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lecture 10 Flashcards

Personality Disorders

1
Q

How are personality disorders clustered together

A

Cluster A: Odd or eccentric cluster
- Paranoid, schizoid, schizotypal

Cluster B: Dramatic, emotional, erratic cluster
- Antisocial, borderline, histrionic, narcissistic

Cluster C: Fearful or anxious cluster
- Avoidant, dependent, obsessive-compulsive

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2
Q

Define Personality Disorders

A

A persistent pattern of emotions, cognitions, and behavior that results in enduring emotional distress for he person affected and/or for others and may cause
difficulties with work and relationships
- pervasive and inflexible traits
- maladaptive
- ego-syntonic: don’t feel that treatment is necessary

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3
Q

What is the prevalence for each cluster of personality disorders

A

PD’s develop slowly overtime

Total prevalence for people who meet criteria for a PD = 10-12%

Prevalence Per Cluster =
Cluster A: 4%
Cluster B: 4%
Cluster C: 7%

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4
Q

What are some challenges associated with Personality Disorders

A
  • Overlapping features across disorders
  • Overlapping features across the categories
  • High comorbidity among the PDs
  • High comorbidity with other disorders
  • Symptoms are highly subjective
  • Misdiagnosis is common
  • Personality researchers generally agree that personality
    is dimensional, but can’t agree on a dimensional system
    for PDs
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5
Q

How are Cluster A Paranoid Personality Disorders Characterised

A

Pervasive and unjustified mistrust and suspicion

  • Preoccupied with unjustified doubts about the loyalty/
    trustworthiness of others
  • Reluctant to confide in others because others may
    use it against them
  • Reads hidden, threatening meaning into benign
    events
  • Persistently holds grudges
  • Perceives attacks on their character/reputation that
    are not apparent to others and quick to counterattack
  • Has recurrent suspicions regarding fidelity of spouse
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6
Q

What is the prevalence for Paranoid Personality Disorders

A

1-2% (female:male 1:1)

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7
Q

List the causal factors for Paranoid Personality Disorders

A
  • Modest genetic transmission
  • Parental neglect/abuse
  • Exposure to violent adults as children
  • Traumatic brain injury
  • Chronic cocaine use
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8
Q

What are the treatment options for Paranoid Personality Disorders

A
  • Cognitive therapy to counter negativistic thinking

(lack of randomised control trials therefore this disorder isn’t well studied)

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9
Q

How are Cluster A Schizoid Personality Disorders Characterised

A

Pervasive pattern of detachment from social relationships AND Very limited range of emotions in
interpersonal situations

  • Neither desires nor enjoys close relationships
  • Almost always chooses solitary activities
  • Has little interest in sex
  • Takes pleasure in few activities
  • Lacks close friends
  • Appears indifferent to praise or criticism
  • Shows emotional coldness, detachment, or flat affect
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10
Q

What is the prevalence of Schizoid Personality Disorders

A

1% - More common in males
* Significant overlap with autism spectrum

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11
Q

List the causal factors for Schizoid Personality Disorders

A
  • Modest genetic transmission
  • Impairment in the affiliative system
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12
Q

What are the treatment options for Schizoid Personality Disorders

A
  • Focus on the value of interpersonal relationships
  • Build empathy and social skills

(lack of randomised control trials therefore this disorder isn’t well studied)

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13
Q

How are Cluster A Schizotypal Personality Disorders Characterised

A

Pervasive pattern of social and interpersonal deficits marked by
acute discomfort with close relationships AND cognitive/perceptual distortions AND eccentricities in behaviour

  • Ideas of reference
  • Odd beliefs or magical thinking
  • Usual perceptual experiences
  • Odd thinking and speech
  • Suspiciousness or paranoid ideation
  • Inappropriate or constricted affect
  • Odd or eccentric behaviour or appearance
  • Lack of close friends
  • Excessive social anxiety that does not diminish with familiarity

Does not occur exclusively during the course of schizophrenia,
bipolar disorder, depressive disorder with psychotic features, or autism
- Appears to be part of the schizophrenia spectrum

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14
Q

What is the prevalence for Schizotypal Personality Disorders

A

1% (more common in males)

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15
Q

List the causal factors for Schizotypal Personality Disorders

A
  • Modest genetic transmission
  • Childhood maltreatment or trauma, especially in men
  • Low SES
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16
Q

What are the treatment options for Schizotypal Personality Disorders

A
  • Low doses of antipsychotics
  • SSRIs
  • Address comorbid depression using CBT
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17
Q

How are Cluster B Antisocial Personality Disorders Characterised

A

Pervasive pattern of disregard for and violation of the rights of
others by the age of 15
* Failure to conform to social norms with respect to the law
* Deceitfulness–repeated lying, use of aliases, conning others
* Impulsivity or failure to plan ahead
* Irritability and aggressiveness, repeated assaults
* Reckless disregard for the safety of self and others
* Consistent irresponsibility—repeated failure to sustain
consistent work behavior or honour financial obligations
* Lack of remorse—indifferent to or rationalises hurting
others
* At least 18yo and doesn’t only occur during a course of
schizophrenia or bipolar disorder

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18
Q

What is the prevalence of Cluster B Antisocial Personality Disorders

A

2-3% overall
- 3% in males
- 1% in females
- 5:1 ratio
- Highly comorbid with substance use

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19
Q

How do Antisocial Personality Disorders differ from Psychopathology

A

Antisocial PD = heavy emphasis on observable behaviours
- e.g. lying, getting into fights, failing to honour financial
obligations

Psychopathology = more emphasis on personality traits
- e.g. superficial charm, lack of empathy, manipulativeness

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20
Q

List the causal factors for Cluster B Antisocial Personality Disorders

A
  • Modest genetic transmission
  • Low family income
  • Having a young mother
  • Being raised in a single-parent household
  • Conflict between parents
  • Delinquent sibling
  • Neglect
  • Large family size
  • Harsh discipline
  • Delinquent peers
  • Physical/sexual abuse
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21
Q

How can Gene-Environment Interactions impact risk of ASPD

A

Monoamine Oxidase A Gene (MAOA gene) is responsible for breaking down neurotransmitters.

Therefore:
* Low MAOA activity + maltreatment = ↑ risk of ASPD
* High MAOA activity + maltreatment = ↓ risk of ASPD
* Low MAOA activity + NO maltreatment = ↓ risk of
ASPD

22
Q

Why is Antisocial Personality Disorder highly comorbid with substance use

A
  • they share common genetic vulnerabilities
  • environmental factors determine which disorder develops
  • those with antisocial personality disorder tend to have poor impulse control, leading them to engage in riskier behaviours than those without ASPD
23
Q

What genetic and environmental risks interact to result in Antisocial Personality Disorder

A

Genetic propenseties for a difficult temperament,
hyperactivity, attentional difficulties, etc

Environmental risks:
* Inadequate parenting
* Disrupted family bonds
* Poverty
* Deviant peers
* Poor relationships with peers, teachers, partners,
employers

24
Q

What are the treatment options for Antisocial Personality Disorders

A
  • Few seek treatment on their own
  • Antisocial behavior is predictive of poor prognosis
  • Emphasis is placed on prevention and rehabilitation
  • Often incarceration is the only viable alternative
  • May need to focus on practical (or selfish) consequences (e.g., if you assault someone you’ll go to prison)
25
Q

How are Cluster B Borderline Personality Disorders Characterised

A

Pervasive pattern of instability of interpersonal relationships, self- image, and affect, and marked impulsivity
* Frantic efforts to avoid real or imagined abandonment
* A pattern of unstable and intense interpersonal relationships
characterised by alternating between extremes of idealization
and devaluation
* Identity disturbance
* Impulsivity in at least two areas that are potentially self- damaging
* Recurrent suicidal behavior, gestures, threats, or self- mutilating behavior
* Affective instability due a marked reactivity of mood
* Chronic feelings of emptiness
* Inappropriate, intense anger or difficulty controlling anger
* Transient, stress-related paranoid ideation or severe
dissociative symptoms

26
Q

What is the prevalence of Borderline Personality Disorder

A

1-2% Overall
- 10% of outpatients
- 15-20% of inpatients
- Female:male ratio = 3:1 (old stats) but 1:1 (current stats)

27
Q

What is the comorbidity for Borderline Personality Disorder

A
  • 80% meet criteria for major depression
  • 10% meet criteria for bipolar disorder
  • 67% meet criteria for substance use disorder
  • Often comorbid with schizotypal, narcissistic, and
    dependent personality disorder
  • 25% make at least one attempt at suicide
  • 8-10% will die by suicide
28
Q

True or False: Borderline Personality Disorder reports higher cases or emotional, physical and sexual abuse is than other PDs

A

True

29
Q

True or False: Borderline Personality Disorder is the most researched PD

A

True

30
Q

List the causal factors for Borderline Personality Disorder

A
  • Modest genetic transmission
  • Childhood abuse
  • Other “bad” childhood experiences including:
  • Poverty
  • Marital discord
  • Parental separations
  • Parental substance abuse
  • Family violence
31
Q

What are the treatment options for Borderline Personality Disorder

A
  • Antidepressants widely used, but little evidence to support their use—might help with comorbid depression
  • Dialectical behaviour therapy
  • Focus on dual reality of acceptance of difficulties and
    need for change
  • Focus on interpersonal effectiveness
  • Focus on distress tolerance to decrease reckless/self-harming behavior
32
Q

How is Cluster B Histrionic Personality Disorder Characterised

A

Pervasive pattern of excessive emotionality and attention
seeking, beginning by early adulthood and present in a variety of settings
* Uncomfortable in situations in which they are not the focus of attention
* Interaction with others is often characterized by inappropriate sexually seductive or provocative behavior
* Displays rapidly shifting and shallow expression of emotions
* Consistently uses physical appearance to draw attention to self
* Has a style of speech that is excessively impressionistic and
lacking in detail
* Shows self-dramatization, theatricality, and exaggerated
expression of emotion
* Is easily influenced by others/circumstances
* Considers relationships more intimate than they actually are

33
Q

What is the prevalence for Cluster B Histrionic Personality Disorder

A

1% overall
- more common in women

34
Q

Why are the causal factors for Cluster B Histrionic Personality Disorder unknown

A

lack of research

35
Q

What are the treatment options for Cluster B Histrionic Personality Disorder

A
  • Focus on attention seeking and long-term negative
    consequences
  • Focus on problematic interpersonal behaviours
  • Little evidence treatment is effective
36
Q

How is Cluster B Narcissistic Personality Disorder Characterised

A

Pervasive pattern of grandiosity, need for admiration, and lack of
empathy, beginning by early adulthood and present in a variety of contexts
* Grandiose sense of self-importance
* Preoccupied with fantasies of unlimited success, power,
brilliance, beauty, or ideal love
* Believes they are unique and special and can only be
understood by other special high-status people
* Requires excessive admiration
* Has a sense of entitlement
* Takes advantage of others to get their way
* Lacks empathy
* Envious of others or believes others envy them
* Shows arrogant behaviours and attitudes

37
Q

What is the prevalence of Cluster B Narcissistic Personality Disorder

A

1% overall
- more common in men

38
Q

What are the causal factors for Cluster B Narcissistic Personality Disorder

A
  • Grandiose narcissism - Parental overvaluation
  • Vulnerable narcissism -Emotional, physical, and sexual abuse, intrusive, controlling, and cold parenting styles
39
Q

What are the treatment options for Cluster B Narcissistic Personality Disorder

A
  • Focus on grandiosity, lack of empathy, unrealistic
    thinking
  • Emphasize realistic goals and coping skills for dealing
    with criticism
  • Little evidence treatment is effective
40
Q

How is Cluster C Avoidant Personality Disorder Characterised

A

Pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation, beginning by early adulthood and present in a variety of contexts
* Avoids occupational activities that involve significant interpersonal
contact because of fears of criticism, disapproval, and rejection
* Unwilling to get involved with people unless certain of being liked
* Shows restraint within intimate relationships because of fear of being shamed or ridiculed
* Preoccupied with being criticized or rejected in social situations
* Inhibited in new interpersonal situations because of feelings of
inadequacy
* Views self as socially inept, personally unappealing, or inferior to others
* Usually reluctant to take personal risks or to engage in any new activities because they may prove embarrassing

41
Q

What is the prevalence of Cluster C Avoidant Personality Disorder

A

2-3% overall
- more common in women

42
Q

What are the causal factors for Cluster C Avoidant Personality Disorder

A
  • Modest genetic contribution
  • Emotional abuse, rejection, or humiliation from parents
43
Q

What are the treatment options for Cluster C Avoidant Personality Disorder

A
  • Focus on social skills, entering anxiety-provoking situations
44
Q

How is Cluster C Dependent Personality Disorder characterised

A

Pervasive and excessive need to be taken care of that leads to submissive and clingy behaviour and fears of separation present in a
variety of contexts
* Difficulty making everyday decisions without an excessive amount of advice and reassurance from others
* Needs others to assume responsibility in most major areas of their life
* Difficulty expressing disagreement with others because of fear of loss
of support or approval
* Difficulty initiating projects or doing things on their own
* Goes to excessive lengths to obtain nurturance and support from others, to the point of volunteering to do things that are unpleasant
* Feels uncomfortable or helpless when alone because of exaggerated fears of being unable to care for themselves
* Urgently seeks another relationship as a source of care/support when a close relationship ends
* Unrealistically preoccupied with fears of being left to take care of themselves

45
Q

What is the prevalence of Cluster C Dependent Personality Disorder

A

1% overall
- more common in women

46
Q

What are the causal factors of Cluster C Dependent Personality Disorder

A
  • Small to moderate genetic contribution
  • Authoritarian and overprotective parents
    (lack of research though)
47
Q

What are the treatment options for Cluster C Dependent Personality Disorder

A
  • Lack of evidence that any treatment works
48
Q

How is Cluster C Obsessive-Compulsive Personality Disorder characterised

A

Pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency
* Preoccupied with details, rules, lists, order, organization, or schedules to the extent that the major point of the activity is lost
* Perfectionism interferes with task completion
* Excessively devoted to work and productivity to the exclusion of leisure activities and friendships
* Overconscientious, scrupulous, and inflexible about matters of morality, ethics, or values
* Unable to discard worn-out or worthless objects that have no sentimental value
* Reluctant to delegate work to others unless they submit to
exactly his or her way of doing things
* Adopts a miserly spending style; money should be hoarded for future catastrophes

49
Q

What is the prevalence of Cluster C Obsessive-Compulsive Personality Disorder

A

2% overall
- slightly more common in men

50
Q

Are the casual factors of Cluster C Obsessive-Compulsive Personality Disorder more attributed to genetic or environmental factors

A
  • Modest genetic contribution
51
Q

What are the treatment options for Cluster C Obsessive-Compulsive Personality Disorder

A
  • Target rumination, procrastination, and feelings of
    inadequacy
  • Not a lot of evidence that treatment works

psychopathology (11 decks)

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