Problem 9: Personality Disorders Flashcards
Personality Disorder
= stable and enduring patterns of thought, feeling, and behavior that emerge in adolescence/early adulthood
- deviate from the norms of one’s culture
- pervasive and inflexible across many aspects of life
- lead to distress or impairment
Cluster A
schizoid, schizotypal, and paranoid personality disorders
= odd or eccentric disorders, because the behavior of persons diagnosed with these disorders seems strange or unusual
Cluster B
antisocial, borderline, histrionic, and narcissistic personality disorders
–> dramatic and erratic disorders, because the behavior of persons diagnosed with these disorders seems impulsive and unstable
Cluster C
avoidant, dependent, and obsessive-compulsive personality disorders
–> anxious and fearful disorders, because the behavior of persons diagnosed with these disorders seems nervous and worried
Schizoid Personality Disorder
- extreme detachment from social relationships
- limited expression of emotions
- no interest in interpersonal relationships
- little joy in non-social settings either
Schizotypal Personality Disorder
- detachment from social relationships
- extreme discomfort with relationships
- highly superstitious, fascinated with paranormal
- may have bizarre perceptual experiences
Paranoid Personality Disorder
- very strong suspiciousness of others’ motives
- suspect others are trying to harm them
- quick to take offense
- tendency to hold grudges against others
Antisocial Personality Disorder
- tendency to disregard the right of others
- deceitful, lying to others for gain
- feel no remorse
- tend to be aggressive, impulsive, irresponsible
Borderline Personality Disorder
- extreme instability in self-image and relationships
- extreme impulsivity
- intense and unstable love/hate relationships
- tendency to be extremely moody/temperamental
Histrionic Personality Disorder
- exaggerated display of emotions
- excessive attention seeking
- intense need to be at center of attention
- use physical appearance to draw attention
- easily influenced by others
Narcissistic Personality Disorder
- grandiosity: consider oneself superior
- selfish lack of concern for others
- fantasize about high status
- arrogant style
Avoidant Personality Disorder
- social inhibition and shyness
- feelings of inadequacy
- oversensitivity to possible neg. evaluation
- lack of social contact (afraid of rejection)
Obsessive-Compulsive Personality Disorder
- preoccupations with orderliness, perfection and control
- tends to be so preoccupied with details that the entire point of activity is lost
- put work ahead of personal relationships
Problems with the DSM-5 Personality Disorders
- symptoms of one disorder do not necessarily go together
- two disorders may have overlapping symptoms
–> comorbidity: many persons are diagnosed with two or more personality disorders at the same time - clusters of PDs do not match factor analysis results
- personality should be seen as a continuum not a category
Alternative System for Personality Disorders
Impaired Personality Functioning and Pathological Personality Traits
Impaired Personality Functioning: Self-Problems
Identity:
1. A person might not have a sense of himself or herself as a unique person, if he or she identifies too strongly with some other person(s), or alternatively if he or she is too much concerned with being independent of certain others.
2. A person might have self-esteem that is highly unstable, being easily threatened by negative experiences, or might have a distorted appraisal of his or her strengths and weaknesses.
3. A person might not be able to regulate his or her emotions or even to recognize what emotions he or she experiences.
Self-direction:
1. A person might not be able to select realistic or meaningful goals in his or her life.
2. A person might lack any internal standards for behavior of the kind that would allow him or her to gain fulfillment through cooperation with others.
3. A person might be unable to reflect constructively on his or her own experiences or motivations.
Impaired Personality Functioning: Interpersonal Problems
Empathy:
1. A person might be unable to understand the experiences or motivations of other people.
2. A person might be unable to understand or unwilling to consider the perspectives of others.
3. A person might have little understanding of how his or her own behavior affects others.
Intimacy:
1. A person might be lacking in positive, sustained relationships with people in general.
2. A person might be unable to engage in close, caring relationships with any other persons.
3. A person might be unwilling or unable to cooperate with others.
Pathological Personality Traits
Negative Affectivity: intense and frequent experience of negative emotions
Detachment: withdrawal from social interactions and from other people
Antagonism: acting in ways that create difficulties for other people
Disinhibition: behaving on impulse, without thinking of consequences
Psychoticism: unusual, bizarre thoughts and perceptions
Psychodynamic Psychotherapy
- helping patient to express emotions
- helping to identify recurring behavioural patterns and examine important relationships
Aim: improve patient’s self-understanding –> improve functioning
Cognitive Behavioral Therapy (CBT)
–> based on idea that PD involve dysfunctional views about self, environment, and future
Aim: understanding irrational beliefs a patient holds and show that traits are maladaptive
Dialectic Behavior Therapy (DBT)
- specifically for borderline patients
Aim: making patient aware of thoughts and feelings (developing mindfulness)
–> patients find it easier to handle the thoughts and feelings causing distress
Prevalence of Personality Disorder
between 4% and 15%
–> higher in criminal offenders (2/3)
–> higher in people in contact with health-care services
ICD-10
–> the ICD-10 disorders are very similar to the DSM-5 ones
main difference:
- schizotypal category is regarded as a part of the spectrum of schizophrenia and not classified with the personality disorders
- narcissistic personality disorder is not present in the classification
- borderline and impulsive personality disorders are subcategories of emotionally unstable personality disorder
ICD-11
–> the proposed ICD-11 classification abolishes all type-specific categories of personality disorder apart from the main one: the presence of personality disorder itself
Diagnosis:
1. establish whether the patient satisfies the general definition of personality disorder
2. identify the severity of personality disturbance
Advantage:
removes the confusing comorbidity of different categories of personality disorder
–> the proportion of patients with unspecified personality disorder should be substantially reduced
Genetic Influences
Personality traits in childhood stabilize throughout life beyond age 30 years
–> roughly 50% heritable, with little variance accounted for by shared environmental factors, the remainder being attributable to individuals’ unique experiences and how their genetic make-up interacts with the environment
–> genetic factors and environmental constancies probably underpin the continuity of personality, whereas changing environmental effects imply plasticity and thereby the opportunity for clinical intervention
Stability and Change
Personality across the normal-abnormal range is…
o moderately stable during childhood
o increases in stability from adolescence to emerging adulthood
o changes more slowly from age 30 years
Psychosocial Intervention
= mixture of group and individual treatments, integrated with other services available to the patient could be optimum for a good outcome
aim: reduce acute life-threatening symptoms and improve distressing mental state symptoms
–> mainly for borderline personality disorder
Pharmacotherapy
= behavioral traits associated with a personality disorder might be associated with neurochemical abnormalities of the CNS
–> focuses on specific aspects of personality disorder’s pathological effects, such as affective instability and cognitive-perceptual disturbances
Dark Triad
Narcissism, Psychopathy, and Machiavellianism
Psychopathy
shaped by impulsivity, low empathy, and anxiety, a lack of guilt or remorse, emotional shallowness, a belief in the superiority of oneself, and a parasitic lifestyle which can involve criminal activities
Machiavellianism
= the willingness to exploit others
–> belief in the effectiveness of manipulative tactics in dealing with other people
–> a cynical view of human nature
–> a moral outlook that puts expediency above principle
Dark Triad and Career Success
narcissism was positively related to salary
–> objective career success
Machiavellianism was positively related to leadership position and career satisfaction
–> objective and subjective career success
psychopathy was negatively related to salary, leadership responsibility, and career satisfaction
–> objective and subjective success
Dirty Dozen
= a concise 12-item measure of the Dark Triad
- fast life strategy: disagreeableness, short-term mating, low levels of conscientiousness
- social exploitation
- aggression: physical, verbal, and hostility
- manipulation
- instability
- men score higher than women –> sociosexuality
