Personality Disorders Flashcards

Question

What is the social etiology of personlaity disorders?

Answer 1

Invalidating environment Early adverse events * Trauma/maltreatment 90% childhood physical, sexual abuse, and/or neglect * Early separation or loss * Abnormal parenting Abnormal bonding Neglectful & overprotective (- parents that are a little checked out - so the kids have a lot of needs or emotions that are not actually meet)

Answer 2

- 8x risk for cluster B PDs (especially BPD) in adulthood Cluster B rates go wayyy up when you have had childhood maltreatment - In cluster A and C you see a very little increase

Answer 3

Biological diathesis for emotional reactivity + invalidating environment = BPD Invalidating environment: Efforts to communicate inner experience disrespected or punished trying to communicate your inner experiences and you shut down. Being told how you are responding is reasonable and you have to stop

Answer 4

* Child suppresses emotions → explodes * Gets parents’ attention * Attention reinforces outburst Dysregulated child difficult to manage Parents ignore or punish emotionality its a cycle

Answer 5

Comorbid mood disorders * SSRIs * Mood stabilizers Psychotic/dissociative symptoms * Antipsychotics

Answer 6

Dialectical behavior therapy (DBT) * Intensive * Expensive Mentalization * Client-therapist relationship * Perspective-taking Transference-based psychodynamic psychotherapy * Client-therapist relationship * Expensive * Takes years40

Answer 7

1. acceptance (ACT, validation) 2. Change (CBT, problem solving) 3. dialectics balance these 2

Answer 8

Acceptance Individuals are doing the best they can They want to improve Change At the same time… They need to do better, try harder, be more motivated to change They may not have caused all of their problems; they have to solve them anyway Their lives are often unbearable as they are currently being lived They must learn new behaviours in many contexts

Answer 9

Individual therapy Skills group * Mindfulness * Emotion regulation * Distress Tolerance (if you are a 7 to 10 you'll lose your skills) * Interpersonal effectiveness **Dialectics (“walking the middle path”)

Answer 10

radical acceptance (fully accepting with your whole self what the situation) distressing situation → Acknowledge → Endure (it will pass) → Don’t give up/give in → Can work to change when it’s effective

Answer 11

Inadequate conscience development Ability to impress & exploit others Irresponsible & impulsive behaviour

Answer 12

Disregard for & violation of the rights of others Deceitfulness Impulsivity Aggressiveness Reckless disregard for safety of self or others Consistent irresponsibility Lack of remorse

Answer 13

Substance abuse Other cluster B PDs

Answer 14

Community 3% men 1% women Prison 47% men 21% women Younger adults Lower SES Women are more likely to go to BPD when you look at the driving events

Answer 15

PFC dysfunction * Poor executive control (a lot more ADHD) Genes * Low MAOA (the “warrior” gene) * Enzyme that breaks down 5-HT, NE, DA * Structural & functional changes in brain * On X chromosome (- which may be one reason why we see it more in dudes. ) Traits * Aggressiveness * Impulsivity * Low anxiety

Answer 16

Low income Low parental supervision Parent psychopathology Delinquent sibling/peers Neglect Abuse (physical or sexual) Harsh discipline

Answer 17

low MAOA activity, way more likely to develop APD after childhood maltreatment.

Answer 18

Strong Risk: ODD by age 6 → CD by age 9 → ASPD ADHD + CD → ASPD (possibly psychopathy)

Answer 19

Some overlap with ASPD ASPD * Broader category * More behavioural symptoms (criminality, etc.) Psychopathy * Narrow * Personality - it is slightly different - in P we are really looking into personality structure - P is kind of born this way

Answer 20

Successful vs. unsuccessful * Ex: corporate vs. incarcerated

Answer 21

core: Interpersonal * Superficial charm * Pathological lying (not just when it serves them) Affective * Lack of remorse, guilt, empathy you do not need all of them but you need chunks of each Behaviour: Lifestyle * Need for stimulation, impulsivity Antisocial * Poor behavioural control * Criminality

Answer 22

Genes ~50% of variance Callous/unemotional traits (heritable) Brain structure Amygdala volume* Brain function PFC dysfunction* *more often in unsuccessful psychopath

Answer 23

Callous/unemotional traits Low levels of fear/poor conditioning of fear * Cognitive encoding * Low physiological and emotional encoding (- they do not encode things are dangerous so much) High reward sensitivity Attentional directedness (tunnel vision) (- tunnel vision - all you want and nothing else is important)

Answer 24

Early parental loss Parental loss or rejection Callous/unemotional traits evoke negative parenting responses * Anger * Frustration * Harsh discipline

Answer 25

ASPD * Difficulty learning to regulate emotions * High emotional reactivity (aggressive, antisocial) in response to stress Psychopathy * Fearlessness * Low anxiety * Poor conscience * Premeditated aggression

Answer 26

Punishment ineffective Treatment is very difficult (- if you have psychopathy you are cool with it, you like it. It is the other people that have the problem with it) Early intervention is CRITICAL (- because this is where there is still some vulnerability and you can shape still here)

Answer 27

Focus on social skills → improves manipulation vs. underlying lack of empathy, etc. (esp. true for group therapy) Better to work toward redirecting their skills toward prosocial goals

Answer 28

If not callous/unemotional*: Reduce * Hostile attributions * Resentment, shame Increase * Closeness in relationships (- you want them to care about people, at least somebody) * Kind responses to self/others * Lean into “softer” primary emotions (- sadness and the fear) * Fear/sadness vs. anger/shame * Compassion in caregivers (- softer and kinder you can be to the little murderer the less likely they are to become a murderer) * Predictable limits *But are they really?