Personality Disorders Flashcards
1
Q
Define personality.
A
Consistency in patterns of thinking, feeling and behaving that are pervasive across life domains and enduring over time.
2
Q
What personality traits does the Five Factor Model identify?
A
Neuroticism, extroversion, openness to experience, conscientiousness and agreeableness.
3
Q
Who can up with the Five Factor Model?
A
Costa and McCrae.
4
Q
What does neuroticism refer to?
A
The pervasive level and stability of an individual’s emotional adjustment.
5
Q
What are individuals high in neuroticism prone to? (2)
A
Psychological distress and poor coping skills.
6
Q
What does extroversion refer to?
A
An individual’s preferred quantity and intensity of interpersonal interactions, activity levels, need for stimulation and capacity for joy.
7
Q
Individuals high in extroversion are: (4)
A
Sociable, talkative, active and optimistic.
8
Q
What does openness to experience refer to?
A
The degree to which an individual actively seeks and appreciates different experiences.
9
Q
Individuals high in openness to experience are: (3)
A
Curious, imaginative, and open to novel and unconventional ideas and behaviours.
10
Q
What does conscientiousness refer to?
A
The degree to which an individual is organised, persistent and motivated in goal-directed behaviour.
11
Q
Individuals high in conscientiousness are: (5)
A
Organised, reliable, hard-working, self-directed and punctual.
12
Q
What does agreeableness refer to?
A
The interpersonal interactions preferred by an individual on a continuum from compassion to antagonism.
13
Q
Individuals high in agreeableness are: (5)
A
Good-natured, trusting, helpful, forgiving and altruistic.
14
Q
What does it mean that personality functioning exists on a continuum?
A
There is no clear or easily detectable point of division between normality and pathology.
15
Q
What do people with higher and lower levels of particular traits than average have in common?
A
They are more likely to manifest disordered behaviours or maladaptive functioning, especially when experiencing a major life stressor or mental or physical illness.
16
Q
What percent of personality traits are inherited?
A
40-60%
17
Q
What do dysfunctional personality traits develop from?
A
The same array of genetic components and life events as normal personality.
18
Q
Explain how the environment affects personality. (2)
A
The environment influences the extent to which genetically- based personality predispositions are expressed, and to shape the behaviours through which a given trait is expressed.
19
Q
Millon identified three enduring characteristics that differentiate disordered personality from normal-range problematic behaviours.
A
Functional inflexibility, self-defeating patterns of behaviour, and unstable functioning in the face of stress.
20
Q
Explain functional inflexibility.
A
A failure to adapt to changing and varied life experiences.
21
Q
Explain self-defeating patterns of behaviour.
A
Typical ways of responding or coping that worsen the current situation or are highly damaging for the person involved, but that the person does not learn from experience and alter the harmful or maladaptive behaviours.
22
Q
Explain unstable functioning in the face of stress,
A
Also called tenuous stability under stress, evident in marked instability in mood, thinking and behaviour during challenging life events.
23
Q
According to the DSM-5, personality disorders are defined as:
A
Enduring patterns of perceiving, relating to and thinking about the environment and oneself that are exhibited in a wide range of social and personal contexts.
24
Q
What must the enduring patterns of personality differ from to qualify for a diagnosis of a personality disorder according to the DSM-5?
A
They must differ markedly from the expectations of the individual’s cultural group and cause significant personal distress and impairment in functioning.
25
What is it nor unusual to see in individual's with personality disorders, regarding life domains?
Behaviour can be disturbed in one area while others remain unaffected.
26
What happens to core personality traits in adults over 30, and how does that differ in personality disorders?
The core personality traits become stable, while personality disorder diagnoses show moderate stability at best.
27
Give a likely explanation for the poor stability of core personality traits in people with personality disorders.
Behaviours and symptoms associated with particular traits come and go over time, like impulsive behaviours are more common in young people.
28
The DSM-5 includes 10 personality disorders, which are further categorised into one of three clusters:
Cluster A, Cluster B and Cluster C.
29
What does Cluster A include?
Paranoid, schizoid and schizotypal personality disorders, which are characterised by odd or eccentric traits and behaviours.
30
What does Cluster B include?
Antisocial, borderline, histrionic and narcissistic personality disorders, characterised by dramatic, emotional or erratic traits and behaviours.
31
What does Cluster C include?
Avoidant, dependent and obsessive-compulsive personality traits, which are characterised by anxious and fearful traits and behaviours.
32
Give the DSM-5's diagnostic criteria for personality disorders.
Behaviours or traits that are characteristic of the person's recent and long-term functioning since adolescence or early adulthood.
33
What is a personality disorder?
A constellation of behaviours or traits that cause either significant impairment in social or occupational functioning or subjective distress.
34
What is the ICD's diagnostic criteria for personality disorders?
A variety of conditions that indicate a person's characteristic and enduring patterns of inner experience (cognition and affect) and behaviour that differ markedly from a culturally expected and accepted range.
35
Why are Cluster A personality disorders difficult to treat?
They are likely to be mistrusting of the motives of treating clinicians.
36
Why are Cluster C personality disorders difficult to treat?
High levels of dependency may result in over reliance on health practitioners.
37
Why are Cluster B personality disorders the most difficult to treat? (7)
Because they are associated with more dramatic and confronting behaviours, like verbal aggression, inappropriate demands, angry behaviour, drug-use, repeated self-harm and inappropriate flirtation or sexual advances.
38
The three Cluster A personality disorders are all characterised by:
High levels of introversion.
39
Define schizotypal personality disorder.
A pervasive pattern of inhibited or inappropriate emotion and social behaviour as well as aberrant cognitions and disorganised speech.
40
Define paranoid personality disorder.
Pervasive, unwarranted mistrust and suspicion of others.
41
Define schizoid personality disorder.
A pervasive pattern of lack of interest in and avoidance of interpersonal relationships as well as emotional coldness in interactions with others.
42
What is schizotypal personality disorder characterised by?
Marked discomfort with close relationships, and a range of perceptual and cognitive distortions and odd behaviour.
43
Give some examples of behaviour associated with schizotypal personality disorder. (5)
Having few close friends, feeling anxious around others as a result of paranoid fears that others are trying to hurt them, experiencing odd ideas and speech, having flattened or inappropriate affect and unusual perceptual experiences.
44
What is paranoid personality disorder characterised by?
Very suspicious, untrusting and hypervigilant for signs of others trying to harm them.
45
Give some examples of behaviour associated with paranoid personality disorder. (4)
Misinterpreting events and others' actions, perceiving malevolence where it is not present, being unforgiving and holding grudges to real or imagined slights, and doubting the fidelity of their partner.
46
What is schizoid personality disorder characterised by?
Low desire for connection with other human beings and no interest in pleasure in social activities, including sex.
47
How do people with schizoid personality disorder behave? (3)
They are emotionally cold with a restricted range of emotional responses, almost always choosing solitary work and leisure activities, and show indifference when praised or criticised by others.
48
How do people with Cluster B personality disorders behave? (3)
Dramatically, acting out, or flamboyantly.
49
Define narcissistic personality disorder.
A pervasive pattern of experiencing inflated thoughts of one's self-worth as well as obliviousness to others' needs and an exploitative, arrogant demeanour.
50
Define histrionic personality disorder.
A pervasive pattern of excessive emotionality and an intense need for attention and approval, which is sought by means of overly dramatic and seductive behaviour.
51
Define borderline personality disorder.
A pervasive pattern of unstable mood, self-concept, interpersonal relationships and impulse control.
52
Define antisocial personality disorder.
A pervasive pattern of criminal, impulsive, callous or ruthless behaviour predicated upon disregard for the rights of others and an absence of respect for social norms.
53
Give the characteristics of narcissistic personality disorder.
Arrogance, only concerned with their power and abilities, disdain and disregard for people, interpersonally exploitative, manifest a sense of self-entitlement, and are envious of others or believe others are envious of them.
54
What do individuals with narcissistic personality disorder lack?
Empathy, meaning they are callous.
55
How do individuals with narcissistic personality disorder treat others?
As an audience to appreciate the individual's greatness, rather than individual people with their own needs.
56
What is histrionic personality disorder characterised by?
A pattern of excessive attention seeking.
57
How do people with histrionic personality disorder behave?
They use their physical attractiveness or sexuality to gain the attention of others, and their behaviour is superficial and lacking in depth.
58
What do people with histrionic personality disorder crave?
Being the centre of attention, and they are deeply uncomfortable when they are not.
59
What are the emotions of histrionic personality disorder like?
They are shallow, and easily influenced by others.
60
What do people with histrionic personality disorder believe about their relationships?
That they are more intimate than they actually are.
61
Give the characteristics of borderline personality disorder.
Emotional instability, a lack of a solid sense of self or identity, impulsivity, easily bored, experiencing feelings of chronic emptiness and extreme anger.
62
What do people with borderline personality disorder oscillate between?
Idealising and devaluing others.
63
How do people with borderline personality disorder behave?
They make frantic efforts to avoid real or imagined abandonment, reflected in a pattern of unstable and intense interpersonal relationships, they engage in elf-destructive behaviours that may include substance abuse, risk-taking behaviours, self-mutilation and suicidal acts.
64
What may people with borderline personality disorder experience in stressful situations?
Paranoia or dissociation.
65
What two disorders are likely to be comorbid with borderline personality disorder?
Mood or substance use disorders.
66
How is antisocial personality disorder different from conduct disorder?
It continues into later teenage and adult years.
67
What does antisocial personality disorder overlap with?
Other Cluster B personality disorders.
68
What is antisocial personality disorder characterised by? (7)
A pattern of behaviour does not conform to social norms or the law, including lying, stealing, cheating, fighting, cruelty to humans and animals, and fire-setting.
69
What is there a lack of in antisocial personality disorder?
Remorse.
70
People with antisocial personality disorder are: (4)
Highly impulsive, irritable and aggressive, with limited regard for the safety of others or themselves.
71
Define psychopathy.
A set of personality traits including superficial charm, a grandiose sense of self-worth, a tendency towards boredom and need for stimulation, pathological lying, an ability to deceive others and be manipulative, and a lack of remorse.
72
What is the difference between antisocial personality disorder and psychopathology?
Psychopathology puts less emphasis on behaviour.
73
What is psychopathy?
A cluster of behaviours and personality traits that describe callous individuals who are aware of their antisocial behaviour but lack remorse.
74
What do psychopaths pride themselves with?
Avoiding capture from the authorities.
75
Who first described psychopathy?
Pinel.
76
How did Pinel describe remorseless behaviour?
Madness without delirium.
77
Psychopathy includes a desire for: (4)
Dominance, manipulation, callousness and a lack or empathy or remorse.
78
What is the PCL-R?
The Psychopathy Checklist-Revised, a standardised, semi-structured interview that is the most widely accepted instrument for diagnosing psychopathy.
79
What two factors does the PCL-R comprise?
Emotional detachment and antisocial behaviour.
80
What does the emotional detachment factor of the PCL-R contain?
Items that describe the core personality traits of psychopathy, like callousness, manipulativeness and remorselessness.
81
What does the antisocial behaviour factor of the PCL-R contain? (3)
History of antisocial behaviour, impulsiveness and violence.
82
How does scoring between antisocial personality disorder and psychopathy differ on the PCL-R?
Psychopaths score highly on both factors, but particularly on the emotional detachment items, while people with antisocial personality disorder score highly on the antisocial behaviour factor alone.
83
What is the prevalence of antisocial personality disorder in the prison population?
75%
84
Why are there less psychopaths in prison than people with antisocial personality disorder?
They have higher socioeconomic status, are socially skilled, possess high intelligence, and may not catch the attention of authorities.
85
Define dependent personality disorder.
A pervasive need to be cared for and fear of rejection, which lead to total dependence on and submission to others.
86
What is dependent personality disorder characterised by? (5)
A strong need to be taken care of, including maintaining physical closeness to others, needing others to do things and make decisions for them, and help them initiate projects/tasks.
87
What does the fear of abandonment drive in people with dependent personality disorder? (4)
They engage in clingy and self-sacrificing behaviours such as volunteering to do things that are unpleasant and avoiding expressing any disagreement with others to maintain their relationship.
88
Define avoidant personality disorder.
Pervasive anxiety, sense of inadequacy and fear of being criticised that lead to the avoidance of most social interactions with others and to restraint and nervousness in social situations.
89
Define obsessive-compulsive personality disorder.
Pervasive rigidity in one's activities and interpersonal relationships.
90
What are the characteristics of obsessive-compulsive personality disorder? (3)
Emotional constriction, extreme perfectionism and anxiety resulting from even slight disruptions to one's routine.
91
What are the characteristics of avoidant personality disorder? (3)
Preoccupation with a fear of being negatively evaluated, criticised and rejected by others, tending to avoid social and intimate situations, particularly if they are not certain they will be liked.
92
What does avoidant behaviour stem from in avoidant personality disorder? (4)
Core beliefs about the self as inadequate, inferior, socially inept and unappealing.
93
How do people with avoidant personality disorder behave? (3)
They tend to engage in solitary work and leisure activities and shun new activities in order to avoid criticism, disapproval or embarrassment, even if this means losing desired opportunities.
94
What kind of behaviour do people with obsessive-compulsive personality disorder exhibit? (6)
Their preoccupation with minor details, rigidly abiding by the rules and getting things perfect results in them losing the point of the activity at hand and interferes with the ability to complete tasks on time; difficultly delegating tasks and little time for leisure of social pursuits.
95
What do people with obsessive-compulsive personality disorder hoard?
Money and worn-out or useless objects.
96
When is the typical onset of personality disorders?
Adolescence or early adulthood.
97
Which personality disorder causes the greatest handicap?
Borderline.
98
Which personality disorder has the highest prevalence.
Obsessive-compulsive, and it is twice as prevalent.
99
Individuals with obsessive-compulsive personality disorder are less:
Disabled than people with other personality disorders unless they develop another disorder, like depression.
100
What needs to happen in conjunction with a genetic predisposition to result in development of a pathological personality or an adaptive one?
The nature, timing and intensity of life events and influences.
101
Major enviromental factors implicated in the causes of disordered personality include:
Disrupted attachment experiences with primary caregivers, trauma, neglect and deprivation in childhood.
102
What does the MAOA gene metabolise and what does that do?
Neurotransmitter, specifically norepinephrine, serotonin and dopamine, which influences thoughts, feelings and behaviours.
103
What can trigger aggression in children (genetically speaking)?
A combination of low MAOA gene activity and maltreatment.
104
What do factor approaches believe regarding understanding personality?
Personality can be captured in terms of the degree to which an individual manifests certain traits and combinations of these traits.
105
What do factor approaches believe personality disorders result from?
Extremely high or low levels of traits.
106
Which trait (of the Five Factor Model) is unrelated to personality disorders?
Openness to experience.
107
Who proposed the 18-factor model of personality and personality disorders?
Livesley.
108
Give the four higher-order factors of Livesley's 18-factor model.
Emotional dysregulation, inhibitedness, compulsivity, and dissocial behaviour.
109
Which FFM trait is emotional dysregulation associated with?
Neuroticism.
110
Which FFM trait is inhibitedness associated with?
Extroversion, specifically low extroversion/introversion.
111
Which FFM trait is compulsivity associated with?
Conscientiousness.
112
Which FFM trait is dissocial behaviour associated with?
Agreeableness, specifically low agreeableness.
113
Give the six lower order factors under emotional dysregulation.
Affective instability, anxiousness, submissiveness, insecure attachment with others, cognitive dysregulation and social apprehensiveness.
114
Give the two lower order factors under inhibitedness.
Intimacy problems and restricted expression of feelings.
115
Give the two lower order factors under compulsivity.
Orderliness and conscientiousness.
116
Give the five lower order factors under dissocial behaviour.
Callousness, rejecting, conduct problems, impulsive sensation seeking, and narcissism or grandiosity.
117
What did Livesley conclude about the development of personality disorders?
Development of personality and personality disorders result from the same genetic influences, including a genetic contribution of individual and clustered traits.
118
What is the 18-factor model better at predicting than the FFM? (4)
Antisocial, dependent, schizoid, and schizotypal personality disorders.
119
The cognitive theory of personality disorder relies on two key premises:
Each personality disorder is thought to be characterised by specific maladaptive core beliefs, and these beliefs influence the processing of social information in such a way as to maintain the person's dysfunctional beliefs by filtering out inconsistent information and interpreting ambiguous information as consistent with the dysfunctional beliefs.
120
What does CBT for personality disorders begin with?
The development of a cognitive case formulation.
121
What is a cognitive case formulation?
Drawing together theory, research and the client's experiences in order to explain the causal and maintaining factors relating to their problems.
122
What kind of treatment is cognitive case formulation and why?
A collaborative one between the client and therapist, with both working together to describe the factors maintaining the client's problems and developing a treatment plan.
123
Give some CBT interventions for personality disorders.
Cognitive restructuring and supporting behavioural change.
124
Why is the assumption that patients are motivated to reduce symptoms, build skills and solve current problems not met in treatment of personality disorders?
Motivation to change may be lacking due to factors like seeing others as in need of changing or lacking confidence that they can successfully change.
125
Why is the assumption that patients will comply with standard treatment approaches not met in treatment of personality disorders?
Many factors make it difficult for those with a personality disorder to comply with standard treatment techniques.
126
Why is the assumption that patients are able to identify their cognitions and emotions and report them not met in treatment of personality disorders?
Individuals are more likely to block/avoid distressing thoughts or feelings so that they cannot easily identify and report them.
127
Why is the assumption that patients will readily engage in a collaborative relationship with the therapist aimed at achieving the agreed goals of therapy not met in treatment of personality disorders?
Those with a personality disorder may be hostile or fearful and avoidant or overly dependent in relationships, which makes it hard for them to establish a strong working relationship.
128
Why is the assumption that patients will have problems that easily lend themselves to goal-focused treatment not met in treatment of personality disorders?
Problems are more likely to be pervasive and diffuse, affecting broad areas of functioning.
129
Why is the assumption that patients will have the capacity to challenge cognitions that are unrealistic/unhelpful not met in treatment of personality disorders?
The rigidity that typifies all personality disorders likely extends to cognitive rigidity, making challenging those beliefs difficult, which can leave people feeling invalidated and inadequate.
130
What is functional inflexibility characterised by?
The tendency to rigidly apply a range of behavioural strategies or responses across diverse life situations, even when the behaviour is inappropriate.
131
What does Young's schema include?
Cognition, emotions, behaviours and bodily sensations.
132
What do Young's schemas refer to?
An organised collection of multidimensional information in memory, that operate automatically to influence information processing and responding.
133
Why does Young call his schemas 'early maladaptive schemas'? (i.e., how do schemas develop?)
Because they are believed to develop as a result of biological dispositions and repeated interpersonal distress with significant others in childhood.
134
According to Young, what do early negative interactions result in?
A failure to meet the child's core emotional needs, which in turn results in the development of various early maladaptive schema.
135
Give the five types of maladaptive schemas that can result from a failure of the secure attachment with others need being met.
Abandonment/instability, mistrust/abuse, emotional deprivation, defectiveness/unlovability, and social isolation.
136
Give the four types of maladaptive schemas that can result from a failure to develop a sense of identity, competence and independence.
Dependence/incompetence, vulnerability to harm or illness, enmeshment/underdeveloped self, and failure to achieve.
137
Give the three types of maladaptive schemas that can result from a failure to express one's desires and emotions.
Subjugation, self-sacrifice, and approval-seeking/recognition seeking.
138
Give the two types of maladaptive schemas that can result from a failure to have realistic limits set by others so as to learn self control.
Entitlement/grandiosity, and insufficient self-control/self-discipline.
139
Give the four types of maladaptive schemas that can result from a lack of spontaneity and play in childhood.
Negativity/pessimism, emotional inhibition, unrelenting standards/hypercriticalness, and punitiveness.
140
Explain the early maladaptive schema abandonment/instability.
The worry that people that the individual feels close to will leave or abandon them.
141
Explain the early maladaptive schema mistrust/abuse.
Worry that people will take advantage of the individual.
142
Explain the early maladaptive schema emotional deprivation.
The lack of someone to nurture, share themselves, or care deeply about the individual.
143
Explain the early maladaptive schema defectiveness/unlovability.
Feelings that people wouldn't want to know the individual's real self.
144
Explain the early maladaptive schema social isolation.
The feeling that the individual is always on the outside of groups.
145
Explain the early maladaptive schema dependence/incompetence.
Not feeling confident about the individual's ability to solve everyday problems.
146
Explain the early maladaptive schema vulnerability to harm or illness.
Feeling that a disaster could strike at any moment.
147
Explain the early maladaptive schema enmeshment/underdeveloped self.
The feeling that the individual does not have a separate identity from their parents or partner.
148
Explain the early maladaptive schema failure to achieve.
The individual believes that most other people are more capable than they are in areas of work and achievement.
149
Explain the early maladaptive schema subjugation.
The individual has a lot of trouble demanding that their rights be respected and that their feelings be taken into account.
150
Explain the early maladaptive schema self-sacrifice.
Other people see the individual as doing too much for others and not enough for themselves.
151
Explain the early maladaptive schema approval seeking/recognition seeking.
Accomplishments are most valuable to the individual if others notice them.
152
Explain the early maladaptive schema entitlement/grandiosity.
The individual feels that they shouldn't have to follow the normal rules or conventions that other people do.
153
Explain the early maladaptive schema insufficient self control/self-discipline.
The inability of the individual to force themselves to do things they don't enjoy even when they know it's for their own good.
154
Explain the early maladaptive schema negativity pessimism.
Even when things are going well, the individual feels that it is only temporary.
155
Explain the early maladaptive schema emotional inhibition.
The individual finds it embarrassing to express their feelings to others.
156
Explain the early maladaptive schema unrelenting standards/hypercriticalness.
An inability to accept second best - the individual must be the best.
157
Explain the early maladaptive schema punitiveness.
The individual feels that they deserve to be punished if they make a mistake.
158
What are the main characteristics of early maladaptive schemas? (4)
They are rigid, resistant to change, associated with high levels of affect, and significantly impair functioning.
159
How may early maladaptive schemas be triggered?
A range of external events or internal stimuli.
160
What is schema perpetuation?
The tendency for schemas to be strengthened over time.
161
Why are schemas perpetuated?
They influence information processing so that the individual selectively perceives and interprets information to support their maladaptive schemas, and filter out information that disrupts this.
162
What do coping skills do, according to Young?
Reinforce the schema.
163
Explain the coping style 'schema surrender'.
The individual accepts the truth of the schema and behaving in consistent ways.
164
What does the coping style 'schema surrender' prevent?
The individual from having experiences that are inconsistent with he schema and therefore challenge the schema.
165
Explain the coping style 'schema avoidance'.
Blocking features of the schema through activities like substance abuse because of the distressing nature of the schema content, and avoiding situations that trigger the schema.
166
Explain the coping style 'schema overcompensation'.
Reacting against the schema by embodying its polar opposite
167
What does schema overcompensation fail to do and what does it risk?
Allow the problem to be recognised and addressed but it risks confirming the core schema because of its personal consequences of alienation and rejection by others.
168
Define schema therapy.
A type of psychological treatment originally developed by Young for the treatment of personality disorders.
169
What does Young's schema therapy focus on?
Helping clients change their early maladaptive schemas.
170
What early maladaptive schema is associated with borderline personality disorder?
Abandonment/instability.
171
What early maladaptive schema is associated with OCPD?
Unrelenting standards.
172
What is the first step in schema therapy?
An extensive assessment phase focused on identifying the patient's early maladaptive schemas and how thy manage them.
173
What is the purpose of the change process in schema therapy and what techniques are used to achieve it?
Using behavioural, cognitive and experiential techniques with the aim of making more adaptive schemas.
174
What do the behavioural techniques in schema therapy do?
Alter coping styles used.
175
What do the cognitive techniques in schema therapy do?
Having the patient test the validity of their schema by examining the evidence for ad against it.
176
What do experiential strategies in schema therapy do?
Trigger the distressing emotions associated with maladaptive schemas to encourage emotional change.
177
Who developed the biosocial model of personality disorder?
Linehan.
178
What was the biosocial model originally developed for?
Borderline personality disorder.
179
What does the biosocial model state that borderline personality disorder is due to?
Dysfunctions in the emotion regulation system.
180
What is the dysfunction in the emotion regulation system thought to be an interaction between?
Biologically based emotional vulnerability and negative experiences.
181
What does the biosocial models' emotional vulnerability include? (4)
A temperament high in neuroticism, increased baseline levels of emotional arousal, an increased intensity of responses to emotional stimuli, and a slow return to baseline levels of arousal.
182
What are the characteristics of Linehan's drastically invalidating environments?
Deprivation, neglect, and physical and emotional abuse.
183
What does dialectical behaviour therapy integrate?
Biological, social, cognitive and behavioural theories.
184
What does dialectic mean?
Integration of opposing elements in thinking and behaving.
185
Dialectic treatment is structured to address dysregultion across five domains:
Emotional, cognitive, behavioural, self and interpersonal.
186
What does dialectical behaviour therapy involve?
Weekly individual therapy and group based skills training.
187
What is the initial focus of dialectical behaviour therapy?
Developing the client's engagement and commitment to treatment, with priority subsequently being given to the reduction of self-harm and suicidality.
188
How does dialectical behaviour therapy view the client?
As a robust, resourceful individual.
189
What is the therapist style in dialectical behaviour therapy? (4)
Active, matter of face, warm and strongly focused on validating the client's experience.
190
What does dialectical behaviour therapy encourage the client to do?
Use newly gained skills, self-knowledge and therapist support to actively solve problems and learn new ways of being in the world.
191
What four areas do clients receive training in in dialectical behaviour therapy?
Mindfulness, distress tolerance, interpersonal effectiveness and emotion regulation skills.
192
Mindfulness skills are derived from Eastern Zen mediations and include the notions of:
Acceptance and taking a non-judgmental stance towards oneself, people and situations; observing rather than needing to immediately act to alter situations, and being in the moment.
193
What are distress tolerance skills based on?
The idea that pain and distress are part of everyday life and refusing to accept this causes pain.
194
Give the four distress tolerance skills.
Comparing yourself to someone less fortunate, comforting yourself using vision, hearing, smell, taste and touch, improving the moment, and being aware of the positive aspects of tolerating distress.
195
What does interpersonal effectiveness include? (2)
Learning how to initiate and maintain good relationships and learning assertiveness skills.
196
Give the emotion regulation skills. (4)
Learning ways of identifying emotions, reducing vulnerability to negative emotions, increasing positive emotions and letting go of emotional suffering.
197
Define cognitive analytic therapy.
A type of psychological treatment that combines concepts from cognitive and psychoanalytic therapies.
198
Who developed cognitive analytic therapy?
Ryle.
199
What kind of model in the cognitive analytic therapy and why?
Relational, because the self is seen as a repertoire of internalised early relational experiences, called reciprocal roles.
200
What do reciprocal roles do?
Shape the way a child relates to others and themselves.
201
According to cognitive analytic therapy, what are personality disturbances seen as resulting from?
A combination of inherited neurobiological factors and early traumatic or neglectful experiences that are internalised and lead to the formation of maladaptive patterns of relating to others and the self.
202
According to cognitive analytic therapy, after an individual is exposed to early relational experiences, what are they more likely to do?
Behave in abusive ways in relationships, choose abusive/violent partners who will victimise them, and enact the role of abuser internally through critical thoughts or self-harm.
203
What is Ryle's multiple self states model applied to?
Borderline personality disorder.
204
Ryle's multiple self states model proposes that there are three features responsible for the range of problems experienced by individuals with borderline personality disorder:
Dissociation between the different aspects of the self, limited repertoire of reciprocal roles consisting of internalised harsh, punitive or abusing reciprocal roles, and a deficient capacity for self-reflection.
205
What stance does the therapist take in cognitive analytic therapy?
A collaborative, curious and respectful stance where the patient is seen as doing the best they can do.
206
What do the early sessions of cognitive analytic therapy involve?
The therapist and client developing a collaborative shared understanding of the client's history and problems that they are in therapy for.
207
What kind of relationship does the therapist seek with the client in cognitive analytic therapy?
A genuinely caring one.
208
In cognitive analytic therapy, what do letters and diagrams assist the therapist and patient to do? (3)
Agree on the goals of therapy, monitor progress and use the therapist-patient relationship to explore new relationship patterns and avoid enacting unhelpful patterns.
209
In cognitive analytic therapy, what is the aim of the reformulation letter? (2)
To present the patient's history in such a way that they can feel validated and understood by the therapist and can start to make sense of the interpersonal patterns that are having a negative impact on their life.
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There is a common genetic contribution between the Cluster A personality disorders and:
Schizophrenia.
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Give some gene-environment inputs. (3)
Low birth weight, low childhood socioeconomic status and childhood institutionalisation.
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Interaction between what predispose an individual to developing a personality with odd, eccentric or psychotic features or schizophrenia? (3)
Genetic neurological abnormalities, and environmental and gene-environment inputs.
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What is schizotypal personality disorder a milder form of?
Surprise, surprise, it's schizophrenia.
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What is the most prevalent disorder found in the biological relatives of schizophrenia?
Schizotypal personality disorder.
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Give two similarities between schizotypal personality disorder and schizophrenia.
People with schizotypal personality disorder show the same deficits in memory and attention as people with schizophrenia, and they have the same abnormalities in brain structure and neuropsychology.
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Why do people with Cluster A personality disorders rarely present for treatment?
They may be indifferent to interpersonal interactions and find intimacy aversive, as well as being suspicious of others.
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When do people with Cluster A personality disorders present for treatment?
When in crisis and experiencing marked anxiety, depression or psychotic symptoms.
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What therapy goals is CBT used to address in regards to Cluster A personality disorders?
Enhancement of self-awareness, social skills and general quality of life.
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What interventions are effective in the treatment of Cluster A personality disorders?
Keeping a record of thoughts and mood on a daily basis, exposure therapy, and using an educational approach.
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What medications are used in the treatment of Cluster A personality disorders?
Anti-psychotics.
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What medications should be used to treat people with Cluster A personality disorders and concurrent depressive and anxiety disorders?
SSRIs and low doses of anxiolytic medications.
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Which personality trait is antisocial personality disorder strongly associated with?
Impulsivity.
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Low levels of what are associated with antisocial personality disorder and what does this mean?
Physiological arousal, and it means that the individual experiences less fear and will be more willing to engage in risky behaviours.
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What kind of state does under-arousal leave in the individual?
A sense of discomfort, which encourages individuals to seek out risky and extreme behaviours to increase arousal.
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What does dysfunction in the prefrontal cortex result is? (4)
Impulse control, planning, problem solving and goal-setting.
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What does parental antisocial personality predict?
Increased aggression and conduct disorders in the offspring.
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Give some biological factors that, upon interact with a negative home environment predispose children to adult violence.
Anoxia, and forceps delivery.
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Give four negative home environments.
Maternal separation, marital discord, parental mental health problems and parental absence.
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What are the two main theories used to explain psychopathy?
The somatic marker hypothesis, and the violence inhibition mechanism model.
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What mechanism does the somatic marker hypothesis introduce?
Emotional process guide decision making.
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According to the somatic marker hypothesis, what do individuals form associations between?
Emotions and behaviour during their experience in the environment.
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What are associations stored as and where, according to the somatic marker hypothesis?
Somatic markers, and they are stored in the ventromedial prefrontal cortex.
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According to the somatic marker hypothesis, what happens when situations are re-experienced?
The somatic marker associations and re-experienced physiologically and bias cognitive processing to direct attention away from the negative options.
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What does a disturbance of the somatic marker system result in?
An insensitivity to potentially negative consequences due to the problems in accessing knowledge of associations between emotions and behaviour.
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What is the main source of evidence for the somatic marker hypothesis?
The outcomes of the Iowa gambling task, where psychopaths are more likely than normal people to continually select options that cause occasional large gains but ultimately lead to large losses.
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Where is the orbitofrontal cortex?
Next to the cavity that contains the eye.
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In the Iowa gambling task, how do psychopaths behave?
Similarly to people with lesions to the orbitofrontal cortex, where they continually make bad choices based on short-term consequences, because they have no emotional biasing signals that steer them away from negative options.
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Who proposed the violence inhibition model of psychopathy?
Blair.
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According to the violence inhibition model, when is a violence inhibition mechanism activated?
Whenever distress cues are present to inhibit aggressive behaviour.
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What does Blair believe psychopaths lack?
A violence inhibition mechanism, due to dysfunction in the amygdala.
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What evidence supports the violence inhibition model?
Psychopaths are prevented from experiencing fear or recognising fear in others by selective impairment in the processing of information relating to fear.
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How may people with antisocial personality disorder misuse therapy? (3)
By lying to the therapist, threatening the therapist or by trying to manipulate the therapist into writing a favourable report that mitigates them for their crimes.
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What do the National Institute for Clinical Excellence guidelines for antisocial personality disorder emphasise?
Intervention and prevention at an early age.
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Where is treatment focused, according to the National Institute for Clinical Excellence guidelines for antisocial personality disorder?
Conduct disorder or relational diagnosis of oppositional defiant disorder.
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What is the majority of treatment for antisocial personality disorder focus on?
Treating comorbid disorders and risk management.
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Give two pieces of evidence that support a genetic basis for borderline personality disorder.
It is associated with a family history of psychological disturbance and abnormalities in serotonin levels.
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What are the component facets of borderline personality disorder in the Five Factor Model? (5)
Anxiety, self-consciousness, vulnerability, hostility and depression.
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Which personality disorders are characterised by high neuroticism, low agreeableness and high conscientiousness?
Borderline, avoidant, schizotypal and obsessive-compulsive.
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The core elements of BPD (impulsivity, emotional instability and impulsive aggression) have been linked to:
Neurobiological impairments, like prefrontal deficits and heightened activity in the limbic system.
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What does a weakening of the prefrontal inhibitory control system result in? (2)
High incidence of impulsive behaviours and suicide and self-harm.
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What form of childhood abuse is strongly linked to BPD?
Child sexual abuse.
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What kind of parenting style can result in BPD?
Inconsistent, neglectful or overly intensive parenting leads to insecure attachment styles that manifest as maladaptive interpersonal behaviours.
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Define cortisol.
A hormone produced by the adrenal cortex that helps the body respond to stressors, including the fight or flight response.
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What structure is detrimentally affected by the enduring effects of trauma in childhood?
The HPA axis, which produces adrenaline and cortisol.
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What does excess cortisol do?
Suppresses the immune system and increase the risk of infections and allergies.
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What does the HPA axis do when cortisol is too high?
It switches off the stress repsonse to prevent the effects of continually high levels of stress hormones.
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What is long-term exposure to cortisol associated with damage to?
Cells in the hippocampus associated with learning.
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What kind of early childhood experiences are associated with narcissistic personality disorder?
Non-empathetic, invalidating or inconsistent.
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In narcissistic personality disorder, what does the failure of nurturance and affection being met result in?
Fulfilment of those needs is played out as an adult.
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What does Kernberg emphasise in reference to narcissistic personality disorder?
The role of cold caregivers displaying indifference or aggression.
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What did Kohut believe narcissism is used to avoid?
Feelings of inadequacy.
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What is grandiose narcissism? (5)
Characterised by self-centredness, inflated self-confidence, a sense of specialness and entitlement, limited capacity for empathy and a willingness to take advantage of others.
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What is vulnerable narcissism?
An external presentation of low self-esteem and anxiety, together with an inner core of inflated self-beliefs and expectations.
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What does grandiose narcissism result from?
Permissive parenting.
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What is corrective disillusionment?
A period when narcissists meet middle age, and realise their grandiose fantasies are unlikely to be realised in their lifetime.
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What do psychoanalytic models emphasise in the development of histrionic personality disorder?
Inconsistent, intense and non-empathetic parenting.
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Why may intense or overwhelming relationships with parents cause histrionic personality disorder?
They may leave children feeling that normal relatedness is insufficient, so they engage in attempts to experience the same early intensity of relationship in adulthood.
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What concurrent symptoms do people with histrionic personality disorder often present with?
Vague anxiety, depressive and somatic symptoms.
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When do concurrent symptoms of histrionic personality disorder tend to arise?
Following failure or disappointment related to unrealistic expectations of the self and others.
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In patients with histrionic personality disorder, how can the therapeutic relationship be complicated by the interpersonal features typical of the disorder? (2)
Seductiveness, both physical, where the therapeutic relationship itself is sexualised, or psychologically, where the client presents symptoms to stimulate interest from the clinician.
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In histrionic personality disorder, what is an effective treatment for challenging assumptions about dependency on others?
Cognitive therapy.
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What Five Factor Model personality traits are the Cluster C disorders characterised by?
Neuroticism and introversion.
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Give some social factors implicated in the development of avoidant personality disorder.
As a response to the pain associated with cold, rejecting and scornful responses from caregivers, social withdrawal eliciting negative reactions from others, and childhood sexual and emotional abuse.
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Why are people with Cluster C personality disorders more likely to seek treatment?
Because they are more likely to have comorbid anxiety disorders or depression.
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What are the usual medications used in treatment of Cluster C personality disorders?
Antidepressants and anxiolytics.
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What kind of behavioural techniques do people with avoidant personality disorder benefit from?
In vivo exposure to feared situations, and training in assertiveness.
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Define separation anxiety disorder.
A disorder of childhood characterised by abnormal fear or worry over becoming separated from caregivers as well as clinging behaviour in the presence of caregivers.
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What kind of disorder is dependent personality disorder?
An attachment disorder.
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How do negative early experiences result in dependent personality disorder?
The child is encouraged to view the world as an unsafe place and that they are incompetent and unlikely to survive without the direct involvement of significant others.
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What behavioural techniques are used in the treatment of dependent personality disorder? (2)
Anxiety management and graded homework tasks aimed at gradually increasing independent and assertive behaviours.
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What cognitive techniques are used in the treatment of dependent personality disorder?
Challenging dysfunctional beliefs related to personal incompetence and extreme reliance on others.
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The genetic vulnerability for OCPD includes what three Five Factor Model personality traits?
High neuroticism and conscientiousness and low agreeableness.
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According to Millon and Davis, why may OCPD develop?
A child may learn to suppress feelings and perform approved behavioural routines in order to avoid punishment.
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What kind of childhood abuse is linked to OCPD?
Emotional and verbal abuse.
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Why do people with OCPD typically seek treatment?
Comorbid anxiety or depression.
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Give the CBT interventions for OCPD. (3)
Challenging dysfunctional beliefs, in vivo exposure and graded homework tasks aimed at gradually altering overly rigid routines.
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Who constructed the TCI and what does it stand for?
Cloninger and Temperament and Character Inventory.
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Give the seven factors that the TCI measures.
Novelty seeking, harm avoidance, reward dependence, persistence, self-directedness, cooperativeness and self-transcendence.
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How does culture influence the development of personality disorder?
By encouraging the expression or suppression of biologically driven temperamental factors, which affects the ultimate occurrence of personality disorders in a particular community.
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Explain the ecological niche model.
The notion that certain personality styles fit certain cultures or occupations, while others are not tolerated or are actively discouraged.
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What is the labelling effect?
Culture plays a role in whether or not it recognises certain behaviours or traits as abnormal or not.
