alternative Model ?
- Impairment in identity (egocentrism), self-direction (lack of prosocial goals), empathy (lack of remorse), and intimacy (exploitation of others)
- Pathological traits include manipulativeness, deceitfulness, callousness, hostility, impulsivity, irresponsibility, and risk-taking
- Can specify “psychopathic features” with low anxiety and high social dominance
What are the core characteristics of Avoidant Personality Disorder in the Alternative Model ?
- Impairment in identity (low self-esteem, excessive shame), self-direction (fear of personal risks), empathy (hypersensitivity to criticism), and intimacy (avoidance of relationships due to fear of rejection)
- Pathological traits include anxiousness, withdrawal, anhedonia, and intimacy avoidance
What are the core characteristics of Borderline Personality Disorder in the Alternative Model ?
- Impairment in identity (unstable self-image, chronic emptiness), self-direction (unstable goals), empathy (hypersensitivity), and intimacy (intense, unstable relationships)
- Pathological traits include emotional lability, anxiousness, separation insecurity, depressivity, impulsivity, risk-taking, and hostility
What are the core characteristics of Narcissistic Personality Disorder in the Alternative Model ?
- Impairment in identity (excessive self-referencing, fluctuating self-esteem), self-direction (goal-setting based on approval), empathy (impaired recognition of others’ feelings), and intimacy (superficial relationships)
- Pathological traits include grandiosity and attention-seeking
What are the core characteristics of Obsessive-Compulsive Personality Disorder in the Alternative Model ?
- Impairment in identity (self-worth based on productivity), self-direction (rigid high standards), empathy (difficulty understanding others), and intimacy (relationships secondary to work)
- Pathological traits include rigid perfectionism, perseveration, intimacy avoidance, and restricted affectivity
What are the core characteristics of Schizotypal Personality Disorder in the Alternative Model ?
- Impairment in identity (confused boundaries), self-direction (unclear goals), empathy (misinterpretations of others), and intimacy (mistrust, anxiety)
- Pathological traits include cognitive/perceptual dysregulation, unusual beliefs, eccentricity, restricted affectivity, and withdrawal
