Lecture 10: Cluster C and Cognitive models Flashcards
What does Cluster C personality involved?
- avoidant PD
- dependent PD
- obsessive-compulsive PD
- internalizing character can hide underlying problems
- high mental health care use
Avoidant PD symptoms
- Avoiding occupational activities involving significant interpersonal contact
- Unwilling to get involved with people
unless certain of acceptance - Restraint within intimate relationships
- Preoccupied with fears of receiving criticism or rejection in social situations
- Social inhibition new interpersonal situations
- Feelings of inferiority
- Reluctant to take personal risks or to engage in any new activities
What are the effects of avoidant PD?
- High amounts of stress
- depression, substance use, somatic symptoms, chronic mental health issues, sleep problems
- Isolation from friends, colleagues and others
- Lower social support
- Negative impact on (academic) career
- Self-fulfilling prophecy?
Causes of avoidant PD?
- Low degree of (healthy) emotional expression in family
- Conflict avoidance in family
- Avoidant modeling by parents
- (preoccupied)-Avoidant attachment
- Ridicule by parents and rejection → Emotional abuse
How are avoidant PD and SAD similar
- both fear interpersonal contact, which are avoided
- avoidant PD is more about fear of criticism and rejection, while SAD more about fear of social situation itself
Continuum hypothesis
AVPD is part of the same dimension, but generalized SAD and non-generalized SAD are more extreme forms
What has evidence found regarding these two hypotheses?
Evidence for 1 and 2 dimensions
Avoidant PD present in samples without SAD (more severe complaints, 46% with SAD diagnosed with AVPD, most people with AVPD have SAD. AVPD patients do not recognize the situational fear response of SAD. Treatment is less effective for both AVPD and SAD together. Support for qualitative differences in traits
What are the qualitative differences?
- Feelings of inferiority
- AVPD general avoidance strategy and inferiority, in SAD, more related to specific
attributes - Feared (social) situations
- Interpersonal vs. performance
- AVPD more strongly related to introversion, openness, agreeableness
- Clinical experience: AVPD more early experiences of isolation and early onset. SAD has a later onset.
- In SAD, anxiety lessens as relationship develops
Dependent PD criteria (at least 5 of 8)
- Difficulty making daily decisions advice and
reassurance - Needs someone else to take over major life
areas - Difficulty disagreeing with others
- Difficulty starting projects on their own
- Go to great lengths to obtain support from
others - Feeling uncomfortable or helpless when alone
- Searches for new relationship after one ends
- Unrealistic preoccupation with being left alone and unable to care for themselves
What is the cognitive/interactionist model?
Over-protective, authoritarian parenting can result in cognitive consequences like schema of self as powerless. There can be motivational effects (desire to obtain and maintain nurturant relationships) which can result in behaviour patterns (relationship-facilitating self presentation strategies) and affective responses
What are the types of dependency?
Functional dependency which can be active in certain situations and risk of losing relationships.
Emotional dependency is seen in separation anxiety, BPD, depression.
High on agreeableness and viewed as passive (pro-active and aggressive/intimidating)
OCD symptoms
- Preoccupation with details, rules, schedules,
organization - Perfectionism that interferes with the task
completion - Devotion to work and productivity to the
exclusion of leisure activities and friendships - Is overconscientious, scrupulous, and inflexible
about matters of morality, ethics, or values - Unable to discard worn-out or worthless objects
- Reluctant to delegate tasks
- A miserly spending style
- Rigidity and stubbornness
Epidemiological characteristics
- most common in general population
- more common in men
- extremely rational
- workaholics (traits valued by society)
- few patients seek help for OCPD
- overcompensating coping
- overlap/comorbidity with other PDs
OCPD etiology
- Lack of emotional expression
- Lack of relaxation, fun, playtime
- Rigid rules, in exchange for love
- Punitive parenting style
- Overprotection
- Emphasis on achievements, rules, production
- Too much responsibility early in life - Parentification
Overlap between OCD and OCPD
- symptom overlap can make correlation analyses difficult
- 25% of OCD has OCPD which is higher than other PDs (unclear whether distinct entities, prevalence of OCPD with mood and anxiety isnt higher)
- OCPD more likely in less severe OCD
- OCD is egodystonic
- similar heritability so could be some links
Overlap of hoarding and OCD
- Rigidity, perfectionism, holding on to
possessions - However, different reasons!
→ Sentiment vs. practical/monetary
Prevalence of avoidant PD
- Around 2.5% healthy population
- 25% clinical population
- More in women and low SES
Prevalence of dependent PD
- Around 1% healthy population
- 15% clinical population
- More in women and low SES
Prevalence of obsessive-compulsive PD
- Around 2% healthy population
- 10% clinical population (low ratio 5:1)
- Probably more in men and higher SES
What is a schema?
- knowledge representation of the self, others
- can be explicit and implicit beliefs which is whether they can be verbalized or not
- Schemas originate in childhood – Early Maladaptive Schemas (EMS)
- The world of a child is limited
- Childish interpretations
- early experiences are the foundation for general view of self, others and the world
What are the different beliefs?
Core beliefs (I am…;
Others are…)
Conditional beliefs (If
x, than y)
Strategic beliefs (do A
to get B)
Beliefs of those with dependent PD
Core: I am weak and
ignorant; Others are
strong, have knowledge,
and can help me
Conditional: If I turn to
someone else for help,
he or she will solve it for
me
Strategic: Let others
decide; cling to others
Beliefs of those with paranoid PD
Core: I am a target, I am
righteous; Others are
out to abuse me
Conditional: If you let
others know too much
about you, they will use
it against you
Strategic: Keep an eye
on others; look for
hidden intention
Beliefs of borderline PD
Core: I am evil, victim,
helpless, lost; Others
abuse or abandon you,
or reject you
Conditional: If you let
others get too close,
they will abandon,
abuse or reject you
Strategic: I need to find
someone who will help
me and will never leave
me
Why are schemas maintained?
Through assimilation: inclusion in an existing schema which can be adjusted-> more dominant
Through accommodation which is the adjustment of schema with new info (difficult). Can influence information processing by:
- attention & selection of info
- interpretation of info
- memory
How does interpretation bias manifest?
There were short stories given with forced responses of BPD, DEP, OCP interpretations. There was an open response too and ratings of believability and credibility. Those with BPD made more BPD interpretations and found these to be more believable.
What are the conclusions of cognitive models?
PDs characterized by beliefs and specific cognitive biases. Schemas cause cognitive processes and maintain personality disorders but no direct causal evidence. Cognitive model is useful for experimental research and translation to practice & treatment
