Personality Disorders Flashcards
What is personality?
Personality refers to enduring and persistent patterns of thinking and behavior that distinguish a person from others, characterized by a unique set of traits.
How does the DSM-5 describe personality?
The DSM-5 describes personality as stable traits, behaviors, and patterns of thinking that are enduring and persistent.
What does “enduring or persistent” mean in the context of personality?
It refers to patterns that are present since young adulthood and evident in almost every day of adult life.
Why is personality considered stable over time?
It involves dominant response and perception modes that form a core framework, anchoring and providing a stable way of functioning in life.
How can personality become pathological?
When the patterns of expressing emotions, thoughts, or behavior become maladaptive, personality disorders can develop.
What aspects of functioning can be affected by maladaptive personality patterns?
Patterns of expressing emotion, thinking about oneself and others, and relating to others can be negatively impacted.
What are some common patterns observed in personality?
Expressing emotion
Feeling
Behaving
Thinking about oneself and others
Relating to others
What is personality according to the DSM-5?
Personality is a set of enduring and persistent traits, behaviors, and thinking patterns that make us unique and stable over time.
What does it mean for personality to be “enduring” or “persistent”?
It means these patterns appear from young adulthood and remain stable, shaping our everyday behavior and responses throughout life.
When do personality patterns become pathological?
When they become maladaptive and negatively impact emotions, thoughts, behavior, or relationships, leading to personality disorders.
What key patterns define personality?
Expressing emotion, feeling, behaving, thinking about ourselves and others, and relating to others.
How can personality patterns lead to conflict with others?
While personality helps us interact with others, extreme or inappropriate patterns of behavior, thought, or emotion can create conflict. These tendencies, even when initially positive, may not fit certain situations and cause unintentional harm.
How can helpful traits, like assertiveness, become problematic?
Assertiveness or healthy skepticism can be advantageous, but if taken to extremes, they may resemble negative traits like paranoia, making it difficult to relate to others.
What distinguishes a healthy personality from a dysfunctional one?
A healthy personality shows flexibility and adaptability, while a dysfunctional personality is rigid, inflexible, and limited in responses, negatively impacting identity, empathy, and relationships.
How does self-confidence exist on a continuum, and why is context important?
Self-confidence can range from grandiosity (extreme confidence) to crippling self-doubt. Whether it is adaptive or impairing depends on the situation, relationships, and how it influences others’ responses and feedback.
Why are personality disorders considered controversial?
They have a high risk of misdiagnosis and low interrater reliability because the criteria focus on patterns of inner experience rather than clear symptoms, making diagnoses difficult to agree upon.
What was the debate around the DSM-5’s classification of personality disorders?
There was discussion about shifting from a categorical to a dimensional model, but no agreement was reached, and the DSM-5 retained the categorical model from DSM-IV.
What is the dimensional model in personality disorder classification?
The dimensional model, included in Section III of DSM-5 for further research, conceptualizes personality on a continuum rather than as discrete categories, reflecting how traits vary across individuals.
Why is diagnosing personality disorders complex?
There is significant overlap with other psychopathologies (e.g., anxiety and mood disorders), and the relationship between personality disorders and major personality models is intricate, with more patterns than the 10 DSM-defined PDs.
What are some criticisms of the DSM-5 personality disorder classifications?
Categories are descriptive and offer little insight into causes (aetiology). Critics argue that the lack of clinical utility and biological mechanisms raises questions about the usefulness of labeling these disorders.
How can gender bias affect personality disorder diagnosis?
Gender bias in how disorders are framed can lead to misrepresentation and issues in identifying psychopathology, indicating potential flaws in the diagnostic criteria.
Why are personality disorders challenging to manage and treat?
Personality disorders are often ego-syntonic, meaning behaviors align with a person’s self-image. This lack of insight makes it difficult for individuals to recognize problems and seek or accept help, complicating treatment.
What are the two key steps in diagnosing a personality disorder (PD) according to the DSM-5?
Confirm the individual meets the general criteria for PD.
If general criteria are met, determine if a specific type of PD can be identified.
What are the four areas where personality disorders manifest according to DSM-5 criteria?
Cognition (perception and interpretation of self, others, and events)
Affectivity (range and appropriateness of emotional responses)
Interpersonal functioning
Impulse control
What additional requirements must be met for a personality disorder diagnosis?
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.
How does social motivation contribute to personality disorders?
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.
What role do cognitive perspectives play in personality disorders?
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.
How do temperament and personality traits relate to personality disorders?
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.
How are personality disorders categorized in the DSM-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
What personality disorders are included in Cluster A?
Schizoid personality disorder
Schizotypal personality disorder
Paranoid personality disorder
Which personality disorders fall under Cluster B?
Borderline personality disorder
Histrionic personality disorder
Narcissistic personality disorder
Antisocial personality disorder
What are the characteristics of Cluster C personality disorders?
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.
What is the hallmark feature of Cluster A personality disorders?
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.
What are some key diagnostic criteria for Paranoid Personality Disorder (PPD)?
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.
What does Criterion A of Paranoid Personality Disorder (PPD) highlight?
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.
What are the key points of Criterion B for Paranoid Personality Disorder?
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.
What is the hallmark feature of Schizoid Personality Disorder (PD)?
A pervasive pattern of detachment from social relationships and a restricted range of emotional expression in interpersonal settings.
What are some key diagnostic criteria for Schizoid PD?
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.
How can Schizoid PD be differentiated from schizophrenia?
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.
What is the hallmark feature of Schizotypal Personality Disorder (PD)?
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.
What are the diagnostic criteria for Schizotypal PD?
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
How can Schizotypal PD be differentiated from psychosis?
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.
How can Cluster A personality disorders be distinguished from schizophrenia?
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.
What characterizes Cluster B personality disorders?
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.
What are the diagnostic criteria for Antisocial Personality Disorder (ASPD)?
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.
What is the hallmark of Antisocial Personality Disorder (ASPD)?
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.
How do psychopathy and ASPD differ according to Cleckley (1976) and Hare (1998)?
Psychopathy: Includes both emotional/interpersonal traits and social deviance.
ASPD: Primarily captures the “social deviance” factor.
What are the key diagnostic criteria for Borderline Personality Disorder (BPD)?
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.
What is the hallmark of Borderline Personality Disorder (BPD)?
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.
Why is it important to consider alternative diagnoses when assessing BPD?
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.
What is the key difference between personality disorders and psychiatric illnesses (like anxiety, schizophrenia, or depression)?
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.
What is the hallmark feature of Borderline Personality Disorder (BPD)?
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.
What distinguishes Bipolar Disorder from BPD in terms of mood duration?
BPD: Quick mood changes with behaviors fluctuating in intensity over a long time.
Bipolar: Slower, episodic mood changes, similar to bad weather.
How do practical behaviors differ between BPD and Bipolar Disorder?
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.
How is treatment for BPD and Bipolar Disorder different?
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.
What are the diagnostic criteria for Histrionic Personality Disorder (HPD)?
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.
What is the hallmark feature of Histrionic Personality Disorder (HPD), and how does it differ from BPD?
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.
What are the diagnostic criteria for Narcissistic Personality Disorder (NPD)?
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.
What is the hallmark feature of Narcissistic Personality Disorder (NPD), and how does it overlap with BPD?
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).
What is the common feature of Cluster C personality disorders?
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.
What are the key characteristics of Avoidant Personality Disorder (AvPD)?
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.
How can AvPD be differentiated from Social Anxiety Disorder (SAD)?
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.
What are the key diagnostic criteria for Dependent Personality Disorder (DPD)?
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
What is the hallmark feature of Dependent Personality Disorder (DPD)?
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.
What are the hallmark features of Obsessive-Compulsive Personality Disorder (OCPD)?
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.
How does Obsessive-Compulsive Personality Disorder (OCPD) differ from Obsessive-Compulsive Disorder (OCD)?
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).
Why is it important to distinguish OCPD from OCD?
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.
What is an “Other Specified Personality Disorder” according to the DSM-5?
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).
What defines an “Unspecified Personality Disorder”?
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.
What is a Personality Disorder due to another medical condition? How does it differ from other PDs?
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.
What are the challenges in estimating the prevalence of Personality Disorders (PDs)?
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.
What is the estimated prevalence for specific Personality Disorders (PDs)?
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.
What challenges arise from the heterogeneity in diagnosing Personality Disorders (PDs)?
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).
How does comorbidity and diagnostic ambiguity create issues with the DSM-5 categories?
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.
What is Cloninger’s (2000) critique of the DSM’s classification of personality disorders (PDs)?
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.
What are some sex differences in the prevalence of personality disorders (PD)?
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.
What controversies surround gender bias in the diagnosis of personality disorders (PD)?
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.
What is the gender-based critique of personality disorder (PD) definitions?
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.
What is the typical course and outcome of personality disorders?
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.
What is the nature of the aetiology of personality disorders (PDs)?
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.
Which developmental theories attempt to explain the link between trauma and PDs?
Attachment theory
Mentalisation
Object relations theory
Cognitive models
Schema-based frameworks
Affect regulation theories
What is the concept of retrospectivity in PD research?
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.
What is the relational perspective on disordered personality?
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.
What factors are commonly reported by adolescent girls with BPD?
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.
How does relational trauma in childhood impact individuals with BPD?
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.
What does Linehan’s Diathesis-Stress Theory explain about BPD?
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.
What are the main psychotherapeutic treatments for Borderline PD?
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.
What role do medications and hospitalization play in treating Borderline PD?
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.
What is the aetiological relationship between Schizotypal PD and Schizophrenia?
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.
What are the treatment challenges and focus areas for Schizotypal PD?
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.
What is the aetiology of Narcissistic Personality Disorder according to Kohut’s psychology model and the social cognitive model?
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.
What is the treatment for NPD?
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.
What is the Aetiology of Antisocial PD?
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.
What is the aetiology of Antisocial PD from a development perspective? label the risk factors
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.
What is the under arousal hypothesis and treatment for Antisocial PD?
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.
What are the treatment and outcomes for people with antisocial PD?
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.
What are some examples of a comorbid PD diagnosis and the outcomes?
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.
What is a maladaptive schema and metacognition?
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.
