Personality Disorders Flashcards
1
Q
What is personality?
A
- the characteristic way a person behaves
- pervasive = influences all aspects of our lives
2
Q
What are the big 5
A
- openness
- contentiousness
- extraversion
- agreeableness
- neurotism
3
Q
Describe - Neuroticism
A
- opposite = emotional stability
- anxious vs unconcerned
- angry/hostile vs dispassionate
- self-conscious vs shameless
- impulsive vs restrained
- vulnerability vs fearless
4
Q
Describe - Extraversion
A
- opposite = introversion
- warm vs cold
- gregarious vs withdrawal
- assertiveness vs submissiveness
- activity vs passivity
- excitement seeking vs dullness
5
Q
Describe - openness
A
- opposite = closedness
- fantasy vs concrete
- feelings vs alexithymia (when people have difficulty expressing emotions)
- actions vs routine
- ideas vs closed-minded
- values vs dogmatic
6
Q
Describe agreeableness
A
- opposite = antagonism
- trust vs mistrust
- straightforward vs deception
- altruism vs exploitation
- compliance vs opposition/aggression
- modesty vs arrogance
- tender-minded vs tough-minded
7
Q
Describe - Conscientiousness
A
- opposite = disinhibition
- competence vs ineptitude
- order vs disordered
- dutifulness vs irresponsibility
- achievement striving vs lackadaisical
- self-discipline vs negligence
- deliberation vs rashness
8
Q
What is a personality disorder>
A
- the characteristic way a person behaves and thinks that causes significant distress to themselves and/or others
- DSM = inflexible and maladaptive, and cause significant impairment or subjective distress
- chronic and pervasive
9
Q
Describe - Paranoid personality disorder
A
- occupation : unable to hold job
- poor relationships: unable to trust people, no long-term relationships/friendships
- lifestyle: unstable, frequently moving bc believes neighbors are out to get them
10
Q
Describe PD - degree vs kind
A
degree - symptoms are extreme versions of otherwise “normal” traits
kind - PD a type of personality disorder that is “different” from psychologically healthy behavior
11
Q
Name some controversy’s with PD
A
- Multiple problems with current system:
- high comorbidity
- low validity of diagnosis
- high overlap in etiologies
- bad reliability, will 2 clinicians diagnose the same thing - Revision: goal to create dimensions of different personality traits along the lines of the “Big 5”
- not included in the DSM5 to to difficulty in making a diagnosis and potential problems in using that info to design treatments
- dimensional models of personality are based on healthy people - may not apply to PD
- is there actually a fundamental difference - Proposal to eliminate paranoid, schizoid, histrionic, avoidant and dependent pd
- rational based on a relative lack of research on these disorders and significant comorbidity ( suggests that maybe there is something else that unifies them)
- general PD with the traits specified (suspiciousness, emotional liability, hostility…)
- final DSM 5 retained all disorders, relegated dimensional model to section 3
- people often just get a really general diganosis
12
Q
Describe based on the 5 factor model of personality: paranoid
A
N:
E: low
O: low
A: low*
C:
13
Q
Describe based on the 5 factor model of personality: schizoid
A
N:
E: low*
O:
A:
C:
14
Q
Describe based on the 5 factor model of personality: schizotypal
A
N: high*
E: low*
O: high*
A:
C:
15
Q
Describe based on the 5 factor model of personality: Borderline
A
N: high*
E: high
O:
A: low
C: low
16
Q
Describe based on the 5 factor model of personality: Narcissistic
A
N: high
E: high
O:
A: low*
C: low
17
Q
Describe based on the 5 factor model of personality: histrionic
A
N: high*
E: high*
O: high*
A:
C: low
18
Q
Describe based on the 5 factor model of personality: antisocial
A
N:
E:
O:
A: low*
C: low*
19
Q
Describe based on the 5 factor model of personality: dependent
A
N: high*
E:
O:
A: high*
C:
20
Q
Describe based on the 5 factor model of personality: Avoidant
A
N: high*
E: low*
O:
A:
C:
- similar to social phobia
- avoid social situations
- social phobia might just avoid giving a speech, but avoidant pd structure their life so they don’t have to interact with people
21
Q
Describe based on the 5 factor model of personality: obsessive - compulsive
A
N: high
E: low
O: low
A: high*
C:
22
Q
Describe - General Personality Disorder
A
a) enduring patterns of inner experience and behaviors that deviates markedly from what is expected if the individuals culture. manifests in 2 + of the following:
1) cognition
2) affectivity ( range, intensity, lability, and appropriateness of emotion response)
3) interpersonal functioning
4) impulse control
b) the enduring pattern is inflexible and pervasive across a broad range of personal and social situations
c) the enduring pattern leads to clinically significant distress or impairment in social, occupational, or other important areas of functioning
d) the pattern is stable ad of long duration, and its onset can be traced back to at least to adolescence or early adulthood
- usually mid 20s
-
e) the enduring pattern is not better explained a a manifestation or consequence of another mental disorder
f) the enduring pattern is not attributable to the physiological effects of a substance or another medical condition
23
Q
What disorders are considered:
A
- paranoid
- schizoid
- schizotypal
24
Q
What disorders are considered: Dramatic/erratic
A
- borderline
- narcissistic
- histrionic
- antisocial
25
What disorders are considered: anxious/fearful
- dependent
- avoidant
- OCD
26
Consequences of the description of general PD
- alternative model defines personality by impairments in personality functioning and pathological personality traits
*****slide "controversys -- after general PD"
27
How do they change the big 5 when looking at PD
- replace openness with psychoticism
opp = lucidity
- culturally incongruent oddness vs conventionality
- cognitive and percept
***** slide 18
28
Controvesy slide with criterion C *****
29
Describe: Odd- eccentric PD
- people with these disorders have symptoms similar to those of people with schizophrenia, including inappropriate or flat affect, odd though and speech patterns, and paranoia.
- people with these disorders maintain their grasp on reality
30
Describe: Dramatic-erratic PD
- people with this disorders tend to be manipulative, volatile, and uncaring in social relationships
- they are prone to impulsive, sometimes violent behaviors that show little regard for their own safety or the safety or needs of others
31
Describe: anxious-fearful PD
- people with these disorders are extremely concerned about being criticized or abandoned by others and, thus, have dysfunctional relationships with others
32
What is the DSM 5 criteria for: Borderline PD ****
- split
- don't know who they are
- lability = variation and extreme variation in mood states that can makes them act rashly and impulsively
- self harm - use to bring themselves into the moment
- borderline bc folks can have breaks with reality, dissociation is common, or as stress mounts get paranoid/delusional symptoms but not a full break with reality
33
What is Borderline PD?
- BPD is one of the most deliberating and heavily stigmatized psychiatric conditions
- functional impairment in severe: many require public assistance, such as support from psychiatric disability
- 8-10% die from suicide
- 1-5% of general population
- 12 -25% of outpatients
- 22-55% of inpatients
- impairment is severe
34
BPD - cormorbiditie
- 25-75% have MDD
- 2-20% bipolar
- 65% have substance use problems
- eating disorders are common
- 40% of men committing violence against partner
- improvements in 30/40s - reduction in impulsivity
- more frequently diagnosed in women
35
What are the problems with BPD critera?
- 246 different combinations
- are they all the same disorder?
- a cluster of related disorders
36
What is the etiology of PBD: personality/emotion regulation
- impulsivity
= low serotonin
- emotional vulnerability
= BPD more actively in amygdala in response to emotional faces
= decreased prefrontal cortex metabolism, similar to mood disorders
= stronger emotional reaction to events
37
Etiology of BPD: history of abuse
- BPD is unresolved PTSD??
- childhood abuse
= higher rates reported by those with BPD
= reduced hippocampal and amygdala volumes in BPD - a consequence of PTSD?
= abnormal prefrontal blood flow in response to trauma memories
= no specificity in abuse - disorder relationship
- chicken and egg problem with determining causes
= does abuse cause BPD?
= abusers also have BPD?
= BPD is more prevalent in families with BPD and MDD
= diatheses may be volative/impulsive personality style + trauma = unastable personaluty style
38
Why " borderline"
- neuroticism and psychotic are the 2 ends
- psychotic - are detached from reality, removed from environment, there is a congruency with this experience and who they are "egotism"
- neuroticism - know something is wrong "egoistic" they are still connective with reality
- so boardline is the middle point of high neurotic state with the potential of psychotic symptoms
39
Etiology of BPD: Behavioral principles
- respondent behavior = behavior is a habitual response/reaction to circumstances
= ex. every time a person perceives rejection, there are overwhelming feelings of panic, followed by suicide gestures (think the blood note)
- operant behavior = behavior that is learned/maintained by consequences
= ex. every time person makes suicide gesture, personal and professional support increases, demands decrease, emotional pain decreases
- intense fear and affect regulation when abandoned
40
What is the conventionalization of BPD symptoms
Emotional Dysregulation:
- high reactivity
- unable to understand/accept emotions
- extreme pain associated with emotion
Identity confusion:
- unstable sense of self
- changing lifestyle
- changing goals/values
Interpersonal Chaos
- relationship conflicts
- changing perceptions of others
- fear of abandonment
Cognitive Dysregulation
- paranoia
- dissociation
Dangerous Impulsivity:
- acting on emotional urges
- relieving tension or reducing numbness
41
How does BPD develop?
Describe Linehan's Biosocial Model
Emotional Vulnerability:
- easily activated, aroused
- high intensity of experience
- slow return to baseline
Chronic Emotional Dysregulation
- inability to understand, label, accept, or modulate one's emotional experience to match goals of the present context
Invalidating Environment:
- label emotional expression, unjustified, or inaccurate
- simplify ease of solutions
- periodically reinforces extreme expression
42
Describe the treatment of DBT for BPD
- CBT is invalidating for people in acute distress (there are fundamental differences - assume that cognitions are not distorted)
= if invalidate their feelings then it can make it worse
- radical acceptance/nonjudgmental stance (being a 'perfect' BPD client)
= take an extreme non-judgmental stance assume that this person is perfect when treating
- dialectical?
- dialectical = an interpretive method routed in the practice of dialogue between 2 people with different ideals and trying to persuade one another in their position
***not examined on the dialectical piece one paragraph above***
43
What are the Dialect - 3 Basic Tenets
1. interrelatedness and wholeness "everything is connected to everything else"
2. Reality is composed of opposing forces ("thesis" and "antithesis"). These opposites can be integrated ("synthesis") to form a closer approximation of the "the truth"
3. Change is constant and inevitable - tension btwn opposing forces in a system is what produces change
44
Describe DBT
- uses techniques from BT, CBT to understand behaviors, regulate emotions, develop treatment plans
- eastern philosophies of mindfulness, acceptance and change
= ex. Charise: any exposure to sexual content made her extremely dysregulated, got angry, sexual regression. goal in treatment was lets find ways you can enjoy your sexuality. So did exposure therapy with the radical acceptance that this was someone that was doing the best they could.
- individual therapy
= conduct a behavioral analysis to address:
a) suicidal behavior = need to be alive so #1
b) therapy-interfering behaviors = like smashing the office, or having outbursts of anger that hurt people trying to help
c) quality of life interfering behavior = looking at interpersonal relationships and jobs
d) increasing skills
- this list ^ is a hierchy
- group therapy:
= mindfulness - being in the moment
= emotion regulation - identifying emotions; changing emotional state through behavior
= distress tolerance - distracting, self-soothing - when can't tolerate emotion this is when they might be suicidal, ex. used an ice pack would hold and help them to not dissociate
= interpersonal skills - effective communication
== use wise mind - be present and acknowledge the emotion then decide from a place of wise mind decide how you will act
45
What is DBT trying to change
DBT = focus on emotion/behavior association
- operant behavior = behavior that is learned/maintained by consequences
= ex. person feels suicidal -> recruited care from family/friends
= instead therapist coaches use of coping skills; call 911 only when absolutely necessary
- respondent behavior = behavior is a habitual response/reaction to circumstance
= ex. person perceives rejection -> previously became suicidal
= instead therapist coaches to identify emotion, self-validate and using coping skills
46
