Personality Disorders Flashcards

Question

What additional requirements must be met for a personality disorder diagnosis?

Answer 1

The pattern must be inflexible, pervasive across social settings, cause significant distress or impairment, and be stable over time, with onset in adolescence or early adulthood.

Answer 2

Low affiliation or a preference for isolation can result in avoiding connections, while a desire for prestige or dominance may create conflict, disrupting social adjustment and contributing to personality disorders.

Answer 3

Unstable or unrealistic self-views and difficulty judging others' motives can impair relationships and social functioning, pushing individuals towards personality disorders by limiting their ability to understand or respond to others' needs.

Answer 4

Personality disorders reflect maladaptive variations in traits, often aligning with OCEAN theory dimensions. These maladaptive patterns are considered a core component in understanding and diagnosing personality disorders.

Answer 5

Cluster A: Social detachment, eccentric/odd Cluster B: Emotional, erratic, dramatic Cluster C: Anxious, fearful Also included: Personality change due to another medical condition Other specified personality disorder Unspecified personality disorder

Answer 6

Schizoid personality disorder Schizotypal personality disorder Paranoid personality disorder

Answer 7

Borderline personality disorder Histrionic personality disorder Narcissistic personality disorder Antisocial personality disorder

Answer 8

Avoidant personality disorder Obsessive-compulsive personality disorder Dependent personality disorder These disorders are described as anxious and fearful, with anxiety and fear at their core.

Answer 9

People with Cluster A personality disorders may appear odd or eccentric to others. An important aspect of these disorders is understanding how pervasiveness and enduring patterns are reflected in the diagnostic criteria.

Answer 10

Suspects, without reason, that others are exploiting, harming, or deceiving them. Doubts the loyalty or trustworthiness of friends or associates. Reluctant to confide in others due to fear of malicious intent. Reads hidden demeaning meanings into benign remarks or events. Bears grudges and is unforgiving of perceived slights. Perceives attacks on their character and reacts angrily or counterattacks. Has unjustified suspicions about a spouse's or partner's fidelity.

Answer 11

It emphasizes heterogeneity by requiring four or more traits from a list, allowing flexibility in diagnosis. Criterion A also reflects the importance of pervasive and enduring patterns in PPD.

Answer 12

Criterion B involves ruling out other conditions with similar symptoms, like eccentric or distrustful behavior. It highlights the challenge of maintaining relationships, as individuals with PPD may misread benign situations, react aggressively, and struggle with social functioning.

Answer 13

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

Answer 14

Does not desire or enjoy close relationships. Prefers solitary activities. Shows little interest in sexual experiences. Takes pleasure in few activities. Lacks close friends other than first-degree relatives. Appears indifferent to praise or criticism. Shows emotional coldness, detachment, or flattened affectivity.

Answer 15

Schizoid PD shows a lifelong pattern of behavior starting in young adulthood, whereas schizophrenia is typically episodic, with symptoms that may gradually resolve over time.

Answer 16

A pattern of interpersonal deficits marked by acute discomfort with and reduced capacity for close relationships, along with cognitive or perceptual distortions and eccentric behavior.

Answer 17

The individual must present at least five of the following: Ideas of reference (excluding delusions) Odd beliefs or magical thinking Unusual perceptual experiences Odd thinking and speech Suspiciousness or paranoid ideation Inappropriate or constricted affect Odd, eccentric, or peculiar behavior Lack of close friends outside of immediate family Excessive social anxiety that does not decrease with familiarity

Answer 18

Although people with Schizotypal PD may have disorganized speech and behavior, they are not psychotic or delusional. They remain in touch with reality, but their symptoms differ in quality and intensity from psychotic disorders.

Answer 19

Schizophrenia involves positive symptoms (hallucinations, delusions), negative symptoms (reduced affect, amotivation, anhedonia), and disorganized thinking and behavior. It also differs from Cluster A disorders in onset, with schizophrenia being episodic and more intense, while Cluster A disorders exhibit lifelong patterns.

Answer 20

Cluster B disorders involve individuals who may appear "dramatic, emotional, or erratic" to others and have marked difficulty maintaining interpersonal relationships. Unlike Cluster A, the disorders within Cluster B show fewer similarities with each other.

Answer 21

Failure to conform to social norms, engaging in illegal acts. Deceitfulness, including repeated lying or use of aliases. Impulsivity and failure to plan ahead. Irritability and aggressiveness, leading to physical fights or assaults. Reckless disregard for the safety of self or others. Consistent irresponsibility, such as failing to maintain work or honor financial obligations. Lack of remorse for harming others.

Answer 22

ASPD involves chronic failure to conform to social norms, with deceitfulness, impulsivity, irritability, recklessness, and lack of remorse. It typically begins early in life and is applied only to adults. Conduct disorder, a similar condition, applies to younger individuals.

Answer 23

Psychopathy: Includes both emotional/interpersonal traits and social deviance. ASPD: Primarily captures the "social deviance" factor.

Answer 24

Frantic efforts to avoid real or imagined abandonment. Unstable relationships marked by idealization and devaluation. Persistent identity disturbance. Impulsivity in self-damaging behaviors. Recurrent suicidal behavior or self-mutilation. Affective instability due to mood reactivity. Chronic feelings of emptiness. Inappropriate, intense anger or difficulty controlling anger. Stress-related paranoia or severe dissociation.

Answer 25

BPD is a diffuse and heterogeneous diagnosis. People with BPD may form intense but unstable relationships, exhibit mood swings between depression, anxiety, and anger, and display impulsive behaviors such as temper tantrums, self-harm, and suicidal threats.

Answer 26

Due to the complexity and variability of BPD symptoms, it is essential to consider other disorders that might explain the same attributes, ensuring a thorough and accurate diagnosis.

Answer 27

Personality is the "hard wiring" of the self, while illnesses reflect a temporary state. Personality can be compared to the climate, whereas depression is like the weather.

Answer 28

BPD involves unstable relationships, self-image, emotional expression, and impulsivity, beginning in early adulthood. Diagnosis requires meeting five or more criteria, with identity disturbances often involving core issues like gender or sexuality.

Answer 29

BPD: Quick mood changes with behaviors fluctuating in intensity over a long time. Bipolar: Slower, episodic mood changes, similar to bad weather.

Answer 30

BPD: Behaviors may appear manipulative, tied to personality. Bipolar: Behavior is not manipulative; self-harm is related to personality traits and coping, not the mood disorder itself.

Answer 31

BPD: Treated with Dialectical Behavior Therapy (DBT), which was created specifically for borderline. Bipolar: Treated primarily with medication for manic episodes, with psychotherapy playing a secondary role.

Answer 32

Uncomfortable when not the center of attention. Interacts with others through inappropriate sexually seductive behavior. Displays rapidly shifting and shallow emotions. Uses physical appearance to draw attention. Has impressionistic and vague speech. Exhibits self-dramatization and exaggerated emotions. Is easily influenced by others or circumstances. Considers relationships to be more intimate than they actually are.

Answer 33

HPD is characterized by excessive emotionality and attention-seeking behavior, starting in early adulthood. Like BPD, it can involve manipulative behaviors, but in HPD, these behaviors are linked to a stronger need for connection with others.

Answer 34

Grandiose sense of self-importance. Preoccupied with fantasies of unlimited success, power, or beauty. Believes they are unique and should only associate with high-status people. Requires excessive admiration. Has a sense of entitlement. Exploitative in relationships. Lacks empathy for others. Often envious of others or believes others are envious of them. Displays arrogant or haughty behaviors.

Answer 35

NPD is characterized by grandiosity, a need for admiration, and a lack of empathy. Individuals with NPD have an inflated sense of self-importance and are preoccupied with their abilities, which they see as special. They are often regarded as arrogant and self-obsessed, with some overlap in behavior with Borderline Personality Disorder (BPD).

Answer 36

Individuals with Cluster C personality disorders often appear anxious or fearful. If anxiety or fear is a pervasive trait, it may indicate a disorder within this cluster.

Answer 37

Pervasive social inhibition and feelings of inadequacy. Hypersensitivity to negative evaluation. Avoids relationships and interpersonal contact due to fear of rejection or criticism. Concerned about intimate relationships and may avoid closeness entirely.

Answer 38

SAD: Avoids specific situations, may have close relationships but avoids public or performance scenarios. AvPD: Avoids relationships more generally, focusing on intimacy and interpersonal closeness, showing a global pattern of avoidance. AvPD is more pervasive and inflexible, with no history of strong social relationships free from these fears.

Answer 39

Difficulty making everyday decisions without reassurance from others. Needs others to take responsibility for major areas of life. Struggles to express disagreement out of fear of losing support. Has difficulty starting projects independently due to lack of confidence. Goes to great lengths to gain support, even doing unpleasant tasks. Feels helpless when alone due to exaggerated fears of being unable to care for oneself. Seeks new relationships for care and support immediately after one ends. Preoccupied with fears of being left to care for themselves

Answer 40

A pervasive and excessive need to be taken care of, leading to submissive and clinging behavior, along with fears of separation. This dependence makes it difficult for individuals to make decisions independently, as they crave constant support and approval from others.

Answer 41

Preoccupation with orderliness, perfectionism, and control at the expense of flexibility and efficiency. Sets unachievable high standards, often appearing to others as workaholics. Relentlessly pursues self-set goals even when other life aspects are negatively impacted. May seem excessively conscientious, moralistic, judgmental, and intolerant of emotional expression in others.

Answer 42

OCPD: Rigidity stems from the belief they are best suited to control things, and their behaviors are typically ego-syntonic (in harmony with their self-image). OCD: Involves intrusive, unwanted thoughts and ritualistic behaviors, often ego-dystonic (causing discomfort and seen as foreign to the self).

Answer 43

Individuals with OCPD may not experience subjective anxiety or distress about their control behaviors. In OCD, control behaviors do not relieve distress or anxiety, whereas in OCPD, these behaviors are part of their self-concept. OCPD focuses on perfectionism and interpersonal control, while OCD revolves around intrusive thoughts and rituals.

Answer 44

General criteria for a personality disorder (PD) are met, but not for a specific diagnostic class. Clinicians specify a reason for the lack of fit with a single PD category (e.g., mixed personality features).

Answer 45

General criteria for a PD are met, but the case does not fully meet criteria for a specific PD. Either there is insufficient information to make a definitive diagnosis, or the clinician does not specify the reason the criteria are met.

Answer 46

A personality disturbance results from a medical condition and is not an enduring pattern. Example: In fronto-temporal dementia, personality changes appear with the onset of physical illness, unlike personality disorders, which typically manifest early in life and endure over time. The timing and co-occurrence of symptoms help distinguish it from other PDs.

Answer 47

Difficulty due to the reliability of diagnostic criteria and comorbidity with other disorders. Many people with PDs may have multiple diagnoses, complicating accurate prevalence measurement. In Australia, lifetime prevalence is estimated at 6% (10% globally). Higher prevalence found in specific populations like prisons and psychiatric care facilities.

Answer 48

OCPD and AvPD: 3-4% of the population (lifetime prevalence). Narcissistic PD (NPD): Affects over 1% of the population but is less likely to be diagnosed. Why NPD prevalence is low: Individuals with NPD may not seek therapy due to grandiosity and self-importance, reducing opportunities for diagnosis.

Answer 49

There are many ways to exhibit the same disorder. For example, diagnosing Borderline PD requires 5 out of 9 possible characteristics, leading to 256 different patterns. Patients may display overlapping traits across multiple disorders. At least 50% of individuals with a PD meet criteria for another PD, and 75% meet criteria for other mental health disorders (e.g., depression or anxiety).

Answer 50

Overly general or arbitrary diagnostic thresholds make it hard to distinguish between normal personality traits and PDs. Common diagnoses like "Other Specified" or "Unspecified PDs" highlight the DSM's struggle to capture personality psychopathology adequately. There is a critique that the current categories might not be fit for purpose, as they do not fully represent the individuals they aim to diagnose, raising concerns about the framing of these disorders in the DSM.

Answer 51

Cloninger argues that the classification of PDs is flawed by assuming multiple discrete categorical disorders. The clusters and categories are seen as redundant and overlapping, making systematic diagnosis impractical in clinical settings and unjustified in psychometric research. The predictive power of categorical diagnoses is weak and inconsistent. Although the critique came before DSM-5, these concerns remain relevant, as the disorders and categories did not change significantly with the DSM-5.

Answer 52

Overall prevalence of PD is about equal in men and women. Antisocial PD is more common in men (approx. 5%) than women (approx. 2%). BPD (Borderline PD) and DPD (Dependent PD) may be more prevalent in women, though evidence is not strong. Some speculation suggests that Paranoid PD and OCPD (Obsessive-Compulsive PD) are more common among men.

Answer 53

There is ongoing debate about gender bias in PD diagnosis. Key question: Are gendered patterns explained by valid aetiological models? If not, potential biases could reflect poorly framed categories, picking up socially constructed traits instead of valid psychopathology. This raises concerns about whether the diagnostic categories are based on sound science or lack clinical utility.

Answer 54

Some PD definitions are based on sex role stereotypes and are inherently sexist. Example: Dependent PD traits like being unassertive or prioritizing others may reflect traditionally feminine traits—raising concerns about whether DSM is arbitrarily labeling these as maladaptive. Clinicians may exhibit bias, being more likely to diagnose women with Borderline PD than men, even when both exhibit the same symptoms.

Answer 55

Long-term course (by definition): If the persistent pattern is enduring, it may require considerable time and effort to change—if it is achieved at all. PDs are often diagnosed in late adulthood or early childhood and can persist throughout a person’s life. The classic view is that PDs are difficult to treat, though newer evidence provides a more hopeful perspective. Long-term nature is due to ingrained tendencies and ego-syntonic traits, making shifts difficult. Present from: Adolescence/early adulthood and persistent. Impact: Disruptive to relationships, work, and sense of self.

Answer 56

No single cause or pathway; PDs have multifactorial aetiology. Some PDs have a genetic basis, while others, like Antisocial PD (ASPD), are influenced by social factors (e.g., parenting, peers, community). Early life experiences, such as trauma or childhood mistreatment, may play a role, especially in Cluster B PDs, but similar histories do not always result in the same condition.

Answer 57

Attachment theory Mentalisation Object relations theory Cognitive models Schema-based frameworks Affect regulation theories

Answer 58

Retrospectivity involves working backwards from observed symptoms to find aetiological factors. Critics argue that DSM criteria might not be reliable or consistently applied, making it difficult to identify correct starting points for PD diagnoses. If criteria and risk factors are misapplied, the DSM risks becoming ineffective in capturing meaningful clinical presentations.

Answer 59

Disordered personality is seen as an adaptation to early relational contexts and efforts to connect with others. Struggles in early relationships can impact one’s ability to form and maintain relationships throughout life. Childhood relationships serve as templates for future connections. Humans are sensitive to disconnection and require connection (as explained by attachment theory). Behaviors learned to maintain early connections are applied more broadly over time. Extreme adaptations in early relational contexts tend to carry over into broader aspects of life.

Answer 60

Lack of supervision Frequent witnessing of domestic violence Exposure to verbal, physical, and sexual abuse Inappropriate behavior by parents or other adults Be aware: The myth that BPD only occurs in females is present in the literature, but we must be cautious about this assumption.

Answer 61

Disrupts attachment relationships, undermining basic security Impacts development and separation-individuation Undermines the ability to regulate emotions (affect regulation) Reduces capacity for mentalisation Important reminder: Not everyone with trauma develops a PD, and not everyone with a PD has experienced trauma.

Answer 62

Emotional regulation difficulties may have a biological basis (diathesis) Families may invalidate emotional experiences and expression This leads to further difficulties in organizing and regulating emotions The model aligns with the core symptoms of BPD and explains how developmental and environmental factors interact to produce symptoms.

Answer 63

Dialectical Behaviour Therapy (DBT): Increases tolerance of strong affective states Builds resources to soothe intensity Therapist's stable presence supports acceptance of challenging behaviors Schema Therapy Interpersonal Therapy Psychodynamic Psychotherapies Mentalisation-based Therapy Study Tip: Adaptations of these therapies may be needed to better suit individuals with personality disorders.

Answer 64

Medications are often used to manage associated symptoms (e.g., antidepressants, antipsychotics), but evidence for their efficacy is limited. Hospitalization is recommended if there is a risk of self-harm or suicide. Key Insight: While medications are commonly prescribed (96% of patients receive at least one), evidence suggests that medications alone are not effective in reducing the severity of BPD.

Answer 65

Research links Schizotypal PD to Schizophrenia. Individuals with first-degree relatives diagnosed with Schizophrenia are more likely to meet criteria for Schizotypal PD. This has led to the postulate that Schizotypal PD is genetically related to Schizophrenia.

Answer 66

Challenges: Limited treatment-seeking behavior and high rates of premature termination. Treatment Approaches: Low-dose antipsychotic medications have shown some effectiveness. Limited evidence supports the effectiveness of psychotherapy. Treatment often focuses on managing comorbid issues, such as depression or substance abuse/dependence.

Answer 67

Kohut's Self-Psychology Model: Masks low self-esteem, worthlessness. Child valued for mirroring, not competency or self-worth. Narcissism used to boost self-esteem in childhood. Failure to develop genuine self-image; child becomes an extension of the parent. Cold, achievement-focused parenting; emotions often dismissed or mocked. Social Cognitive Model: Low self-esteem; self-worth depends on achievements. Interpersonal relationships used to boost self-esteem, not for closeness. Cognitive biases sustain narcissism.

Answer 68

Psychotherapy is the main treatment: Low rates of treatment seeking due to difficulty acknowledging vulnerability. Complicated by interpersonal relationship difficulties. Often short-term during crises; treatment stops after crises resolve. Cyclical engagement is common. Psychodynamic psychotherapies: Focus on increasing willingness to confront vulnerability. Explore how defences impact relationships.

Answer 69

Most studied PD with extensive research on its aetiology. Genetics: Offspring of convicted criminals raised by adoptive families show higher arrest rates and ASPD prevalence. Concordance rates: 55% for identical twins (MZ) and 13% for fraternal twins (DZ). Moderate heritability: Genes may explain some comorbidities (e.g., substance use disorders). Interaction between genetics and environment aligns with the diathesis-stress model.

Answer 70

Risk increases in adverse family environments: Lack of warmth, negativity, parental inconsistency. Poverty, inconsistent discipline, and poor monitoring. Exposure to violence, marital conflict. Parental substance abuse or criminal behavior. Conclusion: Environmental and family factors predict increased risk of ASPD.

Answer 71

Under Arousal Hypothesis: Low levels of anxiety and fear. Lower physiological response to frightening or disgusting stimuli. Longitudinal studies show lower skin conductance, heart rate, and slow-frequency brain wave activity in future criminals. High impulsivity and low responsiveness to conditioning or punishment.

Answer 72

Rarely seek treatment voluntarily; often referred via the legal system. Time-limited treatment aimed at reducing recidivism or addressing substance abuse. Some evidence for targeted interventions improving specific behaviours, though personality traits typically remain unchanged. These personality patterns are often not modifiable in a therapeutic sense.

Answer 73

Metacognitive Interpersonal Therapy (MIT): Applied to a person with Avoidant and Obsessive-Compulsive PDs. Aims to improve metacognition and shift maladaptive schema-driven behavior. Therapy spanned one year with 36 sessions. Interpersonal therapies often require extended time to impact ingrained schemas. Outcome: Improvement seen across three outcomes; the man reported no longer meeting diagnostic criteria and functioning better. Measures like the DAS and Alexithymia scale showed positive results. However, being a case study, generalizability is limited—what worked for one person may not work for others. Further research could validate the approach and strengthen evidence-based practice.

Answer 74

Maladaptive schema: A dysfunctional underlying belief/view that distorts information processing. Metacognition: Awareness and understanding of one’s thoughts, ability to identify and adjust them.