Personality disorders Flashcards
Historical Aspect of Personality Disorder
- The concept of a personality disorder has been described for thousands of
years. In the 4th century B.C., Hippocrates concluded that all disease stemmed from an excess of or imbalance among four bodily humors: yellow bile, black bile, blood, and phlegm. - The medical profession first recognized that personality disorders, apart from psychosis, were cause for their own special concern in 1801, with the recognition that an individual can behave irrationally even when the powers of intellect are intact.
- Nineteenth-century psychiatrists embraced the term moral insanity, the
concept of which defines what we know today as personality disorders.
Personality Disorders def
A personality disorder consists of habitual maladaptive behavior without significant signs or symptoms of other mental illness.
Personality Traits
- Personality Traits are behaviors or mannerisms that are a habit but aren’t pervasive enough to be the full blown personality disorder.
- You will consistently have this trait, but it might not affect all of your life, and it is possible that it will change.
- Everyone has a personality trait. Only a few have a personality disorder.
Example Personality Traits:
Someone who has narcissistic traits might be very cold and ruthless at work, but kind to his children and friends. Perhaps they only became so ruthless
since a big promotion. Someone who has narcissistic personality disorder would be unable to empathise with anyone in any area of life. They would have been this way since late adolescence.
Personality Disorder vs Personality Trait
Personality Disorder
- Think and feel entirely different than others
- Rigid and symptoms don’t change
- Affects all areas of life
- Makes life a constant struggle
Personality Trait
- Can understand others
- Stronger or weaker through life
- Can affect one or several areas
- Causes issues now and then
Three Personality Disorder Clusters
Cluster A: PaSS
- This cluster includes the distrustful, emotionally detached, eccentric personalities.
A. Paranoid Personality Disorder
B. Schizoid
C. Schizotypal
Cluster B: BHAN
- This cluster includes those who have disregard for others, with unstable and
intense interpersonal relationships, excessive attention seeking, and entitlement issues with a lack of empathy for others.
A. Borderline Personality Disorder
B. Histrionic Personality Disorder
C. Antisocial Personality Disorder
D. Narcissistic Personality Disorder
Cluster C: ODA
- This cluster includes the avoider of social situations; the clinging, submissive
personality; and the person preoccupied with details, rules, and order.
A. Obsessive-Compulsive Personality Disorder
B. Dependent Personality Disorder
C. Avoidant Personality Disorder
Cluster A
Cluster A: PaSS
- This cluster includes the distrustful, emotionally detached, eccentric
personalities.
A. Paranoid Personality Disorder: The client is suspicious of others but not
psychotic.
B. Schizoid: The client is aloof, withdrawn and difficult to engage.
C. Schizotypal: The client have odd and nearly psychotic mannerisms but aren’t
fully schizophrenic.
Cluster A: Paranoid
Paranoid personality disorder as “a
pervasive, persistent, and inappropriate mistrust of others. [Individuals with
this disorder] are suspicious of others’ motives and assume that others intend
to exploit, harm, or deceive them”.
- Prevalence has been estimated at 1 to 4 percent of the general population
and is often only diagnosed when the individual seeks treatment for a mood or anxiety disorder.
- The disorder is more commonly diagnosed in men than in women.
Paranoid: Clinical Picture
- Constantly on guard, hypervigilant, and ready for any real or imagined threat.
- Appear tense and irritable.
- They avoid interactions with other people.
- They always feel that others are there to take advantage of them.
- They are extremely over-sensitive and tend to misinterpret even minute cues.
- They are constantly “testing” the honesty of others.
- Maintain their self-esteem by attributing their shortcomings to others.
- They are envious and hostile toward others who are highly successful and believe
the only reason they are not as successful is because they have been treated
unfairly. - Any real or imagined threat can release hostility and anger that is fueled by
animosities from the past
Paranoid: Predisposing Factors
- Studies have revealed a higher incidence of paranoid personality disorder
among relatives of clients with schizophrenia. - Psychosocially, people with paranoid personality disorder may have been
subjected to parental antagonism and harassment. They likely served as
scapegoats for displaced parental aggression and gradually relinquished all
hope of affection and approval. Anticipating humiliation and betrayal by
others, the paranoid person learned to attack first.
Cluster A: Schizoid
Cluster A: Schizoid
- Schizoid personality disorder is characterized primarily by a profound
defect in the ability to form personal relationships or to respond to others in
any meaningful way.
- These individuals display a lifelong pattern of social withdrawal, and their
discomfort with human interaction is apparent.
- Gender ratio of the disorder is unknown, although it is diagnosed more
frequently in men.
Schizoid: Clinical Picture
- People with schizoid personality disorder appear cold, aloof, and indifferent to
others. - They prefer to work in isolation and are unsociable, with little need or desire
for emotional ties. - In the presence of others they appear shy, anxious, or uneasy.
- They are inappropriately serious about everything and have difficulty acting in
a lighthearted manner. - Their behavior and conversation exhibit little or no spontaneity.
- Typically they are unable to experience pleasure, and their affect is commonly
bland and constricted.
Schizoid: Predisposing Factors
- Although the role of heredity in the etiology of schizoid personality disorder is
unclear, the feature of introversion appears to be a highly inheritable
characteristic. - Psychosocially, the development of schizoid personality is probably influenced
by early interactional patterns that the person found to be cold and
unsatisfying. - Clinicians have noted that schizoid personality disorder occurs in adults who
experienced cold, neglectful, and ungratifying relationships in early childhood,
which leads these persons to assume that relationships are not valuable or
worth pursuing.
Cluster A: Schizotypal
- Individuals with schizotypal personality disorder were once described as
“latent schizophrenics.” - Their behavior is odd and eccentric but does not decompensate to the level of
schizophrenia
Schizotypal: Clinical Picture
- Aloof and isolated and behave in a bland and apathetic manner.
- Magical thinking, ideas of reference, illusions, and depersonalization
- Examples include superstitiousness, belief in clairvoyance, telepathy, or “sixth
sense;” and beliefs that “others can feel my feelings.” - The speech pattern is sometimes bizarre. People with this disorder often
cannot orient their thoughts logically and become lost in personal
irrelevancies that seem vague and not pertinent to the topic at hand. - Under stress, these individuals may decompensate and demonstrate
psychotic symptoms, such as delusional thoughts, hallucinations, or bizarre
behaviors, but they are usually of brief duration (Sadock & Sadock, 2007).
They often talk or gesture to themselves, as if “living in their own world.” Their
affect is bland or inappropriate, such as laughing at their own problems or at a
situation that most people would consider sad.
Schizotypal: Predisposing Factors
- More common among the first-degree biological relatives of people with schizophrenia than
among the general population. - Although speculative, other biogenic factors that may contribute to the development of this
disorder include anatomical deficits or neurochemical dysfunctions resulting in diminished
activation, minimal pleasure-pain sensibilities, and impaired cognitive functions. - The early family dynamics of the individual with schizotypal personality disorder may have
been characterized by indifference, impassivity, or formality, leading to a pattern of discomfort
with personal affection and closeness. They were likely shunned, overlooked, rejected, and
humiliated by others, resulting in feelings of low self-esteem and a marked distrust of
interpersonal relations. Having failed repeatedly to cope with these adversities, they began to
withdraw and reduce contact with individuals and situations that evoked sadness and
humiliation. Their new inner world provided them with a more significant and potentially
rewarding existence than the one experienced in reality.
Cluster B
Cluster B: BHAN
- This cluster includes those who have disregard for others, with unstable and
intense interpersonal relationships, excessive attention seeking, and
entitlement issues with a lack of empathy for others.
A. Borderline Personality Disorder: These clients dread separations
B. Histrionic Personality Disorder: These are clients that exaggerate and who
respond with strong emotion to relatively minor difficulties
C. Antisocial Personality Disorder: These clients habitually break the law
D. Narcissistic Personality Disorder: These clients are extremely vain and
cannot empathise
Cluster B: Borderline
- Borderline personality disorder is characterized by a pattern of intense and
chaotic relationships, with affective instability and fluctuating attitudes toward
other people. - These individuals are impulsive, are directly and indirectly self-destructive,
and lack a clear sense of identity. - It is more common in women than in men, with female-to-male ratios being
estimated as high as 4 to 1 (Lubit, 2011).
Borderline: Clinical Picture
- Individuals with borderline personality always seem to be in a state of crisis.
- Their affect is one of extreme intensity, and their behavior reflects frequent changeability.
- Often these individuals exhibit a single, dominant affective tone, such as depression, which may give way periodically to anxious agitation or inappropriate outbursts of anger.
- Inability to be alone: Due to chronic fear of abandonment, clients have little tolerance for being alone. They prefer a frantic search for companionship, no matter how unsatisfactory, to sitting with feelings of loneliness, emptiness, and boredom
- Clinging and Distancing: When clients are clinging to another individual, they may exhibit helpless, dependent, or even childlike behaviors. They over-idealize a single individual with whom they want to spend all their time, with whom they express a frequent need to talk, or from whom they seek constant reassurance. Acting-out behaviors, even self-mutilation, may result when they cannot be with this chosen individual. Distancing behaviors are characterized by hostility and anger, arising from a feeling of discomfort with closeness. Distancing behaviors also occur in response to separations, confrontations, or attempts to limit certain behaviors.
- Self-destructive Behaviors: repetitive, self-mutilative behaviors, though fatal, commonly are manipulative gestures designed to elicit a rescue response.
Suicide attempts are quite common and result from feelings of abandonment following separation from a significant other. The endeavor is often attempted,
however, incorporating a measure of “safety” into the plan
One hypothesis on self-mutilating behaviors proposes that it takes place when the individual is in a state of depersonalization and derealization with the act
continuing until pain is felt in an attempt to counteract the feelings of unreality. Some clients with borderline personality disorder have reported that “to feel pain is better than to feel nothing.” The pain validates their existence.
- Impulsivity: Individuals with borderline personality disorder have poor impulse control based on primary process functioning. May include substance abuse,
gambling, promiscuity, reckless driving, and binging and purging. Many times these acting-out behaviors occur in response to real or perceived feelings of abandonment.
Borderline: Predisposing Factors
- Biochemical: serotonergic defect
- Genetic: linked to depression; persons with borderline personality disorder often have mood disorder as well.
- Psychosocial Influences: childhood trauma; family environments characterized by neglect, and/or separation; exposure to sexual and physical abuse; and serious parental psychopathology, such as substance abuse and antisocial personality disorder.” Forty to 71 percent of borderline personality disorder clients report having been sexually abused, usually by a non-caregiver. In some instances, this disorder has been likened to post-traumatic stress disorder in response to childhood trauma and abuse.
