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Psyc 241 - Final Exam > Personality Disorders > Flashcards

Personality Disorders Flashcards

1
Q

personality

A

personality captures patterns of acting, thinking, and feeling that characterize a given individual and distinguish that person from others

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2
Q

five factor model

A

 Neuroticism, which captures the degree to which an individual is prone
toward experiencing unpleasant emotions like anxiety, sadness, and fear
 Extraversion, which captures the extent of a person’s preference for
social interactions versus solitary activity
 Openness to Experience, which captures how curious an individual is and
how receptive they are to new ideas, approaches, and events
 Conscientiousness, which taps propensity for organization, punctuality,
and achievement motivation
 Agreeableness, which reflects individual differences in people’s
preferences for co-operation and social harmony

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3
Q

dimensional frameworks

A

(1) personality traits are continuously distributed in
populations, and (2) personality pathology reflects extreme variants of typical personality
traits.

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4
Q

categorical approach

A

maladaptive personality functioning is assumed to manifest as a
number of discrete disorders, each defined by a polythetic criterion set - specified
number of symptoms from a larger list

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5
Q

weaknesses of the categorical approach

A

co-occurrence among personality disorders is excessive—far higher than what would be expected if each disorder emerged from unique underlying factors.

PD Unspecified Personality Disorder is more commonly applied than any other

PD diagnosis
polythetic criterion sets yield heterogeneous groups - five out of nine possible
symptoms—allowing for 246 unique combinations - may reduce the clinical utility
of applying a diagnosis at all

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6
Q

hybrid dimensional-categorical approach

A

traditional PD framework includes 10 diagnoses, the alternative model
retains only six

defines personality disorders by impairments in personality functioning and pathological
personality traits

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7
Q

three criterion of the alternative model

A
  • Criterion A: a 0–4 scale of personality functioning in self identity and self-direction and
    interpersonal domains (empathy and intimacy)
  • Criterion B: a dimensional system in which 25 traits are organized into five overarching
    domains (antagonism vs agreeableness; detachment vs extraversion; disinhibition vs
    conscientiousness; negative affectivity vs emotional stability; and psychoticism vs
    lucidity)
  • Criterion C: a prototypal system of six personality disorder types (avoidant, schizotypal,
    antisocial, narcissistic, obsessive-compulsive, and borderline)
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8
Q

current DSM taxonomy

A
  • Criterion A: Behavioural patterns must manifest in at least two of the following areas:
    cognition, emotions, interpersonal functioning, or impulse control.
  • Criterion B: Such patterns must be rigid and consistent across a broad range of personal
    and social situations.
  • Criterion C: Patterns should cause clinically significant distress in social, occupational, or
    other important areas of functioning.
  • Criterion D: Symptoms must be stable and of lengthy duration, with onset in
    adolescence or earlier.
  • Criterion E: Behavioural patterns cannot be accounted for by another mental disorder.
  • Criterion F: Patterns are not due to acute substance use (e.g., drugs or alcohol) or of
    another medical condition.
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9
Q

other reasons for personality disorder diagnoses

A
  • DSM includes diagnoses for personality change due to another medical condition, other
    specified personality disorder, and unspecified personality disorder.
  • other specified PD when a person meets criteria for a general PD, exhibits symptoms
    from a number of personality disorders, yet criteria for any single PD are not met.
  • Unspecified PD is applied when individuals meet general PD criteria, yet their core
    symptoms are not captured by existing specific PD diagnoses
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10
Q

Cluster A disorders

A

Cluster A is defined by odd or eccentric features and includes paranoid, schizoid, and schizotypal PDs

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11
Q

Cluster B disorders

A

(dramatic, emotional, or erratic features) includes antisocial, borderline, histrionic, and narcissistic PDs.

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12
Q

Cluster C disorders

A

(anxious or fearful features) consists of avoidant, dependent, and
obsessive–compulsive PDs.

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13
Q

how should disorders be grouped instead?

A

group disorders by similar phenotypic features (i.e., how behavioural symptoms look on the surface) rather than by shared developmental factors or by a common underlying
structure

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14
Q

limitations affecting available research

A

base rates of these disorders are low and epidemiological research is fairly limited.

PDs are also associated with a number of inaccurate and harmful stereotypes

Personality disorders are more stigmatized relative to other psychiatric diagnoses

more likely to struggle with forming a therapeutic alliance, more likely to perceive these clients as attention seeking, dangerous, manipulative

Due to associated stigma, many clinicians are reluctant to diagnose PDs—particularly
among youth

broadest limitation is that most PDs are simply understudied

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15
Q

cultural considerations of personality disorder

A
  • Researchers often rely on convenience samples from Westernized, educated,
    industrialized, rich, and democratic nations
  • these disorders occur cross-culturally
  • U.S. and Colombia report prevalence estimates of 7.6% and 7.9%, respectively,
    whereas western Europe and Nigeria report far lower estimates of 2.4% and 0.9%
  • variability in study design and sample characteristics makes it difficult to determine
    whether available estimates reflect true cross-national differences in PD prevalence
  • in the UK, White individuals have higher total PD prevalence rates in hospital settings
    compared with Black or Asian individuals
  • Inconsistencies between inpatient and community samples may reflect problems with
    health care accessibility for marginalized groups
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16
Q

cluster A - ecological momentary assessment

A
  • ecological momentary assessment (EMA)
    o paranoid features – cognitive diffculties
    o schizoid traits – blunted affect, lack of caring relationships
    o schizotypal traits – poor social functioning
  • schizotypal PD is the only disorder categorized as both a PD and schizophrenia
    spectrum disorder in the DSM
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17
Q

paranoid personality disorder history

A
  • paranoia originated in ancient Greece and translates to “out of one’s mind”
  • nineteenth century - applying the term paranoid to persons exhibiting suspiciousness,
    hostility, and systematized delusions
  • systematized delusions are logical and coherent, yet based on false grounds (i.e., beliefs that are highly improbable but not impossible
  • Emil Kraepelin conceptualized paranoia as stemming from pathological misinterpretation
    of real events
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18
Q

paranoid personality disorder - clinical features

A
  • patterns of pervasive mistrust, suspiciousness, and resentment of others
  • hypersensitive to interpersonal cues, assume innocuous stimuli have a special meaning
    for them, inclined to interpret others’ motivations as spiteful or malevolent
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19
Q

paranoid personality disorder - DSM diagnosis

A

DSM-5-TR diagnosis requires at least four of seven symptoms, beginning by early
adulthood

of the seven DSM criteria, unjustified suspicion of infidelity was the least
commonly endorsed symptom and the least sensitive indicator for PPD

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20
Q

paranoid personality disorder - four suspiciousness symptoms

A

(1) global suspicion of harm,
exploitation, or deception from others without sufficient basis; (2) preoccupation with unjustified
doubts of loyalty or trustworthiness of friends or associates; (3) reluctance to confide in others due
to unwarranted fear that disclosed information will be used against them; and (4) perceiving benign
remarks or events as carrying hidden threats or demeaning meaning.

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21
Q

paranoid personality disorder - three hostility symptoms

A

(1) persistently bearing grudges; (2)
perceiving attacks on one’s character or reputation that are not apparent to others, and being quick
to counterattack or react aggressively; and (3) recurrent unjustified suspicions of infidelity from a
romantic or sexual partner.

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22
Q

paranoid personality disorder - prevalence

A
  • mild symptoms of paranoia are relatively common in the general population (i.e.,
    20%–30%
  • PPD affects only 1.21% to 4.4% of people
  • women may be more frequently affected, yet the disorder may be more severe among
    men
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23
Q

paranoid personality disorder genetic factors

A
  • individuals with PPD appear to share more genetic similarities with delusional disorder
    and unipolar depression than with schizophrenia
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24
Q

paranoid personality disorder - social factors

A

o Childhood maltreatment is associated with hostile attribution biases

  • deficits in cognitive-affective information processing may constitute one pathway to PPD development
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25
Q

Paranoid Personality Disorder – Diagnostic Overlap and Comorbidity

A

seldomly appearsasastand-alonedisorder

delusional disorder with a specified persecutory type

schizotypal personality disorder is also defined in part by experiences of paranoia

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26
Q

Schizoid Personality Disorder – History

A
  • term schizoid was introduced in 1908 to describe a condition characterized by social
    detachment, pursuit of vague interests, and both emotional sensitivity and emotional
    numbness
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27
Q

Schizoid Personality Disorder – early DSM 5

A
  • schizoid personality disorder was introduced in the DSM-I
    o first two editions, this condition was conceptualized as a form of schizophrenia
    characterized by shyness, emotional sensitivity, avoidance of intimate
    interpersonal relationships, eccentric behaviours, and an inability to directly
    express aggression or hostility

o DSM-III - divided the clinical features described above into three distinct
disorders: schizoid personality disorder, schizotypal personality disorder, and
avoidant personality disorder

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28
Q

Schizoid Personality Disorder – Clinical Features and Supporting Data

A
  • defined by detachment, withdrawal from social relationships, and a restricted range of
    emotional expression in social settings
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29
Q

Schizoid Personality Disorder - Diagnostic criteria

A
  • four of the following seven symptoms
    o (1) no desire or enjoyment of close relationships, including family; (2) indifference
    to praise or criticism from others; (3) little to no interest in having sexual
    experiences with others; (4) almost always choosing solitary activities; (5) lack of
    close friends/confidants other than first-degree relatives; (6) displaying emotional
    coldness, detachment, or flat affect; and (7) taking pleasure in few, if any,
    activities
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30
Q

Schizoid Personality Disorder – Prevalence

A
  • 1% to 5%
  • thought to occur more commonly among males
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31
Q

Schizoid Personality Disorder – Etiology

A

appears to share some genetic vulnerability with schizophrenia, yet to a lesser degree than schizotypal PD

heritability estimate of 0.29, indicating that a substantial portion of the variance in
schizoid PD is attributable to non-genetic factors

major depressive disorder (MDD) in childhood and adolescence prospectively predicts schizoid PD later in adulthood

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32
Q

Schizoid Personality Disorder – Diagnositc Overlap and Comorbidity

A
  • DSM criteria demonstrate low internal consistency and poor diagnostic
    efficiency—meaning symptoms are generally not sensitive or specific to schizoid PD
  • schizoid PD rarely occurs in the absence of another psychiatric condition— particularly
    other PDs - 0.3%

schizoid PD and schizotypal (27–80% co-occurrence), avoidant (10–88%), paranoid
(0–62%), and antisocial PDs (0–40%

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33
Q

Schizotypal Personality Disorder – History

A
  • term schizotypal captures schizophrenia-like symptoms that fall below the threshold for a psychotic episode - dementia praecox
  • schizotypal features can, but often do not, develop into schizophrenia
  • term “borderline schizophrenia” first appeared in the second edition of DSM
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34
Q

Schizotypal Personality Disorder – Clinical Features and Supporting Data

A
  • patterns of eccentric behaviour (e.g., unusual mannerisms), cognitive and perceptual
    distortions (e.g., believing in clairvoyance, hearing a voice whispering one’s name), and
    impaired interpersonal functioning
  • much of the existing literature is based on samples with schizotypy and schizotypal PD
    features, rather than with persons above the diagnostic threshold
    o schizotypy captures a constellation of traits thought to create vulnerability for
    schizophrenia
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35
Q

Schizotypal Personality Disorder - Diagnostic Criteria

A
  • five of nine possible symptoms, beginning by early adulthood - transient psychotic
    symptoms (lasting minutes to hours) that are lower in severity and frequency
    o three dimensions of functioning - cognitive and perceptual (similar to positive
    symptoms of schizophrenia), interpersonal (overlapping with negative symptoms
    of schizophrenia), and disorganization
    o cognitive and perceptual - (1) non-delusional ideas of reference, (2) odd beliefs and magical
    thinking, (3) paranoia, and (4) unusual perceptual or somatic experiences
    o interpersonal - (1) lacking close friends outside one’s immediate family, (2) persistent social
    anxiety even with familiarity (usually due to paranoia rather than fear of judgment), and (3)
    constricted or inappropriate affect
    o disorganized - (1) odd/eccentric behaviours and appearance and (2) odd thinking/speech
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36
Q

Schizotypal Personality Disorder – Prevalence

A
  • 0.8%
  • lifetime prevalence estimates of 3.9%
  • slightly more men affected than women
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37
Q

Schizotypal Personality Disorder - genetics

A
  • heritability estimates are 0.61
  • Family studies report prevalence rates of 4.2% to 14.6% for schizotypal PD among first-
    degree relatives of individuals with schizophrenia
  • both over- and underactive dopaminergic activity appear uniquely associated with
    schizotypal symptoms - Valine/Valine genotype is associated with low dopamine levels in the prefrontal
    cortex and is linked to negative and disorganized schizotypal symptoms
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38
Q

Schizotypal Personality Disorder - childhood factors

A
  • individuals with schizotypal PD were 10.45 times more likely to report experiencing any

form of childhood trauma
- severe childhood sexual abuse had the strongest association with cognitive-perceptual
symptoms (e.g., ideas of reference)

  • severe emotional neglect was most strongly associated with interpersonal symptoms
    (e.g., constricted affect)
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39
Q

Schizotypal Personality Disorder - Diagnositc Overlap and Comorbidity

A
  • having schizotypal PD is associated with a 2.5 times higher likelihood of having a
    substance use disorder, 7.6 times the likelihood of having any anxiety disorder, 7.5 times
    the likelihood of having any mood disorder, and 6.7 times the likelihood for having PTSD
    one year later
  • 26.5 times and 13.6 times higher likelihood of having a lifetime history of BPD and NPD,
    respectively
  • greater risk for developing schizophrenia - 33.1% of schizotypal PD cases developed
    into schizophrenia over the course of 20 year
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40
Q

Schizotypal Personality Disorder - treatment

A

antipsychotics, and produce mixed results, anxiety and paranoia appear
most responsive to psychotropic medication, psychotherapeutic intervention (including
CBT, cognitive remediation, psychodynamic therapy, and social skills training) also
yields mixed findings.

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41
Q

Antisocial Personality Disorder

A
  • pervasive pattern of disregard for, and violation of, other persons’ rights
  • broad higher-order class of externalizing psychopathology
  • carrying the diagnosis is also associated with deleterious outcomes
42
Q

Antisocial Personality Disorder – History

A
  • formalized as a diagnosis in the DSM-III (1980) following evidence that delinquent
    behaviours in childhood are often stable into adulthood
  • original diagnostic criteria overlapped considerably with other PDs and descriptions of
    psychopathy
43
Q

Antisocial Personality Disorder – Clinical Features and Supprting Data

A
  • ASPD is commonly observed among incarcerated samples (47% of males and 21% of
    females) - more prevalent among individuals who serve longer criminal sentences (46%)
  • elevated engagement with the justice system may arise as a consequence of ASPD
    features
    o but perpetrating physical violence (a common cause for arrest) appears to
    differentiate ASPD from manifestations of anger and aggression common to
    other Cluster B disorders
  • irresponsibility is the most commonly endorsed symptom among ASPD participants
    (63%)
44
Q

ASPD and Psychoapthy

A
  • descriptions of psychopathy focus heavily on callous–unemotional personality traits
  • ASPD criteria, which instead prioritize observable behaviour
  • currently unclear whether psychopathy and ASPD are best conceptualized as distinct
    entities or as two points on a shared continuum
45
Q

ASPD Prevalence

A
  • prevalence estimates ranging between 2% and 3% in the general population, and up to
    60% in forensic settings
  • ASPD is two to eight times more likely to be diagnosed among men as compared to
    women
  • Women with ASPD engage in fewer violent crimes and are less likely to report
    aggression, reckless disregard for others, and impulsivity
46
Q

ASPD comorbidity

A
  • commonly co-occurs with other forms of psychopathology, including substance use
    disorders, major depression, ADHD, anxiety disorders, and other Cluster B PDs
  • Lifetime risk of suicide is also higher in individuals with ASPD—particularly among those
    with co-occurring anxiety disorders
47
Q

ASPD ethology - genetics

A
  • Approximately 50% of the variance in ASPD is accounted for by genetic factors
  • specific genes implicated in ASPD development actually confer general risk for
    externalizing behaviour broadly
48
Q

ASPD ethology - psychological factors

A
  • individuals must show evidence of conduct disorder (CD) with onset prior to the age of
    15
  • Negative affectivity is the dispositional tendency to experience negative, unpleasant
    affective states (e.g., anger, anxiety, fear, disgust), and is associated with a range of
    mental disorders, including ASPD
    o Negative affectivity is positively associated with poor impulse control, emotional
    lability, aggression
49
Q

ASPD treatment

A

proposed treatment guidelines that include group-based CBT and cognitive programs used in criminal rehabilitation, most individuals with ASPD present and receive
treatment for co-occurring disorders

50
Q

Borderline Personality Disorder – History

A
  • term borderline emerged from psychoanalytic theorists in the 1930s and reflects a misconception of the era that all psychopathology wasfundamentallywithps
    ychoticorneuroticinnature.
  • “the borderline of psychosis and neurosis”
51
Q

Borderline Personality Disorder – Clinical Features and Supprting Data

A
  • one of the most debilitating and heavily stigmatized psychiatric conditions
  • exceptionally high rates of self-inflicted injury (SII), co-occurring illness, and impaired
    social functioning
  • Functional impairment is often so severe among this population that many require public
    assistance, such as support from psychiatric disability
  • approximately 8% to 10% of people diagnosed with BPD will die by suicide
52
Q

Borderline Personality Disorder - Diagnostic Criteria

A

diagnosticcriteriainclude(1)franticeffortstoavoidrealorimaginedabandonment, (2) a
pattern of unstable and intense interpersonal relationships characterized by alternating idealization
and devaluation, (3) markedly and persistently unstable self-image or sense of self, (4) impulsivity
in at least two areas that are potentially self-damaging, (5) recurrent deliberate self-injurious
behaviours and/or threats of suicide, (6) affective lability and marked mood reactivity, (7)
chronically feeling empty, (8) inappropriate and intense anger or difficulty controlling anger, (9)
transient, stress-related paranoid ideation or severe dissociative symptoms
o more than 90% of affected individuals endorse the affect dysregulation criterion,
40% to 90% engage in SII

53
Q

BPD Prevalence

A
  • affects an estimated 1% to 5% of the general population
  • 12% to 25% of psychiatric outpatients, and a startling 22% to 50% of inpatients
54
Q

BPD - genetics

A
  • complex interactions between individual-level vulnerabilities and environmental risk
    factors that result in core dysfunctions in self-regulation
  • heritable component around 0.40 - two key biological predispositions: trait negative
    affectivity and trait impulsivity
55
Q

BPD - social factors

A
  • biosocial theory proposes that BPD emerges, in part, due to emotionally vulnerable
    youth being raised in an invalidating caregiving environment
    o a child’s emotional expressions are often rejected, invalidated, and disregarded
  • a history of neglect (92%), physical abuse (25% to 73%), and/or sexual abuse (40% to
    76%)
56
Q

BPD Diagnostic Overlap and Comorbidity

A
  • co-occurs at an elevated rate with attention deficit/hyperactivity disorder, anxiety,
    depression, ASPD, and substance use disorders
  • BPD co-occurred with a lifetime mood or substance use disorder in over 70% of their
    sample
57
Q

BPD - Dialectical behaviour therapy (DBT)

A

comprehensive outpatient treatment developed for
adults with BPD and repetitive SII - weekly individual therapy and skills-based group
sessions where clients learn mindfulness skills, emotion regulation skills, distress
tolerance skills, and interpersonal skills.

58
Q

BPD - mentalization-based treatment (MBT)

A

attempts to improve “mentalizing,” or the ability to
understand one’s own and others’ internal states

59
Q

BPD - transference-focused psychotherapy (TFP)

A

therapeutic relationship and making observations/interpretations about client-therapist interactions can help address
interpersonal dysfunction and identity-related problems

60
Q

Histrionic personality disorder - history

A

histrionicderivesfromtheLatinwordhistrio,meaningactorortheatreperformer

evolved from the now-abandoned medical concept of hysteria—defined by hyperbolic,
uncontrollable emotional outbursts

initially believed that hysteria originated in the uterus and thus exclusively affected
women

early 1930s, Franz Wittle and Wilhelm Reich provided some of the first descriptions of a
hysterical personality

appeared in the DSM by its second edition

61
Q

Histrionic Personality Disorder - ClinicalFeaturesandSupportingData

A
  • more persistent thoughts about sex, lower sexual desire, less frequent initiation or
    refusal of a sexual act, and endorse fewer steps taken to prevent pregnancy
  • strong desire for, and tendency to seek out, the attention of others—often using physical
    appearance
  • some argue HPD is a sex-specific counterpart of ASPD
62
Q

Histrionic Personality Disorder - diagnostic criteria

A
  • five of the following eight symptoms: discomfort when not the centre of attention; inappropriate
    seductive or provocative behaviours; shallow and rapidly shifting emotional expressions; frequent use of
    physical appearance to draw attention to oneself; vague and impressionistic style of speech; dramatic,
    theatrical, and exaggerated emotional expressions; easily suggestible; and considering relationships to be
    more intimate than they are
63
Q

HPD Prevalence

A
  • 1% to 3% of the general population
  • some studies report rates as low as 0.3%
  • rates are approximately 6% in clinical samples versus 20.5% in incarcerated samples
64
Q

HPD Etiology - genetics

A
  • virtually non-existent research
  • Heritability estimates for HPD range from 0.62 to 0.79, suggesting a relatively high
    genetic contribution to the disorder
65
Q

HPD Etiology - social factors

A
  • HPD was correlated with permissive parenting by fathers, yet the direction of this effect
    remains unclear
  • childhood trauma, as measured by retrospective self-report, predicted HPD (with a
    relatively small effect size) and other PDs
66
Q

HPD Diagnostic Overlap and Comorbidity

A
  • co-occurs frequently with substance use disorder particularly among men
67
Q

HPD Treatment

A
  • significant reductions in HPD symptoms following treatment with functional analytic
    psychotherapy - a therapeutic approach using behavioural principles like shaping
    through positive reinforcement to treat presenting problems
  • cognitive-behavioural intervention for violence reduction and found individuals with HPD
    showed significant reductions in using negative conflict management strategies and
    exhibited a better treatment response
68
Q

Narcissistic Personality Disorder – History

A
  • term narcissism stems from an Ancient Greek myth in which a man named Narcissus fell
    in love with the sight of his own reflection
  • Kernberg’s (1970) descriptions of a narcissistic personality centred on grandiosity,
    arrogance, and aggression
  • Kohut (1966) emphasized shame, depression, and low self-esteem
  • NPD first appeared in the DSM-III
69
Q

NPD Classification and Taxonomy

A
  • 5/9 symptoms
  • most essential features are maintaining a grandiose sense of self-importance, a need to
    be admired by others, and a lack of empathy

Other criteria include beliefs that one can only be understood by other high-status
individuals, beliefs of entitlement, exploitation of others for personal gain, frequent and
intense feelings of envy, and preoccupation with ideas of success (e.g., power, beauty,
wealth

70
Q

NPD - clinical presentation

A

NPD is associated with
impaired intra- and interpersonal functioning, yet certain individuals are remarkably
successful in professional and/or social arenas

71
Q

grandiose NPD presentation

A

o grandiose presentation - individuals with a strong sense of entitlement, overt
grandiose behaviours (e.g., arrogance), and intentions to control or harm others -
further divided into an extraverted dimension (admiration-seeking) and an
antagonistic dimension (rivalry-seeking)

72
Q

vulnerable NPD presentation

A

o vulnerable presentation - thought to capture individuals with less overtly
grandiose behaviours, hypersensitivity to negative evaluations, and more co-
occurring internalizing symptoms

  • vulnerable features of NPD appear more strongly associated with psychopathology and
    neuroticism - this dimension of NPD may indicate greater distress associated with the
    disorder
73
Q

NPD Clinical Features and Supprting Data

A
  • empirical work on NPD has primarily focused on evaluating the psychometric properties
    of DSM criteria
  • a large portion of available research targets narcissistic traits in community samples; far fewer studies examine NPD symptoms or utilize clinical populations
  • most well-studied NPD symptoms are lack of empathy and grandiose sense of self-
    importance - studies indicate that deficits are apparent in both willingness and capability
  • persons with NPD believe they are less skilled at perceiving and accurately identifying
    others’ mental states
  • some of the socio-emotional dysfunction associated with NPD may occur outside
    individuals’ awareness
74
Q

NPD Prevalence and Comorbidity

A
  • approximately 0.5% to 6.2% of the general population, ranges anywhere from 1% to
    17% in clinical samples
  • approximately 6% of forensic populations
  • more commonly diagnosed among men (7.7%) as compared to women (4.8%)
75
Q

NPD Etiology - genetics

A
  • Heritability estimates for NPD range from 24% to 45%
76
Q

NPD etiology - psychological factors

A

Individualswhohavehighscoresonmeasuresofgrandiosenarcissismshowastrongvapproachmotivationbias

77
Q

NPD etiology - childhood factors

A
  • Kohut and Kernberg’s models, which argue NPD arises from maladaptive parenting
    practices
  • extreme parental affection and excessive unconditional praise (e.g., emphasizing
    superiority over others) are central contributors to narcissism
    o narcissism is also linked to parental coldness, invalidation, and making
    excessive, developmentally inappropriate demands
78
Q

NPD Treatment

A
  • more likely to seek out treatment for co-occurring conditions (e.g., substance use, mood
    disorders) and interpersonal difficulties, making it difficult to recognize and treat NPD-
    specific pathology
  • No RCTs have assessed treatment outcomes among these individuals
79
Q

Avoidant Personality Disorder

A
  • maladaptive avoidance of social experiences, driven by perceptions of inadequacy and extreme sensitivity to negative evaluation and rejection
  • may be an extreme variation of normal shyness
80
Q

Avoidant Personality Disorder – History

A
  • Bleuler composed one of the earliest descriptions of avoidant personality pathology in
    1911 - avoidance stemmed from a tendency to be overstimulated by the outside world
    and that individuals would engage in reclusive behaviours to prevent intense negative
    affective
  • 1945 that a psychoanalyst named Karen Horney proposed that interpersonal problems
    and attachment difficulties underlie avoidance
  • Millon (1981) - distinguished between active (i.e., deliberately avoidant) and passive
    (i.e., lacking motivation/sensitivity) social avoidance.
  • first introduced in the DSM-III
81
Q

Avoidant Personality Disorder - Clinical Features and Supporting Data

A
  • an interpersonal disorder, characterized by a tendency to fear and avoid social
    interactions
  • primary feature of APD is extreme social avoidance
  • tend to be colder, more submissive, and possibly less assertive in their social
    interactions
  • Anxiety, fear, and low self-esteem are core features of APD pathology
  • individuals with APD may still possess a desire to be connected to others
  • report lower self-esteem than other clinical conditions (like BPD)
82
Q

Avoidant Personality Disorder - diagnostic criteria

A

avoidance of occupational activities for fear of criticism or rejection, restraint in
intimate relationships for a similar fear of being criticized or ridiculed, and unwillingness to connect with
others unless there is a certainty of being liked, impairments in self-related functioning, such as a
preoccupation with fear of rejection, inhibition in new social situations due to feelings of inadequacy,
negative self-views (i.e., believing oneself is inferior or socially inept), and reluctance to take personal risks
for fear of embarrassment

83
Q

Avoidant Personality Disorder - Prevalence and Comorbidity

A
  • lifetime prevalence of APD ranges from 1.7% to 2.4%
  • APD co-occurs with social phobia anywhere from 32% to 63% of the time
  • APD co-occurs with and is a significant predictor of depression
84
Q

Avoidant Personality Disorder – Etiology

A
  • modest genetic contribution (i.e., heritability estimates range from 31% to 67% across
    samples
  • specific risk factors may differentially shape APD and social anxiety trajectories
  • Some research links adverse childhood experiences (i.e., neglect, abuse, childhood
    trauma, parental overprotection, childhood teasing) and early-occurring anxiety disorders
    to APD development
85
Q

Avoidant Personality Disorder – Treatment

A
  • CBT typically targets maladaptive beliefs and incorporates social skills training as well as
    behavioural experiments to challenge fears
  • Evidence for psychodynamic therapy is mixed
  • Schema therapy has received some support for treating individuals with APD (80%
    higher recovery rates compared with treatment as usual - targets patterns of cognitions,
    emotions, and actions thought to arise out of unmet childhood needs
86
Q

Dependent Personality Disorder

A
  • term dependency captures relying on others for nurturance, support, and guidance
  • submissive attitudes and behaviours, extreme reliance on others, and maladaptive
    pursuits of interpersonal connection
  • physically clinging to others, frequent reassurance-seeking, and inappropriate bids for
    help
87
Q

Dependent Personality Disorder – History

A
  • Freud articulated a description of dependency in his theory of psychosexual
    development
88
Q

Dependent Personality Disorder - diagnostic criteria

A
  • 5/8 symptoms - (1) difficulty making everyday decisions without others’ guidance or reassurance; (2)
    needing others to assume responsibility over most major life areas; (3) difficulty expressing disagreement
    with others for fear of losing support; (4) difficulty taking initiative due to low self-confidence; (5) extreme
    motivation to obtain support and nurturance from others; (6) feelings of discomfort or helplessness when
    alone; (7) immediately seeking out a new relationship when others end; and (8) consistent fear of being left
    by another to take care of oneself
89
Q

Dependent Personality Disorder - Clinical Features and Supporting Data

A
  • emphasize patterns of passivity, submissiveness, and accommodation to others
  • Some have proposed a passive-submissive type characterized by expressing
    helplessness and vulnerability, and an active-emotional type characterized by making
    others feel indebted, emphasizing one’s own value, and aggression
90
Q

two main types of maladaptive dependency

A

submissive (characterized by difficulty makingdecisions and fearfulness), and exploitable, characterized by a desire to please othersandavoidconflict

91
Q

Dependent Personality Disorder - Prevalence and Comorbidity

A
  • Prevalence estimates in the general population range from 0.37% to 0.49%
  • some studies reporting higher rates and more severe DPD features among women as
    compared to men
  • co-occurs with a range of psychopathology, including mood, anxiety, personality, and
    eating disorders (particularly bulimia nervosa)
    -
    DPDappearstomostfrequentlyaccompanypanicdisorder,socialphobia,andobsessiv
    e-compulsivedisorder
92
Q

Dependent Personality Disorder – Etiology - genetics

A
  • Heritability estimates for DPD range widely, from 0.27 to 0.66
93
Q

Dependent Personality Disorder – Etiology - parenting

A
  • highlights parenting style as a potential source of risk. Attachment theory has heavily
    influenced DPD literature
  • DPD group more often reported early family environments characterized by restrictive
    rules, low openness, and low emotional expression
  • propose links between authoritarian parenting and DPD by citing indirect evidence that
    authoritarian parenting creates fewer opportunities to develop competencies and
    establish agency
94
Q

Dependent Personality Disorder – Treatment

A
  • show greater treatment progress when receiving short-term care
  • large-scale RCTs evidence positive treatment outcomes with CBT, short-term dynamic
    therapy, and relational therapy
  • High treatment engagement is also associated with better outcomes for individuals with
    DPD when being treated for a co-occurring disorder
95
Q

Dependent Personality Disorder - clarification-oriented
psychotherapy

A

is efficacious for reducing maladaptive DPD traits and increasing
self-efficacy

96
Q

Obsessive-Compulsive Personality Disorder – History

A
  • “anal” – freud - believed that the underlying pathology for this personality type arose
    from problems navigating potty-training during the anal stage of his developmental
    model
  • clinical presentation he described was included in the first edition of the DSM as
    compulsive personality disorder
97
Q

Obsessive-Compulsive Personality Disorder - Clinical Features and Supporting Data

A
  • primarily characterized by patterns of perfectionism and preoccupation with control and
    orderliness
  • often rigidly adhere to rules/procedures and take great pains to avoid mistakes
  • complete tasks with painstaking care, getting lost in trivial details, and repeatedly scan
    for possible mistakes
98
Q

Obsessive-Compulsive Personality Disorder - diagnostic criteria

A

4/8 symptoms - 1) preoccupation with details, rules, order, lists, organization, or schedules to the point
that the main purpose of the activity is lost; (2) perfectionism that interferes with task completion; (3)
excessive devotion to work and productivity to the point of excluding leisure activities and friendships (not
accounted for by economic necessity); (4) excessive conscientiousness, scrupulousness, and inflexibility
regarding values, morality, and ethics (not accounted for by culture or religion); (5) unwillingness to discard
worn-out or worthless objects, including objects without sentimental value; (6) reluctance to delegate tasks
or work with others unless they completely adhere to the individual’s own way of

99
Q

Obsessive-Compulsive Personality Disorder – Prevalence

A

estimates ranging from 3% to 9.7%

100
Q

Obsessive-Compulsive Personality Disorder – Etiology

A

Some theorists argue that authoritarian parenting styles characterized by strict demand for unwavering obedience, orderliness, and deference contribute to OCPD

one study found genetic influences accounted for 78% of the variance in OCPD
(Torgersen et al., 2000), another found such factors only accounted for 27%

101
Q

Obsessive-Compulsive Personality Disorder - treatment

A

some preliminary evidence for certain psychotropic medications (e.g.,
carbamazepine and fluvoxamine

however, pharmacological and psychological RCTs are lacking.

Psyc 241 - Final Exam (4 decks)

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