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Psychopathology > Personality Disorders > Flashcards

Personality Disorders Flashcards

1
Q

Cluster A Personality Disorders

A

Odd & eccentric; resembles schizophrenia

  • Paranoid
  • Schizoid
  • Schizotypal
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2
Q

Cluster B Personality Disorders

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Dramatic, emotional, erratic; primarily affective disturbance

  • Antisocial
  • Borderline
  • Histrionic
  • Narcissistic
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3
Q

Cluster C Personality Disorders

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Anxious, fearful

  • Avoidant
  • Dependent
  • Obsessive-Compulsive
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4
Q

Personality Disorder Definition

A
  • Pervasive/inflexible patterns of behavior that deviate from expectations of one’s culture; cross-situational and enduring over time; onset during adolescence/early adulthood; distress or impairment
  • Present in at least 2 areas/domains: cognition, emotions, relationships, impulse control
  • Typically thought to be life-long and unresponsive to treatment (but maybe not? DBT?)
  • Sometimes described as having self-centered/self-focused/selfish components
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5
Q

Potential Problems with Current System

A
  • High comorbidity
  • Instability of diagnoses
  • Symptom thresholds arbitrary
  • High rates of PD-NOS (Other/unspecified)
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6
Q

Five Dimensions of Personality

A
  • Introversion vs extraversion
  • Neuroticism vs emotional stability
  • Conscientiousness vs irresponsibility
  • Antagonism vs agreeableness
  • Avoidant vs open to experiences
  • Should we change to dimensional view?
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7
Q

General Personality Disorder

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A) Enduring pattern of inner experience and behavior that deviates markedly from one’s culture; Manifested by 2+ of following:
-cognition, affectivity, interpersonal functioning, impulse control
B) Inflexible, pervasive, stable, long in duration
C) Leads to distress/impairment
D) Stable and long duration; onset adolescence/early adulthood
E) Not better explained by another MD
F) Not attributable to substance or medical condition

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8
Q

Prevalence of Cluster A PD’s

A
  • Paranoid: 2.3-4.4%, more common in men
  • Schizoid: 3.1-4.9%, slightly more common in men
  • Schizotypal: 0.6-4.6%, slightly more common in men
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9
Q

Paranoid Personality Disorder

A

A) Pervasive distrust in/suspiciousness of others; others’ motives interpreted as malevolent. 4+ of following:
- Suspects that others are exploiting, harming, deceiving
- Preoccupied with doubt about others’ loyalty/trustworthiness
- Reluctant to confide in others (fear info will be used against them)
- Reads threats into benign remarks/events
- Bears grudges
- Perceives unapparent attacks on his/her character
- Recurrent concerns about partner’s fidelity
B) Not only during the course of broader psychosis

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10
Q

Schizoid PD

A

A) Detachment from social relationships and restricted emotional expression in interpersonal settings. 4+ of following:
- Neither desires nor enjoys close relationships
- Mostly chooses solitary activities
- Little interest in sexual activity with another
- Takes pleasure in few activities
- Lacks close friends
- Appears indifferent to praise or criticism
- Shows emotional coldness/flat affect
B) Not schizophrenia or some other psychotic disorder

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11
Q

Schizotypal PD

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A) Social and interpersonal deficits, acute discomfort with close relationships, cognitive distortions, eccentricities of behavior. 5+ of following:
- Ideas of reference
- Odd beliefs/magical thinking
- Unusual perceptual experiences
- Odd thinking and speech
- Suspiciousness/paranoid ideation
- Inappropriate/restricted affect
- Behavior/appearance that’s odd, eccentric, or peculiar
- Lack of close friends
- Excessive social anxiety (maybe associated with paranoia)
B) Not a psychotic disorder

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12
Q

Etiology of Cluster A

A
  • Genetic link to schizophrenia?
  • Risk of schizotypal associated with family history of schizophrenia
  • Schizotypal similar to positive symptoms of schizophrenia?
  • Schizoid similar to negative symptoms of schizophrenia?
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13
Q

Cluster B Epidemiology

A
  • Antisocial: 0.2-3%, more common in men
  • Borderline: 1.6-6%, more common in women
  • Histrionic: 2%, more common in women
  • Narcissistic: up to 6%, more common in men
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14
Q

Antisocial PD

A

A) Pervasive disregard for and violation of the rights of others, occurring since age 15. 3+ of the following:
- Breaking the law repeatedly
- Deceitfulness, repeated lying, use of aliases, conning others
- Impulsivity/failure to plan ahead
- Irritability/aggressiveness
- Reckless disregard for self and others
- Consistent irresponsibility as indicated by failure to maintain job or financial obligations
- Lack of remorse
B) At least 18 years old
C) Evidence of CD before age 15
D) Not during course of schizophrenia or Bipolar

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15
Q

Borderline PD

A

A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity. 5+ of following:

  • Frantic efforts to avoid abandonment
  • Unstable and intense interpersonal relationships, vacillate between idealization and devaluation
  • Unstable self-image or sense of self
  • Self-damaging impulsivity
  • Recurrent suicidal behavior, threats, self-mutilating bx
  • Highly reactive and labile moods
  • Feelings of emptiness
  • Inappropriate, intense anger/inability to control anger
  • Transient paranoid ideation or severe dissociation
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16
Q

Most common PD seen in treatment

A

Borderline PD

17
Q

Borderline ego-dystonic or ego-syntonic

A

Ego-dystonic (others are ego-syntonic)

18
Q

Risk factors for Borderline PD

A
  • History of childhood trauma/abuse, family discord, loss of parent, exposure to violence common
19
Q

Linehan’s Biosocial Model of Borderline PD

A

1) Emotional dysregulation stresses parents
2) Parents respond harshly/confrontationally or with abuse/neglect
3) Invalidates emotional experiences and increases emotional dysregulation
4) Child learns to cope by tantruming (parents eventually attend to tantrums); never learns to manage emotions

20
Q

Identity Disturbance and Borderline PD

A
  • Identity disturbance/chronic emptiness at the core; drive emotional instability and other symptoms
  • Identity disturbance may be related to invalidation/abuse by parents
  • Don’t know how to feel because those who they are supposed to love are hurtful towards them
  • Bowlby’s internal working models of attachment: expect lack of care, unreliability, unresponsiveness
21
Q

Underlying features of Borderline PD

A
  • Fear of abandonment: mistrust due to abuse; feel as though defective
  • Idealization followed by devaluation: attraction of new identity followed by boredom and waiting for betrayal by others
  • Chronic emptiness: lack of stable identity
  • Impulsivity: poor frustration tolerance and emotion regulation; lack of boundaries
  • Mood lability: poor frustration tolerance
  • Self-harm: maladaptive coping; pain distracts from negative affect
  • Suicidal ideation/behavior: maladaptive coping, can be genuine desire to die
  • Inappropriate anger: poor frustration tolerance and mood regulation
  • Unstable but intense relationships: problems with boundaries; want stable, validating relationships; poor modeling from family
  • View the world in black and white
22
Q

Course of Borderline PD

A
  • Worse in young adulthood, risk of suicide higher
  • Therapy can improve symptoms
  • Relationship and vocational stability for some during middle adulthood
  • Symptoms “burn out” by 50s?
  • Relatively high rate of suicide
  • Commonly comorbid with other disorders
  • Self-medication very common
23
Q

Histrionic PD

A

Pervasive, excessive emotionality and attention seeking. 5+ of following:

  • Uncomfortable when not the center of attention
  • Interactions often include inappropriate sexually seductive/provocative behavior
  • Rapidly shifting/shallow expressions of emotion
  • Uses physical appearance to draw attention
  • Speech is excessively impressionistic, lacking detail
  • Self-dramatization, theatricality, exaggerated expression of emotion
  • Easily suggestible
  • Considers relationships more intimate than they really are
24
Q

Narcissistic PD

A

Pervasive grandiosity, need for admiration, lack of empathy. 5+ of following:

  • Grandiose sense of self-importance
  • Fantasies of “unlimited success, power, brilliance, beauty, or ideal love”
  • Believes s/he is special, unique, can only be understood by or associate with high-status people
  • Requires excessive admiration
  • Sense of entitlement
  • Exploits others
  • Lacks empathy
  • Envious of others, believes others are envious of him/her
  • Arrogant, haughty behaviors/attitudes
25
Q

Cluster C Epidemiology

A
  • Avoidant: 2.4%, equal men and women
  • Dependent: .5-.6%, more common in women
  • Obsessive-Compulsive: 2-8%, more common in men
26
Q

Avoidant PD

A

Pervasive social inhibition, feelings of inadequacy, hypersensitivity to negative evaluation. 4+ of following:

  • Avoids jobs that require significant interpersonal contact
  • Unwilling to get involved with someone unless certain of being liked
  • Shows restraint in relationships because of fear of being shamed or ridiculed
  • Preoccupation with being criticized/rejected in social situations
  • Inhibited in interpersonal situations due to feelings of inadequacy
  • Views self as socially inept, unappealing, inferior
  • Reluctant to take risks due to fear of embarrassment
27
Q

Avoidant PD and Social Anxiety Disorder

A

Some argue the same thing

28
Q

Dependent PD

A

Pervasive/excessive need to be taken care of, leads to submissive, clinging behavior, fears of separation. 5+ of following:

  • Difficulty making decisions without excessive advice/reassurance
  • Needs others to assume major responsibilities
  • Trouble expressing disagreement due to fear of loss of support/approval
  • Trouble initiating/doing things on their own
  • Goes to excessive lengths to obtain nurturance/support from others
  • Feels uncomfortable/helpless when alone for fear of being unable to care for oneself
  • Seeks new relationship as source of care/support when close relationship ends
  • Unrealistically preoccupied with fears of being left to care for self
29
Q

Obsessive-Compulsive PD

A

Pervasive preoccupation with orderliness, perfectionism, and mental/interpersonal control, at the expense of flexibility, openness, efficiency. 4+ of following:

  • Preoccupied with details, rules, lists, order, organization, schedules (major point of activity is lost)
  • Perfectionism interferes with task completion
  • Devotion to work/productivity leads to exclusion of leisure, friendships
  • Over conscientious, scrupulous, inflexible about matters of morality, ethics, values
  • Unable to discard worn-out/worthless objects
  • Reluctant to delegate tasks or work with others
  • Miserly spending habits, money viewed as something to be hoarded for future catastrophes
  • Rigid and stubborn
30
Q

Etiology of Personality Disorders

A
  • Temperament: genetics? family studies suggest low to moderate heritability
  • Childhood abuse: disruption of attachment?
  • Long-term, post-trauma reaction?
  • Schizotypal: abnormalities in temporal lobe volume (but reductions in frontal lobe as in schizophrenia not seen)
  • Borderline: Reduced hippocampus and amygdala size, heightened HPA axis activity?
  • Antisocial: chronic underarousal? Higher fear detection threshold?
  • Narcissistic: shield against low self-esteem and negative self-image
31
Q

Section III Criteria

A
  • General criteria for personality disorder are provided
  • Criterion A: Level of personality functioning. Disturbances in self (identity, self-direction) and interpersonal functioning (empathy, intimacy)
  • Criterion B: Pathological personality traits (each specific PD has a subset of traits from a group of 25 traits)
  • Criteria C and D: traits are pervasive and stable
  • Criteria E, F, and G: rule-out alternative explanations
32
Q

Gore and Widiger article

A
  • The DSM-5 maladaptive trait dimensional model proposal included 25 traits organized within five broad domain
  • Domains: negative affectivity (neuroticism), detachment (introversion), antagonism (low agreeableness), disinhibition (low conscientiousness), and psychoticism (openness)
  • Study tested the dimensional model proposed for DSM-V versus the five factor model
  • The results provided support for the hypothesis that all five domains of the DSM-5 dimensional trait model are maladaptive variants of general personality structure
33
Q

Zimmerman article

A
  • Work Group recommended deleting 5 PD’s because too comorbid. Author argues that the core problem with DSM-IV PD’s is methodological, not inadequacies of the criteria themselves.

Psychopathology (16 decks)

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