Personality Disorders Flashcards
What is personality
Unique combination of relatively consistent traits and characteristics that psychologically distinguish one person from another
Identity
Sense of self
- Can be stable and distinct from others
Core aspects of personality
Identity and ability to relate to others
Traits
Enduring predispositions that influence our behaviour across situations
The five factor model
Openness
Conscientiousness
Extraversion
Agreeableness
Neuroticism
General Definition of Personality Disorder
Long-term, rigid, wide-ranging pattern of thoughts, feelings, behaviour causing dysfunction
Generally noticeable by adolescence or young adulthood
- Can emerge as early as childhood
- Typically, not diagnosed until adulthood
- If diagnosed in adolescence must be present for 1 year
Very resistant to treatment
Prevalence of personality disorders in USA
11% of adults
Current types of Personality Disorders
CLUSTER A
- Paranoid personality disorder
- Schiziod personality disorder
- Schizotypal personality disorder
CLUSTER B
- Antisocial personality disorder
- Histrionic personality disorder
- Narcissistic personality disorder
- Emotionally unstable personality disorder
CLUTSTER C
- Avoidant personality disorder
- Obsessive compulsive personality disorder
- Dependent personality disorder
Alternative Model to personality disorders
- Not currently used
- Continuum approach
- Appears to be general personality pathology factor
- Impairment in personality functioning and pathological personality traits
Steps of diagnosing personality disorders
Step 1: Assess impairment in personality functioning
Step 2: Assess pathological personality traits
Step 3a: Apply criteria A and B specific personality disorders
Step 3b: Apply criteria A and B personality disorder-trait specified
Step 4: Apply other inclusion and exclusion criteria
Step 1 of diagnosing personality disorders
ASSES IMPAIRMENT IN PERSONALITY FUNCTIONING
- Self: identity, self direction
- Interpersonal: empathy, intimacy
- generalized severity most important for determining current and future functioning
- Must score moderate of higher to meet criteria for any personality disorder
Step 2 of diagnosing personality disorders
ASSESS PATHOLOGICAL PERSONALITY TRAITS
- Negative affectivity, detachment, antagonism, disinhibition, psychoticism (The bad five)
Step 3 of diagnosing personality disorders
APPLY CRITERIA A AND B FOR SPECIFIC PERSONALITY DISORDERS AND TRAIT SPECIFIED DISORDERS
- Which disorder? or diagnosis of PD-trait specified
Step 4 of diagnosing personality disorders
APPLY OTHER INCLUSION AND EXCLUSION CRITERIA
Are personality problems:
1. Inflexible and pervasive across situations
2. Stable across time, with onset at least adolescence or early adulthood
3. Not better explained by another disorder
4. Not due to substance use or other medical condition
5. Not explained by developmental stage or sociocultural environment
Schizotypal Personality Disorder
Lifelong patterns of odd or peculiar behaviours driven by odd beliefs
Associated Features:
- Social isolation
- Suspiciousness + paranoia
- Preoccupation with bizarre fantasies
- Ideas of reference
- Cognitive + perceptual dysregulation
- Restricted range of emotions
prevalence of schizotypal personality disorder
4.6%
Biological theories of schizotypal personality disorder
- Heritability: 82%
Similar genetic traits and neurological abnormalities to schizophrenia - dysregulation in dopamine
- reduction in gray matter in temporal lobe
- perhaps no impact to PFC
Similar cognitive deficits to schizophrenia
Psychosocial theories of schizotypal personality disorder
Abuse or parent abuse, substance use, jail time
Borderline Personality Disorder
Instability of emotions, interpersonal relationships, and image
- Emotion dysregulation: impulsivity when upset, low emotional understanding, unwillingness to accept emotions
- Extreme sensitivity to perceived interpersonal slights
- Over-reliance on others, worries about rejection and abandonment
Prevalence of Borderline personality Disorder
1.7% general population, 15-28% clinical population
- Increased risk in low SES, early puberty, more distress when young
- Women over men in clinical populations only
Is borderline personality disorder chronic
Yes
- However 85% show remission in 10-15 years (better functioning but still affected)
- Relapse common
Biological theories of borderline personality disorder
- Heritability = 32-72%
- Smaller amygdala and hippocampus
- Structural and metabolic deficits in PFC
Emotional theories of borderline personality Disorder
Difficulties with emotional regulation
- Less willingness to tolerate emotional distress
- Greater variability in mood
- More negative emotional baseline and slower return to emotional baseline
Psychosocial theories of borderline personality disorder
- Childhood instability and parental psychopathology
- Childhood neglect and abuse
- History of emotional invalidation (Causes difficulty with understanding, accepting and controlling emotions, rely on others too much and use indirect strategies to seek support)
Cognitive theories of borderline personality disorder
- Hyperattention to negative emotional stimuli
- Memories are more negative
- More negatively biased interpretations
- Rumination
- Negative views of others and of relationships
- May not differentiate view of themselves from view of others
Splitting
Viewing self and others as all good or all bad, cycling through these views
- Leads to instability in relationships
- Characteristic of borderline personality disorder
Narcissistic Personality Disorder
Broad patterns of grandiosity, need for admiration, lack of empathy
- Exaggeration of achievements and talents
- May react strong to criticism
Shallow relationships, emotional expressions
- May be overly choosy about who they associate with
- Charming, yet difficulty with long term relationships
- Exploit others to gain power; controlling overbearing
Some experience covert feelings in inadequacy
Prevalence of narcissistic personality disorder
6.2% of adults
Biological theories of narcissistic personality disorder
33-59%
Psychosocial theories of narcissistic personality disorder
Differences in upbringing
- Unrealistically positive assumptions
- Narcissism as a response to rejection or unmet emotional needs
History of childhood adversity
- Physical abuse and neglect
- Parents that have experienced abuse
- Parents with psychopathology
Antisocial Personality Disorder
- Pervasive patterns of disregard for and violation of the rights of others
- Considered both personality and a conduct disorder
- Gratifying own desires, violation of major social norms
- Poor impulse control, high thrill seeking
- Must be evident by patterns of disordered conduct before the age of 15
Prevalence of Antisocial personality disorder
1-4%
Psychopathy
Superficial charm, grandiose sense of self-worth, patterns of deceitfulness, manipulative, lack of remorse
Sociopath
A label used to describe a person whose psychopathic traits are assumed to be due to environmental factors
Biological theories of Antisocial personality disorder
- Heritability: 38-69%
- Implications for serotonin system
- Differences in PFC (abstract reasoning, concentration, goal formation, planning, self-awareness)
- Differences in amygdala
- Differences in striatum
- Low arousability (low resting heart rate, low skin conductance, excessive slow-wave EEG patterns, leads to low fear, stimulation seeking)
Psychosocial theories of antisocial personality disorder
- Child abuse and neglect
- Modeling of antisocial behaviour
- Lack of punishment or being rewarded for antisocial behaviour
Avoidant Personality Disorder
Excessive avoidance of interpersonal interactions
- Feelings of inadequacy (prone to shame and low self-esteem, feel inferior and socially inept)
- Fears of criticism and rejection (will avoid situations where criticism is possible, assume everything they do is wrong)
Negative affectivity and detachment
- Appear shy inhibited, nervous
Social isolation and loneliness
Prevalence of avoidant personality disorder
1.5-2.5%
Biological theories of avoidant personality disorder
Heritability about 64%
Psychosocial theories of avoidant personality disorder
Emotional neglect, lower standards of care
Rejection early in life
- Parents less affectionate, more guilt-engendering, less encouraging
Cognitive theories of avoidant personality disorder
Expectations of rejection
Discount positive feedback
Obsessive-Compulsive Personality disorder
- Pervasive patterns of inflexibility and preoccupation with orderliness, perfection and control
- Interpersonal difficulties (rigidly bound to rules, stubborn, difficulty appreciating others, sensitive to flaws, relate to others in terms of status)
- Excessive commitment to work and productivity (bare self-esteem on productivity and meeting unreasonably high goals, difficulty with perfectionism)
- Persist even if their approach is failing
- Grim, strict, tensely in control of their emotions, lack spontaneity
Prevalence of obsessive-Compulsive personality disorder
2-8% prevalence in USA
Biological theories of obsessive-Compulsive personality disorder
Heritability: 27-78%
- Reduced grey matter volume including PFC
Cognitive theories of obsessive-Compulsive personality disorder
Intolerance to flaws
Psychosocial theories of obsessive-Compulsive personality disorder
History of physical neglect
