Lecture 6 Flashcards
What are the characteristics of Cluster B personality disorders ?
- Dramatic
- Emotional
- Unpredictable (erratic)
- Wild
What personality disorders belong to Cluster B ?
- Borderline
- Narcissistic
- Histrionic
- Antisocial
What are the different ways narcissism can manifest ?
- A normal self-esteem regulation mechanism
- A personality trait
- An extreme form of self-esteem
- Narcissistic Personality Disorder (NPD) in DSM-5
How common is NPD in the general population ?
Around 1%, with a higher prevalence in men
How do people with NPD typically seek help ?
They often seek help for secondary issues like frustration, depression, or relationship problems rather than for NPD itself
What are the three main features of NPD ?
- Grandiosity
- Need for admiration
- Lack of empathy.
How many criteria must be met for an NPD diagnosis ?
At least 5
How is NPD different from Borderline Personality Disorder (BPD) ?
NPD has a more stable self-image, less impulsivity, and fewer abandonment concerns
How is NPD different from Histrionic Personality Disorder (HPD) ?
NPD shows excessive pride in achievements, less emotional display, and more disdain for others’ feelings
How is NPD different from Antisocial Personality Disorder (ASPD) ?
Both lack empathy and can be exploitative, but NPD lacks impulsivity, aggression, and deceitfulness
What are the four key areas of personality impairment in NPD ?
- Identity: Fluctuating self-esteem, excessive dependence on others for validation
- Self-Direction: High or low personal standards based on entitlement or need for approval
- Empathy: Poor recognition of others’ needs, focus on others’ reactions only if relevant to self
- Intimacy: Superficial relationships that serve self-esteem regulation
What two pathological personality traits define NPD in the alternative model ?
Grandiosity & attention-seeking
How do people with NPD react to criticism ?
With intense anger, humiliation, or rejection
How do NPD individuals interact with others ?
They tend to be exploitative & lack empathy
How is self-esteem regulated in NPD ?
Through grandiosity & external validation (admiration, success, status)
What is the “narcissistic paradox” ?
Despite an inflated self-image, people with NPD feel empty & worthless without constant external validation
What is overt (grandiose) narcissism ?
Outward arrogance, entitlement & superiority with a strong need for admiration
What is covert (vulnerable) narcissism ?
Hidden feelings of entitlement & grandiosity with avoidance and hypersensitivity to criticism
What does Kohut’s psychodynamic theory suggest about NPD ?
NPD stems from a lack of empathetic parental responses, leading to a fragile self-structure
What does Kernberg’s psychodynamic model propose ?
NPD develops due to emotional deprivation, leading to a defense mechanism of grandiosity
What does Millon’s social learning model suggest ?
NPD results from excessive parental overvaluation, creating an inflated self-image resistant to change
What does the dynamic self-regulatory processing model explain ?
Narcissists have high explicit but low implicit self-esteem, leading to defensive reactions like rage
What does schema therapy propose about NPD ?
NPD arises from early attachment trauma, leading to maladaptive coping strategies (self-aggrandizer or detached protector)
How is NPD linked to suicide risk ?
NPD individuals are 2.4 times more likely to attempt suicide, often due to narcissistic injuries and self-esteem regulation failures
How does NPD change over time ?
Maladaptive traits (e.g., hypersensitivity) tend to decrease over time, and improvement is associated with achievements, new relationships, and disillusionments
What are common self-report measures for NPD ?
- Narcissistic Personality Inventory (NPI)
- Five Factor Model Personality Disorder (FFM-PD)
- Five Factor Narcissism Inventory (FFNI)
What interview-based assessments are used for NPD ?
- Diagnostic Interview for Narcissism
- SCID-5-P & STIP 5.1
What are the main characteristics of Histrionic Personality Disorder ?
- Excessive emotionality
- Attention-seeking
- Theatrical expression of emotions
- Superficial relationships
- Seductive or provocative behavior
- Self-centeredness
- Dependency on others
What is the prevalence of HPD in the general population ?
1.84%, with higher rates in women
What are some historical terms for HPD ?
Hysteria, hysterical neurosis & hysterical PD
What personality traits are common in HPD ?
- Excitability
- Emotional instability
- Over-reactivity
- Self-dramatization
- Immaturity
- Vanity
- Dependence on others
Why is HPD controversial in research ?
Very few empirical studies focus on HPD, and it has conceptual overlap with BPD
How many criteria must be met for an HPD diagnosis ?
At least 5 out of 8
How do individuals with HPD behave in relationships ?
They may struggle with emotional intimacy, acting out roles like “victim” or “princess”
What are common comorbid disorders with HPD ?
- BPD
- NPD
- NPD
- Substance abuse
- Somatic symptom disorder
- Major depression
- Eating disorders
Is HPD considered a pathological disorder ?
Some researchers argue that HPD is neither a pathological nor a moral disorder
How significant is the impairment caused by HPD ?
HPD alone rarely leads to significant impairment
What is the relationship between HPD and Cluster B disorders ?
HPD is often comorbid with other Cluster B disorders and is less associated with ethical concerns compared to BPD & ASPD
According to the Alternative Model, what are the 4 areas of personality functioning impaired in HPD ?
- Identity
- Self-direction
- Empathy
- Intimacy
What personality trait domains are considered in HPD under the Alternative Model ?
- Negative Affectivity (high emotional instability, anxiety, self-harm)
- Detachment (withdrawal from social interactions)
- Antagonism (self-importance, disregard for others)
- Disinhibition (impulsivity, lack of future planning)
- Psychoticism (eccentric behaviors, distorted thoughts)
How is HPD different from BPD ?
- HPD focuses on attention-seeking & theatrical emotions
- BPD is marked by instability in relationships, identity, impulsivity & chronic emptiness
- BPD includes self-destructive behavior & anger outbursts
How is HPD different from ASPD?
- Both are impulsive, superficial & manipulative
- HPD manipulates for attention & nurturance
- ASPD manipulates for personal gain, power, or material benefits
How is HPD different from NPD?
- Both seek attention, but NPD seeks admiration for superiority
- HPD uses seduction & excessive emotions
- HPD is more likely to act fragile for attention, while NPD avoids appearing weak
How is HPD different from DPD ?
- DPD relies on others for support but lacks flamboyance
- HPD craves attention & dramatic validation
- DPD needs guidance, while HPD needs to be the center of attention
Why is HPD considered more common in women ?
- Gender stereotypes may influence diagnosis
- Women may be socialized to express emotions differently
- Some argue HPD, ASPD & Somatization Disorder share an underlying diathesis but manifest differently based on gender
What disorders were rated as feminine in Boysen et al. (2014) study ?
- HPD
- Eating disorders
- Body dysmorphia
- Orgasmic disorder.
What self-report tests assess HPD ?
- Millon Clinical Multiaxial Inventory (MCMI-III)
- Brief screening questionnaire (11 items by Ferguson & Negy, 2014)
- MMPI: High Mania scores, low Social Introversion scores.
- NEO-PI: High in Extraversion facets (Warmth, Gregariousness, Assertiveness, Activity, Excitement Seeking, Positive Emotions)
What structured interviews assess HPD ?
- SCID-5-P
- STIP-5.1
Are there specific treatment guidelines for HPD ?
No, but therapies effective for BPD may help
What are the four main therapies used for HPD ?
- Dialectical Behavior Therapy (DBT)
- Mentalization-Based Therapy (MBT)
- Schema Therapy (ST)
- Transference-Focused Psychotherapy (TFP)
What is the goal of Schema Therapy for HPD ?
- Teach patients to experience love without needing constant attention
- Heal emotional deprivation and reduce impulsivity
- Strengthen the healthy adult mode over attention-seeking behaviors
How is Cluster B pathology linked to violence ?
- Impulsivity and emotional instability can lead to aggressive or violent behaviors
- Stalking is linked to rejection sensitivity and insecure attachment
What percentage of stalkers have a personality disorder ?
50%
What is Meloy’s theory on stalking ?
- Stalking is a result of attachment pathology
- Rejection triggers maladaptive attachment responses
- Stalkers struggle to let go due to fragile self-esteem
