Personality disorders (week 11) Flashcards
What are the 3 clusters of personality disorders?
Cluster A: Odd or eccentric
Cluster B: dramatic, emotional, erratic
Cluster C: anxious and fearful
What is a personality disorder?
- Persistent pattern of
emotions, cognitions,
behaviour resulting
in enduring emotional
distress for affected
person and others - distress may or may not be
subjective - difficulties with
relationships and work - DSM -5 lists 10 specific
ones
Commonalities across personality disorders
- symptoms begin in early adulthood
- fixed and consistent across situations
- NOT diagnosed in early childhood or adolescence
- lack of clear sense of self
- difficulty in relationships
- poor self awareness or insight into these difficulties
Histrionic personality disorder is biased against who?
females
antisocial personality disorder is biased against who?
males
What are the most common personality disorders?
borderline and antisocial
Cluster A disorder:
Odd/ eccentric (socially awkward, isolated, withdrawn)
What is Paranoid personality disorder?
- Suspicious, mistrustful of others without justification
- argumentative, may complain, quiet, hostile towards others, suicidal
- bears relationship to: paranoid type of schizophrenia and delusional disorder
DSM- 5TR criteria of paranoid personality disorder
A ) A pervasive distrust and suspiciousness of others such that their motives are interpreted
as malevolent, begins early adulthood, indicated by 4 (or more) :
* Suspects, without sufficient basis, that others are exploiting, harming, or deceiving them
* Is preoccupied with unjustified doubts about the loyalty or trustworthiness of friends
* Is reluctant to confide in others because of unwarranted fear that the information will be
used maliciously against him or her
* Reads hidden demeaning or threatening meanings into benign remarks or events
* Persistently bears grudges (i.e. - is unforgiving of insults, injuries, or slights)
* Perceives attacks on his or her character or reputation that are not apparent to others and
is quick to react angrily or to counterattack
* Has recurrent suspicions, without justification, regarding fidelity of spouse or sexual
partner
B) Does not occur within the course of schizophrenia, bipolar, depressive disorder with
psychotic features or other psychotic disorder
causes of paranoid personality disorder
- Genetics
- relatives with schizophrenia
- mistreatment or traumatic childhood experiences
- cognitive cultural factors
Treatment for paranoid personality disorder
- cognitive therapy to change mistaken assumptions about others
clinical description of schizoid personality disorder
- detachment from social relationships, no desire to enjoy closeness with others, cold, aloof
- homelessness
- extreme social deficiencies
- social isolation, poor rapport and constricted affect
Schizoid DSM criteria
A) A pervasive pattern of detachment from social relationships and a restricted
range of expression of emotions in interpersonal settings, beginning by early
adulthood, indicated by 4 (or more):
* Neither desires nor enjoys close relationships, including being part of a family
* Almost always chooses solitary activities
* Has little, if any, interest in having sexual experiences with another person
* Takes pleasure in few, if any, activities
* Lacks close friends or confidants other than first-degree relatives
* Appears indifferent to the praise or criticism of others
* Shows emotional coldness, detachment, or flattened affectivity
B) Does not occur within the course of schizophrenia, bipolar, depressive disorder
with psychotic features or other psychotic disorder
Causes of schizoid personality disorder
- childhood shyness, abuse, neglect, low-density dopamine receptors
Treatment for schizoid personality disorder
- social skills training
*role - playing - limited outcomes
clinical description of Schizotypal personality disorder
- Social deficits, psychotic-like symptoms, cognitive
impairments/paranoia - Report unusual perceptual experiences
- Hypersensitive to criticism as children
- Same spectrum as schizophrenia without debilitating
hallucinations and delusions - “Ideas of reference” and “Magical Thinking”
Schizotypal personality disorder DSM-5 criteria
A) A pervasive pattern of social and interpersonal deficits marked by acute discomfort with, and reduced capacity for, close
relationships as well as by cognitive or perceptual distortions and eccentricities of behavior, as indicated by 5+ :
* Ideas of reference (excluding delusions of reference)
* Odd beliefs or magical thinking that influences behavior and is inconsistent with subcultural norms (e.g. -
superstitiousness, belief in clairvoyance, telepathy, or “sixth sense”; in children and adolescents, bizarre fantasies or
preoccupations)
* Unusual perceptual experiences, including bodily illusions
* Odd thinking and speech (e.g. - vague, circumstantial, metaphorical, overelaborate, or stereotyped)
* Suspiciousness or paranoid ideation
* Inappropriate or constricted affect
* Behavior or appearance that is odd, eccentric, or peculiar
* Lack of close friends or confidants other than first-degree relatives
* Excessive social anxiety that does not diminish with familiarity and tends to be associated with paranoid fears rather than
negative judgments about self
B) Does not occur within the course of schizophrenia, bipolar, depressive disorder with psychotic features or other psychotic
disorder
causes of schizotypal personality disorder
- genetics, the prevalence of the disorder in relatives
- left hemisphere damage: brain abnormalities
(difficulty on tests of
memory or learning) - abnormalities in semantic association abilities
What is Cluster C?
Anxious/ fearful
treatment for schizotypal personality disorder
- antipsychotic medication, community treatment, social skills training
- CBT; treatment for depression
Avoidant personality disorder clinical description
- interpersonally anxious
- views self as socially inept, unappealing
- fear of rejection/shame
- pessimistic about their future
- restraint in personal relationships
DSM criteria for avoidant personality disorder
A) A pervasive pattern of social inhibition, feelings of inadequacy, and
hypersensitivity to negative evaluation, as indicated by 4+ of the following:
* Avoids occupational activities that involve significant interpersonal contact
because of fears of criticism, disapproval, or rejection.
* Is unwilling to get involved with people unless certain of being liked
* Shows restraint within intimate relationships because of the fear of being
shamed or ridiculed
* Is preoccupied with being criticized or rejected in social situations.
* Is inhibited in new interpersonal situations because of feelings of inadequacy.
* Views self as socially inept, personally unappealing, or inferior to others.
* Is unusually reluctant to take personal risks or to engage in any new activities
because they may prove embarrassing
* Psychopathology
causes of avoidant personality disorder
- Born with difficult temperament, parental rejection, uncritical love
* Low self-esteem, social
alienation persisting
into adulthood - Overreactive behavioural inhibition system
- Part of social anxiety spectrum?
Treatment for avoidant personality disorder
- Better evidence
- Social skills training
- CBT; Systematic desensitization; Behavioural rehearsal
- Medical interventions as for anxiety
Dependent personality disorder clinical description
- Interpersonally dependent, anxious
- Submissive, timid, and passive
- Feelings of inadequacy, sensitive to criticism, and need
reassurance - Cling to relationships
DSM criteria of dependant personality disorder
A) A pervasive and excessive need to be taken care of that leads to submissive and clinging
behavior and fears of separation, as indicated by 5+:
* Has difficulty making everyday decisions without an excessive amount of advice and
reassurance from others
* Needs others to assume responsibility for most major areas of his or her life
* Has difficulty expressing disagreement with others because of fear of loss of support or
approval (Note: Do not include realistic fears of retribution.)
* Has difficulty initiating projects or doing things on his or her own (because of a lack of
self-confidence in judgment or abilities rather than a lack of motivation or energy)
* Goes to excessive lengths to obtain nurturance and support from others, to the point of
volunteering to do things that are unpleasant
* Feels uncomfortable or helpless when alone because of exaggerated fears of being unable
to care for himself or herself
* Urgently seeks another relationship as a source of care and support when a close
relationship ends
* Is unrealistically preoccupied with fears of being left to take care of himself or herself
causes of dependant personality disorder
- Disruptions in early childhood lead to fears of abandonment
- High in sociotropic traits
- Low on individualistic achievement traits
treatment for dependent personality disorder
- developing confidence; ensuring patient does not depend on therapist
Obsessive-Compulsive personality disorder clinical description
- Preoccupied with rules, lists, order, organization, or schedules
- Overconscientious and inflexible
- Excessively devoted to work and productivity to the exclusion of
leisure - Rigid
- Poor interpersonal relationships due to rigidity
- Quest for perfectionism, which interferes with functioning
DSM criteria of Obsessive-Compulsive disorder
A) A pervasive pattern of preoccupation with orderliness, perfectionism, and mental and
interpersonal control, at the expense of flexibility, openness, and efficiency, as indicated by 4+:
* Is preoccupied with details, rules, lists, order, organization, or schedules to the extent that the
major point of the activity is lost
* Shows perfectionism that interferes with task completion (e.g. - is unable to complete a project
because his or her own overly strict standards are not met)
* Is excessively devoted to work and productivity to the exclusion of leisure activities and
friendships (not accounted for by obvious economic necessity)
* Is overconscientious, scrupulous, and inflexible about matters of morality, ethics, or values (not
accounted for by cultural or religious identification)
* Is unable to discard worn-out or worthless objects even when they have no sentimental value
* Is reluctant to delegate tasks or to work with others unless they submit to exactly his or her
way of doing things
* Adopts a miserly spending style toward both self and others; money is viewed as something to
be hoarded for future catastrophes
* Shows rigidity and stubbornness
Obsessive Compulsive Personality Disorder
Causes
Genetics
Obsessive Compulsive Personality Disorder Treatment
- Relaxation techniques
- CBT to reframe compulsive thoughts
Cluster B disorders
Dramatic and Emotional
Histrionic Personality Disorder Clinical Description:
- Dramatic, theatrical, self-centred, vain, seek constant reassurance,
impulsive
* View situations in
global, black-and-white
terms- Speech is often vague,
lacking in detail
- Speech is often vague,
Who is Histrionic Personality Disorder more common in?
Women: might be overdiagnosed
(Stereotypical female is considered overdramatic, seductive, over-concerned with physical appearance
DSM-5 criteria for Histrionic Disorder (Regina George shows these traits)
A) A pervasive pattern of excessive emotionality and attention-seeking, indicated
by 5 +:
* Is uncomfortable in situations in which he or she is not the center of attention
* Interaction with others is often characterized by inappropriate sexually
seductive or provocative behavior
* Displays rapidly shifting and shallow expression of emotions
* Consistently uses physical appearance to draw attention to self
* Has a style of speech that is excessively impressionistic and lacking in detail
* Shows self-dramatization, theatricality, and exaggerated expression of emotion
* Is suggestible (i.e. - easily influenced by others or circumstances)
* Considers relationships to be more intimate than they actually are
Histrionic personality disorder causes
- Historically blamed on hysteria
- co-occurs with antisocial personality disorder
Histrionic personality disorder treatment
- Improving problematic interpersonal
relationships - Teaching appropriate ways of negotiating their
wants and needs - Little treatment success
Narcissistic personality disorder clinical description:
- Unreasonable sense of self-importance, grandiosity
- No compassion for others, envious, arrogant
- Frequently depressed
Narcissistic Personality Disorder DSM criteria
A pervasive pattern of grandiosity (in fantasy or behaviour), need for admiration, and lack of
empathy, as indicated by 5 +:
* Has a grandiose sense of self-importance (e.g. - exaggerates achievements and talents,
expects to be recognized as superior without commensurate achievements)
* Is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love
* Believes that he or she is “special” and unique and can only be understood by, or should
associate with, other special or high-status people (or institutions)
* Requires excessive admiration
* Has a sense of entitlement (i.e. - unreasonable expectations of especially favourable
treatment or automatic compliance with his or her expectations)
* Is interpersonally exploitative (i.e. - takes advantage of others to achieve his or her own ends)
* Lacks empathy: is unwilling to recognize or identify with the feelings and needs of others
* Is often envious of others or believes that others are envious of him or her
* Shows arrogant, haughty behaviours or attitudes
Narcissistic personality disorder causes
- Failure of empathetic “mirroring” from parents
- Child remains fixated at self-centred, grandiose stage of
development - Increasing prevalence? Parenting?
Narcissistic personality disorder treatment
- CBT, coping strategies (relaxation training, accepting criticism),
empathizing, treatment for depression - Focus on feelings of others
- Very limited research and success
Borderline Personality Disorder is:
one of the most common diagnosed personality disorders
What percentage of the population does BPD affect?
1-2% of the population
BPD clinical description:
- Turbulent relationships, fear abandonment, self-mutilating
behaviours, no control over emotions, high rates of
substance use - Impulsivity is a core feature
- Often engage in suicidal or self-mutilating behaviours
What is the suicide rate among people with BPD?
10% die by suicide
BPD DSM-5 criteria
A) A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked
impulsivity, as indicated by 5+:
1. Frantic efforts to avoid real or imagined abandonment. (Note: Do not include suicidal or self-mutilating
behavior covered in Criterion 5.)
2. A pattern of unstable and intense interpersonal relationships characterized by alternating between
extremes of idealization and devaluation.
3. Identity disturbance: Markedly and persistently unstable self-image or sense of self.
4. Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse,
reckless driving, binge eating). (Note: Do not include suicidal or self-mutilating behavior covered in
Criterion 5.)
5. Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior.
6. Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or
anxiety usually lasting a few hours and only rarely more than a few days).
7. Chronic feelings of emptiness.
8. Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant
anger, recurrent physical fights).
9. Transient, stress-related paranoid ideation or severe dissociative symptoms
Borderline personality disorder causes
- Genetics, high rates in twins
- Changes in the limbic system in the brain
- Memory bias (for negative cognitions typical of this disorder)
- Early trauma and biological predisposition
- Childhood sexual abuse; similarities with PTSD, DTD
- Experienced rapid cultural changes
BPD treatment
- Antipsychotics and antidepressants
- Dialectical behaviour therapy (DBT)
- effective in reducing suicide attempts ***
- Traditional
components: individual
outpatient therapy,
skills training,
phone consultation,
case consultation for
therapists
DBT components:
- individual DBT therapy
- Phone coaching
- therapist consults with team
- skills group
Psychosocial skills training in DBT
- Mindfulness
- rational, emotional and
wise mind - Interpersonal effectiveness skills
(e.g., balancing priorities vs.
demands, building mastery and self-respect) - Emotion regulation (e.g., identifying and labelling emotions)
- Distress tolerance (e.g., distraction, self-
soothe, improve the moment)
Evidence of treatment with DBT
Meta-analysis found moderate decreases in suicidal and
parasuicidal behaviour in adults with BPD
Antisocial Personality Disorder clinical description
- Aggressive, lying, cheating, no remorse, substance abuse,
unnatural death in boys with this disorder - Psychopathy : 30% of those ASPD (Abdalla-Filho & Vollm, 2020)
- 50% to 80% of male offenders diagnosed with this
disorder
Conduct disorder (in children)
- Need history of conduct disorder earlier in development
- Conduct problems lie on a spectrum
- Oppositional Defiant Disorder
- Conduct Disorder
Oppositional Defiant Disorder criteria
- at least 4 symptoms, >6 months, with at l
One person that is not a sibling
Angry/ Irritable Mood - Often loses temper
- Is often touchy or easily annoyed
- Angry and resentful
Argumentative/ Defiant - Argues with authority figures (adults)
- Defies or refuses to comply with requests from adults
- Deliberately annoys others
- Blames others for their mistakes
Vindictiveness - Spiteful or vindictive at least 2 x in the last 6 months
DSM-5TR criteria of conduct disorder (name points of A,B,C)
A) A repetitive and persistent pattern of behavior in which the basic rights
of others or major age-appropriate societal norms or rules are violated,
as manifested by the presence of at least three of the following 15
criteria in the past 12 months from any of the categories below, with at
least one criterion present in the past 6 months:
* Aggression to People and Animals
* Destruction of Property
* Deceitfulness or Theft
* Serious Violations of Rules
B) The disturbance in behavior causes clinically significant impairment in
social, academic, or occupational functioning.
C) If the individual is age 18 years or older, criteria are not met for
antisocial personality disorder.
DSM-V conduct disorder (aggression to people and animals)
- Often bullies, threatens, or intimidates others
- Often initiates physical fights
- Has used a weapon that can cause physical harm to others (e.g., a
bat) - Has been physically cruel to people
- Has been physically cruel to animals
- Has stolen while confronting a victim
- Has forced someone into sexual activity
DSM-V conduct disorder (destruction of property and deceitfulness)
Destruction of Property
* Has deliberately engaged in fire setting with the intention of
causing serious damage
* Has deliberately destroyed others property
Deceitfulness or Theft
* Has broken into someone else’s house, building or car
* Often lies to obtain goods or favors to avoid obligations (e.g.,
“cons” others)
* Has stolen items of nontrivial values without confronting a victim
DSM-V conduct disorder (serious violations of rules)
- Often stays out at night despite parental prohibitions, beginning <
13 years - Has run away from home overnight at least twice while living in the
caregivers home, or once without returning for a lengthy period - Is often truant from school, beginning before age 13 years
Conduct disorder criteria
- Is causing significant distress in the individual or others
- Impacts social, educations, occupational, or other important areas of
functioning - The symptoms do not happen only during the course of Schizophrenia,
or other Psychotic Disorder. - Subtypes
- Childhood onset (symptoms began <10 years old)
- Adolescent onset (symptoms began >10 years old)
- Unspecified onset
- Specifier: with Limited Prosocial Emotion otherwise known as
Callous-Unemotional Traits or “CU traits”
Environmental influences of conduct disorder
- Delinquent friends influence teens
- Dual Failure model
- Less structure can lead to more deviance
- Parents: monitoring or relationship?
- Single parent family
- SES and Indigenous youth
Why do CU traits/ psychopathy develop?
- Genetics?
- Under aroused amygdala
- Sensation seeking boosts activation
- Hare’s cortical immaturity hypothesis- related to impulsive/ childlike
behaviour - Fearlessness hypothesis
- Maltreatment
Primary CU varients are:
genetically based
diminished sensitivity to others
Hypo-aroused/ low anxiety
Secondary CU variants are:
Relationally based
develops “mask” of callousness
Hyper - aroused / high anxiety
ASPD, Conduct disorder, CU traits treatment:
- Prevention is key
- Parent training for diagnosed
children - Parent-Child Interaction
Therapy - Mostly behavioural-focused
- Multifaceted for juvenile offenders
- CBT has limited impact
- For adults
- CBT limited effectiveness
Behavioural programs
- Assumes all behaviour is learned and can be changed
- Positive and negative reinforcement
- Communication skills
- Home rules
- Effect limit setting
- Time outs
- Example: Incredible Years, Triple P
COPE
Attachment programs: connect parent group
- Developed for parents of aggressive adolescence
- Attachment Based
- Psycho-education
- Learn attachment principle each week
- E.g., Empathy is the heartbeat of attachment; attachment
through the lifespan - Roleplays
- Processing of role plays
ASPD DSM diagnosis
- Impulsive, Failure to conform to social norms, aggression, lack of
remorse, reckless, evidence of CD before age 15 - Need 3 symptoms
Psychopathy criteria
- 3 facets: Irresponsible behaviour, Interpersonal style (manipulative,
charming, boastful), and “Affective factor”/ CU traits (lack of empathy,
callousness) - Need to be high on all three
CU traits
- Lack of empathy, callousness, uncaring attitude
- Same as “affective” factor of psychopathy
- Tends to have higher levels of CD compared to low CU traits
- Ends therapy with more symptoms than non-CU peers
