personality disorders (week 4) Flashcards
what is personality? why is it hard to define?
-personality characteristic refers to feature that is typically displayed over time, in various (but not necessarily all) situations
-variability – eg an outgoing, talkative person “clams up” during a presentation
name 5 features/traits of personality disorders
enduring pattern of inner experience + behavior that:
-deviates markedly from the expectations of the indiv’s culture
-inflexible + maladaptive traits which cause impairment
-restricted range of traits
-non-responsive to context
-has an onset in adolescence/early adulthood*
why is diagnosing personality disorders controversial? what is a risk of labels?
-controversial re: stigma, pathologizing
-labels don’t provide explanation - risk of circular reasoning
-not associated w subjective stress
what are the 3 categories of PDs?
-Cluster A: (odd and eccentric) paranoid PD; schizoid PD; schizotypal PD
-most common
-Cluster B (“dramatic / erratic”) Antisocial PD, borderline, histrionic, narcissistic
-Cluster C (anxious / fearful) avoidant, dependent, obsessive compulsive PD
explain comorbidity + overlap issues when diagnosing
-comorbidity: what does it mean to have 2 PDs? How can someone have 2 personalities?
-comorbidity between PDs + other mental disorders
-overlap: where to draw the line?
-issues w overlap between disorders (eg high rates of overlapping symptoms between ASPD+BPD)
explain egosyntonic and egodynostic symptoms in relation to diagnostic issues
-egosyntonic: don’t view fnxing as problematic (“this is just who I am”)
-egodystonic: cause the indiv distress (“I don’t feel like myself”)
-personality disorders are often viewed as egosyntonic
how does gender affect diagnosis?
-sex role stereotypes might be influencing diagnoses
-eg histrionic PD: is a reluctance to diagnose men w it
-eg heistance to diagnose women w APD
what kind of reliability issues are there in diagnosing PDs? how might this be improved?
-reliability: overwhelmingly p low for PDs
-interrater reliability is improving; may be the result of :
-structured interviews
-comprehensive assessments - interview spouses/family/teachers to get an overall picture to see what they’re like in diff contexts
what does psychodynamic theory say about the etiology of PDs? what is the evidence for this?
-disturbances in parent-child relationship, particularly in problems related to separation-individuation (the process by which the child learns that they are an indiv separate from the mother/other people → acquires a sense of themself as an independent person)
-.: difficulties in this process result in either inadequate self (BPD, NPD, histrionic) or problems in dealing w others (eg avoidant or ASPD)
-evidence: relative to people without PDs, people w are more likely to have lost a parent through death, divorce, abandonment / parental rejection
what does attachment theory say about the etiology of PDs?
-suggests that children dev a style of intxting w others based on how their parents relate to them
-if the parent-child bond is poor, the child will:
-lack confidence in interpersonal relationships
-fear rejections
-lack the skills necessary to dev + sustain intimate relationships
what does cognitive-behavioral theory say about the etiology of PDs? what has research found supporting this?
attribute personality disorders to rigid, inflexible schemas
-negative schemas may have been adaptive as children surviving in a damaging environment, but they continue coping like this into adulthood
-research on family history variables: family that invalidate child’s emotional experiences + oversimplify solns to life’s problems
what are biological factors to explain PDs?
-genetic link: : found that Cluster A PDs co-aggregate in families w a history of schizophrenia (twin studies)
-brain functioning: (prefrontal cortex) – those w PDs had ↓ prefrontal volume + poorer prefrontal fnxing
what is paranoid PD characterized by? what are its 4 criteria (A)?
- pervasive suspiciousness abt others’ motives + tendency to interpret what others say/do as personally meaningful in a negative way (primary features)
-typically humorless + eccentric, seen as hostile, jealous, preoccupied w power / control
-pervasive distrust
-suspiciousness of others
-reluctant to confide in others bc of unwarranted fear that the info will be used maliciously against them
-persistently bears grudges (ie is unforgiving of insults, injuries, or slights)
what is schizoid PD characterized by? what are its 4 criteria (A)?
-seem completely uninterested in having intimate involvement w others, display little in the way of emotional responsiveness
-come across as detached, aloof, self-absorbed
-rarely experience intense emotions
-detachment from social relationships
-restricted range of expression
-almost always chooses solitary activities
-takes pleasure in few, if any, activities
what are symptoms of schizotypal PD? (“UFO AIDER”)
-U - unusual perceptions
-F - friendliness except for family
-O - odd beliefs, thinking, speech
-A - affect – inappropriate, constricted
-I - ideas of reference
-D - doubts of others; suspicious
-E - eccentric – appearance / behavior
-R - reluctant in social situations, anxious
what is schizotypal PD characterized by? what are its 4 criteria (A)?
-eccentricity of thought + behavior
Many are extremely superstitious + permeated in odd beliefs (eg telepathy, clairvoyance)
-social + interpersonal deficits marked
-acute discomfort w/lack of close relationships as well as by
-cog/perceptual distortions
-eccentricities of behavior
what are 3 traits commonly found in schizotypal PD?
-ideas of reference: the false belief that irrelevant occurrences/details in the world relate directly to oneself
-odd beliefs/magical thinking: superstitiousness, belief in clairvoyance, telepathy, “sixth sense”
-behaviors that are odd/eccentric/peculiar: unusual mannerisms - may avoid eye contact, wear clothes that are ink-stained / ill-fitting
what is ASPD characterized by? what is the diagnostic criteria?
-pervasive pattern of disregard for + violation of the rights of others, occurring since age 15 (and evidence of conduct disorder in childhood), as indicated by 3(+) of the following:
-nonconformity: failure to conform to social norms w respect to lawful behaviors, as indc by repeatedly performing acts that are ground for arrest
-deceitfulness: repeated lying, use of aliases, or conning others for personal profit/pleasure
-impulsivity
-aggressiveness: repeated phys fights/assaults
-recklessness: disregard for safety of self/others
-irresponsibility: repeated failure to sustain consistent work behavior / honor financial obligations; takes pleasure in few if any activities
-lack of remorse: being indifferent to / rationalizing having hurt, mistreated, stolen from another
describe the course of ASPD
-Childhood: early evidence of conduct disorder; often experience abuse/neglect
-Adolescence: aggression toward others + animals; engaging in crime
-Adulthood: diagnosis only given if evidence of conduct disorder; chronic course
what is an issue with treating ASPD? what treatment is most promising, and how does it work?
-ASPD not really interested in treatment; high attrition + difficult to dev therapeutic alliance
-some promise for early intensive family interventions: multisystemic therapy
-treatment targets ↓ reoffending, symptom reduction, behavior management rather than a “cure”
compare psychopathy and ASPD. which is more severe? is psychopathy a separate diagnosis in the DSM?
-psychopathy considered a more ‘severe’ form of APD; 1/3 of those w APD meet criteria for psychopathy
-however, psychopathy is relatively “new” concept in the US, and is not in the DSM (diagnosed w PCL-R)
-psychopaths have personality traits that overlap significantly w APD
how common is psychopathy in the general population? in prison samples? what about APD in prison samples?
-<1%
-btwn 15-25% will meet criteria for psychopathy
-50-70% will meet criteria will meet criteria for APD
what are 3 features that are unique to psychopathy (compared to APD), according to some research?
-complete lack of affect
-egocentricity + grandiose sense of self
-superficial charm
Psychopathy + violence: offenses tend to be more violent in nature, ↑ likelihood for violent reoffending. why? (2 reasons)
-Psychopathy may ↑ the perceived benefits of crime (eg demeaning others is rewarding, risks are exciting)
-may also ↓ perceived costs of crime (eg not deterred by anxiety, lack of attachment, remorse, empathy)
explain etiology of ASPD + psychopathy
-largely unknown etiology
-abuse and neglect are common
-however, parents w APD are more likely to be erratic, leading to both environmental + genetic influence
-biological explanations:
-neuroabnormalities
-neurotransmitter dysfunction (eg lower lvls of serotonin, higher dopamine)
what is BPD characterized by? what are 9 symptoms?
- instability of interpersonal relationships, unstable sense of self, marked impulsivity
- Frantic efforts to avoid real/imagined abandonment
- A pattern of unstable + intense interpersonal relationships alternating between extremes of idealization + devaluation
- Identity disturbance: markedly + persistently unstable self-image or sense of self
- Impulsivity in at least 2 areas that are potentially self-damaging (eg spending, sex, substance abuse, reckless driving, binge eating)
- Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior
- Affective instability due to a marked reactivity of mood (eg intense episodic dysphoria, irritability, or anxiety)
- Chronic feelings of emptiness
- Inappropriate, intense anger / difficulty controlling anger
- Transient, stress-related paranoid ideation or severe dissociative symptoms
what is a defining characteristic of BPD? how many people are affected by this?
-suicidal thoughts/behavior
-6% will die by suicide
what are 2 risk factors of BPD? is this genetic or environmental?
-abuse (specifically sexual) + neglect *
-likely both (hard to tell): BPD is 5x more prevalent among first-degree biological relatives; mothers w untreated BPD are rated as emotionally cold, emotionally neglectful, etc
what is the most common interpersonal style of people w BPD?
Anxious Ambivalent
– Intense fears of abandonment coupled with a strong
desire for intimacy
– Results in seeking out close relationships and then
becoming highly anxious and withdrawing as
relationship develops.
what is Linehan’s Biosocial Theory of BPD?
biological dysfunctions in the emotional regulation system paired w exposure to pervasively invaliding environment can lead to patterns assoc w BPD (biological dysfunction ⇔ exposure to invalidating environment)
-biological dysfunction incl: intense emotional rxns, ↑ sensitivity, ↑ time to reduce emotional arousal or to “calm down”
-exposure to pervasively invalidating environment: eg minimizing emotional experiences, rejecting attempts to seek closeness
what are 5 characteristics of histrionic personality disorder?
-attention seeking
-“life of the party”
-overly dramatic + emotional
-unable to tolerate not being able to be the center of attention
-“emotionally shallow”
what are some validity issues of HPD?
-one of the most understudied PDs
-no info in DSM-5-TR abt development, course, risk, or prognosis
-most ambiguous diagnostic category in the DSM-5
what are 5 characteristics of NPD?
-grandiose
-egocentric
-exaggerated sense of importance
-“me, me, me”
-can’t handle criticism*
-*doesn’t believe they’re the best, but tries to convince others they are
how to differentiate between NPD and ASPD?
-NPD: conflict to deal w not maintaining relationships
-APD: disregard for others livelihood – ∴ no conflict
what are 4 characteristics of AVPD? what are 3 symptoms + associated features?
fundamental fear is of social rejection:
-social inhibition
-feelings of inadequacy
-hypersensitivity to negative evaluation
-intense fears of criticism / disapproval / rejection
-misinterpret social responses as critical
-problems occur in social + occupational fnxing
-low self esteem + hypersensitivity to rejection
describe the course of AVPD
a) childhood: infancy comprised of isolation, fear of strangers/new situations; shyness that does not dissipate w age ⇒
b) adolescence: ↑ avoidance of new relationships; ↑ shyness ⇒
c) adulthood: chronic, persistent avoidance; occasionally symptoms remit w age (esp in indivs 65+)
differentiate AVPD from social anxiety and agoraphobia
-social anxiety disorder: perhaps represent diff manifestations of the same underlying problems; AVPD may be a more severe form of social anxiety
-agoraphobia: distinguished by motivation for avoidance; fear of panic/harm (agoraphobia) vs fear of rejection (AVPD)
what are 3 characteristics of dependent personality disorder?
-afraid to rely on self to make decisions
-constantly seek advice/reassurance
-seek submissive role in relationships
what are the 2 core characteristics of obsessive-compulsive personality disorder?
-inflexibility + strong desire for perfection
-preoccupation w details, rules, lists, order, organization, or schedules
differentiate OCPD from OCD
-OCD involves presence of true obsessions/compulsions to “neutralize” obsession
-indivs w OCPD will not engage in rituals
