Personality

Question 1

Normal personality

Answer 1

patterns of perceiving relating to and thinking about the world and oneself
* Consistent over time
* Consistent across areas of one’s life
* Shaped by cultural expectations
* Facilitate social and occupational functioning

Question 2

Unhealthy personality function

Answer 2

rigidity, applying same concept to different situations

Question 3

Personality disorders

Answer 3

Enduring pattern of inner experience and behavior that deviates markedly from cultural expectations
Manifests in at least two areas
1. Cognition
2. Affectivity
3. Interpersonal functioning
* Dysfunctional relationships, bad at behaving well with others
4. Impulse control

Inflexible and pervasive: using same strategy across situations, pervades all areas of life

Distress or impairment

Stable and long standing

Question 4

Cognition

Answer 4

Common distorted thinking patterns
All or nothing thinking
Idealizing then devaluing other people of the self
Distrustful,suspicious thoughts

Question 5

Personality disorders

Answer 5

Often the relationships with PDs form are fraught with problems and difficulties

Many with PD believe there is nothing wrong with them

Onset that can usually be traced back to adolescence or early adulthood

Dont stem from reactions to stress but form developing an inflexible and distorted personality

Over Developed and undeveloped behavioral strategies(ways of existing in the world to get through life) specific to each personality disorder are used across situations and time

Strategies may have been adaptive when first developed

Question 6

Epidemiology
of Personality disorders

Answer 6

Up to 10-20% of general population
Some more frequent in men (ASPD)
Some more frequent in women (BPD)
Increased rates of unemployment, homelessness,domestic violence, and substance misuse
Indivduals with PD are at higher risk of early death from suicide or accidents
Associated with poorer respond to treatment
Key factor of treatment is therapeutic relationships, but they are not good at maintaining healthy relationships

Question 7

Cluster A:Odd/eccentric

Answer 7

Paranoid,schizoid, schizotypal

Question 8

Cluster B: dramatic/erratic

Answer 8

Antisocial
Borderline
Histrionic
narcissistic

Question 9

Cluster C:Anxious/fearful

Answer 9

Avoidant
Dependent
Obsessive-compulsive

Question 10

Controversy of clusters DSM

Answer 10

Where is the cut off?
At what point does someone’s score become a personality disorder
Reliability of diagnoses
Very poor reliability of diagnosis in the 80’s
Over time developed more reliable methods
Stability of diagnoses
Overlap of diagnoses
Huge overlap between disorders
Large comorbidity
Gender and cultural issues
Need to infer traits to make diagnosis, don’t have a specific behaviours clinician can judge
Tricky to diagnose

Question 11

Alternate proposed model

Answer 11

Criterion A: dimensional (0-4) rating of personality functioning in self (identity and self direction) and interpersonal (empathy, intimacy) functioning
Criterion B: dimensional ratings of 25 personality trait “facets” organized into five broad trait “domains”
Criterion C:prototypical system of six PD types

Question 12

Criterion B: dimensional ratings of 25 personality trait “facets” organized into five broad trait “domains”

Answer 12

high in detachment
withdrawal from interpersonal relationships
Intimacy avoidance

High Negative affectivity
High levels of wide range of negativity
Depression, anxiety, self-harm
Overly dependent on other people
Hostility

antagonism(opposite agreeableness)
Expecting people to do things for you
Unawareness of other peoples needs
Boost ones ego/self enhancement
grandiose attention seeking
Lack of empathy
Manipulative

Disinhibition(opposite consciousness)
Impulsive behavior
No planning for future

Psychoticism(opposite lucidity/openness)
Eccentric
Affecting social relationships

Question 13

alternate model:Criterion C:prototypical system of six PD types

Answer 13

Avoidant,schizotypal, narcissistic, obsessive-compulsive(less anxiety or fear that OCD), borderline, antisocial

Question 14

Paranoid Pd

Answer 14

Distrust and suspiciousness
* Unfairly suspects others of exploiting,harming,deceiving
* Preoccupied by doubts about others loyalty trust worthiness
* Reluctant to confide in others
* Reads hidden meanings into benign remarks events
* “Ideas of reference”=reading hidden meanings

Hostility
* Persistently bearing grudges
* Quick to react angry
* Recurrent unjustified suspicions of infidelity
* Generally difficult to get along with, have difficulty with close relationships
* Might appear as excessive aloofness or aggressiveness

Question 15

Schizoid PD

Answer 15

Detachment from social relationships and restricted emotional expression
Neither desires nor enjoys close relationships
Always choose solitary activities
Little or not interest in sex with others
Indifferent to praise or criticism
Emotionally cold, detached or flattened

Question 16

Schizotypal PD

Answer 16

Interpersonal difficulties
Unusual or restricted affect
Lack of close friends,confidants
suspiciousness
cognitive/perceptual distortions
Ideas of reference
Odd beliefs/magical thinking
Paranoia
Unusual perceptual experiences
Ie sensing someone there but there isn’t
Eccentric behavior
Odd thinking and speech
Eccentric peculiar behavior

Question 17

Avoidant PD(cluster c)

Answer 17

Avoidance of social situations
Hypersensitive to negative evaluation and rejection
Inhibition in relationships due to feelings of ineptitude and inadequacy
Avoidance of meeting new people
Fears of being shamed or ridiculed
Overlaps with GAD or social phobia(in characteristics, life course, genetic)
Avoidance of interpersonal relationships
Reluctance to try things that include meeting new people

Question 18

Dependent PD

Answer 18

Suggested for removal from DSM
Submissive,clinging behavior related to an excessive need to be taken care of
Requires excessive advice/reassurance for everyday decisions
Reluctant to make decisions
Needs others to assume responsibility
Difficulty expressing disagreement with others
Afraid to threaten relationships, don’t want to lose support from people
Lacks confidence to initiative projects or do things on their own
uncomfortable/helpless when alone
Needing a partner right always

Question 19

Obsessive-compulsive PD

Answer 19

Does not have obsessions or compulsions
Preoccupation with orderliness, perfection, control
Rigid perfectionism interferes with task completion
Excessively devoted to work at cost of leisure time,friendship
Restricted emotional expression
Overly conscientious,inflexible about morality, ethics, values
Overly rigid
Inflexibility
Relationships suffer bc of stubborns
Want tasks to be done in a certain way, not confident other people can do the task their way

Question 20

Narcissistic PD

Answer 20

Variable and vulnerable self-esteem regulated via attention and approval seeking
Draw sense of self from attention from others
Overt or covert grandiosity, need for admiration
Preoccupied with fantasies of unlimited success
Exploitative,entitled
Envious of others who do have success
Arrogant

Question 21

Histrionic PD

Answer 21

Excessive emotionality and attention seeking
Uncomfortable when not center of attention
Consistently uses physical appearance to draw attention to self
Theatrical dramatic style
Suggestible
Considers relationships to be more intimate than they are

Question 22

Borderline PD

Answer 22

Unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation
Affective instability due to a marked reactivity of mood
Frantic efforts to avoid real or imagined abandonment
Identity disturbance:markedly and persistently unstable self image or sense of self
Impulsivity in multiple ways that are potentially risky
Recurrent self injury or suicidal behavior or threats
Chronic feelings of emptiness
Intense angry outburst
Transient stress related paranoid ideation or severe dissociative symptoms

Question 23

Course of BPD

Answer 23

Greatest impairment and risk of suicide in young adulthood
Greater stability in 30s and 40s
50-85% of those diagnosed with BPD do not meet full criteria 10 years later

Question 24

Etiology of BPD

Answer 24

Biological
Genetic:5x more common among first degree biological relatives
Increases familial risk for substance use disorders,antisocial pd, mood disorder
Poor functioning of frontal lobes
Dysfunction in links between overactive limbic system and underactive amygdala dorsolateral PFC pathway

Question 25

Environmental evidence
of BPD

Answer 25

History of physical and sexual abuse common in BPD

Question 26

Antisocial PD

Answer 26

Pervasive pattern of disregard for and violation of rights of others occurring since 15 years as indicated by 3 or more of the following:
1)failure to conform to social norms with respect to lawful and ethical behavior
Repeatedly performing acts that are grounds for arrest
2)egocentric,callous lack of concern for others
Deceitfulness
Reckless disregard for safety of self or others
3)Impulsivity or failure to plan ahead
4)Irritability and aggressiveness
Repeated physical fights or assaults
5)consistent irresponsibility
Failure to sustain consistent work behavior or honor financial obligations
6)lack of remorse
Indifferent to or rationalizing having hurt, mistreated, or stolen from another
Antisocial PD prevalence
3%male,1%female(community)
47%male,21%female(prison)
More common in younger adults and those with lower SES

Question 27

Psychopathy

Answer 27

Key characteristic:poverty of emotions(both pos and neg)
Lack of remorse
No sense of shame
Superficially charming
Manipulates others for personal gain
Lack of anxiety
Other characteristics
Promiscuous sexual behavior
Many short term marital relationships
Criminal versatility

Question 28

Psychopathy checklist
interpersonal/affective

Answer 28

glib/superifical charm
Grandiose self-worth
manipulaitve/conning
callous/no empathy
Failure to accept responsibility for own actions
Pathological lying
Lack of remorse or guilt
Shallow effect

Question 29

Antisocial criminal lifestyle

Answer 29

Early behavioral problems,juvenile delinquency
Lack of realistic, long term plans
Parasitic lifestyle
Poor behavioral controls,impulsive,irresponsible
Need for stimulation
Revocation of conditional release

Question 30

Role of family

Answer 30

Lack of affection
Severe parental rejection
Physical abue
Inconsistent or no discipline
Failure to teach child responsibility toward others
Parental antisocial behavior

Question 31

Genetic correlates
of ASPD

Answer 31

Criminality and ASPD have heritable components
Higher concordance for MZ than DZ pairs
Higher prevalence of antisocial behavior in adopted children with bioparents who had APD and substance abuse

Question 32

Physiological findings
of ASPD

Answer 32

Skin conductance
Lower resting skin conductance
Less reactive to aversive stimulation
Electric shock
Distress in other humans
Heart rate
Normal at rest but faster than normal when anticipating intense or averise stimuli
Impulsivity
Activity in limbic system
EEG:Slow waves and spikes in temporal area

Question 33

Differentiating personality disorders

Answer 33

Avoidant pd vs social anxiety
avoidant personality disorder involves avoidance of most or all social areas of life, while social anxiety may only involve avoidance of a few specific situations
Schiztypal PD vs schizophrenia
Schizophrenia includes hallucinations and delusions. Schizotypal personality disorder does not. Schizotypal personality disorder often co-occurs with mood disorders
Obsessive compulsive PD vs OCD
Ocd has obsessions vs compulsions while Obsssesive compulsive PD does not