Personality Disorders Flashcards
1
Q
personality
A
- uniquely expressed characteristics that influence ABC interactions
- typically stable traits
2
Q
personality disorders
A
- inflexible and pervasive
- extreme and deviate from cultural expectations
- evident in adolescence and early adulthood, stable over time
- associated with distress/impairment
3
Q
DSM5 clusters
A
A: odd, eccentric
B: dramatic, emotional, erratic B
C: anxious, fearful
themes:
- not a lot of research on most PDs (except antisocial + borderline)
- no EBT for many
4
Q
cluster A types
A
- paranoid
- schizotypal
- schizoid
* more is known about symptoms than etiology
* prevalence = 3-5%
5
Q
paranoid PD: symptoms
A
- persistent distrust and suspiciousness of others
- expect to be mistreated and exploited by others
- reluctant to confide in others
- hypersensitive, cautious, vigilant
6
Q
paranoid PD: other aspects
A
- men > women
- prevalence = 3%
- no EBT
7
Q
paranoid PD: causes
A
- psychodynamic perspective
- paranoid personality traits result from projection - cognitive theory
- may filter + interpret responses of others through entrusting mental schema which accounts for their suspiciousness
8
Q
DSM5 schizoid PD
A
- pervasive pattern of detachment from social relationships and restricted range of expression of emotions in interpersonal setting
- at least 4:
1. neither desires/enjoys close relationships
2. almost always choose solitary activities
3. has no interest in sex
4. takes pleasure in few activities
5. lacks close friends or confidants
6. indifferent to praise/criticism from others
7. shows emotional coldness, detachment, flattened affectivity
9
Q
shizoid PD: other aspects
A
- men > women
- prevalence = 3–5%
- no EBT
10
Q
schizoid PD: causes
A
- genetically associated with schizophrenia
- cold + emotionally impoverished childhood lacking in empathy
11
Q
schizotypal PD: symptoms
A
- pervasive pattern of interpersonal deficits + cognitive/perceptual distortions and eccentric of B
- eccentric thoughts
- eccentric B/appearance
12
Q
schizotypal: eccentric thoughts
A
- odd/beliefs/magical thinking
- ideas of reference
- suspiciousness/paranoid ideation
- odd speech/thinking
- unusual perceptual experiences
- inappropriate and constricted affect
- excessive social anxiety
- lack of close friends
13
Q
schizotypal PD: other aspects
A
- men > women
- prevalence = 4%
- no EBT
14
Q
schizotypal PD: causes
A
- cognitive processing abnormalities may lead to
1. social isolation
2. hypersensitivity
3. inappropriate emotional responding - genetic link to schizophrenia
15
Q
cluster B: types
A
- antisocial
- histrionic
- narcissitic
- borderline
16
Q
antisocial PD: symptoms
A
- pervasive pattern of disregard for + violation of the rights of others
- pattern of anti-social behaviour continues into adulthood
- irresponsible B, breaking laws, disregard for safety of others
- deceitful, aggressive - conduct disorder present before age 15
17
Q
antisocial PD: other aspects
A
- men > women
- prevalence = 3%
- psychopaths/sociopaths refer to same subgroup - outdated term
18
Q
psychopathy: Robert Hare
A
factor 1
1. superficial charm
2. grandiose sense of worth
3. lack of empathy
4. shallow affect
5. manipulative
factor 2
1. failure to conform
2. impulsivity
3. irresponsibility
4. aggression
5. deceitful/lying
6. disregard for others
psychopathy encompasses both factors, whereas APD is mostly factor 2
19
Q
etiology: biological view of APD
A
- genetics
- brain abnormalities
- lower emotional responsiveness and stress reactivity
20
Q
biological view of APD: genetics
A
- concordance MZ>DZ
- higher rates of antisocial Bs among adopted children of biological APD parents
21
Q
biological view of APD: brain abnormalities
A
- prefrontal cortex, limbic system (especially amygdala)
- hypersensitivity (more amygdala reactivity) among APD without psychopathy
- evidence that psychopathy is associated with reduced amygdala volume + less response to fearful stimuli
22
Q
biological view of APD: lower emotional responsiveness and stress reactivity
A
- less susceptible to fear and anxiety
- less susceptible to fear + anxiety - adults with criminal records at 23 had impaired fear-conditioning responses responses at 3
- youth exhibiting antisocial B showed less reactivity in amygdala when shown pictures depicting fearful facial expressions
- especially prominent among psychopaths
- psychopaths found to have lower autonomic stress reactivity
23
Q
psychological view of APD
A
- psychodynamic
- cognitive
- behavioural
24
Q
psychological view of APD: psychodynamic
A
- faulty superego development
- poeple with APD = dominated by id impulsies
25
psychological view of APD: cognitive
- core beliefs that world is dangerous and hostile
26
psychological view of APD: behavioural
- neurobiological traits that impede learning
- lack of positive role models
- learn antisocial Bs from others
27
sociocultural view of APD
1. gender
- men more likely to exhibit these characteristics
- gender role socialization
- men tend to engage in direct acting out B
2. individualistic, competitive culture
- may fuel manipulative and dominating B
3. low SES
28
social view of of APD
1. childhood history of emotional and physical maltreatment
2. low parental warmth, harsh parenting
- nurturing parenting can help decrease antisocial traits
- providing positive reinforcement protects against genetic expression of traits
3. association with antisocial peers
29
APD treatments
- about 25% receive treatment
- usually unsuccessful
1. lak motivation
2. deceitful
3. pessism for treating psychopathy in adults
- early intervention is more effective
30
histrionic PD: symptoms
1. pervasive pattern of excessive emotionality and attention seeking
2. overly dramatic
3. superficial in emotions
4. use physical appearance to draw attention
5. inappropriate, sexually provocative and seductive
31
histrionic PD: other aspects
- mixed findings regarding gender prevalence
- prevalence = <1%
- no EBT
32
histrionic PD: causes
biological
1. some heritability
2. autonomic emotional excitability
social
1. parental reinforcement of a child's attention seeking B
2. histrionic parental models
33
narcissistic PD: symptoms
1. pervasive pattern of grandiosity (in fantasy/B), need for admiration, lack of empathy
2. grandiose view of own uniqueness and abilities
3. require almost constant attention and excessive admiration
4. envious of others
5. arrogant, exploitive, sense of entitlement
34
narcissistic PD: other aspects
- men > women
- prevalence = 1%
- no EBT
35
narcissistic PD: causes
- reduced brain connectivity related to reward sensitivity
- cognitive schemas ("others should satisfy my needs") = thought to underlie narcissistic characteristics
36
borderline PD: symptoms
pervasive pattern of instability and dysregulation in:
1. emotion and affect
- erratic moods, moods can shift abruptly
2. interpersonal relationships
- attitudes, feelings towards others vary dramatically
- chaotic relationships, fear of abandonment
3. self-image
- identity disturbance, unsure of themselves, sense of emptiness
4. behaviour
- impulsive B, self-destructive
- non-suicidal self-injury
37
borderline PD: other aspects
- women > men
- prevalence = 2%
- up to 75% report ta last 1 lifetime suicide attempt (up to 5% die by suicide)
- up to 80% engage in non-suicidal self-injury
38
biological view of BPD
1. moderately strong genetic component found in twin studies
2. abnormality in brain structure/functioning in prefrontal cortex + limbic regions
- these regulate and process emotions
- biologically based vulnerability to emotional dysregulation
- high sensitivity + reaction, slow return to baseline
39
psychological view of BPD
cognitive behavioural
1.distorted/inaccurate attributions for others Bs or attitudes
- can contribute to unstable + intense interperson relations
2. 3 basic assumptions
- "the world is dangerous"
- "I am powerless and vulnerable"
- "I am inherently unacceptable"
3. become fearful, vigilant, guarded, defensive, reactive
40
social view of BPD
- early experiences of neglect and abuse = unmet needs
- Linehan's diathesis-stress model
41
Linehan's diathesis-stress model
1. biological dysfunction in emotion regulation system
2. invalidating environment, trauma, abuse, neglect, loss, rejection
combination of both predisposes individual to developing BPD
42
BPD treatment misinformation
- some people believe incorrectly that BPD enjoy their disorder and are manipulative instead of suffering
- many clinicians believe BPD is untreatable (not supported by science, but treatment remains difficult)
43
treating BPD with DBT
- has strongest support
- "build a life worth living"
- rooted in CBT, heavier emphasis on B
- dialectics
- individual therapy + group skills training + consultations = available
- evidence particularly strong for decreasing suicidal B, non-suicidal self-injury, hospitalization, depression
44
dialectics: where 2 opposites can coexist
B to increase
1. distress tolerance
2. emotion regulation
3. interpersonal effectiveness
4. mindfulness
B to decrease
1. cognitive dysregulation
2. emotional reactivity
3. impulsiveness
4. interpersonal chaos
45
cluster C types
1. avoidant
2. dependent
3. obsessive-compulsive
research is limited
46
avoidant PD: symptoms
1. pervasive pattern of social inhibition, feelings of inadequacy, hypersensitivity to negative evaluation
2. fearful in social situations
3. sensitive to possibility of criticism, rejection, disapproval
4. reluctant to enter relationship unless sure you will be liked
47
avoidant PD: other aspects
- no gender difference
- prevalence = 3%
- on continuum with social anxiety
- no EB, though research for CBT = ongoing
48
social anxiety disorder vs avoidant PD
social anxiety:
- fearful of social circumtances
avoidant PD:
- fear of close social relations
49
biological view of avoidant PD
- fearful temperament
- interact with environment
50
psychological view of avoidant PD
- negative beliefs about consequences of social interactions
- avoidance of social situations can result in underdevelopment of social skills
51
social view of avoidant PD
- early childhood environmental (parent + peer rejection)
- parental modeling of fearful behaviours
52
dependent PD: symptoms
1. pervasive and excessive need to be taken of
2. leads to submissive and clinging B and fear of separation
3. overdependent on others
4. lack of self-reliance and confidence
5. subordinate own needs
53
dependent PD: other aspects
- gender differences unclear, more frequently diagnosed in women in clinical setting
- prevalence = 0.5% (varies because society places different values on dependent Bs)
- no EBT
54
dependent PD: causes
1. behavioural
- overprotective, authoritarina parenting
- may prevent child from developing sense of autonomy, self-efficacy
2. cognitive
- distorted beliefs that discourage independence
- see self as inherently inadequate and unable to cope
- course of action should be to find someone to take care of them
55
OCPD: symptoms
1. pervasive pattern of preoccupation with orderliness, perfectionism, mental and interpersonal control
2. at the expense of flexibility, openness, efficiency
3. preoccupied with details, rules, schedules
4. extreme perfectionism, rigid, inflexible
56
OCPD: other aspects
- women > men
- prevalence = 4%
- no EBT
- link with OCD = unclear (clinical presentations = different)
57
OCD vs OCPD
refer to table in notebook for differences and similarities
58
OCPD: causes
- minimal research
- altered brain activityin affect, rumination, cognitive flexibility
59
PD diagnosis challenges
- using curretn diagnostic system = challenging
1. many PDs do not cause distress, person lacks insight
2. poor reliability for PD categories
3. comorbidity = high, reducing diagnostic accuracy
60
approaches to diagnosing: DSM5
- curretn DSM5 = categorical
- 10 specific PDs
- each distinct clinical syndrome
61
alternative approaches to diagnosing: assess personality traits on a continuum
ELEVATION IN 1+ OF THE FOLLOWING PERSONALITY DOMAINS OR FACETS
1. negative affectivity vs emotional stability
2. detachment vs extraversion
3. antagonism vs agreeableness
4. disinhibition vs conscientiousness
5. psychoticism vs lucidity
* significant deviations on 5 key personality traits
62
alternative approaches to diagnosing: assess for personality impairment functioning
AT LEAST MODERATE IMPAIRMENT INVOLVING 2+ OF THE FOLLOWING AREAS
1. identity
- experience of onself as unique, with clear boundaries between self + others; stable self-esteem, capacity to regulate emotions
2. self-direction
- pursuit of coherent/meaningful goals; use self-reflection, positive standards of B
3. empathy
- understand + appreciate other's emotions/perspectives; understand effect of own's B on others
4. intimacy
- desire/capacity for closeness; respectful and interpersonal B
63
alternative approaches to diagnosing: negative affectivity
1. anxiousness
2. emotional lability
3. hostility
4. perseveration
5. (lack of) restricted affectivity
6. separation insecurity
7. submissiveness
64
alternative approaches to diagnosing: detachment
1. anhedonia
2. depressivity
3. intimacy avoidance
4. suspiciousness
5. withdrawal
65
alternative approaches to diagnosing: antagonism
1. attention seeking
2. callousness
3. deceitful
4. grandisosity
5. manipulativeness
66
alternative approaches to diagnosing: disinhibitation
1. distractibility
2. impulsivity
3. irresponsibility
4. (lack of) rigid perfectionism
5. risk taking
67
alternative approaches to diagnosing: psychoticism
1. eccentricity
2. perceptual dysregulation
3. unusual beliefs/experiences
