Personality Disorder Flashcards
What are Personality Disorders?
A group of disorders marked by persistent, inflexible, maladaptive patterns of thought and behaviour that develop in adolescence or early adulthood and significantly impair an individual’s ability to function
What are the characteristics of a personality disorder?
Enduring pattern of behaviour that deviates markedly from expectations within the culture
Associated with unusual ways of interpreting events, unpredictable mood swings or impulsive behaviour
Result in impairments in social and occupational functioning
Represent stable patterns of behaviour that can be traced back to adolescence or early childhood
Previously characterized as Axis II disorders because they represent long-standing, pervasive and inflexible patterns of behaviour
What are the primary clusters of personality disorders?
DSM-IV-TR (APA, 2000) organised personality disorders into three clusters:
Odd/Eccentric Personality Disorders
Dramatic/Emotional Personality Disorders
Anxious/Fearful Personality Disorders
Odd/Eccentric Personality Disorders (Cluster A)
Disorder Characteristics
Paranoid
Suspiciousness and mistrust of others;
tendency to see self as blameless; on
guard for perceived attacks by others
Schizoid
Inability and lack of desire to form attachments to others; impaired social relationships
Schizotypal
Reduced capacity for close interpersonal relationships, eccentric behavior, and peculiar thought patterns
Dramatic/Emotional Personality Disorders (Cluster B)
Disorder Characteristics
Histrionic
Excessive emotionality and attention seeking
behavior; sexually provocative and seductive; theatrical; overly concerned re: own attractiveness
Narcissistic
Grandiosity and need for admiration;
self promoting; lack of empathy
Antisocial
Disregard for and violation of rights of others;
Lack of moral development; deceitfulness;
shameless manipulation of others
Borderline
Instability in interpersonal relationships, affect,
and self-image, impulsiveness; chronic feelings of
boredom; attempts at self-mutilation or suicide
Anxious/Fearful Personality Disorders (Cluster C)
Disorder Characteristics
Avoidant
Social inhibition and hypersensitivity to negative
evaluation; shyness; intimate relationships
difficult without guarantee of acceptance
Dependent
Excessive need to be taken care of leading to
submissive and clinging behavior; indecisiveness
– need others to make decisions for them or
reassure them; to avoid losing approval, never
disagree
Obsessive
Excessive concern with perfectionism,
Compulsive order, rules, and trivial details; lack of expressiveness
and warmth; difficulty in relaxing and having fun
What are some conceptual issues with personality disorders?
Personality Disorders may not be discrete disorders but represent extremes of normal personality (Costa & McRae, 1990)
Many of the characteristics of different personality disorders overlap (e.g. impulsivity)
What are the characteristics of anti social personality disorder?
The term sociopath or psychopath is sometimes used to describe this personality type
APD is now defined mainly in terms of violations of social norms
Is highly associated with criminal and violent behaviour
Prison populations have between 50-70% of inmates diagnosable with APD (Fazel & Danesh, 2002)
What are the characteristics of borderline personality disorder?
Features an enduring pattern of instability in personal relationships and lack of well-defined self-image
Fear of abandonment is a central feature which leads to conflict-ridden relationships
Associated with regular mood swings and aggressive behaviour
Highly comorbid with Axis I disorders such as depression and anxiety disorders
What Is ‘Disordered’ About Personality Disorders
People with personality disorders are often referred for treatment because of the consequences of their behaviour:
Some are unable to form lasting, close relationships
Many often develop comorbid Axis I disorders
Their behavioural style may be a risk to themselves or others
Many behavioural styles interfere with an individual’s ability to achieve in occupational or educational spheres
Gender Differences in Personality Disorders
75% of individuals diagnosed with Borderline Personality Disorder are female (Widiger & Trull, 1993)
Risk of avoidant, dependent and paranoid personality disorder is also greater in women
Cultural Differences in Personality Disorders
Little evidence to suggest that the prevalence of personality disorders differs across cultures
There may be some ethnic differences – BPD is higher in Hispanic than Caucasian & African Americans (Grant et al., 2004)
THE AETIOLOGY OF PERSONALITY DISORDERS
Because most symptoms of personality disorders differ, there will be no over-arching theory of causation personality disorders
One characteristic that is common to all is that their behaviour patterns are enduring, suggesting that inherited or developmental factors are important
Cluster B: Antisocial Personality Disorder
Because APD is closely related to criminal and antisocial behaviour attempts have been made to:
Identify childhood behaviours that may predict later adult APD
Identify the developmental factors that cause APD
Ascertain whether there is an inherited component to APD
Identify any biological or psychological processes that may be involved in APD
Childhood & Adolescent Behavioural Precursors of APD
The best predictor of APD is a diagnosis of conduct disorder during childhood
Adolescent smoking, alcohol use, illicit drug use, police trouble and sexual intercourse before 15-years are strong predictors of APD
Some theorists also suggest that ADHD is a predictor of APD (but see next slide)
Developmental Factors - APD
Antisocial behaviour may be learnt from parents (Paris, 2001)
Parents may reinforce antisocial behaviour (Capaldi & Patterson, 1994)
Lack of parental love may nurture antisocial behaviour (Gabbard, 1990)
Inconsistent parenting may be important during the development of APD (Marshall & Cooke, 1999)
Genetic Factors – APD
APD appears to run in families
Twin studies suggest higher concordance rates in MZ than DZ twins (Lyons et al., 1995)
Incidence of APD in an adopted child is better predicted by APD in the biological than adopted mother (Ge et al., 1996)
Cognitive Models - APD
Individuals with APD may possess dysfunctional schemas that determine their antisocial reactions (Young et al., 2003)
When responding to important events, individuals with APD may switch quickly and unpredictably between schemas to make their behaviour seem erratic (Horowtiz et al., 2001)
Physiological & Neurological Factors – APD
Individuals with APD exhibit physiological characteristics that may explain their APD:
Have significantly lower levels of anxiety and lower levels of physiological reactivity
Respond to emotional stimuli with slow autonomic arousal and low levels of EEG activity
Frequently fail to exhibit fear learning in aversive classical conditioning procedures (Lykken, 1995)
Risk Factors for BPD
A history of difficulties in childhood, including childhood physical, verbal and sexual abuse, childhood neglect or rejection, inconsistent or loveless parenting, and inappropriate parental behaviour (e.g. substance misuse or sexual promiscuity)
Academic underachievement, low intelligence and poor artistic skills
Biological Theories of BPD
Evidence for a genetic component (twin studies indicate concordance rates of 35% and 7% for MZ and DZ twins respectively) (Torgersen et al., 2000)
44% of individuals with BPD belong to a broader bipolar disorder spectrum
Individuals with BPD have a number of brain abnormalities e.g. dysfunctions in brain dopamine
Neuro-imaging techniques reveal abnormalities in a number of brain areas
Psychological Theories of BPD
Object Relations Theory
argues that individuals with BPD have received inadequate support and love from important others, resulting in an insecure ego which is likely to lead to lack of self-esteem and fear of rejection.
Splitting
A defence mechanisms in which aspects of others which are evaluated in a polarised fashion.
As with APD, individuals with BDP may acquire a set of dysfunctional schemas that maintain their erratic and emotional behaviour (Young et al., 2003)
Dialectical Behaviour Therapy (DBT)
Developed in the 1990s by Marsha Linehan, particularly for the treatment of BPD
Based on a biosocial theory of BPD (Linehan, 1993, cited in Palmer, 2002)
Dialectical refers to contrasting views or positions taken by the client
Emphasis on integrating opposing behaviours & on interconnectedness
Brings together aspects of CBT and principles of Zen Buddhism e.g. acceptance
Aims to foster the development of emotional regulation & tackle areas of skills deficit
Linehan published Cognitive Behaviour Treatment of Borderline Personality Disorder in 1993
Outpatient delivery
Intervention lasts around one year
Individual sessions, group skills training sessions and telephone support, plus weekly consultation group
4 modules
Emotion regulation, mindfulness, distress tolerance, interpersonal effectiveness
Schema Therapy
Developed by Young, Klosko & Weishaar (2003)
Schema theory outlines three specific stages:
Clients need to be convinced that their maladaptive schemas are actually a cause of their symptoms
Attempts to identify and prevent schema avoidance responses
Examination of the life events that have given rise to maladaptive schemas
Schema Domains & Early Maladaptive Schemas
Disconnection & Rejection
Mistrust/abuse
Abandonment/instability
Defectiveness/shame
Emotional deprivation
Social isolation/alienation
Impaired Autonomy & Performance
Failure
Dependence/incompetence
Enmeshment/undeveloped self
Vulnerability to harm or illness
Schema Domains & EMSs
Impaired Limits
Entitlement/grandiosity
Insufficient self-control/self-discipline
Other-Directedness
Subjugation
Self-sacrifice
Approval seeking
Overvigilance & Inhibition
Punitiveness
Emotional inhibition
Negativity/pessimism
Unrelenting standards
Schema Responses/Coping Styles
Avoidance
Overcompensation
Surrender
