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C82PIN 18/19 > Personality and abnormal personality > Flashcards

Personality and abnormal personality Flashcards

1
Q

What is a mental disorder?

A

A clinically significant behavioural or psychological syndrome or pattern that occurs in an individual associated with present distress or disability, significant increased risk of suffering, death, pain, disability or an important loss of freedom.

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2
Q

What is a mental disorder not?

A

An expected or culturally sanctioned response to a particular event - hence grief is different to mental illness.
The behaviour and conflicts between individual and society, unless it is the symptom of dysfunction.

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3
Q

What must a mental disorder be?

A

Currently considered a manifestation of a behaviour, psychological or biological dysfunction in the individual.

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4
Q

What is common in personality disorders?

A

Co-morbidity.

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5
Q

What is a personality trait?

A

An enduring pattern of perceiving, relating to and thinking about the environment and oneself that are exhibited across a wide range of social and personal contexts.

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6
Q

How are personality traits related to personality disorders?

A

When traits are inflexible, maladaptive and cause functional impairment and/or distress.

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7
Q

What is a personality disorder?

A

An enduring pattern of inner experience and behaviour that deviates markedly from expectations of prevailing culture. Manifests within two or more of: cognitions, affectivity, interpersonal functioning and impulse control.

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8
Q

What are the features (A-E) of personality disorders according to the DSM?

A

A disorder that:
A. Is inflexible and pervasive across contexts
B. Leads to clinically significant distress or impairment in social, occupational or other areas
C. Is stable and can be traced back to adolescence or before
D. Is not better accounted for by another disorder
E. Is not due to physiological effects of substance or general medical condition

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9
Q

How are personality disorders coded (Axis II)?

A

By cluster.

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10
Q

What is Cluster A, and what personality disorders does it include?

A

Odd, eccentric. Includes paranoid, schizoid, and schizotypal.

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11
Q

What is Cluster B, and what personality disorders does it include?

A

Dramatic, emotional. Includes antisocial personality disorder, borderline, histrionic, and narcissistic.

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12
Q

What is Cluster C, and what personality disorders does it include?

A

Fearful, anxious. Includes avoidant, dependent, and obsessive-compulsive.

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13
Q

What is the prevalence of paranoid PD?

A
  • 0.5-2.5% general population
  • 2-10% outpatient mental health
  • 10-30% inpatient mental health
  • Increased if family has history of schizophrenia and delusions
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14
Q

When are symptoms of paranoid PD apparent from?

A

Childhood and adolescence.

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15
Q

What did Edens, Marcus & Morey (2009) state?

A

Evidence supports a dimensional rather than a dichotomous model for paranoid PD.

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16
Q

What is paranoid PD characterised by?

A

A pervasive pattern of mistrust of other people.

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17
Q

What are the main diagnostic criteria for paranoid PD?

A

Pervasive distrust and suspicion of others across contexts which doesn’t occur exclusively during a psychotic disorder or due to medication.

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18
Q

What is the prevalence of schizoid PD?

A
  • Uncommon in clinical settings

- Increased if family history in schizophrenia and schizotypal

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19
Q

What is schizoid PD distinguished from?

A

Psychotic disorders, ASD, avoidant and OCD.

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20
Q

What is schizoid PD not to be confused with?

A

Those who have defensive interpersonal styles, e.g. those who have moved to a strange new area.

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21
Q

When are symptoms of schizoid PD apparent from?

A

Childhood and adolescence - solitariness and poor peer relations (prone to victimisation).

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22
Q

Outline the key diagnostic criteria for schizoid PD.

A
  • Pervasive detachment from social relationships
  • Restricted emotional expression
  • Doesn’t occur exclusively during a psychotic disorder or due to medication
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23
Q

What is the prevalence of schizotypal PD?

A
  • 3% in general population

- Increased if 1st degree family shows biological schizophrenia

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24
Q

What is schizotypal PD distinguished from?

A

Psychotic disorders, schizoid PD, avoidant PD, ASD and language disorders.

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25
Q

What is schizotypal PD not to be confused with?

A

Those who have religious beliefs characterised by rituals.

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26
Q

How does schizotypal PD change over a lifetime?

A

Very little - stable life course, very few develop schizophrenia. However structure changes to become taxonic in adults (Fossati et al., 2007).

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27
Q

Outline the diagnostic criteria for schizotypal PD.

A
  • Acute pervasive discomfort with social relationships
  • Cognitive and perceptual distortions
  • Eccentric behaviour
  • Doesn’t occur exclusively with a psychotic disorder, pervasive development disorder or due to medication
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28
Q

What is the prevalence of antisocial PD?

A
  • 3% males, 1% females (community samples)
  • 3-30% in clinical samples
  • Higher in drug treatment and forensic settings
  • Increased if family history of antisocial PD or substance abuse
  • Nurture also plays a part in familial relationships
  • Higher in lower SES, perhaps due to middle class judgements of acceptable behaviours.
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29
Q

What is antisocial PD distinguished from?

A

Substance-related disorders, narcissistic PD, histrionic PD, borderline PD and paranoid PD.

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30
Q

When are symptoms of antisocial PD apparent from?

A

Childhood and adolescence, tend to diminish across lifespan.

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31
Q

What did Walters (2011) state about antisocial PD?

A

It’s dimensional.

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32
Q

Outline the diagnostic criteria for antisocial PD.

A
  • Pervasive disregard of rights of others since 15yrs
  • Over 18yrs old
  • Conduct disorder prior to 15yrs
  • Not during schizophrenia or mania
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33
Q

What is the prevalence of borderline PD?

A
  • 2% general population
  • 10% outpatient mental health
  • 20% inpatient mental health
  • 30-60% of PD clinical populations
  • Increased if family 1st degree biological, substance disorders, antisocial PD or mood disorders
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34
Q

What is borderline PD distinguished from?

A

Histrionic, schizotypal, narcissistic, antisocial and dependent PDs.

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35
Q

What is borderline PD not to be confused with?

A

Adolescent settling into identity/relationships.

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36
Q

When are symptoms most evident for borderline PD?

A

In early adulthood - relative stability in 30s.

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37
Q

What did Edens, Markus & Ruiz (2008) find about borderline PD?

A

It’s dimensional.

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38
Q

Outline the diagnostic criteria for borderline PD.

A
  • Pervasive instability of interpersonal relationships, self-image and affect
  • Marked impulsivity
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39
Q

What is the prevalence of histrionic PD?

A
  • 2-3% general population

- 10-15% inpatient and outpatient mental health

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40
Q

What is histrionic PD distinguished from?

A

Borderline, ASPD, narcissistic and dependent.

41
Q

What is histrionic PD not to be confused with?

A

Cultural norms of emotional expressiveness.

42
Q

When is histrionic PD evident from?

A

Early childhood.

43
Q

Outline the diagnostic criteria of histrionic PD.

A

Pervasive excessive emotionality and attention seeking expression.

44
Q

What is the prevalence of narcissistic PD?

A
  • <1% general population

- 2-16% clinical population (mostly male)

45
Q

What is narcissistic PD distinguished from?

A

Histrionic, borderline, OCD, schizoid, schizotypal. Grandiose beliefs not due to delusions.

46
Q

What is narcissistic PD not to be confused with?

A

Adolescent self-absorption.

47
Q

When are symptoms of narcissistic PD apparent from?

A

Early adulthood.

48
Q

What did Foster & Campbell (2007) state about narcissistic PD?

A

It’s dimensional.

49
Q

Outline the diagnostic criteria for narcissistic PD.

A
  • Pervasive grandiosity, need for admiration, lack of empathy.
50
Q

What is the prevalence of avoidant PD?

A
  • 0.5-1% general population

- 10% outpatient mental health

51
Q

What is avoidant PD distinguished from?

A

Social phobia, panic with agoraphobia, dependent, schizoid, schizotypal, paranoid.

52
Q

What is avoidant PD not to be confused with?

A

Expected difficulties due to immigration and childhood shyness.

53
Q

When is avoidant PD evident from?

A

Early childhood, doesn’t dissipate with age.

54
Q

Outline the diagnostic criteria for avoidant PD.

A

Pervasive social inhibition, inadequacy, hypersensitive to negative evaluation.

55
Q

What is the prevalence of dependent PD?

A

Extremely common in mental health clinics

56
Q

What can dependent PD be distinguished from?

A

Axis I, borderline, histrionic and avoidant.

57
Q

What is dependent PD not to be confused with?

A

Cultural norms of dependency in close relationships.

58
Q

When is dependent PD evident from?

A

Early adulthood.

59
Q

Outline the diagnostic criteria for dependent PD.

A
  • Pervasive need to be taken care of

- Submissive and clingy behaviour

60
Q

What is the prevalence of obsessive-compulsive PD?

A
  • 1% general population
  • 3-10% clinical mental health
  • Twice as common in males
61
Q

What is obsessive-compulsive PD distinguished from?

A

ASPD, narcissistic and schizoid.

62
Q

What is obsessive-compulsive PD not to be confused with?

A

Cultural norms of work ethics.

63
Q

When is obsessive-compulsive PD evident from?

A

Early adulthood.

64
Q

What did Calamari et al. (2004) state about obsessive-compulsive PD?

A

Some evidence of taxon structure.

65
Q

Outline the diagnostic criteria of OCPD.

A

Pervasive preoccupation with orderliness, perfectionism and control at expense of flexibility

66
Q

What is the normal personality trait N linked with in terms of personality disorders?

A

N is linked with most psychiatric conditions (Costa & McCrae, 1992).

67
Q

What is the normal personality trait E linked with in terms of personality disorders?

A

E associated with histrionic (+ve) and schizoid (-ve) (Wiggins & Pincus, 1989)

68
Q

What is the normal personality trait O linked with in terms of personality disorders?

A

O can influence the type of therapy a patient will respond to

69
Q

What is the normal personality trait A linked with in terms of personality disorders?

A

A influences rapport between patient and therapies (Costa & McCrae, 1992)

70
Q

What is the normal personality trait C linked with in terms of personality disorders?

A

C linked to ASPD (-ve), OCD (+ve) (Lyons et al., 1990)

71
Q

What is the normal personality trait P linked with in terms of personality disorders?

A

P linked to continuum with psychoticism through psychopathy to schizophrenia (Eysenck)

72
Q

What did Costa and McCrae (1992) investigate?

A

Personality disorder links with normal personality traits. Showed that paranoid PD is linked to N and A, borderline PD to N, O and A, and antisocial PD to E, O and A.

73
Q

What did Rector et al. (2002) study?

A

OCD links with Five Factor Model - examined personality differences in patients with a primary diagnosis of OCD or major depression.

74
Q

According to Rector et al. (2002), what should OCD be related to?

A

Higher C. OCD and Big 5 may also be related to depression.

75
Q

What did Rector et al. (2002) find?

A
  • Patients had higher N and low E & C compared to control statistics
  • OCD group had higher E, A and C than MD group
  • MD group had higher levels of N
76
Q

What did Rector et al. (2002) find when depression severity was controlled across patients?

A
  • OCD had higher E and A

- MD had higher N

77
Q

Which of Rector et al. (2002)’s findings is counter-intuitive, and why may this be?

A

OCD findings of no difference in C after controlling for depression severity.
May be due to OCD patients’ exceptionally high standards and so items are being responded to not via norms of others but of self.

78
Q

What problems are there with Rector et al. (2002)’s experiment?

A

Didn’t assess Axis-II co-morbidity, and used a cross sectional design.

79
Q

What did Costa & McCrae (1990) do?

A

Investigated the relationship between personality disorders and the FFM.

80
Q

What did Costa & McCrae (1990) measure?

A

Community population, using a combination of self-report, spouse ratings and peer ratings. Gave them the MMPI (based on DSM-III) and NEO-PI (self and other ratings).

81
Q

What did Costa & McCrae (1990) find?

A 
Significant correlations between:
Cluster A:
- Schizoid PD and N, -E, O, -A and C.
- Schizotypal PD and N, -E and -A.
- Paranoid PD and N, -A, and -C.
Cluster B:
- Schizoid and N, -E, O, -A and C.
- Schizotypal and N, -E and -A.
- Paranoid and N, -A and -C.
- Histrionic and -N, A, O and -C.
- Narcissistic and -N, E and -A.
- Antisocial and N, O, -A and -C.
- Borderline and N, -A and -C.
Cluster C:
- Avoidant and N and -E.
- Dependent and N, -E, A and -C.
- Compulsive and N, -E and -A.
82
Q

What did McClaren & Best (2010) investigate?

A

Non-suicidal self-injury (NSSI) (one of diagnostic elements) and borderline PD.

83
Q

What did McClaren & Best (2010) do?

A

Divided undergraduates into high, low and no self-harm (NSSI) and compared this to their scores for the FFM.

84
Q

What did McClaren & Best (2010) find?

A

High NSSI = higher N, lower A and C than control.
Low NSSI = higher N, lower A and O than control.
Those high in BPD tend to score higher N and lower A and C (same as high NSSI group). Borderline estimates from FFMs show higher borderline indicators in both NSSI groups.

85
Q

What did DeCuyper et al. (2009) investigate?

A

ASPD and psychopathy - they’re similar but distinct with different aetiologies , and links with FFM hypothesised in a dimensional approach which can help tease apart the disorders.

86
Q

What did DeCuyper et al. (2009) do?

A

Used work of Widiger & Lyman (1998) and Widiger et al. (2002), who translated psychopathy and ASPD into FFM criteria. Performed a meta-analysis looking at the effects across studies measuring the FFM and ASPD and psychopathy to see where the effects lie.

87
Q

What did DeCuyper et al. (2009) find?

A

Only found one of the hypothesised differences (Anxiety (N1)) between ASPD and psychopathy - for the rest of the scores they were the same.

88
Q

Can the FFM be used in clinical assessment?

A

According to Ben-Porath and Waller (1992), any additional measure needs to:

  • Do all the jobs of existing measures if replacement or,
  • Do additional functions to existing measures if supplement
89
Q

What is important to consider, as well as the content of the assessment, when using the FFM in clinical assessment?

A

The manner of interaction with therapist/assessment.

90
Q

What does a clinical assessment need to do according to Ben-Porath and Waller (1992)?

A
  1. Identification of symptoms and differential diagnosis
  2. Current adjustment and stable personality
  3. Treatment implications (related to forensic and legal issues)
91
Q

Can the Big 5 fulfil Ben-Porath and Waller (1992)’s requirements for clinical assessment?

A

Essentially, no:

  • John (1990): definitive labels not yet achieved for the big 5
  • Briggs (1989): “the big 5 (+/- 2) have yet to be defined by consensus with any degree of specificity” (p.248)
  • Some aspects not dealt with by big 5
    • E.g. autonomy, traditional values, maturity
92
Q

What problems with the Big 5 as a clinical assessment were outlined by Ben-Porath and Waller (1992)?

A
  1. Protocol validity

2. Depression, impulsivity and anxiety all load onto N

93
Q

Outline the problem of protocol validity.

A
  • The Big 5 doesn’t give information on how the client is cooperating
  • Costa & McCrae (1992) say SR is valid even when people aren’t removed on basis of question about engagement in assessment
  • According to Ben-Porath and Waller (1992), still may not give information on single client
94
Q

Outline the problem of depression, impulsivity and anxiety all loading onto N.

A

Tallegen (1985) stated that:

  • Depression = low positive emotionality (E)
  • Anxiety = high negative emotionality (N)
  • Impulsivity = low control (C)
95
Q

What did Costa & McCrae’s reply to Ben-Porath and Waller (1992) state?

A
  1. Don’t consider big 5 as standalone
  2. Don’t believe protocol validity checks work. When looking at MMPI against MMPI (observer ratings), protocol validity controls make the validity worse.
  3. Scales are different at facet level to domain
  4. Anxiety can be a part of depression (panic attacks) - impulsivity (of considered inability to resist urges and cravings), is similar to inability to tolerate tension and frustration = N.
96
Q

What is a problem with PD and the GFP?

A

Rushton et al. propose that GFP share characteristics of g, i.e. high levels of GFP are functional, lower levels are dysfunctional. The problem is that it may well be that extreme scores at either end are maladaptive (McDonald, 1995).

97
Q

What evidence is there for both extremes of GFP being maladaptive?

A

Livesley, Jang and Vernon (1998) found 4 similar phenotypic factors from PD that resembled 4 FFM domains, e.g. emotional dysregulation resembles high N, which is linked to paranoid, BDP, NPD and avoidant PD.
Importantly, O’Connor and Dyce (2001) examined correlations between FFM and low PDs and found that Low N, high in E, A and C i.e. high GPF without O is the profile of histrionic PD, which is completely contrary to GFP theory.

98
Q

What conclusions can be drawn from personality and PDs?

A
  1. ‘Normal’ personality traits can inform personality disorders
  2. Assumption that measures made for community samples can be used for clinical populations is a point for debate
  3. Links between PD and FFM has major problems for GFP
  4. It all rests on the key question: is personality to personality disorder a continuum (dimensional) or separate?

C82PIN 18/19 (11 decks)

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