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Psychology - Forensic - Level 4 > Personality Disorders > Flashcards

Personality Disorders Flashcards

1
Q

Personality

A

Personality disorders are often considered to be maladaptive express of normal/adaptive personality traits.

Extreme deviation from the way a typical person in a given culture would think, feel and relate to others.

Personality disorders are quan. rather than qual. different to normal / adaptive personality.

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2
Q

Personality Disorders

A

Personality disorder is enduring pattern of inner experience and behaviour that deviates markedly from expectations of individual’s culture.

Other common features:

  • PD’s are associated with unusual ways of interpreting events, unpredictable mood swings or impulsive behaviour.
  • Result in impairments in social and occupational functioning
  • Represent stable patterns of behaviour that can be traced back to adolescence or early childhood.

DSM-5 contains the diagnostic criteria for 10 PD.

Prevalence is 4.4%
- men 5.4
women 3.4

Approx. 1/4 million in UK have PD (Coid et al, 2006).

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3
Q

Personality Disorder Clusters

Cluster A

A

Odd / eccentric disorders

Paranoid

Schizoid

Schizoptyal

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4
Q

Personality Disorder Clusters

Cluster B

A

Dramatic / emotional disorders

Antisocial

Borderline

Histrionic

Narcissistic

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5
Q

Personality Disorder Clusters

Cluster C

A

Anxious / fearful disorders

Avoidant

Dependent

Obsessive-compulsive

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6
Q

Cluster A

Paranoid

Key Features

A
  • Expect others to exploit, harm or deceive them.
  • Suspicious of others
  • Hypervigilant to threats and insults
  • Secretive
  • Unforgiving
  • Reacts angrily to perceived attacks on their character
  • Suspect unfaithfulness from their sexual partner.
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7
Q

Cluster A

Paranoid

Prevalence

A

2.3-4.4%

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8
Q

Cluster A

Paranoid

Co-morbidity

A

Schizotypal and avoidant PDs

Big 5 - low extraversion, low agreeableness, high neuroticism.

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9
Q

Cluster A

Paranoid

Treatment

A

Anti-psychotic medication

Psychodynamic therapies

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10
Q

Cluster A

Schizoid

Key Features

A
  • detachment from close interpersonal relationships
  • solitary interests
  • little interest in sex
  • few pleasures
  • lacks close friends
  • indifferent to praise / criticism
  • aloofness / emotionally cold
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11
Q

Cluster A

Schizoid

Prevalence

A

3.1-4.9%

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12
Q

Cluster A

Schizoid

Co-morbidity

A

Other cluster A PDs and avoidant PD.

Big five - low extraversion, agreeableness and openness.

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13
Q

Cluster A

Schizoid

Treatment

A

Anti-psychotic medication

Psychodynamic therapies

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14
Q

Cluster A

Schizotypal

Key Features

A
  • ideas of reference
  • odd or magical beliefs
  • sensory illusions e.g. sensed presence
  • odd thinking / speech
  • suspiciousness
  • emotional flatness
  • eccentric appearance, behaviour e.g. talking to self in public
  • social isolation
  • social anxiety relate to paranoid fear
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15
Q

Cluster A

Schizotypal

Prevalence

A

0.6-4.6%

slightly more common in males

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16
Q

Cluster A

Schizotypal

Co-morbidity

A

Highly comobid with other personality disorder, esp. paranoid and avoidant.

Big five - low agreeableness and conscientiousness, high extraversion and neuroticism.

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17
Q

Cluster A

Schizotypal

Treatment

A

Anti-psychotic medication

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18
Q

Cluster B

Anti-Social Personality Disorder

Key features

A

18+ only - evidence of conduct disorder pre-15+

Disregard for law and social norms

Dishonest

Impulsivity

Irritability / aggression / violence

High disregard for, and violation of the rights of others.

Socially irresponsible

Lack remorse

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19
Q

Cluster B

Anti-Social Personality Disorder

Prevalence

A

0.2 - 3.3%

Between 50-70% in prison meet diagnostic criteria for ASPD.

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20
Q

Cluster B

Anti-Social Personality Disorder

Co-morbidity

A

Other cluster B PD’s

Big five - low agreeableness, low consciousness, low neuroticism

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21
Q

Cluster B

Anti-Social Personality Disorder

Treatment

A

Medication

CBT

Reasoning and Rehabilitation

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22
Q

Cluster B

Borderline

Key Features

A
  • fear of abandonment
  • instability of interpersonal relationships
  • unstable sense of self
  • unpredictability / impulsivity
  • suicidal behaviour / self-harm
  • sudden, erratic & intense mood swings
  • chronic feelings of emptiness
  • extreme anger
  • severe dissociative episodes
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23
Q

Cluster B

Borderline

Prevalence rate

A

1.6-5.9%

Mainly female

24
Q

Cluster B

Borderline

Co-morbidity

A

All cluster A PDs

Big 5 - low agreeablesness and conscientiousness, high extraversion and neuroticism

25
Q

Cluster B

Borderline

Treatment

A

Medication
DBT
CBT

26
Q

Cluster B

Histrionic

Key Features

A

attention-seeking

sexually provocative / seductive

emotionally extravagant yet shallow

physical appearance used to draw attention - extreme / flamboyant

speech delivered with dramatic flair

self-dramatization

suggestible

superficial relationships - perceives them to be more intimate than they in fact are

27
Q

Cluster B

Histrionic

Prevalence

A

1.8-3

Mainly female

28
Q

Cluster B

Histrionic

Co-morbidity

A

Borderline PD, all other cluster B PDs, and dependent PD often co-occur

Big Five: high extraversion

29
Q

Cluster B

Histrionic

Treatment

A

Psychodynamic therapies

CBT

30
Q

Cluster B

Narcissistic

Key Features

A 
perceived self importance
fantasies about unlimited power
excessive self love
constant need admiration 
sense of entitlement 
expoitative 
lacking empathy
envious 
self-absorbed/arrogant/bragging 
aggression - episodes of narcissistic rage

sub type of ASPD?

31
Q

Cluster B

Histrionic

Prevalence

A

0.6-2%

males

32
Q

Cluster B

Histrionic

Co-morbidity

A

All cluster b, esp. aspd and borderline.

big five - high extraversion / low agreeableness

33
Q

Cluster B

Histrionic

Treatment

A

Psychodynamic therapies

CBT

34
Q

Cluster B - interpersonal violence

A

10x more likely to have criminal conviction than those without.

8x more likely to have spent time in prison.

increase in criminal risk was not found for those with cluster A or cluster C PD. (Coid et al, 2006).

35
Q

Cluster B pathology risk

ASPD

A

Antisocial PD is characterised by a lack of regard for others, aggressiveness and impulsivity, and a lack of remorse for actions (Emmelkamp & Kamphuis, 2007). Antisocial PD has been associated with violent behaviour in and out of relationships, for men and women (Barros & Serafim, 2008; Ehrensaft et al., 2006; Emmelkamp & Kamphuis, 2007).

36
Q

Cluster B Pathology Risk

Borderline

A

Borderline PD is characterised by general instability across many areas of life, including relationships, emotions, fear of abandonment, insecure attachment and impulsivity (Emmelkamp & Kamphuis, 2007). Borderline PD has been associated with IPV perpetration, and also with violence outside relationships, in both men and women (Barros & Serafim, 2008; Dutton, 1994b; Emmelkamp & Kamphuis, 2007)

37
Q

Cluster B Pathology Risk

Narcissistic PD

A

Narcissistic PD associated with men’s and women’s violence within and outside of relationships (e.g. Bushman & Baumeister, 2002; Henning et al., 2003; Lawrence, 2006).
Those with higher levels of narcissism are more likely to react with aggression in response to insults, criticism or conflict within relationships, or if they feel humiliated, socially rejected, that their self-esteem is challenged
These feelings in narcissists can lead to aggression to save face or seek revenge, and this can apply to both violence towards partners and violence towards others.

38
Q

Cluster B Pathology Risk

Histrionic PD

A

Individuals with histrionic PD are excessively emotional and misinterpret their relationships as being more intimate than they in fact are. They have a need to always be the centre of attention , and behave inappropriately to increase attention: such as being overtly sexual, flirtatious and provocative (Emmelkamp & Kamphuis, 2007).
Research has found that histrionic PD is present in female perpetrators of IPV (Simmons et al. 2005; Henning et al., 2003).
Histrionic traits have been associated with men’s and women’s reasons for perpetrating IPV. For example, to get attention, wanting to prove love, or because their partner appears to not be fully committed (Harned, 2001; Henning et al., 2005).

39
Q

Cluster B and Stalking

A

Witful, malicious and repeated following or harassing of another person that threatens his or her safety.

Is described as an abnormal enduring pattern of interpersonal behaviour

Intense reaction to rejection, loss and abandonment.

  • associated with Narcissistic and BPD.
40
Q

Cluster B - childhood trauma

A

Environmental factor contributing to the aetiology of PD.

  • maltreatment
    physical/emotional/sexual/neglect
  • childhood trauma has been found to be related to PD
    most evidence related to BPD.
  • individuals who have been maltreated have been found to be 3x more likely to develop PD (Johnson et al 2001)
  • but not all children maltreated develop PD.
    gene-environment interaction: when genetically vulnerable children (nature) encounter childhood trauma within family environment (nurture).
  • longitudinal research also investigated whether problem parenting (lack of parental affection, harsh punishment) risk factor of PD.
41
Q

Cluster C

Avoidant

Key Features

A
  • social inhibition - shuns socialising, relationships i.e. for self protection - includes occupation and interpersonal relationships.
  • hypersensitive to negative evaluation: criticism / disapproval / rejection
  • feelings of inadequacy
  • perceives self as socially inept, inferior or unappealing.
  • terrified of embarrassment / appearing foolish
42
Q

Cluster C

Avoidant

Prevalence

A

2.4

43
Q

Cluster C

Avoidant

Co-morbidity

A

Borderline, dependent and cluster A PDs.

44
Q

Cluster C

Avoidant

Treatments

A

Psychodynamic therapies

CBT

45
Q

Cluster C

Dependent

Key Features

A
  • overreliance on others
  • neediness, subordinates own decisions and needs
  • difficulty disagreeing with others
  • low self confidence
  • excessive need to be taken care of
  • uncomfortable with soliude
  • needs close relationship
  • preoccupied fear left alone to care for self.
46
Q

Cluster C

Dependent

Prevalence

A

0.4-1.5

47
Q

Cluster C

Dependent

Co-morbidity

A

Borderline
Avoidant
Histrionic

48
Q

Cluster C

Dependent

Treatment

A

CBT

49
Q

Cluster C

Obsessive-Compulsive PD

Key Features

A
  • preoccupation with detail, rules, schedules, control freaks
  • perfectionism
  • excessively devoted to work to the detriment of all other life activities
  • serious, formal, inflexible
  • poor decision making / time management
  • hoards
  • reluctant to delegate
  • frugal
  • rigid / stubborn

Paradoxically, most (80%) of OCPD sufferers have no obsessions or compulsions OCPD not same as obsessive-compulsive disorder (OCD)

50
Q

Cluster C

Obsessive-Compulsive PD

Prevalence

A

2.7-7.9

males

51
Q

Cluster C

Obsessive-Compulsive PD

Co-morbidity

A

Avoidant PD

52
Q

Cluster C

Obsessive-Compulsive PD

Treatment

A

CBT

53
Q

Cluster C - interpersonal violence

A

Some evidence that people with avoidant and dependent PDs have a higher risk of being victims of violence (Cormier et al., 2006).
Cluster C PDs associated with the perpetration of IPV in men (Dutton, 2003; Dutton & Kerry, 1999;) and women (Henning et al., 2003).
Dutton and Kerry (1999) found that it was avoidant PD that predicted male spousal homicide
those with avoidant PD are sensitive to “criticism, disapproval, and rejection” (Emmelkamp & Kamphuis, 2007, p. 14).
However, some longitudinal research found that cluster C PDs were protective in relation to IPV perpetration in men and women (Ehrensaft et al., 2006).
those with Cluster C disorders avoid interpersonal contact through fear of inadequacy and not being liked, which may protect them from perpetrating IPV as they may be less likely to enter into a relationship in the first place.

54
Q

Gender

A

Sex differences have been reported in personality disorders
However it could be argued that some sex differences are a result of sex biases in diagnoses.
Some research (e.g. Ford & Widiger, 1989; Garb, 1997) has presented psychologists with case histories and varied the sex of the patient, and found that psychologists were more likely to diagnose female patients with histrionic than antisocial PD, and more likely to diagnose male patients with antisocial than histrionic PD.
This may be because histrionic PD contains stereotypic traits of femininity (e.g. emotionality) and antisocial PD contains stereotypic traits of masculinity (e.g. aggressiveness): therefore creating a sex bias in diagnosis.

55
Q

Theories: genetic

A

There are genetic and environmental links to PD
Also, parents personality traits can influence the environment that they provide for their children
There is an increased prevalence for all Cluster A PDs in the relatives of individuals with schizophrenia
Antisocial, borderline - More common among first-degree biological relatives than the general population
Few studies on the genetics of Cluster C

56
Q

Theories: Attachment

A

Bowlby’s attachment theory
Influential to the understanding of the development of personality, and therefore an important factor in the development of personality disorders
Insecure attachment associated with PD, specifically:
Dismissive attachment – narcissistic and antisocial PD
Pre-occupied attachment – borderline, histrionic, obsessive-compulsive, schizotypal PD (Rosenstein & Horowitz, 1996)
Most research has investigated the relationship between attachment and borderline & antisocial PD

57
Q

Conclusion

A

Personality traits are only diagnosed as PD when they are inflexible, maladaptive, and persisting and cause significant functional impairment or subjective distress (DSM-5)

Those who meet the diagnostic criteria for one PD, often also meet the criteria for several others

Psychology - Forensic - Level 4 (8 decks)

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