Personality disorders Flashcards
What is a personality disorder?
personality traits/systems that are maladaptive
Five characteristics of personality disorders>
- Atypical
- Causes problems/harm (to individual AND others)
- Must include a level of social dysfunction
- Stable over time
- Ego-syntonic behaviour (behaviours that align with self-perception
What was Funder’s proposal of how Personality Disorders arise? (2013)
PD are a manifestation of healthy typical traits that have gone wrong somehow
-e.g. (independent, self-sufficient>schizoid) (proud>narcissitic)
2 key characteristics of PD>
> social
stable
ego-syntonic behaviour=
Behaviours that align with self-perception
2 key characteristics of PD> (1) social: (2) + (2)
- relative degree of extremity
- interpersonal:
>other people require for expression of traits
>expression of traits often problematic for others (not self)
2 key characteristics of PD> (2) stable>
- like other aspects of personality
- patterns usually emerge in late childhood or adoelsence
- difficult to change
How are personality disorders classified: 3 main clusters»
- Cluster A: Odd, eccentric
(difficult SOCIAL relationships with others) - Cluster B: Dramatic, impulsive, erratic,
(negative impact on others: ‘Outward’ facing) - Cluster C: anxious, avoidant fearful
(most self-damaging: ‘Inward facing’)
ego-syntonic=
“thats who i am” “other people are the problem not me” perception
>makes PD hard to treat
PD: Cluster A> cluster A is typified by?> (&impact)
contains 3 PD;
each typified by COGNITIVE thinking
impact: fractious personal & social relationships
Ego-dystonic=
opposite of ego-syntonic
contradiction between person’s sense of self and what they actually do
>(e.g. morally against stealing, but do so to fund addiction)
PD: Cluster A> includes:
- Paranoid personality disorder
- Schizoid personality disorder
- Schizoytpal personality disorder
PD: Cluster A: Paranoid personality disorder> what is it? summary
> extremely distrustful of motives of other people (very isolating)
affects 4% of general population
PD: Cluster A: Paranoid personality disorder> Behaviours> (3)
- persistent feelings of paranoia
- hypersensitive (innocent statements as personal attacks)
- persistent grudges against those perceived to have ‘wronged’ them
PD: Cluster A: Paranoid personality disorder> DSM-5> (6)
4+ for diagnosis
- without rational evidence, assume others out to exploit them
- preoccupied with trustworthiness of friends & family
- reluctance to confide in others
- persistent grudges regardless of actions to appease
- unjustified suspicions about sexual infidelity
- quick to verbally attack others to defend self
DSM=
Diagnostic systems manual
PD: Cluster A: Schizoid personality disorder> what is it? summary?
very inward facing, pattern of detachment from interpersonal & social relationships;
affects 1.6% of population
PD: Cluster A: Schizoid personality disorder> Behaviours (4)
- will ALWAYS seek solidarity
- lack close network of friends
- indifferent to praise/criticism
- limited sexual interest in others
PD: Cluster A: Schizoid personality disorder> DSM-5 (6)
4+ for diagnosis
- do not seek out close relationships
- takes pleasure in few activities
- always chooses solitary activites
- often no close friends
- emotionally cold to others (no level of attachment shown)
- little/no interest in sexual encounters
PD: Cluster A: Schizotypal personality disorder> what is it? summary
extreme discomfort with close relationships and distortions in thinking
>affects 1.6% of general population
PD: Cluster A: Schizotypal personality disorder> behaviours> (4)
- Athough aware the feeling originates from themselves a persistent belief others are noticing them
- Magical thinking: mind can affect physical world (sixth sense, idea control objects with mind etc)
- Identify objects as having special meanings
- Speak in metaphors & over-elaborate
PD: Cluster A: Schizotypal personality disorder: DSM-5 (4)
4+ for diagnosis:
- ideas of reference- the world is focused on them & their actions
- regular magical-thinking fantasies- ‘sixth’ sense, telepathy
- body illusions: distortions in sensations which manifest as phantom pains or unusual body feelings
- excessive social anxiety relating to feelings of paranoia about others
PD: Cluster B> how many disorders? & typified by? & impact?:
- 4 disorders, defined by lack of impulse control & disturbed cognition & affect
-impact: dramatic & impulsive behaviours which can negatively impact on others
PD: Cluster B: includes>
- Anti-social personality disorder
- Borderline personality disorder
- Histrionic personality disorder
- Narcissistic personality disorder
PD: Cluster B: Anti-social personality disorder> what is it? summary
General disregard for others which manifests in harmful behaviours;
>affects 0.2-3.3% of the general population
PD: Cluster B: Anti-social personality disorder> Behaviours (3)
- consistently violate the rights of others with impulsive or reckless behaviour
- consistently fails to plain or maintain long-term goals
- difficulty in controlling anger
PD: Cluster B: Anti-social personality disorder> DSM-5 (5)
3+ for diagnosis & MUST have occured since age 15
- continued failure to conform to social norms (acting within law)
- persistent deceitfulness- (personal profit & pleasure)
- repeatedly fails to plan ahead & instead acts on impulse
- consistent irritability (engagin in physical fights & arguments)
- lack of remorse for actions
PD: Cluster B: Borderline personality disorder> what is it? summary
unstable in self-image and typically has difficult interpersonal relationships (fear of abandonment)
>affects 0.7%>2.6% of population
PD: Cluster B: Borderline personality disorder> behaviours (3)
- poor impulse control (money, substance abuse)
- persistently seeks the company of others (fear of being alone)
- stress-related behaviour (anxiety, anger or depression)
PD: Cluster B: Borderline personality disorder> DSM-5 (9) + (4)
5+ for diagnosis
- frantic efforts to avoid real (or imagined) abandonment
- extremes with personal relationships (e.g. idealisation> dismissive & devaluing)
- identity disturbance (persistently unstable sense of self)
- impulsivity in at least 2 of: (1) eating, (2) driving, (3) sexual behaviour, (4) substance abuse
- repeated attempts at suicide/self-harm during difficult periods
- marked changes in mood (elation>extreme irritability)
- persistent feelings of emptiness
- difficulty controlling anger in social settings
- under duress, exhibit paranoid ideas or disassociation
PD: Cluster B: Histrionic personality disorder> what is it? summary
Excessive & persistent attention seeking & desire for approval
>affects 1.6-2% of the population
PD: Cluster B: Histrionic personality disorder> Behaviours>
- Over-involved in romantic relationships
- Increasing demands for excessive attention from partner (or others)
- engage in provocative sexual behaviour (means of attention seeking)
PD: Cluster B: Histrionic personality disorder> DSM-5 (8)
- Uncomfortable when not the centre of attention
- interpersonal interactions often sexual- based or provocative
- conversations based on creating an impression, not on exchange of ideas/facts/knowledge
- overly dramatic & engage in expressions of exaggerated emotion
- easily influenced by others & circumstances
- insincere & shallow expressions of emotion
- uses own physical appearance to draw attention to themselves
- considers relationships to be a great deal more intimate than the actual reality
PD: Cluster B: Narcissistic personality disorder> what is it? summary
inflated sense of self-importance & pre-occupied with personal achievements
>affects 1.6-2% of the general population
PD: Cluster B: Narcissistic personality disorder> Behaviour> (3)
- seeks admiration from others
- centre inter-personal relationships around themselves
- engage in fantasies about own achievements
PD: Cluster B: Narcissistic personality disorder> DSM-5 (7)
5+ for diagnosis
- inflated sense of self (grandiose)
- preoccupied with power fantasies
- believe themselves to be unique
- entitled to what they want (unrealistic expectations)
- tendency to be envious of others who achieve what they want
- arrogant in behaviour + attitude
- exploitative of others & lacking in empathy
PD: Cluster C: how many disorders? & characterised by & impact=
3 disorders typified by persistent feelings of inadequacy, high anxiety & difficult social relationships
>impact: most self-damaging & least to other
PD: cluster C> includes>
- Avoidant personality disorder
- Dependent personality disorder
- Obsessive-compulsive personality disorder
PD: Cluster C: Avoidant personality disorder> what is it? summary
Due to persistent low self-esteem, are extremely socially inhibited & feel like will be negatively judged by others
>affects 5% of population
PD: Cluster C: Avoidant personality disorder> Behaviours (3)
- Avoid social gatherings, (despite some desire to attend)
- Exhibit traits others would classify as ‘shy’
- Only form relationships after a long period of developing trust
PD: Cluster C: Avoidant personality disorder> DSM-5 (6)
4+ for diagnosis
- Avoid activities which involve interpersonal engagement
- Must be certain they will be like before engaging in social activities
- restrained in intimate relationships due to feelings of inadequacy
- preoccupied with possibility of criticism
- self-perception as socially inept
- unusually reluctant to engage in new activities for fear of embarrassment
PD: Cluster C: Dependent personality disorder> what is it? summary
A persistent and pathological need for others to take care of them (0.6% of the population)
PD: Cluster C: Dependent personality disorder> Behaviours> (3)
- Display submissive & ‘clinging’ behaviour
- let others take the responsibility for major areas of their life
- Derive self worth from achievements of others
PD: Cluster C: Dependent personality disorder> DSM-5 (8)
5+ for diagnosis
- Difficulty making everyday decisions
- need others to take responsibility for major areas of their life
- tendency to agree with others for fear of displeasing them
- reluctance to initiate activities due to a lack of confidence
- will go to excessive lengths to please others (even at personal cost)
- uncomfortable alone as fear they will not be able to cope
- quickly seek out a new relationship after one ends
- unrealistically preoccupied with fears of abandonment
PD: Cluster C: Obsessive-compulsive personality disorder> what is it? summary
excessively preoccupied with maintaining order & perfection
>affects 21-7.9% of the population
PD: Cluster C: Obsessive-compulsive personality disorder> Behaviours> (3)
- Frequent checks to maintain ‘perfection’
- Inflexible in their approach to completing a task (even if it is inefficient)
- Resistant to collaboration & accepting ideas from others
PD: Cluster C: Obsessive-compulsive personality disorder> DSM-5 (7)
4+ for diagnosis
- overly preoccupied with details & organisation to the detriment of the task
- interest in perfectionism which interferes with completion of the task
- excessive devotion to work at the cost of personal life
- tendency to enforce rigid moral standards on themselves and others
- unable to discard worthless objects
- does not delegate tasks to others in group activities
- miserly (stingy) with money for themselves and others
What is the dark triad? concept
idea that 3 traits: narcissism, machiavellianism & psychopathy together create the most toxic, dangerous person that can exist
What are the three components of the dark triad?
> Narcissism= inflated sense of importance (arroagnce, self-absorbed, selfish)
Machiavellianism= highly manipulative, entirely self-interested, absence of morality
Psychopathy= impulsivity, zero/little empathy, anti-social behaviour
The dark triad: Behaviours> (5)
> initial encounters= charming & engaging> later fades
perpetual victimhood= gaslight others so they qn reality
relationship dynamics= inability to sustain long-term relationships
pathological lying= inventing fantasy & backstories relevant to context & desires
fulfilment seeking= emotionally, physically & financially
Measuring Dark triad>
- found high % of people in business with dark triad
Difficulty of measuring dark triad> & how to overcome
> self report: cannot trust self-report from pathological liars
can overcome with experimental research:> participant must not know researcher’s intentions
PD: Nature or nurture?> study of twins & 3 clusters (Torgersen, 2001)> Findings
heritability quotient: 0=all environment; 1=all genetics
>Cluster A: (0.37)
-paranoid: (0.28); schizoid (0.29), schizotypal (0.61)
>Cluster B: (0.60)
-antisocial (NR), Bordeline (0.69), Histrionic (0.67), Narcissistic (0.77)
>Cluster C: (0.62)
-avoidant (0.28), Dependent (0.57), OCD (0.77)
>average across all PDs: (0.60)
PD: Nature or nurture?> study of twins & 3 clusters (Torgersen, 2001)> Overall & summary of findings
- Schizotypal (A), Narcissistic (B) & OCD (C) all had very high heritability quotient (0.60+)
- across all PDs (0.60)
PD: Nature or nurture?> study of PD heritability amoung children (coolidge et al, 2001)> outcome>
12 personality disorders: (N=112)
outcome: average heritability coefficient=0.75
N or N?> study of Childhood & Cluster C PDs (R-K et al, 2008)> which PD was found most likely to be inherited?
Avoidant personality disorder most likely to be inherited
PD: nature or nurture? trend suggested across data>
There is strong evidence for a genetic heritability component (predisposed), which needs to be environmentally shaped (via stress/ traumatic experiences) to develop it
Nurture & PD> DSM assumption>
PD can develop in childhood in abusive parental circumstances
Nurture & Antisocial personality disorder (APD)
> low-levels of parental affection= increased risk of APD (johnson et al, 2006)
61% of adult participants with APD reported emotional abuse in childhood (Rettew et al, 2003)
Nurture & BPD> study: (Helgeland & Torgensen, 2004)
- 28 year longitudinal study for BPD vs control group
- BPD group= higher incidents of abuse & parental psychopathy
Nurture & Schizotypal (SPD)- findings from literature review (Dong-2021) of 1994-2018>
parent related negative incidents (e.g. disrupted or severely inconsistent parenting) were higher in SPD sufferers
Big 5 & personality disorders> Saulsman & Page (2004) Meta-analysis- Big 5 & 10 personality disorders> findings»
All PD’s (except dependent) best understood via (1) neuroticism & (2) LOW-scoring agreeableness
Can PDs be treated?>
- very hard to treat
- over 1/3 drop out of treatment
- psychotherapy works for some (borderline) but not others (anti-social) [cristea, 2017; gibbon, 2020]
- major qn of how to access “improvement”> informant report? self report?
Implications of diagnosing PD>
- Are we just pathologising human responses to traumatic situations?
- where is line between normal/abnormal
- what counts as “disordered”?
- socially undesirable?= context dependent (dark triad: SU now but has pros etc)
