Personality Disorders

Question 1

Personality disorder overview

Answer 1

• enduring inflexible predispositions
• Begin early childhood
• Chronic
• Poor prognosis
  
  • Strong counterparts to the therapist
• Don’t feel the treatment is necessary: externalization common– problem is with everyone else
• 10 disorders into 3 clusters
• Distress or impairment in two or more areas
  
  • self or cognition (identity/perception)
  • affect
  • interpersonal function (empathy)
  • impuslve control (risky behavior)

Question 2

Clusters

Answer 2

• Cluster A: Odd or Eccentric
  
  • Schizoid, paranoid, schizotypal
• Cluster B: dramatic, emotional, erratic
  
  • Antisocial, histrionic, borderline and narcissistic
• Cluster C: anxious or fearful
  
  • Obsessive compulsive, avoidant and dependent

Question 3

Paranoid

Answer 3

• Unjustified suspicion of everyone
• Misinterpret everyday occurrences e.g.wrong change at the store
• Overly cautious, find hostility in benign comment or criticism
• Cold and distant few relationships
• poor quality of life
• *

Question 4

Paranoid causes and treatment

Answer 4

• Causes
  
  • Not well understood
  • Could involve early learning that people can’t be trusted
• Treatment
  
  • Few seek out professional help (mistrust of therapists)
  • Developing trust
  • CBT to counter negative thinking
  • Lack of good outcome studies

Question 5

Schizoid

Answer 5

• No desire for close social relationships
• Come off as cold, distant
• Differs from paranoid
  
  • no suspiciousness or fear of rejection
• flat affect
• Overlap with autism spectrum disorder
  
  • Shared preference for social isolation
  • ASD doesn’t understand emotions schizoid doesn’t care
• Causes
  
  • Unclear
  • Usually childhood shyness
  • Childhood abuse sometimes
• Treatment
  
  • Few seek professional help
  • Establish the value of interpersonal relationships
  • CBT to build empathy
  • lack of good outcome studies

Question 6

Schizotypal

Answer 6

• Isolated and highly suspicious
• Exreme discomfort in social relationships
• Loose associations in conversation (Napolean dynamite monologue)
• Psychotic like symptoms: magical thinking (e.g. telepathy), ideas of reference (e.g. personalised commericals) and illusions (less severe than hallucinations)

Question 7

Schizotypal Causes and treatment

Answer 7

• Causes
  
  • Mild expression of schizophrenia genes?
  • Potentially more likely to develop after childhood trauma
  • potentially other brain deficits
• Treatment options
  
  • address comorbid depression (significantly increased chance)
  • Combination of antispsychotic medication, CBT and social skills training
  • poor prognosis

Question 8

Antisocial PD

Answer 8

• Failure to comply with social norms
• Men tend to be diagnoses
• Disregard for others
• Can be charming or manipulative (Ted Bundy)
• Larger proportion of criminals with antisocial than gen population
• “psychopathy” associated with personality traits associated with disorder

Question 9

Neurobiological & Antisocial

Answer 9

• Underarousal: reduced emotional response (sweating HR) to fear-inducing images
• Fearlessness: failure to respond to danger cues
• Cortical immaturity: cerebral cortex not fully developed
• Smaller frontal lobe: judgement and impulse control impaired
• Grays model: inhibition signals outweighed by pleasure signals i.e. dopamine high seratonin low

Question 10

Psychosocial Antipersonality

Answer 10

• Dont care about others needs
• Less likely to give up when goal is unattainable, why they continue with crime after being punished
• Genetic/family
  
  • Parents have antisocial (genes and modeling)
  • Inconsistent discipline and support
    
    • neglect/abuse some cases
    • may not learn to fear consequences
• Low SES and urban settings

Question 11

Antisocial development

Answer 11

• Early history of behavioral problem e.g. skipping school, aggression towards people and animals
• previous diagnosis of conduct disoder
  
  • Aggression, destructiveness and/or rule violations before age 13
  • “Callous-unemotional type:
• Mutual bio-environmental influence
  
  • antisocial tendencies alienate peers that could be postive role models
  • family stress and antisocial behavior

Question 12

Treatment APD

Answer 12

• Few seek out treatment
• Poor prognosis
• prevention and rehabilitation
  
  • e.g. school programs targeting aggression; parents not accidentally reinforcing behavior
• Often prison
• focus on selfish consequences (if you assault someone you go to prison)

Question 13

Borderline (and comorbidity)

Answer 13

• Hallmark: emotional instability
• Intense and unstable relationships & moods
• Impulsivity, fear of abandonment, unstable sense of identity, feelings of emptiness
• Self-destructive behavior to relieve emotional suffering: mutilation, suicidal behavior, unsafe sex, drug use
• Comorbidity rates high with other disorders
  
  • 80% bipolar patients also hhave
  • 67% substance use
  • 25% bulimia patients have

Question 14

Borderline causes

Answer 14

• strongly inherited
  
  • emotional reactivity: impairment of the limbic system and amygdala
• Early trauma/abuse increases risk
• High levels of shame and low self-esteem
• Biopsychosocial: genetic risks + tendency to experience intense emotions + bad family environment = BPD

Question 15

Borderline Treatment

Answer 15

• No medication but antidepressants used
• psychotherapy: difficult patients
  
  • seek out therapy but drop out
  • quick to open up then shut down
  • violate boundaries (call the emergency line for non-emergency situations)
  • Small provocation = anger towards helpers
• Use relationship with therapist as model for other relationships

Question 16

Dialectal behavior therapy

Answer 16

• Borderline Treatment
• Emphasizes the dual reality of acceptance of difficulties and need to change
• Individual and group therapy to develop skills
  
  • distress tolerance
  • emotion regulation
  • interpersonal effectiveness
  • mindfulness
• effective in preventing suicide and self harm

Question 17

Histrionic

Answer 17

• Sexually provocative
• Need for attention
• Theatrical gestures, grandiose language, eyecatching clothes
• Shallow emotions
• More commonly diagnosed in women (gender bias)

Question 18

Histrionic Causes and Treatment

Answer 18

• Causes
  
  • Unknown
  • Maybe early learning about how to attract attention from distant caregivers
  • Co-occurs with antisocial PD (female variant of traits?)
• Treatment
  
  • Focus on long term negative consequences of attention-seeking
  • Better ways to solve problems
  • Inner satisfaction and self-reliance
  • Little evidence that treatment is effective

Question 19

Narcissistic Personality Disorder

Answer 19

• Exaggerated sense of self importance
• Preoccupation with attention
• Entitled to special treatment
• Sensitive to criticism: may show rage or cold indifference
• Lacks compassion
• more common in men

Question 20

Narcissistic Causes and Treatment

Answer 20

• Causes largely unknown
  
  • Failure to learn empathy as a child
  • Psychodynamic: parents either cold an distant or too positively
  • sociology: product of “me” generation
  • Western ideals
• Treatment
  
  • Difficult: client must acknowledge weakeness
  • Emphasize dealing with criticism
  • Little evidence of effective treatment

Question 21

Avoidant Personality Disorder

Answer 21

• Extreme sensitivity to opinions of others
• Lack of trust bc expects the worst
• Avoidant of most interpersonal relationships: fear of rejection, need constant reassurance
• Emotionally inhibited but deep craving for affection and acceptance
• Low self-esteem
• Frequently overwhelmed by feelings of inadequacy

Question 22

Avoidant causes and Treatment

Answer 22

• Causes: likely similar to social anxiety: conditional fears, maladaptive beliefs
  
  • Frequently comorbid diagnosis (some researchers think it’s the same)
  • SAD is fear of social situation; avoidant is fear of close relationships
  • Childhood experiences of neglect, isolation, and rejection
• Treatment
  
  • Similar to social phobia: fear hierarchy of exposure
  • Focus on social skills, entering anxiety-provoking situations
  • Good relationship with therapist important
  • Some good outcome studies exist

Question 23

Dependent PD (causes and treatment too)

Answer 23

• Reliance on others to make all life decisions
• submissive in interpersonal relationships
• similar to avoidant bc feelings of inadequacy, fear of criticism; different bc has difficulty terminating relationships
• Causes
  
  • Not well understood
  • Disruption to early learning independence
  • Parents might have rewarded clingy behavior
• Treatment
  
  • Lacking research
  • Challenge false beliefs (I am helpless)
  • Low progression bc of lack of independence
  • “the goodbye is the work”

Question 24

Obsessive compulsive PD

(causes and treatments too)

Answer 24

• Obsession with doing things the right way
• highly perfectionistic, emotionally shallow
• can’t be spontaneous
• interpersonal problems
• Compulsions are rare
  
  • OCD = intrusive unwanted thoughts leading to repetitive behaviors
  • OCPD = need to do things a certain way bc of rigidity not anxiety

Causes

• Unknown: genetics?

Treatment

• Antidepressants
• Target ruminations about imperfections
• Emphasis on prioritizing what matters
• Reapraisal of doing things “wrong” to address rigidity