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)
