module 8 Flashcards
1
Q
what is personality
A
characteristic ways that people think and behave across numerous situations
2
Q
what is a personality disorder
A
- disrupted emotions, cognitions, and/or behaviour
- persistent across situations and time
- enduring emotional distress and/or impairment
- not episodic, very enduring
- not something you just have, how someone thinks and behaves is disordered which is why treatment is much more difficult
- individuals may use their disorder to enhance their own status
3
Q
gender issues within personality disorders
A
- men and women tend to be diagnosed with different disorders
- men tend to be characterized as aggressive, perfectionistic, self assertive or detached
- women tend to be characterized as submissive, emotional, or insecure
- due to biased criteria, biased tools or biased clinicians
- clinician bias and clinicians leaning into stereotypes especially occurs in cluster B disorders
4
Q
age of onset within personality disorders
A
- exist in childhood
- diagnosis in late teens or young adulthood to suggest such a weight carrying label
5
Q
cluster A defining characteristics
A
- odd and eccentric behaviours
- seem most similar to psychotic disorders
- no age of onset data because they are considered lifetime disorders
6
Q
cluster A disorders
A
- paranoid PD → life % = 2-5%
- schizoid PD → life % = 3-5%
- schizotypal PD → life % = 1-5%
7
Q
paranoid PD
A
- 4/7 criteria
- no hallucination or delusions but have an overall poor quality of life
- more common in men
- pervasive distrust and suspiciousness of others, as indicated by:
- suspects others are exploiting, harming, or deceiving them;suspicious of motives and believe malicious intent
- reads hidden demeaning or threatening meanings into benign remarks or events
- perceives attacks on their character or reputation that are not apparent to others
8
Q
paranoid PD etiology
A
- genetics: if a family member has a psychotic disorder they may have a slightly increased risk of paranoid PD
- childhood maltreatment: related to reason individuals often perceive threats on themselves or character or belief people have malicious intent
- very negative cognitive schemas
9
Q
paranoid PD treatment
A
- very unlikely to see treatment and very difficult to form a therapeutic alliance
- treatment rarely works cause they often drop out
- CBT to challenge assumptions and behaviours
10
Q
schizoid PD criteria
A
- need 4/7 criteria
- most common in men
- pervasive detachment from social relationships and a restricted range of interpersonal emotional expression, as indicated by:
- neither desires nor enjoys close relationships
- lacks close friends or confidants other than 1st degree relatives
- almost always chooses solitary activity
- shows emotional coldness, detachment, or flattened affectivity
- indifferent to praise or criticism
11
Q
schizoid PD etiology
A
- genetics: if a family member has a psychotic disorder they may have a slightly increased risk of schizoid PD
- possible lower density of dopamine receptors
- childhood abuse, neglect or shyness
12
Q
schizoid PD treatment
A
they will rarely seek treatment but when they do in involves pointing out the value of relationships and increasing social skills training
13
Q
schizotypal PD
A
- pervasive social and interpersonal deficits marked by acute discomfort with, and diminished capacity for, social relationships, AND cognitive or perceptual distortions and eccentric behaviour, as indicated by:
1. ideas of reference
2. odd beliefs or magical thinking
3. unusual perceptual experiences, including bodily sensations
4. odd thinking and speech
5. odd/peculiar/eccentric behaviour and appearance
6. lack of friends
7. preoccupation with fantasy and daydreaming - more common among men
- comorbid with MDD
- main difference between schizotypal and schizophrenia is that with schizotypal they are very aware of society just experience magical thinking, daydreaming and quirky/odd behaviour
14
Q
ideas of reference - schizotypal PD
A
- individuals may believe that meaningless events are actually personally meaningful/significant
- e.g. believing trees are speaking to them, believing people on TV are talking about them
15
Q
odd beliefs - schizotypal PD
A
- believe that their own thoughts, actions, ideas or use of symbols can influence the course of events in the world
- e.g. belief they are telepathic, psychic or predict the future
16
Q
unusual perceptual experiences - schizotypal PD
A
- perceive events that other don’t
- e.g. may experience or perceive someone coming into a room and sitting next to them when no one is there, or experience sensations like they are levitating
17
Q
schizotypal PD etiological factors
A
- genetics: if a family member has a psychotic disorder they may have a slightly increased risk of schizotypal PD
- brain abnormalities: issues in the left hemisphere (speech centres) and may be what leads individuals to see things like ideas & speech/words as more connected than they are
18
Q
schizotypal PD treatment
A
- generally not effective
- antipsychotic medications show limited effectiveness
- focus on increasing social skills b/c they are more awkward or aloof
19
Q
cluster b defining characteristics
A
- elevated impulsivity that they end to be born with it
- dramatic, emotional, and erratic behaviours
20
Q
cluster b disorders
A
- antisocial PD
- borderline PD
- histrionic PD
- narcissistic PD
21
Q
antisocial PD
A
- pervasive disregard for and violation of the rights of others, as indicated by:
1. failure to conform to norms regarding lawful behaviour
2. impulsivity or failure to plan ahead
3. lack of remorse - history of conduct disorder or behaviour before age 15
- overtime criminal behaviour decreases around 30-40
- substance abuse is common and chronic
- more common among men
22
Q
antisocial PD etiological factors
A
- genetics
- underarousal hypothesis: individuals with antisocial PD are chronically underaroused and they commit terrible acts to increase that arousal
- fearlessness hypothesis: individuals with antisocial PD have a much higher threshold for experiencing fear
- coercive/inconsistent parenting
- low SES
- childhood physical abuse
23
Q
genetics as an etiological factor of antisocial PD
A
- influence both antisocial PD and is predictive of criminal activity
- family, twin, and adoption studies
- concordance rates in identical twins vs. fraternal twins, in identical twins the concordance rate is 55% )both twins will be criminals) and is only 13% in fraternal twins
- greatest risk factor is kids with antisocial parents and raise don an environment characterized by chronic stress
24
Q
coercive/inconsistent parenting as an etiological factor of antisocial PD
A
- coercive meaning parents using excessive coercive tactics to control their kids behaviour (e.g. domination, intimidation and humiliation to promote obedience)
- inconsistent meaning that rules exist but with enough push back from kids, parents will give into demands
25
Q
antisocial PD treatment
A
- will rarely seek treatment and when they do they may actually try and manipulate their therapist
- CBT and prevention programs include cognitive restructuring, and training parents to use praise and rewards to modify behaviour rather than coercion
26
Q
controversy of antisocial PD
A
- all psychopaths have antisocial PD but not all people with antisocial PD are psychopaths; psychopaths are a subset of antisocial PD
- 50-80% of male offenders have antisocial PD but only 15-25% have psychopathy
27
Q
characteristics of psychopathy
A
- glibness/superficial charm
- grandiose sense of self-worth
- pathological lying
- conning/manipulative
- lack of empathy
- more likely to plan out their acts (difference from antisocial PD)
- more likely to commit violent or sexual acts
- far less likely to engage in treatment
28
Q
borderline PD
A
- pervasive instability of relationships, self-image, and affects, as well as marked impulsivity, as indicated by:
1. frantic efforts to avoid real or imagined abandonment
2. impulsivity in two areas that are potentially self-damaging
3. chronic feelings of emptiness
4. recurrent suicidal behaviour, gestures, or threats, or self-harm
5. affective instability due to reactivity of mood
6. inappropriate/intense anger, or difficulty controlling anger
7. relationships are characterized by love and hate
8. substance abuse is common - symptoms tend to lessen in severity from age 30 onward
- more likely to be diagnosed in women
29
Q
etiological factors of borderline PD
A
- genetics: if a family member has BPD they are predisposed to BPD or other mood disorders
- correlation between early sexual or physical abuse and BPD: 60-90% of individuals with BPD may have been abused or neglected as children
- poor coping strategies: emotion regulation difficulties
30
Q
borderline PD treatment
A
- when they seek treatment it is often not for BPD but for comorbid diagnosis like depression, substance abuse or because of encouragement from people close to them
- medications: tricyclics, lithium, atypical antipsychotics
- dialectical behaviour therapy (DBT)
31
Q
dialectical behaviour therapy (DBT)
A
- holding two opposing emotions or thoughts and having acceptance for both of them
- involves mindfulness, cognitive restructuring, interpersonal work, and radical acceptance
- reduces suicidal behaviour and emergency room visits
- 88% achieve remission within 10 years; enough tools so that symptoms aren’t as severe or impairing them at the same level anymore
- become the most substantial and effective way of treating BPD
32
Q
bordline PD controversy
A
- borderline is comorbid with mood disorders
- 24%-74% have MDD
- 4%-20% have bipolar disorders
- and this proposed the question, could borderline PD be a rapid-cycling subtype of bipolar disorder?
33
Q
histrionic PD
A
- pervasive excessive emotionality (dramatic) and attention seeking, as indicated by:
1. uncomfortable in situations when they are not the centre of attention
2. uses physical appearance to draw attention
3. rapidly shifting and shallow expressions of emotions
4. highly suggestible/easily influenced by others because it helps them get attention - rates seem to be similar between men and women but women are more likely to be diagnosed because of therapist bias and stereotypes
34
Q
etiological factors of histrionic PD
A
- female form of antisocial PD: antisocial and histrionic co-occur more than you expect, so is it a different gendered expression of the same disorder?
- often present with all-or-nothing thinking, making simple life events or viewed as major life events and turn molehills into mountains (catastrophic cognitive distortion)
35
Q
histrionic PD treatment
A
- examining interpersonal relationships: help lear appropriate ways of gaining attention, understanding why they want attention
- help them to understand the short-term vs. long-term gains and consequences of their behaviour
36
Q
narcissistic PD
A
- pervasive grandiosity, need for admiration, and lack of empathy, as indicated by:
1. grandiose sense of self-importance
2. believes he/she is special and unique
3. lacks empathy
4. preoccupied with fantasies of unlimited success, power, brilliance, beauty or ideal love - commonly diagnosed in men (3/4)
37
Q
etiological factors of narcissistic PD
A
- lots of overlap with psychopathy
- failure to develop empathy
- hypersensitivity to evaluation: theories that they are incredibly insecure and presenting with grandiosity is a front to mask that
38
Q
narcissistic PD treatment
A
- treatment often occurred based on encouragement from others
- decreasing sense of grandiosity and hypersensitivity to evaluation through CBT
- increasing empathy: difficult to do because someone would need to be highly motivated to learn to be empathetic
- highly comorbid with MDD so you may be treating that as well
- motivational interviewing could be effective as well when dealing with comorbidity as well as narcissistic PD
39
Q
defining characteristics of cluster c
A
anxious and fearful behaviours
40
Q
cluster c disorders
A
- avoidant PD
- dependent PD
- obsessive-compulsive PD
41
Q
avoidant PD
A
- pervasive social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation, as indicated by:
1. avoids occupations that involve significant interpersonal contact often due to fear of criticism, disapproval or rejection
2. unwilling to get involved with others unless certain of being liked
3. restrained in intimate relationships and reluctant to engage in new activities b/c of fear shame, ridicule or embarrassment
4. views self as socially inept, personally unappealing, or inferior; inadequate to their core - equal in men and women
42
Q
etiology of avoidant PD
A
- parental rejection or lack of love; however, these are retrospective memories where there could be bias
- increased behavioural inhibition: exhibited this temperament as kids; hesitant to engage in new situations, fearful of strangers or newness in general
43
Q
avoidant PD treatment
A
- graduated exposure to feared situations
- social skills training in group formats
44
Q
controversy of avoidant PD
A
- comorbidity rate of approximately 40% with social anxiety disorder
- people with SAD may feel like the have poor social skills but they don’t they are just fearful whereas with avoidant PD they do have traits of social skill deficits
- avoidant PD use avoidance to cope with fundamental feelings of inadequacy where as people with SAD have healthy self-esteem but use avoidance to avoid negative scrutiny, not because they have a self-worth issue
- differences in childhood history: both may have experienced parental abuse or neglect; but seems to be much more of a risk factor for avoidant PD
- debilitation of symptoms: avoidant PD tend to have increased levels of anxiety compared to those with SAD
- differences in insight: people with SAD understand on a basic level that their anxiety/fears are irrational whereas with avoidant PD lack that insight and hold deep-rooted fear and feeling of worthlessness and believe it is true; leading them to often experience shame and self-loathing cause they believe they are worthless
45
Q
dependent PD
A
- pervasive and excessive need to be taken care of, leading to submissive and clinging behaviour and fears of separation, as indicated by:
1. difficulty making everyday decisions without excessive advice and reassurance
2. difficulty expressing disagreement with others b/c they fear loss of support and criticism
3. goes to excessive lengths for support from others: the ultimate people pleasers
4. urgently seeks new relationships for care and support when one ends - equal in men and women
- concern when they form relationship with antisocial PD or narcissistic PD
46
Q
etiology of dependent PD
A
- genetic influence
- excessive sociotropy: excessively valuing positive social interactions b/c they need others to enjoy their experience with them
- lack of autonomy
- influence on relationships
47
Q
dependent PD treatment
A
- CBT to gain independence and become personally responsible: evaluate their beliefs surrounding have to do something alone
- however they want therapist approval
48
Q
obsessive-compulsive PD
A
- pervasive preoccupation with orderliness, perfectionism, and mental or interpersonal control, as indicated by:
1. preoccupied with rules, lists, schedules, etc
2. perfectionism that interferes with task completion
3. excessively devoted to work and productivity
4. unable to discard worn-out or worthless objects; slight hoarding behaviour
5. rigidity and stubbornness: centres around morality and are inflexible in those areas; things are black or white
49
Q
etiology of obsessive-compulsive PD
A
- weak genetic contribution
- parental reinforcement of conformity, neatness, and orderliness: not uncommon to see a neat and tidy parent
- high levels of perfectionism, worry and rumination: they feel inadequate so they worry and ruminate, and even procrastinate about minor details cause they want it done so correctly
50
Q
obsessive-compulsive treatment
A
- CBT and relaxation: challenge automatic thoughts about cleanliness and rules
51
Q
obsessive-compulsive controversy
A
- sounds similar to obsessive-compulsive disorder
- comorbidity rate of 20-30%
- those with obsessive-compulsive PD tend to not have obsessive thoughts or compulsions
- they don’t have ego dystonic features, they just want things orderly and clean, but it is not achieved through compulsive, ritualistic behaviours
