personality disorders (week 4)

Question 1

what is personality? why is it hard to define?

Answer 1

-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

Question 2

name 5 features/traits of personality disorders

Answer 2

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*

Question 3

why is diagnosing personality disorders controversial? what is a risk of labels?

Answer 3

-controversial re: stigma, pathologizing
-labels don’t provide explanation - risk of circular reasoning
-not associated w subjective stress

Question 4

what are the 3 categories of PDs?

Answer 4

-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

Question 5

explain comorbidity + overlap issues when diagnosing

Answer 5

-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)

Question 6

explain egosyntonic and egodynostic symptoms in relation to diagnostic issues

Answer 6

-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

Question 7

how does gender affect diagnosis?

Answer 7

-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

Question 8

what kind of reliability issues are there in diagnosing PDs? how might this be improved?

Answer 8

-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

Question 9

what does psychodynamic theory say about the etiology of PDs? what is the evidence for this?

Answer 9

-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

Question 10

what does attachment theory say about the etiology of PDs?

Answer 10

-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

Question 11

what does cognitive-behavioral theory say about the etiology of PDs? what has research found supporting this?

Answer 11

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

Question 12

what are biological factors to explain PDs?

Answer 12

-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

Question 13

what is paranoid PD characterized by? what are its 4 criteria (A)?

Answer 13

• 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)

Question 14

what is schizoid PD characterized by? what are its 4 criteria (A)?

Answer 14

-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

Question 15

what are symptoms of schizotypal PD? (“UFO AIDER”)

Answer 15

-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

Question 16

what is schizotypal PD characterized by? what are its 4 criteria (A)?

Answer 16

-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

Question 17

what are 3 traits commonly found in schizotypal PD?

Answer 17

-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

Question 18

what is ASPD characterized by? what is the diagnostic criteria?

Answer 18

-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

Question 19

describe the course of ASPD

Answer 19

-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

Question 20

what is an issue with treating ASPD? what treatment is most promising, and how does it work?

Answer 20

-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”

Question 21

compare psychopathy and ASPD. which is more severe? is psychopathy a separate diagnosis in the DSM?

Answer 21

-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

Question 22

how common is psychopathy in the general population? in prison samples? what about APD in prison samples?

Answer 22

-<1%

-btwn 15-25% will meet criteria for psychopathy

-50-70% will meet criteria will meet criteria for APD

Question 23

what are 3 features that are unique to psychopathy (compared to APD), according to some research?

Answer 23

-complete lack of affect
-egocentricity + grandiose sense of self
-superficial charm

Question 24

Psychopathy + violence: offenses tend to be more violent in nature, ↑ likelihood for violent reoffending. why? (2 reasons)

Answer 24

-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)

Question 25

explain etiology of ASPD + psychopathy

Answer 25

-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)

Question 26

what is BPD characterized by? what are 9 symptoms?

Answer 26

• instability of interpersonal relationships, unstable sense of self, marked impulsivity

1. Frantic efforts to avoid real/imagined abandonment
2. A pattern of unstable + intense interpersonal relationships alternating between extremes of idealization + devaluation
3. Identity disturbance: markedly + persistently unstable self-image or sense of self
4. Impulsivity in at least 2 areas that are potentially self-damaging (eg spending, sex, substance abuse, reckless driving, binge eating)
5. Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior
6. Affective instability due to a marked reactivity of mood (eg intense episodic dysphoria, irritability, or anxiety)
7. Chronic feelings of emptiness
8. Inappropriate, intense anger / difficulty controlling anger
9. Transient, stress-related paranoid ideation or severe dissociative symptoms

Question 27

what is a defining characteristic of BPD? how many people are affected by this?

Answer 27

-suicidal thoughts/behavior

-6% will die by suicide

Question 28

what are 2 risk factors of BPD? is this genetic or environmental?

Answer 28

-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

Question 29

what is the most common interpersonal style of people w BPD?

Answer 29

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.

Question 30

what is Linehan’s Biosocial Theory of BPD?

Answer 30

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

Question 31

what are 5 characteristics of histrionic personality disorder?

Answer 31

-attention seeking
-“life of the party”
-overly dramatic + emotional
-unable to tolerate not being able to be the center of attention
-“emotionally shallow”

Question 32

what are some validity issues of HPD?

Answer 32

-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

Question 33

what are 5 characteristics of NPD?

Answer 33

-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

Question 34

how to differentiate between NPD and ASPD?

Answer 34

-NPD: conflict to deal w not maintaining relationships
-APD: disregard for others livelihood – ∴ no conflict

Question 35

what are 4 characteristics of AVPD? what are 3 symptoms + associated features?

Answer 35

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

Question 36

describe the course of AVPD

Answer 36

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+)

Question 37

differentiate AVPD from social anxiety and agoraphobia

Answer 37

-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)

Question 38

what are 3 characteristics of dependent personality disorder?

Answer 38

-afraid to rely on self to make decisions
-constantly seek advice/reassurance
-seek submissive role in relationships

Question 39

what are the 2 core characteristics of obsessive-compulsive personality disorder?

Answer 39

-inflexibility + strong desire for perfection
-preoccupation w details, rules, lists, order, organization, or schedules

Question 40

differentiate OCPD from OCD

Answer 40

-OCD involves presence of true obsessions/compulsions to “neutralize” obsession
-indivs w OCPD will not engage in rituals