Lecture Material Flashcards
What PDM spectrum do clinicians use to understand personality pathology?
Spectrum of personality organization from neurotic to psychotic (with borderline in the middle)
Used to figure out, in general, how healthy the individual is!
Used to be a black and white perspective of being either neurotic or psychotic, but now there is more of a spectrum.
What are some characteristics of neurotic behavior?
- Anxiety based
- No distortion in reality
- Suffer from specific areas (loss, rejection, self-punitive)
- Can be rigid and inflexible (ex. treating everyone with suspicion)
- Able to recognize that their behaviours are problamatic
Ex. eating disorders is a prime example of neurotic behaviour
True or False: Individuals with neurotic behavior have perceptual distortions like hallucinations or delusions.
False!!
No distrortion to reality
How do neurotic individuals perceive their behavior?
Use the mice example in your explination
They recognize that their behavior is problematic!
Ex. phobia of mice → an outsider would be able to tell if one has a fear of mice by the panic, and may choose to calm them down by saying “oh it can’t hurt you” → the neurotic person KNOWS that is cannot them still remains terrified (able to recognize that their reaction is way out of proportion but cannot change reaction!)
Fill in the blank: Neurotic behavior is characterized as a ———– behavior pattern that does not involve any distortions in reality.
[maladaptive]
What are the 3 levels of functioning people can operate on?
- Neurotic
- Borderline
- Psychotic
These characteristics have a dramatic impact on diagnoses, as these levels identify the level of psychopathology within the disorder and can determine treatment!
People with neurotic behaviour have personalities that are often ——-, but are clearly compromised in some domains.
Provide an example of this.
INTACT (no issues of personality disorganization)
Ex. Someone has very significant depression, and it shows up badly in the work domain, but they can still have good relationships.
What are some characteristics of borderline personality?
- Show both neurotic and psychotic tendencies
- Affect regulation difficulties (hard time controlling emotions)
- Relational difficulties (challenges relating and interacting with others)
- Intimacy, work, impluse regulations.
What defines psychotic behavior?
- Major distortions in reality
- Some personality disorganization
- Lack of insight into the problem (does not know their behaviour is problematic)
- Socially inappropriate
- Psychic equivilance
Explain how these two quotes relate to neurotic behaviour:
- “Doing the same thing over and over and expecting a different outcome”
- “You yourself produce the thing you fear the most”
- A neurotic person can gain insight into their patterns, but often continues to do the same thing expecting a different outcome (even with the knowledge that way they are doing is not working)
- A neurotic person often procduses or contributes to their own problems.
Ex. a perfectionist wants to appear perfect to find a sense of beloning, but their perfectionist behaviour often drives people away, creating their own problems in a sense.
What is the neurotic paradox?
Behaving in ways to reduce anxiety that ultimately causes greater suffering!
This paradox involves dealing with anxiety in defensive fashion, usually avoidance reduces anxiety in the short term (but is damaging in the long term)
What types of disorders does neurotic behavior include?
With anxiety-based disorders including:
- Generalized Anxiety
- Panic
- Obsessive Compulsive
- Phobias
- Others with anxiety as a basis
Neurotic individuals are ego dsystonic. What does this mean for their perceptions of their behaviours?
ego dsystonic = apart from the ego/self
They know their behaviour is unacceptable or irrational and know people do not like them, but do NOT know that they are creating/contributing to the problem.
What is neurotic anxiety?
A central component of anxiety disorders where people feel fear when there is no obvious danger or threat
Event or stimulus is objectively minor or inssignificant
Response to a stimulus with anxiety that is is way out of proportion
(ex. mice, thunder, shoppig malls, etc.)
The defensive behaviour of the ——- ———— results in self-defeating behaviour!
Neurotic Paradox!
Neurotic people view basic things (innocuous events) as dangerous, causing avoidance of things that are vital to our survival (like social support/interactions).
What are long-term outcomes of the neurotic paradox?
- Blocks personal growth
- Relationship problems
- Anxiety becomes the focus of life
- Lack of energy and enthusiasm
- Egocentric concerns (very focused on themselves and lacks ability to engage with others)
Example of neurotic behavior: A person repeatedly chooses partners who do not work out. What does this illustrate?
Doing the same thing over and over and expecting a different outcome.
Neurotic person knows what they’re doing is not working but continues to engage in the same behaviour.
True or False: Some neurotic people function in ways where they avoid pain and minimize pleasure.
meaning they essentially have no enthusiasm or enjoyment for positive things
True
Whereas healthy people usually maximize pleasure and minimize pain.
What did Doug, the graduate student going on many dates, exemplify in terms of neurotic behavior?
Criticizing dates for little things despite wanting a long-term relationship.
Very good example of neurotic people creating their own problems (neurotic paradox)
What is the immediate effect and the long term effect of the Neurotic Paradox?
Immediate Effect of Neurotic Paradox = Reduce Anxiety
Long Term of Neurotic Paradox = Don’t resolve the actual problem
What are neurotic styles?
They are ways of relating to others in a problematic manner
NEUROTIC STYLES ARE NOT PERSONALITY DISORDERS!
What are the three main themes/issues present within neurotic syltes (problematic ways of relating to others)
1. Deficit in behavioural repertoire (inhibition)
- The person INHIBITS certain behaviours and becomes anxious in specific contexts.
- Ex. so anxious to ask someone on a date that they will inhibit their date requesting behaviours.
2. Behaves in an inflexible and exaggerated manner opposite to the deficient behaviour
- I inhibit one behaviour so I really go overboard with the opposite behaviour
3. Behaviour does not fully contain the anxiety
What happens when a neurotic individual exhibits exaggerated behaviour opposite to their inhibited behaviour?
They overcompensate by behaving in an inflexible and exaggerated manner! (common in the neurotic styles)
What are the 4 different neurotic styles?
- Aggression/Assertion Inhibition
- Responsibility/Independence Inhibition
- Compliance/Submission Inhibition
- Intimacy/Trust Inhibition
What is Aggression/Assertion Inhibition?
Inhibiting any aggressive behaviours and exaggerating warm or caring responses.
Any impluse to be aggressive is anxiety provoking - making similar behaviours of assertiveness or standing up for oneself be inhibited as well.
Irrationally clings to the cooperative stance!
Can have sudden aggressive outburts after supressing it for so long!
What causes Aggression/Assertion Inhibition in individuals?
Derives from parents who withdraw from the child when the child displays aggression (even when it is potentially normal displays of aggression)
Child learns: “If I am aggressive, people will withdraw from me”
What are potential consequences of Aggression/Assertion Inhibition?
- Hypertension
- Ulcers
- Migraines
- Other stress-related disorders
- Sudden aggressive outbursts
What defines Responsibility/Independence Inhibition?
Inhibition of autonomous behaviours and autonomy, causing an exaggeration of incompetence.
Avoids situation where they are in charge/control of others or themselves.
Behave in an exaggerated way to appear to be incompetent in simple tasks to make sure somebody else comes in and completes the task for them!
What typically causes Responsibility/Independence Inhibition?
Arises from an overprotective parent who does most tasks for the child which lessens their child’s agency as they never do anything on their own.
What are the interpersonal effects of Responsibility/Independence Inhibition?
- Poor relationships (often lets a lot of other people down)
- Helplessness
- Depression
What characterizes Compliance/Submission Inhibition?
Inhibition of cooperation/compliance/submission to authority, and exaggeration of independence and self-reliance.
Often the “rebel” by avoiding submission to authority, but can also just be just very independent and not rebel.
Where does the Compliance/Submission Inhibition derive from?
In children with parents who are incredibly useless, leading to self-reliance as they had to learn to do everything themselves (cannot trust others to do so)
What is Intimacy/Trust Inhibition?
Inhibition of closeless/intamcy, by retreating from closeness and withdrawing from deeper relationships
All relationships and friendhips are short-term to avoid intimacy. Ends relationships at crucial points.
Great with one-time interactions with people, but seeing the same person often creates much anxiety.
What can cause Intimacy/Trust Inhibition?
Parents with narcissistic or borderline personality disorders.
This causes intimacy/closeness to become an opportunity for devestation.
What are some interpersonal consequences of neurotic styles?
- Some consequences will result in depending too much on others that results in others feeling “used and manipulated”
- Unpredictable demands on others that results in others feeling angry, frustrated, guilty, etc.
What interpersonal aspect is common in neurotic styles?
Extreme sensitivity to acts, opinions, and feelings of others.
What are interpersonal aspects of individuals with neurotic styles?
- Often have superficial relationships (if any)
- Extremely sensitive to opinions and feelings of others
- Lack of spontaneity (instead they are very controlled and mechanical)
- Private life involves much inner torment
- Do not have large networks of enduring relationships
What would a “match made in hell” be in neurotic styles?
You would think that two people complimenting eachother on opposite inhibition styles would be good, but it is very BAD!
Ex. if you have a responsibility inhibition (wants to be controlled), and you meet with someone who has a compliance inhibition (very controlling) it will not work well.
What is perfectionism?
Very broad and complex layered personality style
It is viewed as an underlying, causal factor that can cause various problems and diagnoses (transdiagnostic!)
Who wrote ‘New Ways in Psychoanalysis’?
Karen Horney
The first time someone ever took issue with Freud, as he was very dominent at the time.
The book provides insights into narcissism, perfectionism, and dependency in a cultural context stemming from early childhood-parent relationships.
Define perfectionism in terms of a way of being in the world
*the definition by Dr. Hewitt
The requirement of or demand for perfection of oneself or of others, reflecting a drive to perfect the self!
Navigating the world trying to be perfect!
List characteristics of perfectionism.
- Marked need or motivation to be perfect
- Equating worth or esteem with perfection or flawlessness
- Punishment in failure AND success (even punishment to themselves when they succeed)
- Maintenance of unrealistic expectations
- Construing the self & world in terms of evaluation
What is the difference between perfectionism and mastery striving/conscientiousness?
Mastery striving involves setting high standards and satisfaction in achieving them (very healthy in people!)
Perfectionism lacks satisfaction all together.
True or False: Perfectionists are typically organized.
FALSE
There is evidence of disorganization and procrastination associated with perfectionism!
People often think perfectionism is obsessionality. What is the difference?
Perfectionism = perfect the self (the task is irrelevant, they are evaluating the self)
Obsessionalism = perfect things
What are the three components of the comprehensive model of perfectionistic behavior?
1. Perfectionism Traits
- stable, consistent ways of interacting
- traits provide the function and drive for behaviours.
2. Interpersonal or Other-Relational
- the need to appear to others that they are perfect.
- Interpersonal expression of one’s “perfection”
3. Intrapersonal or Self-Relational
- Automatic perfectionism thoughts and recriminations.
What are the three types of trait perfectionism within the comprehensive model?
Self-oriented perfectionism - “I need to be perfect.”
Other-oriented perfectionism - “I do not need to be perfect, but others need to be perfect.”
Socially prescribed perfectionism - “Others require perfectionism of me” / “The world needs me to be perfect”
What is self-oriented perfectionism?
*one of the trait perfection orientations in the comprehensive model
Active striving for oneself to be perfect with stringent self-evaluation.
“I need to be perfect”
Define other-oriented perfectionism.
*one of the trait perfection orientations in the comprehensive model
Requiring others to be perfect with stringent evaluations of others.
“I do not need to be perfect, but others do”
What is socially prescribed perfectionism?
*one of the trait perfection orientations in the comprehensive model
Belief that others require oneself to be perfect.
“Others require perfectionism of me” / “The world needs me to be perfect”
What are the three expressions of perfectionistic self presentation/interpersonal section of the comprehensive model?
- Perfectionistic Self Promotion - “I am the best”
- Non Display Imperfections - “I will never DO things that might reveal a flaw”
- Non Disclosure Imperfections - “I will not reveal in any relationships any flaws I have”
What is perfectionistic self promotion?
*a type of interpersonal expression of perfectionism
Telling everyone how perfect they are.
Activiely promoting one’s supposed perfection.
What does non-display of imperfections refer to?
*a type of interpersonal expression of perfectionism
Avoiding situations where flaws might be shown.
Ex. will not speak in public, show off their golf swing, etc.
What is non disclosure of imperfections?
*a type of interpersonal expression of perfectionism
Avoiding disclosures of imperfections
“I will not reveal in any relationships any flaws I have”.
This is especially damaging with intimate relationships
Explain the intrApersonal or self-relational components of perfectionism according to the comprehensive model.
Involves the self dialogue and behaviours that criticizes oneself when they are not perfect.
Self dialogue involving:
- Automatic Perfectionistic
- Self Statements (relating to the need to be or to appear perfect)
- Automatic Self Recriminations
- Lack of Self Soothing (dialogue is unable to be positive or soothing)
- Lack of Self-Affirming
Behaviours (related to negative relationship to self):
- Self-neglect and self-harm
Involves “voices” of internalized others
Introjection (internalizing percieved external standards from others)
What did Karen Horney say about the neurotic’s image of perfection?
It leads to a disregard for their true self, focusing only on an idealized self.
At the core of the perfectionistic individual is a distrubed and negative person.
What psychological/psychiatric problems are associated with perfectionism?
- Unipolar depression
- Suicide behavior
- Eating disorders
- Anxiety disorders
- Personality disorders
These problems stem from the dysfunctional aspects of perfectionism.
What relationship problems can arise from perfectionism?
- Marital satisfaction issues
- Intimacy/sexual problems
- Negative social interactions
- Poor help-seeking
What physical problems are linked to perfectionism?
- Stress reactions
- Chronic headaches
- Sleep problems
- Somatic anxiety
- Early death
What achievement problems are caused by perfectionism?
- Procrastination
- Self-handicapping
- Fear of failure
- Underachievement
- Writing problems
- Imposterism
- Burnout
Perfectionists often struggle to achieve their potential due to fear of imperfection.
Why do perfectionists often struggle with writing?
Writing problems stem from the inability to be vulnerable and reveal oneself to others.
This reflects the perfectionist’s fear of judgment.
What treatment issues arise from perfectionism?
1. Help seeking
- negative attitudes towards seeking help
- avoidance of psychotherapy/professional help
2. Therapeutic Alliance
- Anxiety about clinicians
- Little connection to therapist
- Therapist’s negative reaction to perfectionistst
3. Compliance
- Confronts patients with failure/concerns with judgment
4. Treatment outcome
- Associated with negative outcome, due to alliance problems.
What is transference in the context of perfectionism?
Patients may see therapists as more judgmental and feel increased anxiety in their presence.
This can lead to a negative therapeutic experience.
What is countertransference concerning perfectionistic patients?
- Clinicians may like perfectionistic patients less
- Difficulty in connecting with them
- Belief that they will not do well in therapy
- Therapists feel inadquate
This dynamic can hinder treatment outcomes for perfectionists.
What is the main idea from the Perfectionism Social Disonnection Model regarding the development of perfectionism?
Perfectionists often learn from early experiences that they are flawed and that their needs for love and belonging are unmet.
This causes and maintains perfectionism-related dysfunction.
Model focuses on early connections with caregivers and even siblings.
*as in the article, asynchrony is at the core of developing a perfectionism personality style
This foundational belief shapes their perfectionistic behavior.
What are the three major elements of the developmental portion of the Perfectionism Social Disconnection Model?
- Attachment and Working Models
- Development of Flawed Sense of Self
- Affect & Self States
These elements explain how perfectionism develops in childhood.
Children feel this flawed sense of self from parents - “if I am perfect, then I will be accepted and feel loved and be good enough”
How does perfectionism serve as a reparative strategy?
Perfectionism aims to create a sense of belonging and demonstrate worth to connect with others.
Strategy that appearing perfect will promise acceptance, which means ok in the world.
This strategy often fails, leading to further issues.
Perfectionism is an ——— strategy aimed at repairing a ——— self by seeking acceptance and connection through appearing perfect.
*the most accurate definition of perfectionism - perfectionism social disconnection model
unconscious strategy
defective self
This definition emphasizes the underlying motivations of perfectionistic behavior.
Explain the cause and maintenance portion of the PDSM
Perfectionistic behaviour causes interpersonal hostility and sensitivity (causing failed social connections), which confirms defective self, leading to psychological distress/disorders
All perfectionism traits and self-presentational facets predicted increased depression over time via social disconnection.
Social hopelessness, loneliness, and need for reassurance of worth were identified as main mediators.
In a study looking at perfectionism traits predicting other issues, what was revealed?
this aligns with the cause and maintenance portion of PSDM.
All perfectionism traits and self presentational facets predicted increased depression over time via social disconnection
Social hopelessness, loneliness, and need for reassurance of worth were main mediators.
When patients with perfectionistic personality styles seek treatment, what do they seek help for?
Patients either seek help specifically for perfectionism and/or problems resulting from perfectionism
What are important considerations when looking at treatment for perfectionism?
- Important to treat because of its association with disorders & dysfunctions
- By targeting perfectionism we are asking the perfectionistic to do the thing they fear the most: embrace imperfection
- Perfectionistic individuals often believe their perfectionism has served them well in the past
What is a formulation-based approach for perfectionism? How would you develop formulation?
Formulation aids in understanding the patient and the role of perfectionism in the person’s life.
Develop formulation through a working model of the person:
- How person functions
- Role and purpose of perfectionism
- Impact of perfectionism on life
- How perfectionism influences negative aspects of person’s life
What is Dr. Hewitt’s Integrative approach to treatment of perfectionism and formulation?
The focus is not just on behaviour but on the relational underpinnings of perfectionism
Formulation:
- Need to understand the attachment needs, the effects that arise from the needs, and how the person defends/copes. (triangle of adaption)
- Need to understand how attachment needs have played out in past, current, and theraputic relationships (triangle of object relations)
Explain the Triangle of Adaption?
Focus on the cycle of development for how one has adapted to perfectionistic tendencies and maintained them.
Explain the Triangle of Object Relations
Focus on how the past and current relationships of the perfectionistic person influences the nature of the relationship with the therapist based on attachment needs.
How is the use of triangles in treatment benefitial?
- Exploration of past and current relationships
- Allows attachment needs for perfectionistic behaviour to arise
- Looks at the fears underlying not being perfect
- Looks at the need for the therapist to be perfect & how pattern is similar to other relationships (past and current
What do our behavioral patterns reflect?
The personality
Unique patterns of traits or behavioral tendencies make up the individual!!
What characterizes personality disorders?
Inflexible and maladaptive behavior patterns to the point of causing distress or social/occupational impairment.
These patterns really influence the person in a negative way - perception, thinking, and relating to the world.
People with PDs are unable to flexibly adapt to things happening in their life.
What leads to the development of personality disorders?
A distorted set of behavioral tendencies/patterns!
They are NOT reactions to stress or painful events or trauma.
How are personality disorders usually noticed? ?
By other people, not the person themselves.
Problematic for other people, often more than for the person with the PD themselves.
What is a key characteristic of personality disorders?
Excessively rigid patterns of behavior preventing adjustment to external demands.
Ex. in life there will be times to have agency, and there are other times in life where you need to let other people control the situation (but people with personality disorders have such rigid ways of relating to people, it makes it hard to adjust to what is happening).
What is the difference between mild and severe personality disorders?
Mild = function reasonably well but viewed as troublesome, unusual, and difficult to get to know
Severe = extreme or unethical behavior, may be incarcerated.
Name examples of trait patterns related to personality disorders.
Suspiciousness, Excessive Self-regard, Fear of Rejection.
These trait patterns come to dominate reactions to new situations, making the maladaptive behaviour quite repetitive
What is the difference between DSM’s Clinical Syndromes and Personality Disorders?
Clinical Syndromes = specific symptom clusters, time-limited, and egodistonic (seperate from the self)
- Ex. depression, anxiety disorders, psychotic dysorters
Personality Disorders = are viewed as ego-syntonic (personality issues are acceptable, unobjectionable and part of the self).
- Tend to blame others for problems in their lives and not able to see that something is wrong with themselves.
What does egodistonic mean?
Viewed as separate from self, unacceptable, objectionable, and alien.
Clinical syndromes in the DSM are egodistonic (ex. depression, anxiety, etc.)
What are the difficulties in diagnosing personality disorders?
- Need to infer traits to make diagnosis
- Lots of overlap among disorders
- Hard to draw the line between PD and normal behaviour
What clusters does the DSM include regarding personality disorders?
Clusters of different personality disorders with symptom characteristics.
- Cluster A (odd/eccentric PD group)
- Cluster B (dramatic/emotional PD group)
- Cluster C (anxious/fearful PD group)
How does PDM differ from DSM in its approach to personality disorders?
PDM views disorders as personality styles, which is not as pathological, that are problematic for people (not just focusing on the disorder)
Trying to place people on the neurotic, borderline, and psychotic level psychoanalytical clinicians use
(PDM views person to function as one of the three within the person’s PD).
What 3 disorders are in Cluster A (odd/eccentric PD group)?
- Paranoid Personality Disorder
- Schizoid Personality Disorder
- Schizotypal Personality Disorder
What are the characteristics of Paranoid Personality Disorder?
- suspicious of others motives
- interprets actions of others as deliberately demeaning/threatening
- expectation of being exploited
- see hidden messages in benign comments
- easily insulted/ bears grudges
- appear cold and serious
Example: Jim Jones at People’s Temple - a cult that ended in a mass suicide due to Jones’s paranoia of the FBI.
Example: Undergrad student followed Dr. Hewitt after their therapy session.
In the psychodynamic diagnostic manual for paranoid PD, what is the central patterns, tension, affects, and ways of defending?
Patterns: possibly irritable/aggressive
Tension: attacking and being attacked by humiliating others
Affects: Fear, rage, shame, contempt
Ways of Defending: Projection, projective identification, denial, reaction formation
In the psychodynamic diagnostic manual for paranoid PD, what are the characeristic pathogenic other-belief and self-belief?
Characteristic Pathogenic Self-Belief:
Hatred, aggression, and dependency are dangerous.
Characteristic Pathogenic Other-Belief:
World is full of potential attackers and users.
What are the characteristics of schizoid PD?
- indifferent to relationships
-limited social range (some are hermits)
- aloof, detached, called loners
- no apparent need of friends or sex
- solitary activities
- seem to be missing the “human part”
- Absolutely no desire to connect with others or responsiveness to others trying to connect with them!!
Ex. Theodore Kacynski created letter bombs to other professors as a vendetta
In the psychodynamic diagnostic manual for schizoid PD, what is the central patterns, tension, affects, and ways of defending?
Patterns: highly sensitive, shy, easily overstimulated
Tension/Preoccupation: Fear of closeness/longing for closeness
Affects: Emotional pain when overstimulated, powerful effects that are suppressed.
Ways of defending: Withdrawl, physically and into fantasy, and idiosyncratic preoccupations
In the psychodynamic diagnostic manual for schizoid PD, what are the characeristic pathogenic other-belief and self-belief?
Characteristic Pathogenic Self-Belief:
Dependency and love are dangerous
Characteristic Pathogenic Other-Belief:
Social world is impinging and dangerously engulfing
What are the characteristics of schizotypal personality disorder?
- peculiar patterns of thinking and behaviour
- perceptual and cognitive disturbances
- trange way of speaking
magical thinking (ex. Conspiracy theories) - They are not psychotic (just odd and use language in an odd way)
- Perhaps the distant cousin of schizophrenia
What is the difference between schizotypal PD and schizophrenia?
Schizotypal would be a mild version of schizophrenia EXCEPT the fact that it is a personality disorder that has always been there, whereas schizophrenia is more developed from an event/stress.
Is Schizotypal PD included in the PDM?
NO it is not included in the PDM!
What are the 4 personality disorders in Cluster B (dramatic-emotional)?
- Antisocial Personality Disorder (dissocial)
- Borderline Personality Disorder
- Narcissistic Personality Disorder
- Histronic Personality Disorder
*Behaviours in these disorders are so dramatic, emotional, or erratic that it is almost impossible to have truly giving and satisfying relationships
What cluster of PDs is most commonly diagnosed?
Cluster B - Dramatic/Emotional Cluster
What are the characteristics of Antisocial Personality Disorder?
- pattern of irresponsibility, recklessness, impulsivity beginning in childhood or adolescence (e.g., lying, truancy)
- patterns in childhood about breaking rules, etc
- criminal behaviour/little adherence to societal norms
- difficulties establishing secure identity
- distrust and conflict with others.
*the two videos of people with APD failed to develop the normal range of feelings for others, contributing to the unremorseful murders they committed.
What is one of the most commonly diagnosed personality disorders?
Borderline Personality Disorder
The PDM has a spectrum and neumorous PDs that reflect severe borderline personality disorganization (neurotic, borderline, and psychotic)
The DSM has only ONE type of definition/category for borderline personality disorder.
What are the characteristics of Borderline Personality Disorder?
- marked instablity of mood, relationships, self-image
- intense, unstable relationships
- uncertainty about sexuality
- Everything is “good” or “bad” (engaging in splitting)
- chronic feeling of emptiness
- recurrent threats of self-harm
What are people with Borderline Personality Disorders like in treatment?
Therapist “killers” (very difficult to treat)
Therapists have a very hard time working with them.
Tend to be avoided by many clinicians
Takes lots of training and experience to treat effectively
What are the characteristics of Narcissistic Personality Disorder?
Relies on the self for esteem (looks internally)
Grandiose, sense of self-importance
They present themselves as these fantastic people and believe people are so lucky to be with them.
Lack of empathy
Hyper-sensitive to criticism
Exaggerate accomplishments/ abilities
Below surface is fragile self-esteem
Explain what was happening in the “Narcissistic Rage Video” where a girl with narcissistic PD was challenged?
Obsessed with how others perceived her → standing alone waiting for her date, she thought that others would think of her as “less than” causing her to rage at her boyfriend.
Would come into therapy saying “showtime” → as if she was a celebrity, she always had to be the star/center of attention.
What are the characteristic pathogenic self and other-beleifs in people with narcissistic PD according to the PDM?
Characteristic Pathogenic Self-Belief = I need to be perfect to feel ok
Characteristic Pathogenic Other-Belief = Others enjoy beauty, riches, power, fame and the more I have of those the better I feel.
Whar are the ways of defending, affects, and tension within people with narcisistic PD accoridng to the PDM?
Ways of Defending: Idealization, Devaluation
Tension/Preoccupation: Inflation/Deflation of Self-Esteem
Affects: Shame, Contempt, Envy
What is Histrionic Personality Disorder characterized by?
Excessive emotional displays and dramatic behavior
Includes attention-seeking and shallow emotions
What are common behaviors associated with Histrionic Personality Disorder?
Attention-seeking, victim stance, seeking reassurance and praise, very suductive.
Often described as self-centered and flamboyant
What is a primary feature of Avoidant Personality Disorder?
Overriding sense of social discomfort
So distressed by interacting with others and always need emotional support.
Individuals are easily hurt by criticism and often retreat into loneliness
What behaviors are characteristic of Dependent Personality Disorder?
Submissive, clingy behavior and fear of separation
Individuals often need emotional support and are easily hurt by criticism
What is the central tension, ways of defense, patterns, and affects in Dependent Personality Disorder according to the PDM?
Tension: Keeping/Losing Relationships
Ways of defending: regression, avoidance
Patterns: placidity
Affects: pleasure when securely attached, sadness/fear when alone.
This includes feelings of inadequacy and the need for others’ care
What are the 4 core elements of Borderline Personality Disorder?
1. Difficulties in establishing secure self-identity
- They cope with the emptiness inside by depending on others to provide a sense of identity (issues with boundaries)
2. Distrust and splitting
- Think people will abandon them
- Will idealize, then denigrate people quickly.
3. Impulsive and self-destructive behavior
- Ex. reckless driving, drugs, unsafe sex, etc.
4. Difficulty in controlling anger and emotions
These elements contribute to unstable relationships and self-image
How do people with borderline personality disorder have issues with object permanence?
People with BPD often “borrow” other people’s identity.
When that person leaves, they think they do not exist anymore (which means part of the BPD person’s identity has been taken away)
Ex. can arise when therapists take a vacation - loosing the identity they took from the therapist
What does ‘splitting’ refer to in the context of Borderline Personality Disorder?
A defensive position where a person is idealized one moment and denigrated the next
Occurs the most in intimate relationships
What is a common emotional experience for individuals with Borderline Personality Disorder when people leave?
They experience an emptiness and a loss of identity
They may feel that the person has taken part of their identity away
What is the primary characteristic of Obsessive Compulsive Personality Disorder?
Excessive control and perfectionism
They are very inflexible, judgemental, humorless, and often workaholics.
Individuals often ignore family members and are preoccupied with trivial details
Fill in the blank: The characteristic pathogenic self-belief of individuals with Passive Aggressive Personality Disorder is: I am ———-.
inadequate, needy, impotent
Reflects their feelings of dependency and inadequacy
True or False: Individuals with Avoidant Personality Disorder often try to socialize despite their distress.
True
They occasionally attempt to socialize but find it distressing
What are the two remaining disorders in the DSM 5 related to somatoform disorders?
Somatic Symptom Disorder, Conversion Disorder
What are 3 main psychological disorders related to the physical body?
- Somatoform disorders (ex. somatization or hypochondraisis)
- Conversion disorders
- Factitious disorders
What are the four PSM somatoform elements (feelings, cognitive patterns, states, and relationships)?
- Feeling = sense of something wrong with the body, anxiety, pain, or denial
- Cognitive Patterns = preoccupation with sensations as symptoms (all they can think about)
- Somatic States: fight or flight reactions
- Relationship Patterns: intense, aggressive, need for reassurance (really unhealthy for relationships)
What are commonalities of somatoform disorders in general?
- Body complaints or loss of function
- Often no organic pathology
- Maladaptive response to symptoms (they are not faking - their perception is that their pain is very real!)
- Psychological factors play an important role
- ‘La belle indifference’
- Precipitant triggers expression of symptoms
What is Somatization Disorder also known as?
Briquet’s Syndrome
What are common complaints for Somatization Disorder? How are these complains presented?
- Headaches, Fatigue, Heart palpitations, Fainting spells, Nausea, Paralysis, Numbness, Blindness
These complaints are presented in a very dramatic fashion and they often report that MANY different things hurt.
Ppl with this are very narcissistic
*the drama of how complaints are presented is the main giveaway for physicans indicating a somatization disorder
What characterizes Hypochondriasis?
Unrealistic interpretation of physical signs or sensations as abnormal leading to preoccupation with having a serious disease
A patient comes to the doctor and is complaining about general pain and being very vauge. They tell the doctor that this is their 6th doctor this year and that they read medical journals a lot to try and figure out their pain.
What disorder does this person likely have?
Hypochondraisis
(falls under somatic symptom disorder in the DSM 5)
What is one of the most frequently seen somatoform disorders?
Hypochondriasis
overlaps with narccism and histronic PD (bc of the drama)
What is the main characteristic of hysterical blindness? What 2 demonstrations support this?
Individuals are indifferent about their blindness and can navigate as if they can see.
2 demonstrations:
* Hysterically blind people always start on the same side of the table where an object they are meant to find is (compared to actual blind people where it varies)
- When a fire alarm goes off, hysterically blind people get out the door much faster than true blind people
Can hysterically blind people actually see?
YES, they just do not know they can see!
The visual cortex still interprets information from the eyes, but there is an issue in the cerebral cortext to understand what that information means!
Hence, an issue in cerebral cortex in hysterical blindness!
What is a conversion disorder?
Pattern in which symptoms of some physical malfunction or loss of control appear with no organic pathology.
Can often find a trauamatic or stressful event that caused the start of these symptoms.
Onset occurs usually in early adults, but still can later in life.
Most common symptoms = paralysis, anesthesia, blindness, tunnel vision.
What are the three categories of symptoms in conversion disorders?
- Sensory: any sensory symptom (hearing, sight, taste, smell)
- Motor: paralysis, tremors, tics, aphonia
- Visceral: headache, lump in throat, choking, coughing
What is one way to distinguish conversion disorders from actual, true, medical sysmptoms?
When they are indifferent about it!
A person with a conversion disorder would say “Oh, I am indifferent about being blind today!”, whereas a person who woke up actually blind would be freaking out!
Also hypnosis can relive symptoms.
What is a defining feature of Factitious Disorders? What is the goal of these people?
Pathological lying and voluntary control over physical symptoms
People are injuring and making themselves sick on purpose with the goal of being an impatent at a hospital
(“something is wrong with me take care of me”)
This is a lifelong disorder (always will want to be taken care of)
People often have extensive knowledge about hospitals (ex. go on the weekend when younger doctors are working who would be less suspicious of a factitious disorder)
What is another name for Factitious Disorder?
Munchausen’s Syndrome
What are the four PDM characteristics of Factitious Disorders?
- Affective: anxiety, hostility, superficiality
- Cognitive Patterns: ruminations, preoccupation with suffering
- Somatic States: chronic tension, self-inflicted injury
- Relationship Patterns: needy, dependent, negativism
What is Munchausen’s by Proxy?
Factitious Disorder Imposed on Another, where a parent creates symptoms in a child to seek medical attention
What is the difference between malingering and factitious disorders?
Malingering involves voluntary control of symptoms for a specific goal (ex. money), while factitious disorders involve self-created symptoms for attention!
What personality disorders are in the PDM but do not exisit in the DSM?
- depressive
- axious-avoidant/phobic
- Somatizing
- Psychopathic
- Sadistic
- Borderline
*note the PDM does not include Schizotypal (but the DSM does in Cluster A)
