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Personality Disorders Flashcards

1
Q

What is the DSM-5 General Definition for Personality Disorders?

A

American Diagnostic Association: for mental disorders

A personality disorder is:
-an enduring pattern of inner experience and behaviour
-deviates from the expectations of the individual’s culture
-is pervasive/ inflexible
-has an onset in adolescence/ early adulthood that is stable over time, and leads to impairment

-not typical behaviour of society
-distress caused to the individual

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2
Q

After psychiatrists identify the pattern of inner experience via two or more criteria what do they check for?

A

They check to see if it is:

Inflexible and pervasive across personal and social contexts

If it leads to clinically significant distress or impairment in social, occupational areas (work life)

Whether its stability can be traced back to adolescence/ earlier

Rule out that it cannot be accounted for by another mental disorder (symptom overlap/)

Is not due to medication/ medical condition (brain injury) physiological effects of substance abuse

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3
Q

-DSM-5 Categorical classification identified 10 personality disorders into 3 clusters A, B, and C.

Which 4 disorders in cluster B are classed as “erratic or emotional” in the DSM-5 Categorical classification?

A
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4
Q

-DSM-5 Categorical classification identified 10 personality disorders into 3 clusters A, B, and C.

Which 3 disorders in cluster A are classed as “eccentric or odd” in the DSM-5 Categorical classification?

A
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5
Q
  • Presence or absence of PD symptoms
  • PDs are QUALITATIVELY distinct from each other, and from normal personality
  • No assumptions are made about the underlying dimensions or structure of PD

These belong to which classification of Personality Disorder?

A

Categorical classification

-DSM-5-TR (March, 2022) still contains categorical classification system, but this has been much debated!

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6
Q

The DSM-5 General Diagnostic Criteria measures a patient’s pattern of inner experience via two or more criteria. Name them:

A

The pattern of inner experience is manifested via two or more of: (1) cognitions,
(2) affectivity,
(3) interpersonal functioning
(4) impulse control.

-If affecting at least 2 (or more), psychiatrists will look to see which personality disorder falls into the categories

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7
Q

What 4 characteristics is a personality disorder defined by (PIMS)?

A

Persisting
Inflexible
Maladaptive
Significant impairment/ distress

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8
Q

Which classification of Personality Disorder represents PD’s as being qualitatively distinct from each other, (diagnosis of borderline and SZ personality are 2 distinct conditions) and from normal personality.

A

Categorical classification

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9
Q

Personality Disorder Classification: The Debate

Clinicians and Personality Psychologists argue that there are 2 classifications for someone with a personality disorder.

Name the two classifications of PDs:

A

Categorical classification

Dimensional classification

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10
Q

Which classification of Personality Disorder represents personality to manifest on a continuous scale with dimensions of traits
(eg. extraversion exists on an entire continuum as one can be rated extremely high to extremely low E on a scale, meaning P can vary)?

A

Dimensional classification

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11
Q

-DSM-5 Categorical classification identified 10 personality disorders into 3 clusters A, B, and C.

Which 3 disorders in cluster C are classed as “fearful or anxious” in the DSM-5 Categorical classification?

A
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12
Q

Which personality disorder is the distrust and suspicion of others across contexts and without basis?

A

Paranoid DP
Cluster A

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13
Q
  • Personality manifests on continuous dimensions of traits
  • PDs are QUANTITATIVELY distinct from normal personality due to being extreme and maladaptive levels of personality traits (on a continuum scale)

These belong to which classification of Personality Disorder?

A

Dimensional classification

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14
Q

-DSM-5 Categorical classification identified 10 personality disorders into 3 clusters A, B, and C.

Name the disorders and their clusters:

A

These are descriptive clusters, no empirical evidence/ factor analysis that shows this. Other than these disorders share similarities clinically.

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15
Q

-DSM-5 Categorical classification identified 10 personality disorders into 3 clusters A, B, and C.

Name the 2 other separate categories
(separate to clusters A, B, or C):

A

1- Personality change is due to another physiological or medical condition.

2- Other specified PD or unspecified PD:
Individual meets the general diagnostic criteria for PDs but does not meet the full symptom criteria for any one of the 10 PDs.
eg. having 4/9 symptoms
Insufficient evidence for the clinician to make diagnosis of one PD.

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16
Q

Which personality disorder is the detachment from relationships and restricted emotional expression?

A

Schizoid PD
Cluster A

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17
Q

Which personality disorder is the persuasive disregard of the rights of others since or before 15 years of age?

A

Antisocial PD
Cluster B

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18
Q

Which personality disorder is the pervasive discomfort with relationships. Showing eccentric behaviour and cognitive or perceptual distortions?

A

Schizotypal PD
Cluster A

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19
Q

Which personality disorder is the pervasive instability of interpersonal relationships, self-image, and affect and is marked by impulsivity?

A

Borderline PD
Cluster B

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20
Q

Which personality disorder is the persuasive disregard of the rights of others since or before 15 years of age?

A

Antisocial PD
Cluster B

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21
Q

Which personality disorder is the grandiosity, need for admiration, and lack of empathy?

A

Narcissistic PD
Cluster B

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22
Q

Which personality disorder is the persuasive and excessive emotionality and attention seeking behaviours?

A

Histrionic PD
Cluster B

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23
Q

Which personality disorder is the persuasive social inhibition, inadequacy, and hypersensitivity to negative evaluation.

A

Avoidant PD
Cluster C

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24
Q

Which personality disorder is the persuasive need to be taken care of showing submissive and clingy behaviour?

A

Dependent PD
Cluster C

25
Q

Which personality disorder is the pervasive pre-occupation with order, perfection, and control at the cost of flexibility?

A

Obsessive-Compulsive PD
Cluster C

26
Q

Individuals with which personality disorder must show 4 or more:

Suspects others of harming, plotting or deceiving.
Doubts trustworthiness of friends.
Suspects infidelity in relationships.
Reluctant to confide in others.
Reads hidden meaning into. remarks.
Bears grudges and does not forgive.
Perceives attacks and reacts quickly with anger?

A

Paranoid PD
-distrust and suspicion of others across contexts and without basis

27
Q

Individuals with which personality disorder must show 5 or more:

Odd beliefs, outside norms.
Odd thinking and speech patterns (I’m not very talkative today)
Perceptual illusions.
Odd or incorrect interpretations of events.
Peculiar behaviour.
Suspicious or paranoid.
Lack of confidants.
Social anxiety that does not lessen with familiarity with others as they find situations extremely anxiety-provoking which does not reduce.
Inappropriate or constricted affect?

A

Schizotypal PD
-pervasive discomfort with relationships with eccentric behaviour and cognitive or perceptual distortions

28
Q

Individuals with which personality disorder must show 4 or more:

Does not seek or enjoy relationships.
Little interest in sexual relationships.
Prefers solitary activities.
Enjoys very few activities.
Lacks close confidants.
Indifference to praise or criticism.
Emotional coldness, detachment and flattened affect?

A

Schizoid PD
-detachment from relationships and restricted emotional expression

29
Q

What are the similarities that PD’s from Cluster A in the DSM-5 all share?

Paranoid PD
Schizoid PD
Schizotypal PD

A

Reluctant to confide in others/ lack of, or don’t confide
But all reasons to not confiding are different:

Either due to not wanting any intimacy, worried about conspiring against you or just anxiousness

Schizotypal PD is more accentuated on the thought patterns

30
Q

Which disorder does she have:
Paranoid PD
Schizoid PD
Schizotypal PD

A

Schizotypal PD

31
Q

Individuals with which personality disorder must show 3 or more:

Lack of conformity to social norms.
Lying, deceiving others for profit or pleasure.
Impulsivity.
Irresponsibility and failure to maintain obligations.
Irritability and aggressiveness.
Reckless disregard for safety of self and others.
Lack of remorse (over 18+)?

A

Antisocial PD
-persuasive disregard of the rights of others since or before 15 years of age. Consistently fail to conform to rules+ no empathy

32
Q

Individuals with which personality disorder must show 5 or more:

Frantic efforts to avoid abandonment (real or imagined).
Extreme idealization and devaluation in relationships.
Identity disturbance.
Impulsivity in at least two areas – sex, spending, drinking.
Recurrent suicidal gestures and/or self-harm.
Persistent feelings of emptiness.
(Short lived) reactivity in mood.
Inappropriate anger.
Transient, stress-related paranoia or severe dissociative symptoms?

A

Boarderline PD
-Pervasive instability of inter-personal relationships, self-image, and affect. Marked impulsivity

33
Q

Which personality disorder involves heightened sensitivity to the feeling of abandonment leading to the shifting of emotions and self-image.

A

Boarderline PD

34
Q

Individuals with which personality disorder must show 5 or more:

Uncomfortable if not centre of attention.
Interactions often inappropriately sexual or provocative.
Rapidly shifting and shallow emotional expression.
Gains attention through physical appearance.
Speech is impressionistic and lacking in detail.
Self-dramatization, theatrical expression of emotion.
Suggestable.
Considers relationships more intimate than they are?

A

Histrionic PD
-persuasive and excessive emotionality and attention seeking behaviours

35
Q

Individuals with which personality disorder must show 5 or more:

Grandiosity (without commensurate achievements).
Preoccupied with fantasies of power or success.
Requires excessive admiration.
So gifted, few people can understand them.
Arrogance.
Sense of entitlement.
Interpersonally exploitative.
Lacks empathy.
Envious of others, and believes others envy them?

A

Narcissistic PD
-grandiosity, need for admiration and lack of empathy

36
Q

Which disorder includes superior belief in themselves but feeling threatened when that is challenged by others leading to a fragile sense of esteem and attention-seeking behaviour?

A

Narcissistic PD

37
Q

What are the similarities that PD’s from Cluster B in the DSM-5 all share?

Antisocial PD
Borderline PD
Histrionic PD
Narcissistic PD

A

Experience of high intensity emotions. (high Extroversion)

Display of erratic (impulsive) or provocative behaviours.

Altered perceptions of others - reduced concern with others feelings, need for admiration, or fear of abandonment.

38
Q

Narcissistic PD
Histrionic PD and Borderline PD
Antisocial and Borderline PD
Borderline PD

A

Antisocial and Borderline PD

39
Q

Individuals with which personality disorder must show 4 or more:

Avoids interpersonal contact due to fear of rejection or disapproval.
Only involved with people where certain to be liked.
Restraint in relationship to avoid ridicule.
Preoccupation with social rejection.
Reluctant to take socials due to fear of failure or embarrassment.
Views self as socially inept?

A

Avoidant PD
-persuasive social inhibition, inadequacy, and hypersensitivity to negative evaluation

39
Q

Which disorder is characterised by order, perfection and control?

A

OCD PD

40
Q

Individuals with which personality disorder must show 5 or more:

Difficulty making everyday decisions without advice or reassurance.
Needs other to take responsibility.
Difficulty expressing disagreement due to fear of loss.
Difficulty initiating projects.
Goes to great lengths to gain support and nurturance.
Uncomfortable when alone.
Immediately seeks new relationship when one ends.
Preoccupied with fears of being left to care for oneself?

A

Dependent PD
-persuasive need to be taken care of. Submissive and clingy behaviour

40
Q

Individuals with which personality disorder must show 5 or more:

Preoccupied with details, rules, lists.
Perfectionism hinders completion.
Devoted to work at expense of leisure and relationships.
Inflexible about morals/ethics.
Rigidity and stubbornness.
Reluctant to delegate unless others follow exact instructions.
Unable to discard items (even with no value).
Misery form of spending on self and others?

A

Obsessive-Compulsive PD
-pervasive pre-occupation with order, perfection and control at the cost of flexibility

40
Q

What are the similarities that PD’s from Cluster C in the DSM-5 all share?

Avoidant PD
Dependant PD
OCD DP

A

Underlying fear or anxiety behind behaviour or avoidance of situations and/or people.

Selecting situations that feel safe to maintain a sense of personal control.

41
Q

Avoidant PD
Dependant PD
OCD PD

A

Avoidant PD

41
Q

A03: Limitations 1
DSM-5 Categorical Approach
-you have the disorder or you don’t

Presence or absence of a PD.
PDs are qualitatively distinct from each other.
PDs are qualitatively distinct from normal personality (FFM).
No assumptions are made about the underlying dimensions or structure of PDs.

Essay:

A

Hopwood et al. (2018) identified
The dimensional personality disorder diagnosis:

Found no evidence supporting the presence of 10 discrete PD categories.
Diagnostic comorbidity between 10 PD categories.

Within-disorder heterogeneity
-Diagnosed when shown different combinations of the 4 symptoms/7-9

Few validated interventions for the 10 distinct PD categories.
-If there are no treatment options then why are we need classifying disorders

Categorical approach lacks evidence base when compared to trait approach
-By telling someone they have this specific PD, you are excluding stability overtime, biological and evolutionary basis by not measuring them as dimensional constructs

41
Q

A03: Limitations 2
DSM-5 Categorical Approach
-you have the disorder or you don’t

Presence or absence of a PD.
PDs are qualitatively distinct from each other.
PDs are qualitatively distinct from normal personality (FFM).
No assumptions are made about the underlying dimensions or structure of PDs.

Essay:

Marinangeli et al. (2000) examined the issue of comorbidity in PD classification in DSM-3 Criteria
(the simultaneous presence of two or more diseases or medical conditions in a patient)

A

Individuals admitted themselves to a psychiatric ward 159 patients (90 women)
Semi-structured clinical interview for PD classification based on DSM-3 criteria

Found:
10/12% of sample was classified as having more than one disorder
Suggests that there may be an underlying structure/ dimension

Further looked at if having 1 disorder concurred with a diagnosis of another personality disorder:
Results showed that Borderline PD occurred which almost every other disorder presented

41
Q

If there is evidence for why PD should take a Dimentional approach, then we should be able to see a relationship between PD’s and and FFM traits.

A
41
Q

A03: Limitations 3
DSM-5 evidence against the Categorical Approach
Samuel & Widiger (2008) conducted a large Meta-analysis.

To be included, studies had to measure all thirty facets of the FFM + all 10 DSM categorical personality disorders.

Had a sample of 3000 people 16 studies
Looked at the interpretation of different PD classifications and The Big 5
What did they find for each cluster A,B,C in relation to the FFM?

A

Found: Relationships between FFM and PD’s

Cluster A:
-high levels of negative emotion and low extraversion
Paranoid PD
Schizoid PD
Schizotypal PD

Cluster B:
-low agreeableness and low conscientiousness
Antisocial PD
Borderline PD
Histrionic PD
Narcissistic PD

Cluster C:
-high negative emotions and low extroversion
Avoidant PD
Dependant PD
OCD DP

42
Q

A03: Limitations 3
DSM-5 evidence against the Categorical Approach
Samuel & Widiger (2008) conducted a large Meta-analysis.

To be included, studies had to measure all thirty facets of the FFM + all 10 DSM categorical personality disorders.

Had a sample of 3000 people 16 studies
Looked at the interpretation of different PD classifications and The Big 5
Which 2 traits of the FFM are either related to all/ not any PDs?

A

High levels of Neuroticism are associated with most PDs positively across all disorders, suggesting that we are not good at distinguishing between these PDs. Can we represent them in more broader traits?

Openness to change/ experience is not correlated with any PD

42
Q

DSM-5 Dimentional Approach
-you can have a PD on a scale ranking from mild to severe

Personality manifests on continuous trait dimensions.
PDs are quantitively distinct from normal personality (you only differ in terms of level of extremity)
PDs manifest in individuals as extreme and maladaptive levels of normal personality traits

Essay:

Widiger & Simonsen (2005):
Reviewed 18 proposals that could update DSM-3 with a dimensional approach to PD classification.
Proposed that all of them can be integrated into a hierarchical structure of maladaptive personality traits.

Which 5 broad traits did they extract? (not same as FFM)

A

Theoretically proposed 5 broad traits:
1- Extraversion – Introversion
talkative/ bold/ theatrical - reserved/ cold (avoidance)

2- Antagonism – Compliance
how much we relate to others
modest/ trusting - distrusting/ uncooperating

3- Constraint – Impulsivity
disciplined/ achievable (OCD)- recklessness (Antisocial)

4- Negative Affect – Emotional Stability
anxious- stable in self-image

5- Unconventionality – Closed to Experience
less evidence for this
more focused on magical thinking (schizoid)

43
Q

Moving toward a Dimensional approach:

Krueger et al. (2012) empirically validated a dimensional approach for use in DSM-5

Designed a PID Assessment (a measure of the 5 F personality traits for mental health related services)

A

Adding Psychotism as a maladaptive trait, magical thinking

Did not include Openness!

44
Q

After Krueger et al. (2012) empirically validated a dimensional approach for use in DSM-5 By designing a PID Assessment (a measure of the 5 F personality traits for mental health related services), the Hybrid approach was an aidditional diagnostic assesment for PD’s (Skodol et al., 2015).

Why is it known as the Hybrid approach?

A

As it still retains elements of the categorical system

Step 1= dimensional traits
Step 2= categorical traits
Criteria A (step 1) = Maladaptive Personality Functioning assessed from 0 (no impairment) to 5 (extreme impairment). Level of personality functioning scale.

Criteria B (step 2) = Maladaptive Personality Content

45
Q

Explain how an individual would be classified with Borderline PD from a DSM-5 Hybrid Approach:

A

Moderate impairment in at least two areas of identity, self-direction, empathy, and intimacy.

Experience of 4+ of these 7 facets of maladaptive traits:
Emotional liability, anxiousness, separation insecurity, or depressively (Negative Affectivity).

IMPULSIVITY and RISK TAKING (Disinhibition)
HOSTILY (Antagonism)

At least one of these 3 FACETS must be present for diagnosis.

46
Q

DSM-5 Dimensional Approach to PDs 1
Samuel et al. (2013):

Archival data of a clinical sample of 370 participants receiving treatment for substance abuse.
PD diagnoses in sample – antisocial (58%), borderline (33%) and avoidant (18%).

Self-report measures of normal traits (FFM) and a clinical interview (via DSM-4) for PDs.
They selected the FFM items from which trait?

A

Neuroticism trait
the most characteristic of borderline PD.

46
Q

DSM-5 Dimensional Approach to PDs support:
Samuel et al. (2013):

Archival data of a clinical sample of 370 participants receiving treatment for substance abuse.
PD diagnoses in sample – antisocial (58%), borderline (33%) and avoidant (18%).

Self-report measures of normal traits (FFM) and a clinical interview (via DSM-4) for PDs.
Which statistical technique did they use?

A

Item Response Theory
-looks at whether different items cluster on the same underlying latent trait

  • we usually don’t measure traits directly, only cognitive symptoms, thoughts, behaviours to = a PD

If Neurotcism (N) is normal personality and Boarderline personality is distinct they should not load onto the same trait (unrelated)

Instead, they found: N and items from Boarderline diagnostic checklist all loaded on the same trait
eg. chronic emptiness, difficulty controlling anger, feel discouraged
suggests there is value on representing PD on a dimensional scale

Also measured Beta level of extremity of traits:
found boarderline diagnostic criteria were more extreme versions of the same trait

46
Q

Name another reason that FFM trait theories are a better measurement of personality disorders?

A

FFM shows temporal consistency over time
Point A measurement of personality should be consistent at point B

Points should be the same for maladaptive traits
They found test scores were relatively high at both points A and B

To be a PD they should be consistent across time which is found in maladaptive traits also

46
Q

If psychiatrists use the dimensional approach and more extreme versions of normal personality traits…

A

we would expect to see consistency. predict in a similar manner.

46
Q

Clinical Utility of Dimensional Classification 4:

In both samples, categorical (taxonic) and dimensional maladaptive traits were correlated with key outcomes.

A

Anderson et al
In both samples, the dimensional maladaptive trait model tended to perform better than the categorical model.
It was able to meaningfully predict more outcomes with precision when using the dimensional approach.

46
Q

Evaluation of the Dimensional approach:

A

Having more information on the maladaptive facet traits = Psychiatrists know a lot more about the nuances (eg. if they are high or low on the scale). Allowing them to tailor a treatment plan with alot more precision then they would with only an overall classification of PD

However, lack of interpretation of information for patient and clients. Others may find it useful to establish self-insight and understanding for classifying their disorder. Patient POV had to establish.

Personality (9 decks)

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