Personality Disorders Flashcards

Question

Genetic factors of Schizotypal PD

Answer 1

- Increased risk if a relative has schizophrenia | - Adoption studies support these findings

Answer 2

- Resemble those found in schizophrenia - Abnormalities in frontal lobe and temporal lobe activation - Enlarged ventricles

Answer 3

- Impairment of smooth pursuit of eye movements | - Inability to inhibit the startle response to weak stimuli

Answer 4

- Impaired working memory, episodic memory and spatial attention - Reduced verbal IQ

Answer 5

- Antipsychotic drugs used to reduce the symptoms exhibited by the individual - This treatment is used to treat all of the Cluster A personality disorders

Answer 6

- Clients do not respond well to insight-oriented therapies - May not see themselves as having a psychological problem - Very uncomfortable with close relationships - A supportive educational approach focused on fostering basic social skills may be beneficial if the treatment goals are modest - No controlled studies of psychological treatments with schizotypal personality disorder

Answer 7

A pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) symptoms

Answer 8

1. Suspects, without sufficient basis, that others are exploiting, harming, or deceiving him or her. 2. Is preoccupied with unjustified doubts about the loyalty or trustworthiness of friends or associates. 3. Is reluctant to confide in others because of unwarranted fear that the information will be used maliciously against him or her. 4. Reads hidden demeaning or threatening meanings into benign remarks or events. 5. Persistently bears grudges (i.e., is unforgiving of insults, injuries, or slights). 6. Perceives attacks on his or her character or reputation that are not apparent to others and is quick to react angrily or to counterattack. 7. Has recurrent suspicions, without justification, regarding fidelity of spouse or sexual partner

Answer 9

- Apparent in childhood and adolescence – solitary, poor peer relationships, social anxiety, underachievement, hypersensitivity - Appears ‘odd’ or ‘eccentric’ and attracts teasing

Answer 10

2.3% to 4.4% | More commonly diagnosed in males

Answer 11

May be part of a schizophrenia spectrum disorder

Answer 12

- The person’s relationship with their parents is a key factor - Parenting style that was demanding, distant, overly rigid and rejecting - Lack of love provided leads the person to be suspicious of others and unable to trust people

Answer 13

A pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following syptoms

Answer 14

1. Neither desires nor enjoys close relationships, including being part of a family 2. Almost always chooses solitary activities. 3. Has little, if any, interest in having sexual experiences with another person 4. Takes pleasure in few, if any, activities 5. Lacks close friends or confidants other than first-degree relatives 6. Appears indifferent to the praise or criticism of others 7. Shows emotional coldness, detachment, or flattened affectivity

Answer 15

- Apparent in childhood and adolescence – solitary, poor peer relationships, underachievement - Marked as ‘different’ and attracts teasing

Answer 16

- 3.1% to 4.9% | - More commonly diagnosed in males

Answer 17

May be part of a schizophrenia spectrum disorder

Answer 18

- Parents may have been rejecting or abusive | - The child then becomes unable to give or receive love

Answer 19

Pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

Answer 20

1. Has a grandiose sense of self-importance 2. Is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love. 3. Believes that he or she is “special” and unique and can only be understood by, or should associate with, other special or high-status people 4. Requires excessive admiration 5. Has a sense of entitlement 6. Interpersonally exploitative 7. Lacks empathy 8. Envious or believes others are envious at her 9. Shows arrogant, haughty behaviors or attitudes

Answer 21

- Hans Kohut (1966) – Self Psychology - Parents are cold, rejecting and lack empathy - Lack of parental empathy and support – sets the stage for pathological narcissism - The child fails to develop sturdy sense of self-esteem - The child feels incapable of being loved and admired - They construct a grandiose façade of self-perfection that cloaks inadequacies - This façade is always on brink of crumbling so the person needs constant reassurance and admiration

Answer 22

- Aim – to encourage the formation of a more realistic image of self and others - Initially allow the client to express grandiose self-images and idealisation of the therapist - Point out imperfections in a sensitive way - Gradually explore roots the of their narcissism

Answer 23

A pervasive pattern of disregard for and violation of the rights of others, occurring since age 15 years, as indicated by three (or more) of the following: - The individual is at least age 18 years. - There is evidence of conduct disorder with onset before age 15 years. - The occurrence of antisocial behavior is not exclusively during the course of schizophrenia or bipolar disorder.

Answer 24

1. Failure to conform to social norms with respect to lawful behaviors, as indicated by repeatedly performing acts that are grounds for arrest. 2. Deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure. 3. Impulsivity or failure to plan ahead. 4. Irritability and aggressiveness, as indicated by repeated physical fights or assaults 5. Reckless disregard for safety of self or others 6. Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honour financial obligations 7. Lack of remorse, as indicated by being indifferent to or rationalising having hurt, mistreated, or stolen from another

Answer 25

- 0.2% to 3.3% - More common in males - Highest prevalence (>70%) – convicted criminals

Answer 26

1. Transient – adolescence, limited to common forms of social behaviour, often adaptive, disappears by adulthood 2. Non-transient – small proportion are life-course persistent

Answer 27

- Types of antisocial behaviour may vary with age e.g. hitting, vandalism, child abuse - “burnout” – 40 to 45 years old, behaviour diminishes but personality traits remain evident - May have found new outlets e.g. fraud, child abuse - Less likely to get caught

Answer 28

- Clear evidence of a genetic component - Cadoret (1995) – study to determine interaction between genetic factors and adverse environmental events - -Target group – separated at birth from Antisocial parents - -Control group – separated at birth from parents with no psychological disorders - Measured conduct disorder, aggression and antisocial behaviour - Measured adversity of adoptive home environment e.g. drug abuse, criminal activity, severe marital difficulties - Children raised in more difficult adoptive homes were more likely to engage in aggressive and antisocial behaviour - Harmful effects of unfavourable environment more pronounced in target group - Target group – more likely to exhibit symptoms of conduct disorder as children and aggressive behaviour as adults if raised in adverse home environment - Control group – being raised in an adverse home environment did not increase probability conduct disorder or antisocial behaviour - Concludes that antisocial behaviour is the result of an interaction between genetics and the environment

Answer 29

Prefrontal cortex – controlling impulsive behaviour, weighing consequences of actions, solving problems

Answer 30

- Cleckley (1976) – people with antisocial personalities can maintain their composure in stressful situations that would induce anxiety in most people - Little, if any, fear or anticipatory anxiety about being caught and punished

Answer 31

- Hare (1965) – people with antisocial personalities have lower GSR levels when expecting painful stimuli - Low skin conductance at age 3 predicts scores at age 28 - May explain why the threat of punishment does not deter antisocial behaviours

Answer 32

- Examines the physiological responses while performing laboratory tasks - Control group - the magnitude of the response is increased if they are startled when engaging in a task that elicits fear or negative emotional states - Participants did not show and exaggerated startle response that is indicative of fear in the presence of aversive stimuli - May explain why the individual is insensitive to, or able to ignore, the effects of punishment

Answer 33

- The degree of arousal needed at which you feel your best and can function most efficiently - Antisocial PD – individuals have exaggerated cravings for stimulation - May need a higher-than-normal threshold of stimulation to maintain optimal arousal, maintain interest and function normally - May explain why they become bored easily, can ignore distressing stimuli and are more risk-seeking

Answer 34

Risk factors - childhood abuse and neglect - McCord & McCord (1964): - Children normally associate parental approval with conformity and disapproval with disobedience - When tempted to misbehave they feel anxious about losing parental love - Anxiety signals the child to inhibit their antisocial behaviour - Eventually the child identifies with parents and internalises these social controls in the form of a conscience - When parents don’t show love this identification doesn’t occur - Children don’t fear the loss of love as they have never had it

Answer 35

- Failure to learn from experience | - Failure to show signs of fear learning in aversive conditioning procedures

Answer 36

- Fail to learn to respond to others as potential reinforcers - May not become socialised in the usual way as their learning experiences lacked consistency and predictability - Childhood - their behaviour may have been intermittently rewarded and harsh punishment delivered at random - Do not learn to see are relationship between their own behaviour with reinforcement

Answer 37

- Studied the role of observational learning in aggressive behaviour - People do not usually imitate aggressive behaviour unless they are provoked and believe they are more likely to be rewarded than punished for it - Most likely to imitate violent role models who get their way with others by acting aggressively - Also may also acquire other antisocial behaviours e.g. lying and cheating by direct reinforcement if they find that those behaviours help them to avoid blame or manipulate others

Answer 38

Pervasive pattern of excessive emotionality and attention seeking, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

Answer 39

1. Is uncomfortable in situations in which he or she is not the centre of attention. 2. Interaction with others is often characterized by inappropriate sexually seductive or provocative behavior. 3. Displays rapidly shifting and shallow expression of emotions. 4. Consistently uses physical appearance to draw attention to self. 5. Has a style of speech that is excessively impressionistic and lacking in detail. 6. Shows self-dramatization, theatricality, and exaggerated expression of emotion. Is suggestible (i.e., easily influenced by others or circumstances). 7. Considers relationships to be more intimate than they actually are

Answer 40

1.84% | Somewhat more common in women

Answer 41

Pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

Answer 42

1. Frantic efforts to avoid real or imagined abandonment 2. A pattern of unstable and intense interpersonal relationships characterised by alternating between extremes of idealisation and devaluation. 3. Identity disturbance: markedly and persistently unstable self-image or sense of self. 4. Impulsivity in at least two areas that are potentially self-damaging 5. Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior. 6. Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days). 7. Chronic feelings of emptiness. 8. Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights). 9. Transient, stress-related paranoid ideation or severe dissociative symptoms.

Answer 43

- Chronic instability in early adulthood - High levels of use of health and mental health resources - Risk of suicide greatest in the young-adult years - Individuals who engage in therapeutic intervention often show improvement in the first year - 30s and 40s – most individuals attain greater stability in their relationships and occupational functioning - After about 10 years, as many as half of the individuals no longer meet the full criteria for borderline personality disorder

Answer 44

- Concordance rates – MZ twins 35%; DZ twins 7% - Personality traits inherited – neuroticism, emotional dysregulation - May belong to a broader bipolar disorder spectrum

Answer 45

- Low levels of serotonin – impulsivity and depression | - Dysfunction in dopamine activity – emotion-based information processing and impulse control

Answer 46

- Frontal lobe – impulsive behaviour - Amygdala – controlling and regulating emotions - It is unclear if these abnormalities are a cause or consequence of the disorder

Answer 47

- BPD is a failure, in early childhood, to develop a sense of constancy and unity in one’s image of oneself and others - Childhood abuse or inadequate love and support leads to the development an insecure superego - Leads to lack of self-esteem, increased dependence, fear of separation and rejection - Primary defence mechanism – “splitting” - “splitting” – evaluating people, events and themselves as either “all good” or “ all bad” (nothing in-between)

Answer 48

- BPD results from not mastering the separation-individuation process - Symbiosis – state of oneness in which child’s identity is fused with the mother’s identity during the first year of life - Separation-individuation – the gradual development of a separate psychological identity from the mother (separation) and recognition of personal characteristic that define one’s self-identity (individuation) - The mother disrupts process by refusing to let go of the child or by pushing them toward independence too quickly - Results in a disturbance in the person’s ability to maintain a reliable/stable sense of self or individual identity.

Answer 49

- Transference plays a key role in therapy - Make the client aware of how their normal way of behaving is defensive - Increase the person’s ability to experience themselves and others in a more realistic and integrated way - Provide the person with more adaptive ways of coping - Challenging to treat - 50% to 66% drop out after first few weeks - Can be effective if the person is able to establish a good working relationship with the therapist

Answer 50

- Combination of behavioural therapy and supportive therapy | - Emphasis on the therapist’s acceptance of the client

Answer 51

1. Address dangerous and impulsive behaviours 2. Moderate extreme emotions 3. Improve self-esteem and the person’s ability to deal with relationships 4. Promote positive emotions such as happiness

Answer 52

- Tolerate distressing emotions - Accept yourself and your situation without judgement - Distraction, self-soothing

Answer 53

1. Distress Tolerance 2. Mindfulness 3. Emotion Regulation 4. Interpersonal Effectiveness

Answer 54

- Staying present, using all of your senses - Pay attention to and observe thoughts and feelings - Living in the moment

Answer 55

- Identifying emotions - Reducing person’s vulnerability to “emotion mind” - Taking the opposite action - Applying distress tolerance and mindfulness skills

Answer 56

- Identifying and communicating your needs - Interacting with others more effectively - How to listen, be non-judgemental and validate the feelings of others

Answer 57

- Study - compered DBT with treatment as usual - 17% premature termination (60% for treatment as usual) - Significant decrease in frequency and severity of suicide attempts - Fewer days spent in psychiatric hospitals - Higher self-rating on social adjustment - No difference on measures of depressive symptoms and hopelessness - More effective in long-term if combined with medication

Answer 58

Pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following:

Answer 59

1. Is preoccupied with details, rules, lists, order, organization, or schedules to the extent that the major point of the activity is lost 2. Shows perfectionism that interferes with task completion 3. Is excessively devoted to work and productivity to the exclusion of leisure activities and friendships 4. Is overconscientious, scrupulous, and inflexible about matters of morality, ethics, or values (not accounted for by cultural or religious identification) 5. Is unable to discard worn-out or worthless objects even when they have no sentimental value 6. Is reluctant to delegate tasks or to work with others unless they submit to exactly his or her way of doing things 7. Adopts a miserly spending style toward both self and others; money is viewed as something to be hoarded for future catastrophes 8. Shows rigidity and stubbornness

Answer 60

1. The child’s behaviour may have been rigidly controlled 2. May have been punished for small transgressions 3. Develops inflexible, perfectionistic standards 4. The child focuses on developing themselves in an area in which they excel and they do not become well-rounded 5. They avoid taking risks and being spontaneous

Answer 61

Antidepressants and benzodiazepines

Answer 62

- Aim - to explore the logical errors and dysfunctional schemas underlying the problematic behaviours - Dysfunctional schema – everything has to be done correctly or perfectly - Logical error – if I make an error then I am incompetent

Answer 63

Pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following:

Answer 64

1. Avoids occupational activities that involve significant interpersonal contact because of fears of criticism, disapproval, or rejection 2. Is unwilling to get involved with people unless certain of being liked 3. Shows restraint within intimate relationships because of the fear of being shamed or ridiculed 4. Is preoccupied with being criticized or rejected in social situations 5. Is inhibited in new interpersonal situations because of feelings of inadequacy 6. Views self as socially inept, personally unappealing, or inferior to others 7. Is unusually reluctant to take personal risks or to engage in any new activities because they may prove embarrassing

Answer 65

Pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

Answer 66

1. Has difficulty making everyday decisions without an excessive amount of advice and reassurance from others. 2. Needs others to assume responsibility for most major areas of his or her life 3. Has difficulty expressing disagreement with others because of fear of loss of support or approval 4. Has difficulty initiating projects or doing things on his or her own (because of a lack of self-confidence in judgment or abilities) 5. Goes to excessive lengths to obtain nurturance and support from others, to the point of volunteering to do things that are unpleasant 6. Feels uncomfortable or helpless when alone because of exaggerated fears of being unable to care for himself or herself 7. Urgently seeks another relationship as a source of care and support when a close relationship ends 8. Is unrealistically preoccupied with fears of being left to take care of himself or herself