Personality Disorders Flashcards
How does DSM-5 define a personality trait?
enduring patterns of perceiving, relating to, and thinking about the environment and oneself that are exhibited in a wide range of social + personal contexts.
how does dsm-5 define a personality disorder?
- enduring pattern of inner experience and behaviour that deviates markedly from the expectations of the individual’s culture,
- pervasive + inflexible
- onset in adolescence or early adulthood
- stable over time + leads to distress/impairment
four general characteristics of a personality disorder
traits are:
- pervasive
- maladaptive
- inflexible,
- cause distress/impairment
how can personality be a disorder?
the way ppl perceive + interact with things is not always healthy.
- interacting with world can get in the way of how one functions
personality + disorders : recognize what?
recognize that most of us have traits + behaviours that are indicative of a disorder, but that doesnt imply you have one.
- when have too many traits that interfere with life then it becomes a disorder
what does pervasive mean?
- occur in wide range of social + personal contexts
when do personality disorders begin? most important about course?
early adolescence/adulthood.
course: endures – key.
what is egosyntonic?
the way a person thinks is not an issue, it is consistent with themselves and not distressing.
what is egodystonic?
ways of thinking and behaving are in conflict with my sense of self.
issues and implications with egosyntonic disorder?
- harder to treat if person doesnt think it’s an issue.
- lack insight into their pathology
two models to classify personality disorders according to DSM-5?
categorical model: traditional. 10 disorders, each fundamentally different - discrete, separate syndromes
dimensional: proposed. 6/10 disorders are extreme versions of a set of dimensions/aspects of personality
Dimensional model: what 5 personality domains can be thought of as spectrum?
- negative affectivity vs emotional stability
- detachment vs extraversion
- antagonism vs agreeableness
- disinhibition vs conscientiousness
- psychoticism vs lucidity
what is negative affectivity ?
frequent, intense experiences of high levels.
- negative emotions + behavioural manifestations
what is detachment?
meaningful avoidance of anything that’s socio-emotional.
- withdraw from interpersonal intxn.
what is antagonism?
behaviour that puts someone at odds with other individuals. exaggerated sense of self importance.
what is disinhibition?
orientation towards immediate gratification, impulsive behaviour, driven by current thoughts, feelings, enviro stimuli.
- disregard for past learning + potential consequences.
what is pyschoticism?
wide range of culturally incongruent, odd, eccentric, unusual behaviours/cognitions
overlap in traits + in disorders
lots of overlap of traits in diff disorders.
- can be hard to distinguish.
difference between categorical and dimensional diagnoses?
categorical: need X traits by X age. potentially restrictive. but parsimonious
dimensional: more sliding scale. less parsimonious, less restrictive.
statistics of personality disorders?
10-20% of popln
stats of co-morbidity of personality disorders?
50% of those with pd have another psychiatric disorder
how many personality disorders are there?
- how many clusters?
10 disorders
3 clusters
what are the 3 clusters of PD?
A - Mad: odd, eccentric
B - Bad: dramatic, emotional
C- Sad: anxious, fearful
What are the characteristics of Cluster A PD?
- mad, odd, eccentris
- verge on psychotic
Heritability of Cluster A?
familial genetic association.
- if 1st order relative has, another relative is likely to have it too.
what are the Cluster A PDs?
- paranoid
- schizoid
- schizotypal
potential characteristics of Paranoid PD?
- # 1 DISTRUCT + SUSPICIOUS
- suspect that others are exploiting/harming them
- pre-occupied with doubt about loyalty
- reluctant to confide bc of fear
- reads in threatening messages
- bears grudges
- perceives attacks on character
- suspicious of fidelity
prevalence of paranoid pd?
2-4%
etiology of PD?
psych factors
- negative view of world + others motives
core belief of Paranoid PD?
I’m vulnerable, others are malicious
treatment of PD?
- rarely seek, limited evidence about effectiveness
single characteristic of Schizoid PD?
pervasive detachment and restricted range of emotions
Prevlance of schizoid PD
3-5%
more M than F; 2:1
potential characteristics of Schizoid PD?
- neither desires/enjoys close relationships
- chooses solitary activities
- little/no interest in sexual experiences
- pleasure in few activities
- lacks close friends
- appears indifferent
- emotional coldness, detachment, flat affect
- prefer to be by themselves
etiology of schizoid PD?
psych factors
core beliefs of Schizoid PD?
I’m DEFECTIVE, others HAVE NOTHING TO OFFER ME
defenses to core beliefs of Schizoid PD?
fantasy, isolation of affect.
treatment of schizoid PD?
unlikely, unlikely that they’ll want to talk
Main symptom of Schizotypal PD?
- pervasive interpersonal deficits, cognitive + perceptual distortions
prevalence of Schizotypal PD?
3-4%
potential characteristics of Schizotypal?
- ideas of reference (think ppl talking to them)
- odd beliefs/magical thinking inconsistent with subcultural norms. superstitions.
- unusual perceptual experiences (illusions)
- odd thinking + speach
- suspicious, paranoid ideation
- inappropriate/constricted affect
- odd, eccentric, peculiar behaviour
- lack of close friends of confidants
excessive social anxiety - excessive social anxiety
- bizarre, eccentric
what are illusions?
stimuli present, but misinterpreting it.
compare schizotypal + schizoid
similar, but schizotypal is more pathological.
what is etiology of schizotypal PD?
- some say flu during pregnancy
- genetic factors
clear genetic association between schizotypal and what other disorder?
psychotic disorder
schizotypal is common when other family members have?
schizophrenia.
- suggests that the two are on a continuum not in separate categories.
- schizotypal may be phenotype of schizophrenic genotype.
general characteristics of Cluster B?
“Bad”, dramatic, emotional
cluster b and genetic associations?
familial genetic association with MOOD DISORDERS
- pathologically reactive, manipulative.
what are the Cluster B PDs?
- antisocial
- psychopathy
- borderline PD
- histrionic pd
- narcissistic pd
main characteristic of anitsocial PD?
pervasive DISREGARD and VIOLATIONS of the rights
prevalence of antisocial PD?
0.2-3%. more M»_space;F
potential characteristics of antisocial pd
- failure to conform to social norms
- deceitfulness
- impulsivity/failure to plan ahead
- irritability and aggressiveness
- reckless disregard for safety of self+ others
- consistent irresponsibility
- lack of remorse
- not all are criminals, but many are good business ppl.
diagnosis of antisocial PD?
- conduct disorder diagnosed before 15, then antisocial after 18.
- the two are reltaed.
- life course persistent model
etiology of Antisocial PD?
genetic: 55% concordance with MZ twins
genetic/enviro interaction : strong genetic + poor parents (due to likelihood of having aPD = bad environment has impact)
psych factors: believe others think like them, best defence is great offence
core belief of antisocial PD?
I’m vulnerable, others will exploit me
specified “with psychopathic features” means?
- low anxiety + low negative affectivity
- low withdrawal + high attention seeking
- not prone to stress; under-aroused, search for homeostasis
psychopathy as DSM diagnosis?
- is not.
psychopathy + sociopathy is the same.
but concordance btw psychopathy and Antisocial is high. - don’t need conduct disorder for psychopathy, but do in antisocial.
most important piece of info when making diagnosis?
life history.
empathy + violence
Q: can empathy be taught
violence: most likely violent at age 2. if persists into 3-4 yoa = probably more violent for life.
conduct disorder - diagnosis + persistence
diagnosed earlier = persists later into life
if diagnosed later = more likely to desist. pro-social job can help “treat”
2 psychopathy assessment toold to know about?
- Cleckley Criteria : 16 characterisitc (charm, absence of delusions, absent nervousness, truthfulness)
- PCL-R/ Revised Psychopathy Checklist: high scores = less likely to benefit from treatment + more likely to reoffend
3 theories of psychopathy/antisocial PD
- cortical immaturity hypothesis: underdeveloped cerebreal cortex = childlike, impulsive behaviour
underarousal hypothesis: risk taking behaviour boosts cortical arousal to NORMAL levels
fearlessness hypothesis: abnormally high fear threshold
treatment for Psychopathy?
stimulants
- easily abused
- compliance is weak
main characteristic of Borderline PD?
pervasive unstable relationships + affect, with marked impulsivity.
prevalence of Borderline PD?
1-2%, 50-75% are female.
- ost M diagnosed are domestic abusers.
potential characteristics of Borderline PD?
- frantic efforts to avoid real/imagined abandonment
- unstable/intense interpersonal relationships
- identity disturbance: unstable self-image/sense of self
- impulsive + self-damaging
- recurrent suicidal behaviour
- affective instability due to marked reactivity of mood
- emptiness
- inappropriate/intense anger
- stress-related paranoid ideation or severe dissociative symptoms.
etiology of borderline pd?
- Biosocial: highly sensitive + invalidating enviro = borderline
- psychological
why called borderline?
bc borderline btw neurosis + psychosis.
core beliefs of Borderline PD?
i’m undesirable, others will abandon me.
– self-fulfilling
treatment for borderline PD?
dialectical-behavioural therapy
what is dialectical-behavioural therapy
modified form of CBT emphasizes: - individual + group skills - safety - validation + acceptance - problem-focused - emotion regulation - distress tolerance - mindfulness
what does dialectic mean?
see word in spectrum as opposed to opposites
dbt is good for?
decreasing inappropriate anger, self-harm
improves functioning
what are main characteristics of histrionic pd?
- pervasice excessive emotionality +attention seeking
prevalence of histrionic PD?
2-3%
more F >M
potential characteristics of histrionic?
- uncomfy when NOT Centre of attention
- inappropriately sexual/provocative
- shifting/shallow expression of emotions
- use appearance to draw attention to self
- impressionistic speech, lacks detail.
- self-dramatization, exaggerated emotion
- suggestible
- considers relations more intimate than they are.
gender bias in diagnosis
- some criteria fit in traditional gender roles. make diagnosis more for one gender then.
- may be systematically different tho; more F just have this criteria than M.
ie. more males are antisocial PD. more females are histrionic PD.
assessment of gender bias
bias form the evaluators interpretation of the criteria + application of criteria.
- will assign differently if patient is M or F.
what is main characteristic for Narcissistic PD?
need for ADMIRATION , lack of EMPATHY.
prevalence of narcissistic PD
1-6%
50-75% are M
potential characteristics of Narcissistic PD?
- grandiose sense of self-importance
- pre-occupied with fantasies
- believes that they are special
- requires excessive admiration
- sense of entitlement
- interpersonally exploitative
- lacks empathy
- often envious
- arrogant
- inflated sense of self; demand entitlement, fragile ego underneath
what is cluster C?
sad, anxious, fearful
cluster C is genetically associated with ?
anxiety disorders
main characteristics of avoidant PD
pervasive inadequacy and hypersensitivity
prevalence of avoidant PD?
2-3%
potential characteristics of Avoidant PD?
- avoid interpersonal contact
- unwilling to get involved with ppl bc fear
- restraint in intimate relationships
- preoccupied with rejection
- inhibited in new interpersonal situations
- views self as socially inept
- reluctant to take personal risks
- hypersensitive: leads them to withdraw. inferiority complex.
diff btw avoidant PD + schizotypal PD in avoiding ppl
S: doesnt want to be around ppl, “likes” to be alone
A: likes ppl, too scared of being rejected to engage with them
what are main characteristics of Dependent PD?
pervasive + excessive need to be taken care of + clingy behaviour
prevalence of Dependent PD
0.5-0.6%
potential characteristics of Dependent PD?
- difficulty making decisions
- need others to take responsibility
- difficulty expressing disagreement with others.
- difficulty initiating projects/doing things on their own. (bc of lack of self-confidence)
- excessive lengths to BE nurtured/supported by others.
- uncomfy/helpless when alone because of fear of being unable to care for self.
- seeks another relationships as source of care + support
- unrealistically pre-occupied with fear of taking care of self
how are avoidant PD and dependent PD different?
avoid: fear of being rejected/disliked so shy away from ppl
dependent: difficulty being on their own. really want to be with people, lack of self-confidence.
What is Obsessive-Compulsive PD characterized by?
pervasive preoccupation with orderliness + Control at expense of flexibility + timeliness
how is OCPD diff from OCD?
OCPD is egosyntonic. preoccupation is desirable, reasonable
OCD: egodystonic, dont like state. aware that it’s compulsive + unreasonable but terrified to not do actions.
prevalence of OCPD
2-8%
more M>F
potential characteristics of OCPD?
- pre-occupied with details, rules, lists, organization to the extent that point of activity is lost
- perfectionism interferes with task completion
- excessively devoted to work/productivity = exclusion of leisure activities + friendships
- overconscientious, scrupulous, inflexible.
- unable to discard worn-out, worthless objects
- reluctant to delegate tasks
- adopt miserly spending style.
- rigid + stubborn
- uptight, perfectionist, workaholic, inflexible.
