Personality Disorders

Question 1

What is a personality disorder? P 445

Answer 1

A persistent pattern of emotions, cognitions, and behaviour that results in enduring emotional distress for the person affected and or for others and may cause difficulties with work and relationships

Question 2

Personality disorder: Cluster A - Odd or eccentric disorders (3 disorders in this cluster) p 447
Describe paranoid personality disorder.

Answer 2

A pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent.

Question 3

Personality disorder: Cluster A - Odd or eccentric disorders (3 disorders in this cluster) p 447
Describe schizoid personality disorder.

Answer 3

A pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings.

Question 4

Personality disorder: Cluster A - Odd or eccentric disorders (3 disorders in this cluster) p 447
Describe schizotypal personality disorder.

Answer 4

A pervasive pattern of social and interpersonal deficits marked by acute discomfort with reduced capacity for close relationships, as well as by cognitive or perceptual distortions and eccentricities of behaviour.

Question 5

Personality disorder: Cluster B - Dramatic, Emotional or Erratic disorders (4 disorders in this cluster) p 447
Describe antisocial personality disorder.

Answer 5

A pervasive pattern of disregard for and violation of the rights of others

Question 6

Personality disorder: Cluster B - Dramatic, Emotional or Erratic disorders (4 disorders in this cluster) p 447
Describe borderline personality disorder.

Answer 6

A pervasive pattern of instability of interpersonal relationships, self image, affects and control over impulses.

Question 7

Personality disorder: Cluster B - Dramatic, Emotional or Erratic disorders (4 disorders in this cluster) p 447
Describe histrionic personality disorder.

Answer 7

A pervasive pattern of excessive emotion and attention seeking

Question 8

Personality disorder: Cluster B - Dramatic, Emotional or Erratic disorders (4 disorders in this cluster) p 447
Describe narcissistic personality disorder

Answer 8

A pervasive pattern of grandiosity (in fantasy or behaviour), need for attention and lack of empathy.

Question 9

Personality disorder: Cluster C - Anxious or fearful disorders (3 disorders in this cluster) p 447
Describe avoidant personality disorder

Answer 9

A pervasive pattern of social inhibition, feelings of inadequacy and hypersensitivity to negative evaluation.

Question 10

Personality disorder: Cluster C - Anxious or fearful disorders (3 disorders in this cluster) p 447
Describe dependent personality disorder

Answer 10

A pervasive and excessive need to be taken care of, which leads to submissive and clinging behaviour and fears of separation.

Question 11

Personality disorder: Cluster C - Anxious or fearful disorders (3 disorders in this cluster) p 447
Describe obsessive compulsive personality disorder

Answer 11

A pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness and efficiency,

Question 12

Personality disorder prevalence rates p 448

Question 13

Comorbidity of personality disorders is common? True or False p 450

Answer 13

True

Question 14

Personality disorder: Cluster A - paranoid personality disorder
Causes / contributions
What are the biological, psychological and cultural contributions? P 453

Answer 14

Biological research on contributions is limited with some research suggesting the disorder may be slightly more common among relatives of people who have schizophrenia.
Psychological contributions to be interpreted with care due to chance of strong bias in recall, but early maltreatment or childhood trauma may play a role
Early learning influences on schemas that perceive people as malevolent and deceptive.
Cultural contributions
Certain groups of people such as prisoners, refugees, people with hearing impairments, and older adults are thought to be particularly susceptible due to their unique experiences.

Question 15

Personality disorder: Cluster A - paranoid personality disorder treatment
P 453
Standard practices may include?

Answer 15

The mistrust of people makes seeking help unlikely. Developing a meaningful therapeutic alliance an important first step. Help seeking usually occurs following a crisis. Therapist try to provide an atmosphere conducive to developing a sense of trust. They often use cognitive therapy to counter persons mistaken assumptions of others.
To date however there are no confirmed demonstrations that any form of treatment can significantly improve the lives of people with paranoid personality disorder.

Question 16

Cluster A personality disorders
Psychotic like symptoms include p 454

Answer 16

Positive ideas of reference
Negative (social isolation etc)
See above image

Question 17

Personality disorders cluster A
Schizoid causes / contributions and treatment. P 454
Discuss causes

Answer 17

Early findings suggest that the brainstem inhibitory dysfunction more pronounced under fear and sadness
Childhood shyness is reported as a precursor which may be inherited and served as an important determinant in development of the disorder.
Abuse and neglect in childhood
Biological causes of autism spectrum disorder thought to overlap with schizoid personality disorder.

Question 18

Personality disorders cluster A
Schizoid causes / contributions and treatment. P 454
Discuss treatment

Answer 18

Rare for a person with schizoid personality disorder to seek treatment except on crisis such as extreme depression or losing a job.
Therapist often begins by pointing out value in social relationships. May need to be taught the emotions felt by others in order to develop empathy.
Often receive social skills training through role playing
Outcome research quite limited so evaluating effectiveness is done with caution.

Question 19

Schizotypal personality disorder (cluster A) causes p 456
Discuss

Answer 19

The idea of a relationship between schizotypal personality disorder and schizophrenia arises partly from the way people with the disorder behave. Many characteristics, including ideas of reference, illusions and paranoid thinking are similar but milder compared to the behaviours of schizophrenia individuals. Genetics also supports this relationship. Family, twin and adoption studies have shown an increased prevalence of schizotypal among relatives of schizophrenia people. These studies also show the strong influence that environments…

Question 20

Schizotypal personality disorder (cluster A) treatment p 456
Discuss

Answer 20

Will often seek help due to anxiety or depression. The presence of schizotypal disorder significantly increases the risk for developing major depressive disorder even in later years. Treatment includes some of the medical and psychological treatments for depression
Research had found using a combination of approaches either reduced symptoms or postponed the onset of later schizophrenia (anti psychotic drugs, community treatment and social skills training)

Question 21

Clusters B Personality Disorders p 459
Antisocial personality disorder and criminality discussed

Answer 21

Some have few or no legal or interpersonal difficulties, in other words, some psychopaths are not criminals,
A classic prospective longitudinal study showed that the at risk children with lower IQs were the ones who got in trouble suggesting having a higher IQ may protect from developing serious problems, or at least from getting caught.

Question 22

Clusters B Personality Disorders p 459
Antisocial personality disorder and criminality
Genetic influences / contributions / causes
Discussed p 460

Answer 22

Family, twin and adoption studies all suggest a genetic influence on both antisocial personality disorder and criminality.
Adopted as newborns, but with biological mothers who were felons - adopted offspring significantly higher rates of arrest, conviction and antisocial personality than adopted offspring born to non felon mothers.
This research also suggests at gene environment interaction as it was found that the adopted offspring who later became criminals (born to felons) spent more time in interim orphanages
Genetic research points to an interaction between genetics and environmental influences such as academic difficulties, peer problems, low family income, neglect and hash parental discipline.

Question 23

Clusters B Personality Disorders p 461
Antisocial personality disorder and criminality
Neurobiological influences / contributions / causes
Discussed

Answer 23

General brain damage does not explain why some people become psychopaths or criminals

Question 24

Clusters B Personality Disorders
Antisocial personality disorder and criminality
Arousal theories / contributions / causes
Discussed p 461
(Neurobiological)

Answer 24

According to the underarousal hypothesis, the abnormally low levels of cortical arousal characteristic of psychopaths are the primary cause of their antisocial and risk taking behaviour; they seek stimulation to boost their chronically low levels of arousal.

Question 25

Clusters B Personality Disorders
Antisocial personality disorder and criminality
Arousal theories / contributions / causes
Discussed p 462
(Neurobiological)

Answer 25

According to the fearlessness hypothesis, psychopaths posses a higher threshold for experiencing fear. Things that greatly frighten the rest of us have little effect on the psychopath

Question 26

Clusters B Personality Disorders
Antisocial personality disorder and criminality
Arousal theories / contributions / causes
Discussed p 462
(Neurobiological)
Gray s BIS and BAS brain Systems

Answer 26

Several theorists have applied Gray’s model of brain functioning to people with antisocial personality disorder, especially those with psychopathy. According to Gray, three major brain systems influence emotional behaviour and learning; the BIS, the reward system and the fight/flight system. The BIS is responsible for ability to stop or slow down when we are faced with impending punishment, nonreward, or novel situations. Activation of this system leads to anxiety and frustration.
The reward system is responsible for how we behave, in particular our approach to positive rewards and is associated with hope and relief.
An imbalance between BIS and the reward system may make the fear and anxiety produced by the BIS less apparent and the positive feelings associated with the reward system more prominent.

Question 27

Clusters B Personality Disorders
Antisocial personality disorder and criminality
Psychological and social contributions / causes
Discussed p 463

Answer 27

Discusses a card game where psychopathic criminals were more likely to continue playing and not be deterred despite feedback that reward was no longer forthcoming.
Aggression in children with antisocial personality disorder may escalate partly as a result of their interactions with their parents. … Child learns to fight and not give up (to get what they want) when parents give in to demands in order to restore calm.

Question 28

Antisocial personality disorder cluster B
Developmental influences / causes / contributions p 463
It is reported that antisocial behaviour begins to decline markedly around what age?

Answer 28

40
Non psychopath incarceration rates remain relatively stable

Question 29

Antisocial personality disorder cluster B
An integrated model / causes / contributions p 464
Biological, psychological and cultural factors combine in intricate ways, discuss.

Answer 29

Takes into account the gene environment interactions such as the potential role of fear conditioning in children. If this learning is impaired how does a child learn to avoid things that can harm you.
Deficits in amygdala are thought to make individuals unable to recognise cues that signal threat, making these people relatively fearless
Biological influences further interact with other environmental experiences such as early childhood adversity. In a family that may already be under stress because of divorce or substance use disorder there may be an interaction style that encourages antisocial behaviour on the part of the child.

Question 30

Antisocial personality disorder cluster B
Treatment p 464
What are the treatment methods used?

Answer 30

Issue is that these people rarely identify as needing treatment.
In general, therapists agree with incarcerating to deter future antisocial acts,
At risk children identified so treatment can be attempted before these children become adults.
A large study of violent offenders found CBT could reduce likelihood of violence 5 years after treatment, but success was negatively correlated with PCL-R ratings (traits like self, callous and remorseless use of others) - high scores on these trait’s related to psychopathy
The most common treatment strategy for children is parent training where parents are taught to recognise behaviour problems early and to use praise and privileged to encourage pro social behaviour.

Question 31

Cluster B Borderline Personality Disorder p 465
Comorbidity and prevalence rates include?

Answer 31

Mood disorder are common with one study showing 80% also had major depression and approximately 10% had bipolar II disorder.
Eating disorders are also common with 65% having some form of eating or feeding disorder , 25% with bulimia, 20% anorexia. Up to 64% are also diagnosed with at least one substance use disorder.

Question 32

Cluster B Borderline Personality Disorder p 468
Discuss the integrative model.

Answer 32

No currently accepted integrative model at this time but tempting to borrow from work on anxiety disorders. (Chapter five discusses the triple vulnerability theory)
The first vulnerability (or diathesis) is a generalised biological vulnerability. We can see the genetic vulnerability to emotional reactivity and the way it affects specific brain function.
Second - is a generalised psychological vulnerability- tend to view the world as threatening and to react strongly to real and perceived threats.
Third - specific vulnerability learned from childhood experiences where trauma or abuse may advance this sensitivity to threats ..

Question 33

Cluster B Borderline Personality Disorder p 468
Discuss treatment

Answer 33

These individuals are more likely than say antisocial personality disorder people to seek help due to marked distress, even more likely than people with anxiety and mood disorders.
Efforts to provide successful treatment are complicated by drug misuse, none compliance with treatment and attempts to take their own lives. Clinicians are generally reluctant to work with these people.
Dialectic Behaviour Therapy involves helping people with the stressors that seem to trigger suicidal behaviour and other maladaptive responses. Priority is first given to addressing behaviour that may result in harm then behaviour that interfere with therapy, and then those behaviours that interfere with quality of life…
Final stage clients learn to trust their own responses rather than depend on the validation of others ….

Question 34

Cluster B Histrionic personality disorder
Causes / contributions p 470
It has been proposed that histrionic personality disorder co occurs with what personality disorder and it has thus been suggested that histrionic is the sex typed female version / alternative expression of the same unidentified underlying condition.

Answer 34

Antisocial personality disorder.

Question 35

Cluster B Histrionic Personality Disorder p 470
Discuss treatment

Answer 35

Little research demonstrates success.
A large part of therapy usually focuses on the problematic interpersonal relationships. They often manipulate others through emotional crises, using charm, sex, seductiveness or complaining. Often need to be shown short term gains result in long term costs.

Question 36

Cluster B Narcissistic Personality Disorder. P 471
True or false, when confronted with successful people they can be extremely envious and arrogant and because they often fail to live up to their own expectations, they are often depressed?

Answer 36

True on both accounts

Question 37

Cluster B Narcissistic Personality Disorder. P 471
Causes / contributions and treatment
Discuss the role of socialisation,

Answer 37

We start out as self-centred, demanding infants which is part of our struggle for survival. Part of the socialisation process, however, involves teaching children empathy and altruism. Some believe this disorder arises largely as a failure by parents to successfully model empathy in the child’s development. Consequently the child remains fixated at a self-centred grandiose stage of development. In addition, the child and later the adult becomes involved in an essentially endless and fruitless search for the ideal person who will meet their unfulfilled empathic needs.
In a sociological view, prevalence in western societies is on a rise due to consequence of large scale social change including greater emphasis on short term hedonism, individualism, competitiveness snd success. However this apparent increase could be due to an increased interest in the disorder.

Question 38

Cluster B Narcissistic Personality Disorder. P 471
Causes / contributions and treatment
Discuss the treatment options.

Answer 38

Research is extremely limited.
When treatment is attempted, it often focuses on their grandiosity, hypersensitivity to evaluation and their lack of empathy toward others. Cognitive therapy strives to replace fantasies with a focus on the day to day pleasurable experiences truly attainable. Coping strategies such as relaxation training to help cope with accepting criticism. Helping them focus on the feelings of others.
Due to vulnerability in developing severe depression, particularly in middle age, treatment is often initiated for the depression.

Question 39

Cluster C Avoidant personality disorder p 473
Discuss causes / contributions

Answer 39

Some evidence suggests that it is related to other schizophrenia related disorders, occurring more often in relatives of people who have schizophrenia.
A number of theories proposed that integrate biological and psychological influences as the cause. For example, may be born with a difficult temperament or personality characteristics and as a result, parents may reject them or not provide enough early uncritical love. This in turn results in low self esteem and social isolation , conditions that persist into adulthood …

Question 40

Cluster C Avoidant personality disorder p 473
Discuss treatment

Answer 40

There are a number of well controlled studies.
Behavioural interventions techniques for anxiety and social skills problems have had some success.
Due to similarity with social phobia, research had looked at medical interventions for anxiety (selective serotonin etc) and found to be effective.
Therapeutic alliance appears to be an important predictor for success.

Question 41

Cluster C Dependent personality disorder p 474
Discuss causes / contributions and treatment

Answer 41

Part of the socialisation process in most cultures involves helping us live independently. It was thought early childhood experiences such as death of a parent, neglect or rejection by caregivers could cause people to grow up fearing abandonment. Also clear that genetic influences are important yet it is not yet clear on the interaction between genetic and environmental influences

Question 42

Cluster C obsessive compulsive personality disorder p 475
Discuss causes / contributions and treatment

Answer 42

There seems to be a moderate genetic component, some people being predisposed to favour structure in their lives but reaching level considered distressing and impaired may require reinforcement by caregivers etc.
Therapy often attacks the fears that seem to underlie the need for orderliness. These individuals are often afraid of inadequacy so procrastinate and excessively ruminate about important issues and minor details alike.
Therapist help with relaxation or use cognitive reappraisal techniques to reframe compulsive thoughts.