Module 7 - Personality Disorders

Question 1

What is a personality trait?

Answer 1

A feature that is typically displayed over time and in various (but not necessarily all) situations.

Question 2

What is the DSM’s definition of a personality disorder?

Answer 2

An enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time, and leads to distress or impairment.

Question 3

Why do we “pathologize” or diagnose a condition that causes the affected person little distress?

Answer 3

Abnormal psychology seeks to classify these conditions in order to aid in the prediction, diagnosis, and treatment of behaviour. Psychopathy is a good example of a construct that helps to predict behaviour.

Question 4

What are the six formal criteria in defining personality disorders?

Answer 4

Criterion A states that the pattern of behaviour must be manifested in at least two of the following areas: cognition, emotions, interpersonal functioning, or impulse control.

Criterion B requires that the enduring pattern of behaviour be rigid and consistent across a broad range of personal and social situations.

Criterion C states that this behaviour should lead to clinically significant distress in social, occupational, or other important areas of functioning.

Criterion D requires stability and long duration of symptoms, with onset in adolescence or earlier.

Criterion E states that the behaviour cannot be accounted for by another mental disorder.

Criterion F requires that the behavioural patterns are not the result of substance use (e.g., drugs or alcohol) or of another medical condition.

Question 5

What are the 3 clusters of Personality Disorders?

Answer 5

Cluster A odd and eccentric disorders (paranoid, schizoid, and schizotypal);

Cluster B dramatic, emotional, or erratic disorders (antisocial, borderline, histrionic, and narcissistic); and

Cluster C anxious and fearful disorders (avoidant, dependent, and obsessive-compulsive).

Question 6

The other specified personality disorder and unspecified personality disorder is a category provided to address what two situations?

Answer 6

1) the individual meets criteria for a general personality disorder and exhibits symptoms of a number of personality disorders, but the criteria for any single personality disorder are not met

2) the individual might meet criteria for a general personality disorder but the key symptoms are not reflected in the existing personality disorders.

Question 7

What are the 10 Personality Disorders and their key features?

Answer 7

Paranoid personality disorder -pattern of distrust and suspiciousness such that others’ motives are interpreted as malevolent.

Schizoid personality disorder - pattern of detachment from social relationships and a restricted range of emotional expression.

Schizotypal personality disorder -pattern of acute discomfort in close relationships, cognitive or perceptual distortions, and eccentricities of behavior.

Antisocial personality disorder -pattern of disregard for, and violation of, the rights of others.

Borderline personality disorder -pattern of instability in interpersonal relationships, self-image, and affects, and marked impulsivity.

Histrionic personality disorder -pattern of excessive emotionality and attention seeking.

Narcissistic personality disorder -pattern of grandiosity, need for admiration, and lack of empathy.

Avoidant personality disorder -pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation.

Dependent personality disorder -pattern of submissive and clinging behavior related to an excessive need to be taken care of.

Obsessive-compulsive personality disorder - pattern of preoccupation with orderliness, perfectionism, and control

Question 8

T/F

Individuals suffering from major mental health difficulties (e.g., schizophrenia, bipolar disorder) have far more impaired functioning than do most patients with personality disorders.

Answer 8

True.

An objective evaluation of people with personality disorders indicates impaired life circumstances, but their actual abilities appear relatively intact compared to those with major mental disorders.

Question 9

What is the difference between egosyntonic and egodystonic?

Answer 9

for many people with personality disorder, their functioning is egosyntonic. That is, they do not view it as problematic.

In contrast, most other mental disorders are generally considered egodystonic as they cause distress and are viewed as problematic by the individual.

Question 10

Why have personality disorders traditionally presented more diagnostic problems than most other mental disorders?

Answer 10

1) lower reliability of their diagnosis

2) their poorly understood etiology

3) Weaker treatment efficacy.

Question 11

John Livesley argued that personality disorders are better viewed as ______________, each of which lie along a continuum, rather than as disorders that people simply have or do not have.

Answer 11

constellations of traits

Question 12

What is the difference between comorbidity and overlap?

Answer 12

Comorbidity = the co-occurrence of two or more different diagnoses for one person.

Overlap = the similarity of symptoms in two or more different disorders (i.e., some of the same criteria apply to different diagnoses). Ie: NPD & ASPD are both associated with a lack of empathy or concern for others.

Question 13

A recent World Health Organization study estimated that worldwide, ______ % of individuals diagnosed with personality disorders meet the criteria for at least one other mental disorder.

Answer 13

51.2 percent.

Question 14

Historically, most attention on personality disorders has focused on what we now call ____________, or the related condition psychopathy.

Answer 14

antisocial personality disorder

Question 15

What comprises the “Dark Triad” constellation of personality traits that are deemed to be socially aversive.

Answer 15

1) Machiavellianism (callous, manipulative, and deceptive personality characteristics)

2) Subclinical narcissism

3) Subclinical psychopathy

Question 16

One of the first written descriptions of psychopathy was by __________ who described a psychiatric condition associated primarily with amorality rather than psychosis.

He referred to this condition as ___________. In such patients, he observed profound deficits in emotion but no apparent reasoning/intellectual dysfunction. Such patients were prone to stealing, violence, and lying, but seemed to have no other mental health difficulties.

Answer 16

Pinel (1809).

manie sans délire

Question 17

James Pritchard (1835) coined the term _________ to delineate a mental condition characterized by an absence of morality, rather than the “madness” seen in other psychiatric patients.

Answer 17

moral insanity

Question 18

Koch objected to the term moral insanity and gave the opinion that a more appropriate term would be __________________.

Answer 18

psychopathic inferiority

In his view, the condition of psychopathy stemmed from a type of biological abnormality that resulted in personality anomalies such as extreme selfishness. This conceptualization of psychopathy, with its focus on personality pathology, was more closely aligned to the modern conceptualization of psychopathy than were earlier views.

Question 19

Sociologists also took interest in the early part of the twentieth century. Not surprisingly, they saw social conditions as critical. Accordingly, they replaced the term psychopath with the descriptor _______________.

Answer 19

Sociopath

Partridge (1930) argued that individuals with this psychopathic inferiority were exhibiting a “social” disorder and coined the term sociopath, reflecting the idea that the condition involved an “anti-society” view of life. Such views were eventually incorporated into the APA’s first edition of the DSM in 1952, which described a “sociopathic personality disturbance, antisocial reaction.”

Question 20

The current conceptualization of psychopathy is founded largely in the clinical observations of psychiatrist Hervey Cleckley in a series of clinical case vignettes presented in his classic text called what?

Answer 20

The Mask of Sanity (1941).

Question 21

How do psychodynamic views see the etiology of personality disorders?

Answer 21

As resulting from disturbances in the parent–child relationship, particularly in problems related to separation-individuation. Thus, according to psychodynamic theorists, difficulties in this process result in either an inadequate sense of self (e.g., borderline, narcissistic, or histrionic personality disorders) or problems in dealing with other people (e.g., avoidant or antisocial personality disorders).

There is clear evidence that adults with personality disorders are far more likely than other people to have had difficult childhoods, including the loss of a parent through death, divorce, or abandonment or parental rejection. This evidence has also served to bolster other environmental theories of personality disorders, particularly attachment theory and learning-based theories.

Question 22

What theory asserts that children learn how to relate to others, particularly in affectionate ways, by the way in which their parents relate to them?

Answer 22

Attachment theory

Question 23

What role do some theorists think attachment plays in contributing to personality pathology in adulthood?

Answer 23

Researchers have shown that if parent–child attachments are poor, the child will typically develop adult relationship styles that are characterized by ambivalence, fear, or avoidance. Poor attachments typically lead to deficits in developing intimacy such that various maladaptive ways of dealing with interpersonal relationships are likely.

The fact that personality disorders usually become obvious during late adolescence when the demands for social interaction become preeminent lends some support to the importance of attachment deficits in the origin of these disorders. Consistent with these claims, researchers found that patients with personality disorders typically described their parents as either uncaring or overprotective, or both.

Rates of childhood maltreatment among individuals with personality disorders are generally high (73 percent reporting abuse; 82 percent reporting neglect). As expected, borderline personality disorder was more consistently associated with childhood abuse and neglect than were other disorders.

Question 24

What does the Cognitive-Behavioural Theory say in the etiology of personality disorders?

Answer 24

Cognitive strategies or schemas (e.g., beliefs, assumptions, and attitudes) are said to develop early in life, and in individuals with personality disorders these schemas become rigid and inflexible.

Because they form early in life as a result of damaging experiences (e.g., abandonment), Young believed that negative schemas are familiar. The views of new events become distorted to maintain the validity of the schemas. People cope with their negative schemas in ways that may have been adaptive when they were children trying to survive in a damaging environment (e.g., by surrendering or overcompensating), but they continue coping in this same manner into adulthood.

Linehan argued that people who develop borderline personality disorder come from families who consistently invalidate their childhood emotional experiences and over-simplify the ease with which life’s problems can be solved. So they learn that the way to communicate and get the attention of their parents (and, as a consequence, to communicate with others) is through a display of major emotional outbursts. Linehan’s theory could apply to other personality disorders, particularly those in Cluster B. Of course, parents may also model inappropriate personal styles themselves, and there is considerable evidence that modelling is a powerful influence on children’s behaviour.

Question 25

What does the biological model say about the etiology of personality disorders?

Answer 25

Both schizophrenia and schizotypal personality disorder occurred exclusively in children of parents with schizophrenia. Children of parents with schizophrenia also were at increased risk for avoidant personality disorder but not paranoid personality disorder. These relationships were particularly strong for males. These findings strongly suggest that there is a familial vulnerability to schizophrenia spectrum disorders (especially schizotypal personality disorder) that is observable before adulthood.

Other study - The personality disorder group showed reduced prefrontal volume and poorer frontal functioning compared to both other groups.

Other study - in Borderline Personality disorder - dysregulated responding of the prefrontal areas of the brain as well as fronto-limbic dysfunction in the form of overactivation of the amygdala.

Question 26

Summary of Etiology:

With Cluster A disorders = the most prominent observations are genetic links .

For Cluster B disorders, the two etiological factors that have received the best support are biological factors and attachment problems.

Cluster C - very limited info/findings since these disorders are less prevalent.

Question 27

What are the two personality disorders have received the bulk of research attention over the past several years?

Answer 27

antisocial personality disorder and borderline personality disorder.

Question 28

What are the main features of paranoid personality disorder?

Answer 28

Pervasive suspiciousness concerning the motives of other people and a tendency to interpret what others say and do as personally meaningful in a negative way are the primary features of someone with paranoid personality disorder. Misperceive innocent actions as threatening, they’re hypervigilent, humourless and eccentric and viewed by others as hostile, jealous, and preoccupied with power and control.

Question 29

What is the main difference between paranoid PD and schizophrenia?

Answer 29

The severity (e.g., in terms of bizarreness, extension) of people’s paranoid beliefs.

In schizophrenia, paranoid beliefs are sufficiently bizarre and ingrained that they are considered “psychotic”— that is, a delusion.

In paranoid PD, the individual’s paranoid beliefs are non-bizarre, within the realm of possibility, and pertain to general suspiciousness, even though they are mistaken.

Question 30

Recent data suggests that __________ personality disorder is one of the most commonly diagnosed personality disorders in community samples.

Answer 30

Paranoid.

Question 31

What are the main features of Schizoid PD?

Answer 31

Individuals with this condition seem completely uninterested in having any sort of intimate involvement with others, and they display little in the way of emotional responsiveness. They come across as being detached, aloof, or self- absorbed. These individuals typically spend significant time alone and can appear cold and indifferent toward others. In fact, they seem not to enjoy relationships of any type. They avoid social activities and do not seek or seem to desire sexual relations.

Question 32

More recently, data conclude that schizoid PD appeared to be distinct from paranoid and schizotypal PD. They suggested that schizoid PD may be more related to asocial disorders such as _________________.

Answer 32

Autism Spectrum Disorder.

Question 33

What are the main features of schizotypal PD?

Answer 33

The major presenting features of individuals with schizotypal personality disorder are eccentricity of thought and behaviour. Superstitious, odd beliefs, magical thinking, believe in telepathy, clairvoyance etc.

Like paranoid PD, and to a lesser extent schizoid PD, this condition has some similarities with schizophrenia. However, the difference lies in the severity and quality of the symptoms. Although their beliefs, perceptual experiences, speech, and behaviours are odd and they tend to isolate them from others, they are not usually considered to be so eccentric as to meet the criteria for delusional or hallucinatory psychotic experiences. (But there is disagreement on this issue, more research is needed.)

Question 34

True or False?

ASPD and psychopathy are the same.

Answer 34

False.

Individuals with ASPD have been referred to as psychopaths, sociopaths, or dyssocial personalities, with these terms sometimes being used interchangeably. In correctional settings, the terms psychopathy and ASPD have been confused for decades. Many researchers and clinicians continue to use the concept of psychopathy rather than following DSM-5 criteria, or vice versa. But ASPD and Psychopathy are not the same.

ASPD and psychopathy are in fact related, but that psychopathy is more severe than ASPD. Psychopathy incorporates a richer set of emotional, interpersonal, and behavioural features than the DSM-5 definition of ASPD, which chiefly focuses on observable behaviour.

Question 35

What is the most widely accepted measure of psychopathy?

Answer 35

the Psychopathy Checklist (PCL-R). It considers both behaviour and personality.

Question 36

Why is the DSM criteria not the best for tapping into the core features of psychopath?

Answer 36

The DSM-5 criteria for ASPD are a highly reliable set of indicators of a socially deviant lifestyle; however, they are not the best criteria for tapping the core features of psychopathy (e.g., shallow affect, lack of empathy), which are best measured by the Psychopathy Checklist–Revised.

Question 37

What are the main features of Antisocial Personality Disorder (ASPD)?

Answer 37

The DSM-5 criteria for the diagnosis of APD include seven exemplars reflecting the violation of the rights of others: nonconformity, callousness, deceitfulness, irresponsibility, impulsivity, aggressiveness, and recklessness. Reflecting a polythetic approach (meaning only a subset of symptoms or behaviours is required for a diagnosis, unlike most medical diagnoses), three or more of the above symptoms must be met for the diagnosis to be applied.

Question 38

What is the etiology of ASPD?

Answer 38

While a strictly biological explanation has been found to be insufficient to account for the etiology of antisocial behaviour, such factors appear to interact with childhood experiences to produce criminality. There appear to be neuropsychological markers that, in combination with specific environmental circumstances (e.g., criminogenic environment, poor parenting, neglect, and physical abuse), interact to make children vulnerable to developing an antisocial lifestyle and personality.

Psychological explanations for ASPD focus on inadequate self-regulation. Lykken suggested that such individuals are essentially fearless. This fearlessness hypothesis claims that those with ASPD have a higher threshold for feeling fear than do other people. Events that make most people anxious (e.g., the expectation of being punished) are thought to have little or no effect on those with ASPD. HOWEVER, as children, individuals with ASPD appear to have been exposed to severe physical punishment from their parents or guardians that was frequently not contingent upon their behaviour. So Schmauk concluded that individuals with APD ware differentially responsive to different kinds of punishment as a result of early learning experiences, rather than completely fearless or unresponsive to all punishment.

Question 39

Newman has described the pathology of psychopaths as due primarily to ______________.

Answer 39

Information processing deficiencies.

-involving the automatic directing of attention to stimuli that are peripheral to ongoing directed behaviour. That is, once engaged in reward-based behaviour, the psychopath is less likely to attend to other cues to modulate his or her ongoing response.

(In contrast, the antisocial and criminal behaviour exhibited by those with ASPD involves schema-based deficits. These deficits comprise antisocial schemas and cognitive distortions not requiring automatic attentional cueing. Such research supports the idea that psychopathy and ASPD are different diagnoses implying different etiology, intervention, and prognosis.)

Question 40

What are the treatment recommendations for ASPD?

Answer 40

Reviews of treatment efficacy for patients with APD have been generally pessimistic. Attrition from treatment programs is also high.

2/3 of psychiatrists think that individuals with ASPD are sometimes treatable. Despite a poor response to hospitalization, prognosis is improved for these clients if there is a treatable anxiety or depressive feature to their behaviour or if they can be convinced to form an effective therapeutic alliance. According to current views, treatment should be aimed at symptom reduction and behaviour management rather than at a cure.

Many of the more recent developments in treatment programs for criminal populations include a focus on some combination of aggressive and antisocial attitudes and beliefs, impulsivity or poor self-regulation, social skills, anger, assertiveness, substance abuse, empathy, problem solving, and moral reasoning. However, the overreliance on self-report assessment methods is problematic in a population in whom honesty is suspect.

Another strategy for managing antisocial or acting-out behaviour has been pharmacotherapy. Short-term use of psychopharmocological agents is most often used to manage difficult or threatening behaviour. However there are side effects of long-term drug use and problems of noncompliance. Symptom alleviation is rarely sustained, and patients are typically provided with no new skills to improve their ability to deal with future situations.

Question 41

T/F

For some ASPD patients, medication may reduce arousal level sufficiently for them to participate more fully in cognitive-behavioural treatment.

Answer 41

True.

Question 42

Though psychopathy is not included in the DSM, what are some features of a psychopath?

Answer 42

Psychopaths are a distinctive subgroup of offenders best described by their unique interpersonal and affective disposition. They are egocentric, deceptive, callous, manipulative individuals who lack remorse and emotional depth. They’re chronic deceivers, often but not always lying for instrumental reasons such as to escape punishment. They are “users” of others.

Not only are psychopaths successful scam artists, they also appear to have a heightened ability to discern vulnerable individuals from non-vulnerable individuals.

Question 43

Researchers have established a strong link between psychopathic traits and _____________ in both adult offenders and psychiatric patients.

Answer 43

Aggression or violence.

This link helps us predict whether an offender is likely to commit future violent behaviour. Not only do psychopaths commit more violence, they commit particularly heinous violence.

Question 44

Psychopaths adhere to the selective impulsivity theory. What does this theory mean?

Answer 44

That is, they are not out of control, but are able to quickly weigh the pros and cons of their actions. They will act impulsively only if the consequences are worth the risk.

Question 45

What is the etiology of psychopathy?

Answer 45

The data are primarily correlational in nature and it is not possible to offer a definitive causal account.

Psychopaths are insensitive to the emotional content of information - Such abnormalities have been identified in the prefrontal cortex, hippocampus, angular gyrus, basal ganglia, and amygdala.

Neurotransmitters - lower 5-HIAA concentrations (a metabolite of serotonin) and high catecholaminergic activity (HVA) in the cerebral spinal fluid of violent forensic inpatients. The authors concluded that the impulsive aggression of psychopaths may be linked to serotonergic hypofunctioning in combination with a high dopamine activity.

Research on twin pairs of children indexed the callous and unemotional component of psychopathy at age seven and found significant group heritability and no environmental influence on this component of psychopathy. Such findings have led some researchers to argue that there is a stronger genetic cause as opposed to social cause of psychopathy.

Environment - there is some data for an association between early emotional deprivation (i.e., parental neglect, erratic punishment) and psychopathic characteristics in adulthood. Psychopaths had experienced a more negative upbringing (e.g., poor discipline, emotional abuse/ neglect) and negative school experience than had non-psychopaths.

Question 46

Porter (1996) has suggested that there are in fact two pathways that can lead to the development of psychopathy:

Answer 46

1) Fundamental psychopathy - the disorder is the inevitable result of a biological (probably polygenic) predisposition within the individual that hinders the development of affective bonds.

2) Secondary psychopathy, the development of the disorder is heavily dependent on and the result of negative environmental experiences during the formative years of childhood, such as extreme neglect or abuse. With secondary psychopathy, the profound affective deficit may be the result of the individual’s ability to detach him or herself from his or her emotions, as opposed to an inability to actually experience emotions, as is the case with fundamental psychopathy.

Question 47

T/F

A recent study found support for dissociation as a mediator between childhood maltreatment and higher PCL-R scores measuring an impulsive and antisocial lifestyle.

Answer 47

True.

Thus, it is possible that psychopathy may have its roots in biological predispositions and/or environmental experiences, depending on the individual.

Question 48

T/F

Like all personality disorders, psychopathy is typically a lifelong condition.

Answer 48

True.

Question 49

What are the treatment recommendations for psychopaths?

Answer 49

Effectiveness of treatment with psychopaths have not been encouraging. Any way you look at it, adult psychopaths represent a unique group of offenders who can be expected to be resistant to treatment. According to leading researchers, programs should focus on changing and managing behaviour rather than on changing the core personality traits of the psychopath.

Question 50

What are the main features of Borderline personality disorder (BPD)?

Answer 50

Instability across various domains of personality functioning. Specifically, the hallmark features of BPD are: (a) fluctuations in and difficulty regulating emotions, (b) an unstable sense of one’s identity, (c) instability in social relationships, and (d) impulsive behaviour.

Question 51

True or False?

Borderline refers to someone on the “border” of psychosis or “going crazy”.

Answer 51

False.

This is not typically the case. Most people with BPD do not experience psychotic symptoms and such views are arguably pejorative and contribute to stigma.

Question 52

True or False?

Some of BPD’s key features, including affective instability or identity, are normative experiences for many young people.

Answer 52

True.

Question 53

What is the etiology of BPD?

Answer 53

The evidence strongly implicates disruptions in the family of origin and childhood abuse and neglect as very significant factors in the development of borderline personality disorder. Patients with BPD typically recall their parents as either neglectful or abusive. Attachment problems with parents may be an etiological factor in BPD.

Brains of individuals with BPD revealed that these individuals have significantly reduced right hippocampal volumes compared to healthy participants. A similar study found that individuals with BPD also have reduced volumes of grey matter in the dorsolateral prefrontal cortex (DLPFC). BUT this evidence is unconvincing at this time.

Biosocial theory describes BPD primarily as dysfunction of the emotion regulation system. According to the theory, people with BPD have a biologically predisposed difficulty in regulating their own emotions.

Question 54

What is the relationship style that characterizes borderline patients?

Answer 54

Once they begin to get close to their partner, they become anxious and begin to back away from the relationship. While they desire closeness, they appear to be afraid of it. The features of BPD may then be seen as attempts to adjust to their desire for, but distrust of, intimacy.

Question 55

What is the recommended treatment for BPD?

Answer 55

Dialectical behaviour therapy (DBT).

One of the main features of this approach is the acceptance by the therapist of the patient’s maladaptive and at times self-destructive behaviours. In addition, several standard behavioural procedures are used, such as exposure treatment for the external and internal cues that evoke distress, skills training (e.g., distress tolerance, mindfulness, interpersonal effectiveness), contingency management (i.e., use of positive reinforcement for desired behaviour), and cognitive restructuring.

According to Robins and Chapman, DBT is the only outpatient psychotherapy that has been shown to be effective with patients with BPD.

Question 56

What are the main features of histrionic personality disorder (HPD)?

Answer 56

Can some- times be “the life of the party.” Indeed, attention-seeking behaviours tend to characterize people with this disorder. In fact, there seems to be little that someone with HPD will not do to solicit attention. They are overly dramatic in their emotional displays, self-centred, and constantly attempting to be the centre of attention. Attention seeking outfits/clothes. These displays are intended to make others focus on them, as they seem unable to tolerate being ignored. Indeed, they may become quite annoyed if another person in a group setting receives more attention than they do.

Because of their strong need for attention, they tend to be very demanding and inconsiderate, and not surprisingly, their relationships are often short-lived and tumultuous. Again, as a result of their need to be the centre of attention, these individuals are often flirtatious, and seem unable to develop any degree of deep intimacy in relationships.

Question 57

What are the main features of Narcissistic Personality Disorder (NPD)?

Answer 57

Patients who are narcissistic are grandiose and consider themselves to have unique and outstanding abilities. They have an exaggerated sense of self-importance; indeed, egocentricity is the staple characteristic of these individuals. If you were to have a conversation with someone who has NPD, you would quickly get the impression of “me me me,” with every topic somehow being turned to the person’s own greatness.

They are so preoccupied with their own interests and desires that they typically have difficulty feeling any concern for others; this can mirror the empathy deficit seen in ASPD or psychopathy. However, unlike these latter conditions, individuals with NPD are easily hurt by any perception that their greatness is not being recognized.

They expect, and demand, to be treated as “special.” This, coupled with a lack of empathy, leads them to exploit others to serve their own needs. Like those with HPD, the actions of those with NPD alienate others. Thus, these individuals are frequently lonely and unhappy. When frustrated or slighted, they can become vengeful and verbally or physically aggressive. Research has validated these features as characteristic of NPD. When NPD is diagnosed, there is considerable overlap with BPD.

Question 58

What is the narcissistic paradox?

Answer 58

Their self-esteem is readily shattered by negative feedback from others, presumably because they desire only admiration and approval.

Question 59

What are the main features of Avoidant personality disorder (APD)?

Answer 59

A pervasive pattern of avoiding interpersonal contacts and an extreme sensitivity to criticism and disapproval. Individuals with APD tend to avoid intimacy with others, although they clearly desire affection (unlike schizoid personality disorder). As a result, they frequently experience terrible loneliness.

While social discomfort and a fear of negative evaluation are commonly experienced, the fundamental fear of those with APD is social rejection. These individuals restrict social interactions to those they trust not to denigrate them.

There is also a problem differentiating avoidant disorder and social phobia. Indeed, there is considerable overlap between these conditions with some researchers indicating they only differ in symptom severity.

Question 60

What are the features of dependent personality disorders (DPD)?

Answer 60

People with this condition appear to be afraid to rely on themselves to make decisions. They seek advice and direction from others, need constant reassurance, and seek out relationships in which they can adopt a submissive role. Not only do they allow other people to assume responsibility for important aspects of their lives, but also seem to desperately need to do so. They seem unable to function independently. They subordinate their needs to those of other people, even people they hardly know.

Question 61

Which is arguably the most culture-laden of the personality disorders?

Answer 61

DPD - which seems to be rooted in the individualistic culture of North America, but is not as prevalent in collectivist cultures.

Question 62

What are the main features of obsessive-compulsive personality disorder (OCPD)?

Answer 62

Inflexibility and a desire for perfection. It is the centrality of these two features, and the absence of obsessional thoughts and compulsive behaviours, that distinguish this personality disorder from OCD. Preoccupation with rules and order makes these patients rigid and inefficient as a result of focusing too much on the details of a problem.

Question 63

What are some obstacles to treatment for clients with personality disorders?

Answer 63

1) Many of these patients are not themselves upset by their characteristic personality style and so do not seek treatment

2) High treatment dropout rate.

Question 64

What are Sperry’s five basic premises to achieving effective treatment outcomes with PD patients?

Answer 64

1) These disorders are best conceptualized in a way that considers both biological and psychological factors, and the more effective treatment will reflect this approach,

2) Before treatment, it is important to assess the individual’s amenability to treatment

3) Effective treatment is flexible and tailored to the individual client,

4) The lower the level of treatability in the client, the more the therapist must combine multiple treatment approaches, and

5) The basic goal of treatment should be to help the client improve in his or her overall level of functioning.

Question 65

What are the 3 main treatment approaches for PDs?

Answer 65

1) object-relations therapy (correcting the flaws in the self that have resulted from unfortunate formative experiences. Very slow process.)

2) Cognitive-behavioural approaches (cognitive restructuring - challenging the core beliefs that are thought to underlie PDs. Recent review suggests it significantly reduces symptoms and enhances outcomes for all the personality disorders.)

3) Medication.

Question 66

How does Schema therapy differ from CBT approach to treating PDs?

Answer 66

It also incorporates gestalt, object-relations, and psychodynamic treatment techniques while placing a heavy emphasis on clients’ early difficult life experiences and on their current therapeutic relationship.

Question 67

What medications can be used to treat borderline PD?

Answer 67

Antidepressants (e.g., SSRIs, tricyclics, MAOIs)

mood stabilizers (e.g., lithium carbonate)

anxiolytics (e.g., anti-anxiety medications),

opiate antagonists, and neuroleptics.

(antipsychotics were most effective among individuals with BPD who also displayed psychotic-like features. Antidepressants were found to yield significant improvements for those with BPD and major depression. Anticonvulsants were effective at reducing affective instability and impulsivity in individuals with BPD.)

Question 68

What medications have been found to be moderatly effective for schizotypal PD?

Answer 68

low doses of thiothixene

they also seem to respond to antidepressants.

Question 69

What four personality disorders have been propsed to be removed from the DSM completely?

Answer 69

schizoid, histrionic, paranoid, dependent