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Psychopathology > Personality Disorders > Flashcards

Personality Disorders Flashcards

1
Q

Clinical Features of Personality Disorders

A
  • Chronic interpersonal difficulties
  • Problems with identity or sense of self
    • Formerly known as “character disorders”
    • Often cause significant problems in lives of others
    • Gradually develop inflexible and distorted personality and behavior patterns
    • Part of one’s being, overpowering
    • Extreme personalities
    • May represent extreme levels of normal personality traits i.e. histrionic, dependent, obsessive-compulsive
    • The particular trait patterns affected individuals have developed, color their reactions to each new situation and lead to a repetition of the same maladaptive behaviours because they don’t learn from previous mistakes or troubles
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2
Q

Cluster A Personality Disorders

A

(1) Paranoid
(2) Schizoid
(3) Schizotypal
• individuals with these disorders seem odd or eccentric.
• “sad” disorders
• Schizoid and schizotypal seem to be related “familial” to schizophrenia

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3
Q

Cluster B Personality Disorders

A

(1) Histrionic
(2) Narcissistic
(3) Antisocial
(4) Borderline
• individuals with these disorders share a tendency to be dramatic, emotional, and erratic
• “mad” disorders

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4
Q

Cluster C Personality Disorders

A

(1) Avoidant
(2) Dependent
(3) Obsessive-Compulsive
• Individuals with these disorders show fearfulness or tension, as in anxiety-based disorders
• Children with an inhibited temperament may be at heightened risk for avoidant personality disorder, and individuals high on neuroticism and agreeableness, with authoritarian and overprotective parents, may be at heightened risk for dependent personality disorder.
• “scared” disorders

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5
Q

Personality Disorders Prevalence

A

• Ranges from 4.4% to 14.8%
- likely due to problematic diagnostic criteria
• About 75% comorbidity

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6
Q

Difficulties Doing Research on Personality Disorders

A

• Little research has been conducted on causal factors
• Difficulties in studying the causes of personality disorders spring from
- The fact that such disorders have received consistent attention only since DSM-III was published in 1980
- The fact that these disorders are less amenable to thorough study
- The fact that most studies to date are retrospective

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7
Q

Five-Factor Model of Personality

A 
O.C.E.A.N.
rated on spectrum
• Openness to experience 
• Conscientiousness 
• Extraversion 
• Agreeableness
• Neuroticism
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8
Q

Histrionic Personality Disorder

A

Excessive attention seeking, emotional instability, and self-dramatization
• High extroversion and neuroticism
• Over-concern with attractiveness
• suffocating, stressful on relationships
• Irritability and temper outbursts if attention seeking is frustrated
• Prevalence: 2–3%
• more “feminine”
- research has shown that it’s overwhelmingly seen in women
> can be seen in men who are highly feminine
• Highly innapropriate attention seeking
• May attempt to control their partners through seductive behavior and emotional manipulation, but they also show a good deal of dependence
Causal Factors:
- highly comorbid with borderline, antisocial, narcissistic, and dependent personality disorder diagnoses
- some evidence for a genetic link with antisocial personality disorder
> common underlying predisposition that is more likely to be manifested in women as histrionic personality disorder and in men
- maladaptive schemas revolving around the need for attention to validate self-worth.

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9
Q

Paranoid Personality Disorder

A

• Suspiciousness and mistrust of others
• Tendency to see self as blameless
• On guard for perceived attacks by others
• Beginning by early adulthood
• Not usually psychotic
• Prevalence: 0.5–2.5%
• males > females
Causal Factors:
- maybe genetics (not consistent); may occur through the heritability of high levels of antagonism and neuroticism
- psychosocial causal factors that are suspected to play a role include parental neglect or abuse and exposure to violent adults (may play a role in other disorders as well)

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10
Q

Schizoid Personality Disorder

A

• Impaired social relationships
• Inability and lack of desire to form attachments to others and activities
- hate people, very abrasive
• Prevalence: <1%
• males > females
• LOW: warmth, gregarious (outgoing), positive emotions, low openness to experience feelings
Causal Factors:
- any genetic link that may exist is very modest
- personality traits have been shown to have only a modest heritability

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11
Q

Schizotypal Personality Disorder

A

• Excessive introversion, pervasive social interpersonal deficits, cognitive and perceptual distortions, and eccentricities in communication and behavior.
• Peculiar thought patterns
• Oddities of perception and speech that interfere with communication and social interaction
- aka “TWilight Zone Patients”
• Beginning by early adulthood
• Prevalence: 3%
• males > females
Causal Factors:
- Genetic abnormalities similar to schizophrenia
- Heritability is moderate
- Possible link to childhood abuse and early trauma
- In adolescence, has been associated with elevated exposure to stressful life events and low family socioeconomic status

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12
Q

Narcissistic Personality Disorder

A

• Grandiosity (in fantasy or behaviour)
• Preoccupation with receiving attention
• Self-promoting
• Lack of empathy
• Vulnerable narcissists have unstable self-esteem
• Prevalence: <1%
• more “masculine”
- research has shown that it’s overwhelmingly seen in men
> can be seen in women who are highly masculine
• Two subtypes of narcissism: grandiose and vulnerable narcissism
• unwilling or unable to take the perspective of others
Causal Factors:
- Grandiose narcissism has not generally been associated with childhood abuse, neglect, or poor parenting.
- Some evidence that grandiose narcissism is associated with parental overvaluation.
- Vulnerable narcissism has been associated with emotional, physical, and sexual abuse, as well parenting styles characterized as intrusive, controlling, and cold

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13
Q

Antisocial Personality Disorder

A

Disorder characterized by continual violation of and disregard for the rights of others through deceitful, aggressive, or antisocial behavior, typically without remorse or loyalty to anyone.
• Lack of moral or ethical development
• pPison is the cost of doing buisness for them
• Inability to follow approved models of behavior
• Shameless manipulation of others
• History of conduct problems as a child
- problems with the law
• Prevalence: 1% females, 3% males
• more “masculine”
- research has shown that it’s overwhelmingly seen in men
> can be seen in women who are highly masculine

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14
Q

Borderline Personality Disorder

A

• Impulsiveness
• Instability in interpersonal relationships, self-image and moods
• Inappropriate anger
• Drastic mood shifts
- true love or total hate
• Chronic feelings of boredom
• Border between being psychotic and neurotic
• Attempts at self-mutilation or suicide - for manipulation purposes
• Affective instability, manifested by unusually intense emotional responses to environmental triggers, with delayed recovery to a baseline emotional state.
• Prevalence: 2%
• more “feminine”
- research has shown that it’s overwhelmingly seen in women
> can be seen in men who are highly feminine
Causal Factors:
- Genetics (heritability)
- neurotransmitters (serotonin)
- traumatic events (90% report this) (correlational)

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15
Q

Avoidant Personality Disorder

A

• Hypersensitivity to rejection or social derogation
- deserately wants to be with people but not as much as they fear people
• Limited social relationships
• Low self-esteem
• Shyness
• Insecurity in social interaction and initiating relationships
• Prevalence: 0.5–1%
• Gender ratio: males = females
Causal Factors:
- genetically and biologically based inhibited temperament may often serve as the diathesis

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16
Q

Dependent Personality Disorder

A

• Extreme dependence on others
- Difficulty in separating in relationships
- Discomfort at being alone
- prefer to bow to the will of others than to make their own decisions
• Subordination of needs to keep others involved in a relationship
- core beliefs about weakness and competence and needing others to survive
• Indecisiveness
• High agreeableness (submissive) and neuroticism
• Prevalence: 2%
• Gender ratio: males = females
Causal Factors:
- Inheritance of high neuroticism and agreeableness

17
Q

Obsessive-Compulsive Personality Disorder

A 
• Excessive concern with order, rules, and trivial details 
- extreme "workaholics"
- "Living Machines"
• Perfectionism to the extreme
- looking so hard at the minute details that they miss the large picture
• Lack of expressiveness and warmth
• Difficulty in relaxing and having fun
• High conscientiousness
• Prevalence: 1% 
• males > females (by 2:1)
Causal Factors:
- modest genetic influence
- personality traits (those listed on this card)
18
Q

Difficulties in Treatments and Outcomes for Personality Disorders

A
  • Personality disorders are generally very difficult to treat
  • Goals may vary
  • Clients may believe there is no need to change
  • Relationships, including therapist/client relationships, can be difficult to form
19
Q

Adapting Therapeutic Techniques for Specific Personality Disorders

A

• Therapeutic techniques may need to be adapted for each personality disorder
• Settings can have an impact
- Inpatient
- Partial hospitalization
- Outpatient
• Cognitive therapy attempts to change biased and dysfunctional schemas of PD clients

20
Q

Treating Borderline Personality Disorder

A

• Regarding treatment, borderline has received more clinical and research attention than the other PDs
• Antidepressant medications (SSRIs)
• Dialectical behavior therapy (DBT)
- A unique kind of cognitive and behavioral therapy adapted specifically for borderline
- Systematic research supports DBT

21
Q

Antisocial Personality Disorder and Psychopathy (diagnostic criteria)

A

Diagnostic Criteria
- Age 18 years and over
- At least three behavioral problems occurring after age 15
- At least three instances of deviant behavior before age 15
• Genetic and temperamental, learning, and adverse environmental factors seem to be important in causing psychopathy and ASPD.
• Psychopaths also show deficiencies in fear and anxiety as well as more general emotional deficits.
i.e. showed less significant physiological reactivity to distress cues

22
Q

The Clinical Picture in Psychopathy and Antisocial Personality Disorder

A

• Inadequate conscience development
• Irresponsible and impulsive behavior
- i.e. substance abuse, irregard for consequences
• Ability to impress and exploit others

23
Q

Causal Factors in Psychopathy and Antisocial Personality Disorder

A 
• Genetic influences
- strong environmental influences
- individuals with low MAO-A activity were far more likely to develop ASPD if they had experienced early maltreatment 
- moderate heritability 
• Low levels of fear; poor conditioning of fear
• More general emotional deficits
• Early parental loss
• Parental rejection
• Inconsistent discipline
24
Q

Developmental Perspective of Psychopathy and Antisocial Personality Disorder

A

• Antisocial behavior in childhood is the single best predictor of antisocial personality disorder in adulthood
• The younger the antisocial behavior starts, the higher the risk
• Antisocial personality disorder is often preceded by conduct disorder, oppositional defiant disorder, or ADHD
- When ADHD co-occurs with conduct disorder (which happens in at least 30 to 50 percent of cases), this leads to a high likelihood that the person will develop a severely aggressive form of ASPD and possibly psychopathy

25
Q

Personality Disorder (Definition)

A

Gradual development of inflexible and distorted personality and behavioral patterns that result in persistently maladaptive ways of perceiving, thinking about, and relating to the world.

26
Q

Epidemiological Study

A

designed to establish the prevalence (number of cases) of a particular disorder in a very large sample (usually many thousands) of people living in the community.

27
Q

Pathological Extremes of the Dimensions of the Five-Factor Model of Personality

A
  • Negative affectivity (neuroticism)
  • Detachment (extreme introversion)
  • Antagonism (extremely low agreeableness)
  • Disinhibition (extremely low conscientiousness).

• A fifth dimension, psychoticism, does not appear to be a pathological extreme of the final dimension of normal personality (openness)—rather it reflects traits similar to the symptoms of psychotic disorders (e.g., schizophrenia)

28
Q

Psychological Causal Factors

A

• Psychodynamic theorists originally attributed great importance in the development of character disorders to an infant’s getting excessive versus insufficient gratification of his or her impulses in the first few years of life
• More recently, learning-based habit patterns and maladaptive cognitive styles have received more attention as possible causal factors
- hypothesized to play important roles for certain disorders may originate in disturbed parent–child attachment relationships rather than derive simply from differences in temperament
• Parental psychopathology and ineffective parenting practices have also been implicated in certain disorders

29
Q

Vulnerable Narcissists

A
  • Very fragile and unstable sense of self-esteem, and arrogance and condescension is merely a façade for intense shame and hypersensitivity to rejection and criticism
  • May become completely absorbed and preoccupied with fantasies of outstanding achievement but at the same time experience profound shame about their ambitions.
  • May avoid interpersonal relationships due to fear of rejection or criticism.
30
Q

Multidimensional Diathesis-Stress Theory of Borderline Personality Disorder (Paris, 1999)

A 
Genetic and biological variabilities lead to:
• affective instability 
and 
• impulsivity 
plus 
• trauma 
and/or 
• parental psychopathology and/or failure 
and/or 
• loss and/or rejection, 
these lead to 
• dysphoria and emotional lability 
or 
• impulsive acting out and chaotic interpersonal relationships
ultimately leading to 
• borderline personality disorder
31
Q

Dialectal Behaviour Therapy

A

A unique kind of cognitive and behavioral therapy specifically adapted for treating borderline personality disorder.
• The therapy combines individual and group components as well as phone coaching. In the group setting, patients learn interpersonal effectiveness, emotion regulation, and distress tolerance skills.
• Patients receiving DBT show reductions in self-destructive and suicidal behaviors as well as in levels of anger
• works in women but not men
• DBT is still not in widespread use, likely because the treatment is complex and lasts several years
• many therapists - can’t form attachment
- if the patient behaves they get attention
- if they misbehave - the therapist becomes a robot in their responses

32
Q

Psychopathy (definition)

A

A condition involving the features of antisocial personality disorder and such traits as lack of empathy, inflated and arrogant self-appraisal, and glib and superficial charm.

33
Q

Gray’s Model

A

(1) The Behavioral Inhibition System
- proposed to be the neural system underlying anxiety
- the neural system responsible for learning to inhibit responses to cues that signal punishment.
(2) Behavioral Activation System.
- activates behavior in response to cues for reward (positive reinforcement) as well as to cues for active avoidance of threatened punishment (such as in lying or running away to avoid punishment that one has been threatened with).

34
Q

Sociocultural Causal Factors and Psychopathy

A
  • Encouraging or discouraging its development
  • One of the primary symptoms where cultural variations occur is the frequency of aggressive and violent behavior.
  • Affective-interpersonal dimension of psychopathy is the most consistent across cultures
  • Estimates of the prevalence of ASPD are much lower in Taiwan, a relatively collectivist society, than they are in the United States (individualistic)
35
Q

Difficulties in Diagnosing Personality Disorders

A
  • Diagnostic criteria are not sharply defined
  • Diagnostic categories are not mutually exclusive
  • Have to be careful with diagnosis
  • Don’t diagnose children with a personality disorder
  • Personality characteristics are dimensional in nature
36
Q

DSM Criteria for Personality Disorders

A

• DSM criteria include enduring behavior pattern

  • Pervasive and inflexible
  • Stable and of long duration
  • Clinically significant distress or impairment in functioning
  • Manifested in at least two areas: cognition, affectivity, interpersonal functioning, or impulse control

Psychopathology (7 decks)

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