lecture 10 Flashcards
Personality Disorders
How are personality disorders clustered together
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
Define Personality Disorders
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
What is the prevalence for each cluster of personality disorders
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%
What are some challenges associated with Personality Disorders
- 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
How are Cluster A Paranoid Personality Disorders Characterised
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
What is the prevalence for Paranoid Personality Disorders
1-2% (female:male 1:1)
List the causal factors for Paranoid Personality Disorders
- Modest genetic transmission
- Parental neglect/abuse
- Exposure to violent adults as children
- Traumatic brain injury
- Chronic cocaine use
What are the treatment options for Paranoid Personality Disorders
- Cognitive therapy to counter negativistic thinking
(lack of randomised control trials therefore this disorder isn’t well studied)
How are Cluster A Schizoid Personality Disorders Characterised
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
What is the prevalence of Schizoid Personality Disorders
1% - More common in males
* Significant overlap with autism spectrum
List the causal factors for Schizoid Personality Disorders
- Modest genetic transmission
- Impairment in the affiliative system
What are the treatment options for Schizoid Personality Disorders
- Focus on the value of interpersonal relationships
- Build empathy and social skills
(lack of randomised control trials therefore this disorder isn’t well studied)
How are Cluster A Schizotypal Personality Disorders Characterised
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
What is the prevalence for Schizotypal Personality Disorders
1% (more common in males)
List the causal factors for Schizotypal Personality Disorders
- Modest genetic transmission
- Childhood maltreatment or trauma, especially in men
- Low SES
What are the treatment options for Schizotypal Personality Disorders
- Low doses of antipsychotics
- SSRIs
- Address comorbid depression using CBT
How are Cluster B Antisocial Personality Disorders Characterised
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
What is the prevalence of Cluster B Antisocial Personality Disorders
2-3% overall
- 3% in males
- 1% in females
- 5:1 ratio
- Highly comorbid with substance use
How do Antisocial Personality Disorders differ from Psychopathology
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
List the causal factors for Cluster B Antisocial Personality Disorders
- 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
How can Gene-Environment Interactions impact risk of ASPD
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
Why is Antisocial Personality Disorder highly comorbid with substance use
- 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
What genetic and environmental risks interact to result in Antisocial Personality Disorder
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
What are the treatment options for Antisocial Personality Disorders
- 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)
How are Cluster B Borderline Personality Disorders Characterised
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
What is the prevalence of Borderline Personality Disorder
1-2% Overall
- 10% of outpatients
- 15-20% of inpatients
- Female:male ratio = 3:1 (old stats) but 1:1 (current stats)
What is the comorbidity for Borderline Personality Disorder
- 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
True or False: Borderline Personality Disorder reports higher cases or emotional, physical and sexual abuse is than other PDs
True
True or False: Borderline Personality Disorder is the most researched PD
True
List the causal factors for Borderline Personality Disorder
- Modest genetic transmission
- Childhood abuse
- Other “bad” childhood experiences including:
- Poverty
- Marital discord
- Parental separations
- Parental substance abuse
- Family violence
What are the treatment options for Borderline Personality Disorder
- 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
How is Cluster B Histrionic Personality Disorder Characterised
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
What is the prevalence for Cluster B Histrionic Personality Disorder
1% overall
- more common in women
Why are the causal factors for Cluster B Histrionic Personality Disorder unknown
lack of research
What are the treatment options for Cluster B Histrionic Personality Disorder
- Focus on attention seeking and long-term negative
consequences - Focus on problematic interpersonal behaviours
- Little evidence treatment is effective
How is Cluster B Narcissistic Personality Disorder Characterised
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
What is the prevalence of Cluster B Narcissistic Personality Disorder
1% overall
- more common in men
What are the causal factors for Cluster B Narcissistic Personality Disorder
- Grandiose narcissism - Parental overvaluation
- Vulnerable narcissism -Emotional, physical, and sexual abuse, intrusive, controlling, and cold parenting styles
What are the treatment options for Cluster B Narcissistic Personality Disorder
- Focus on grandiosity, lack of empathy, unrealistic
thinking - Emphasize realistic goals and coping skills for dealing
with criticism - Little evidence treatment is effective
How is Cluster C Avoidant Personality Disorder Characterised
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
What is the prevalence of Cluster C Avoidant Personality Disorder
2-3% overall
- more common in women
What are the causal factors for Cluster C Avoidant Personality Disorder
- Modest genetic contribution
- Emotional abuse, rejection, or humiliation from parents
What are the treatment options for Cluster C Avoidant Personality Disorder
- Focus on social skills, entering anxiety-provoking situations
How is Cluster C Dependent Personality Disorder characterised
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
What is the prevalence of Cluster C Dependent Personality Disorder
1% overall
- more common in women
What are the causal factors of Cluster C Dependent Personality Disorder
- Small to moderate genetic contribution
- Authoritarian and overprotective parents
(lack of research though)
What are the treatment options for Cluster C Dependent Personality Disorder
- Lack of evidence that any treatment works
How is Cluster C Obsessive-Compulsive Personality Disorder characterised
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
What is the prevalence of Cluster C Obsessive-Compulsive Personality Disorder
2% overall
- slightly more common in men
Are the casual factors of Cluster C Obsessive-Compulsive Personality Disorder more attributed to genetic or environmental factors
- Modest genetic contribution
What are the treatment options for Cluster C Obsessive-Compulsive Personality Disorder
- Target rumination, procrastination, and feelings of
inadequacy - Not a lot of evidence that treatment works
