Personality Disorders Flashcards
DSM-5 Definition of Personality Disorder
a persistent pattern of emotions, cognitions and behavior that results in enduring emotional distress for the person affected and or for others and may cause difficulties with work and relationships
Personality Disorder
The pattern of maladaptive experience and behavior must also be:
-inflexible and pervasive across a broad range of personal and social situations
-the source of clinically significant distress or impairment in social, occupational or other important areas of functioning
-stable and long duration with an onset that can be traced back at least to adolescence or early adulthood
What are the DSM-5 Personality Disorders?
Cluster A: Odd or Eccentric Disorders
1. Paranoid PD
2. Schizoid PD
3. Schizotypal PD
Cluster B: Dramatic, Emotional or Erratic Disorders
1. Antisocial PD
2. Borderline PD
3. Histrionic PD
4. Narcissistic PD
Cluster C: Anxious or Fearful Disorders
1. Avoidant PD
2. Dependent PD
3. Obsessive-compulsive PD
What is the reliability of the personality disorder diagnoses?
Low!
-there is a lot of overlap among PD clusters
-gender bias
Prevalence of PD
10 to 14%
Paranoid PD (cluster a)
a pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent and 4 or more of the following:
-suspects others are exploiting, harming or deceiving
-preoccupied with unjustified doubts about loyalty or trust of friends
-reluctant to confide in others because of fear that it will be used against them
-reads hidden meanings into benign remarks or events
-persistently bears grudges
-perceives arrack on character and is easily angered
-recurrent suspicions without justification with fidelity of partner
Schizoid PD (cluster a)
A pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings, as indicated by four or more of the following:
-Neither desires nor enjoys close relationships, including being part of a family
-Almost always chooses solitary activities
-Has little, if any, interest in having sexual experiences with another person
-Takes pleasure in few, if any, activities
-Lacks close friends or confidants other than first-degree relatives
-Appears indifferent to the praise or criticism of others
-Shows emotional coldness, detachment, or flattened affect
Schizotypal PD (cluster a)
A pervasive pattern of social and interpersonal deficits marked by acute discomfort with, and reduced capacity for, close relationships as well as by cognitive or perceptual distortions and eccentricities of behavior as indicated by 5 or more of the following:
-Ideas of reference (excluding delusions of reference)
-Odd beliefs or magical thinking that influences behavior and is inconsistent with subcultural norms (e.g., superstitiousness, beliefs in clairvoyance, telepathy, or “sixth sense”, bizarre fantasies or preoccupations)
-Unusual perceptual experiences, including bodily illusions
-Odd thinking and speech (e.g., vague, circumstantial, metaphorical, overelaborate, or stereotyped)
-Suspiciousness or paranoid ideation
-Inappropriate or constricted affect
-Behavior or appearance that is odd, eccentric, or peculiar
-Lack of close friends or confidants other than first-degree relatives
-Excessive social anxiety that does not diminish with familiarity and tends to be associated with paranoid fears rather than negative judgments about self
Antisocial PD (cluster b)
There is a pervasive pattern of disregard for and violation of the rights of others occurring since age 15 years (and meets criteria for Conduct Disorder before the age of 15), as indicated by 3 or more of the following:
-Failure to conform to social norms with respect to lawful behaviors as indicated by repeatedly performing acts that are grounds for arrest
-Deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure
-Impulsivity or failure to plan ahead
-Irritability and aggressiveness, as indicated by repeated physical fights or assaults
-Reckless disregard for safety of self or others
-Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations
-Lack or remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another
**2-3 million in North America (only 100 are serial killers)
**no sense of shame or guilt or empathy for others & unable to learn from experience (Dr. Harvey Cleckley)
**Lee Robins (1996) did a longitudinal study of children with conduct disorder (30 years, compared psychotic and antisocial children’s characteristics)
Etiology of Antisocial PD
Bio: amygdala is less active and smaller, orbital cortex functions differently, ventromedial prefrontal cortex is defective, less reaction to emotional words
Enviro: parental loss, alcoholism, drug abuse, violence acts at home, pornography, violent media
Beh: modeling, reinforcement, childhood behavior problems
Treatment for Antisocial PD
-consequences for behavior
-empathy training
-transcranial stimulation
Example of Antisocial PD
Ted Bundy
Histrionic PD (cluster b)
A pervasive pattern of excessive emotionality and attention seeking, as indicated by 5 or more of the following:
-Is uncomfortable in situations in which he or she is not the center of attention
-Interaction with others is often characterized by inappropriate sexually seductive or provocative behavior
-Displays rapidly shifting and shallow expression of emotions
-Consistently uses physical appearance to draw attention to self
-Has a style of speech that is excessively impressionistic and lacking in detail
-Shows self-dramatization, theatricality, and exaggerated expression of emotions
-Is suggestible (i.e., is easily influenced by others or circumstances)
-Considers relationships to be more intimate than they actually are
Example of Histrionic PD
Scarlett O’Hara
Narcissistic PD
A pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy, as indicated by 5 or more of the following:
-Has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements).
-Is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love
-Believes that he or she is “special” and unique and can only be understood by, or should associate with, other special or high-status people (or institutions)
-Requires excessive admiration
-Has a sense of entitlement, i.e., unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations
-Is interpersonally exploitative, i.e., takes advantage of others to achieve his or her own ends
-Lacks empathy: is unwilling to recognize or identify with the feelings and needs of others
-Is often envious of others or believes that others are envious of him or her
-Shows arrogant, haughty behaviors or attitudes
Example of Narcissistic PD
Breaking Bad
Narcissistic PD: Gaslighting
-manipulated into ignoring your better instincts and judgements
-a pervasive pattern for people with this disorder
Danger of Narcissistic PD
-people with this diagnosis can be dangerous mentally (gaslighting, blaming, projection) and physically (trigger rage/interpersonal violence, careful when breaking up)
Malignant Narcissism?
-A combination of narcissistic and antisocial and paranoid personality disorders along with sadism
-Very egocentric
-Project their own “bad behavior” onto others
-Lack of conscience
-Lack true empathy
-Enjoy inflicting psychological, emotional, and/or physical harm or humiliation on others
-Manipulative
-Lie
-Paranoid
Borderline PD (cluster b)
A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity, as indicated by 5 or more of the following:
-Frantic efforts to avoid real or imagined abandonment (don’t include suicidal or self-mutilating behavior covered in criterion 5)
-A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation
-Identity disturbance: markedly and persistently unstable self-image or sense of self
-Impulsivity in at least 2 areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge-eating). Do not include suicidal or self-mutilating behaviors.
-Recurrent suicidal behavior, gestures, threats, or self-mutilating behavior
-Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days)
-Chronic feelings of emptiness
-Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights)
-Transient, stress-related paranoid ideation or severe dissociative symptoms
What is Otto Kernberg’s Psychodynamic Formulation for Borderline PD
-Faulty ego structure (weak ego)
-Primary process thinking (id impulses rule!)
-Lack of impulse control
-Splitting (Experience of self and other is divided into rigid categories—black and white, all good or all bad) (may explain mood swings and unstable relationships)
What is Masterson’s “The Search for the Real Self”?
Borderline PD
-Rewarded for regression and withdrawal
-As children, they submitted to parental wishes and expectations versus “self-activation”
-As adults, Self-activation triggers feelings of abandonment and leads to original defenses
-Depression develops from feelings of loss
What is Linehan’s Dialectical Behavior Theory and Therapy for Borderline PD?
-Primary problem is dysregulation of emotion combined with an invalidating environment
-High intensity of negative emotions
-Focus is on skill deficits in emotional regulation and interpersonal skills
-Key components include radical acceptance and distress tolerance
-Treatment focuses on individual and group therapy to learn new skills primarily in the areas of affect regulation and interpersonal relationships
Bio and treatments for Borderline PD
-no clear genetic link but being studied
-study focused on emotional reactivity
-medication somewhat helpful (mainly antidepressants)
