PSY311 Midterm 3 Flashcards
What was personality disorder before DSM-5?
There was classification (like most common mental health disorder, medical issues) and they were not well investigated
- What is the definition of personality?
2. When does a disorder occurs?
1.Characteristics that describe how a person behaves and thinks.
2. Interferes with a person’s relationships and
Causes distress or impairment in daily life activities
What is a personality disorder?
A persistent pattern of emotions, cognitions, and behaviors that results in enduring emotional distress for the person affected and/or others and may cause difficulties with work or relationships
-> This is a global definition, there is more than 1 personality disorder (there are 10 in total)
What is the chronic course of a personality disorder?
Stems from childhood and continues on (difficult to treat something chronic ). also it does not mean they are diagnosis at childhood (very rare because you do not know if it is persistent or not) - the signs can be there. A major hint is childhood environment.
Personality disorder is comorbid with…?
depression (very important) and anxiety. This is why this is difficult to see betond that, that there is a pathology.
Name all the personality disorder of cluster A ‘‘odd cluster’’ eccentric cluser’’
→ social awkwardness, distorted thinking
paranoid personality disorder
schizoid personality disorder
schizotypal personality disorder
Name the key terms of paranoid personality disorder
Unjustified distrust
Suspicious unfounded
Can be argumentative and sensitive to criticism
Can be short-tempered: able to attack someone if needed
what is the etiology of paranoid personality disorder? they are common…
- Biological contribution
- Psychological contribution
- Sociocultural contribution
Biological contribution
Weak genetic contribution
Psychological contribution
Weak-moderate contribution
Early traumatic childhood experiences → distorted schemas that develop in childhood when ask about it
Sociocultural contribution
Prisoners, refugees, people with hearing impairments more likely to develop this disorder
We don’t really know why
little research about it, not much
What is the treatment for paranoid personality disorder?
Unlikely to seek professional help
Difficulty in developing a trusting relationship with the therapist
Usually present to clinic following a crisis or for other disorders
Cognitive therapy
Change distorted schemas “everyone is untrustworthy”
No documented effectiveness
Name the key terms of schizoid personality disorder
“Loner”
Detached and lack emotional expression
Do not appear affected by praise or criticism
“Observers” - they are not team work player, prefer to observe then participate
Do not have unusual thought processes: not like paranoid personality
Schizoid personality disorder rtiology: 2 key points different from other personality disorder
- connexion with Autism spectrum disorder (little evidence)
- Low dopamine receptors (when underdeveloped)~ detachment: low reward, low motivation
What is the treatment for schizoid personality disorder?
Rarely seek treatment Psychotherapy Increase value of social relationships Social skills training No documented effectiveness
Schizotypal personality disorder is possibly on a continuum with…
Schizophrenia BUT in less severe form.
Schizotypal personality disorder: etiology
Breakdown biological contribution
Weak genetic contribution
Connection with Schizophrenia
E.g. Catechol-O-methyltransferase (COMT) → enzyme involved in breakdown of various NT such as dopamine, norepinephrine. alteration in the COMT genes.
the brain region that runs on dopamine seems to be overactive in limbic region, that is why most of the time, when you think about schizophrenia, the major treatment is an antipsychotic . but not overactive in the frontal regions, not enough dopamine - not much regulation…
Brain alterations
E.g. deep in temporal lobe (volume is reduce) → Odd speech, odd beliefs
What are the treatments for Schizotypal personality disorder.
30-50% of individuals seeking help for other symptoms
Psychotherapy:
Social skills training: Modestly effective
Medication
Antipsychotics
Not always effective- more effective for schizophrenia
High drop outs
Negative side effects
Huge difficulties with medication compliance
What are the personality disorder in cluster B which is characteristic ‘‘dramatic, emotional thinking and behavior, impredictable’’
Antisocial personality
Borderline Disorder
Histrionic Personality
Narcissistic Disorder
What are some criteria of antisocial personality disorder?
A pervasive pattern of disregard for and violation of the rights of others, occurring since age 15 years, as indicated by ≥3 of the following:
- Failure to conform to social norms with respect to lawful behaviors -Deceitfulness, - Impulsivity or failure to plan ahead - Irritability and aggressiveness -Lack of remorse,
The individual is at least age 18 years.- adulthood
There is evidence of conduct disorder with onset before age 15 years.
The occurrence of antisocial behavior is not exclusively during the course of schizophrenia or bipolar disorder.
What is a conduct disorder? what does it precedes?
It precedes antisocial personality disorder. It develops in childhood.
- agression to people and animals
- destruction of property
- deceitfulness or theft
- serious violations of rules
what is psychopathy subset?
Stats among prisionner
Psychopathy: subset of individuals with antisocial personality disorder with all of the following additional characteristics
Glibness -smooth talk, work people-, superficial charm
Grandiose sense of self-worth
Proneness to boredom, need for stimulation
Pathological lying
Conning, manipulative
Lack of remorse
80% of prisonnier are diagnosed with antisocial disorder but out of the 80%, only 20% display are the characteristics of psychopathy
what is the etiology of antisocial personality?
- genetic influences
- Gene x environment
- Neurobiological influences
- Neuropsychological influences
- Psychological influences
- Social influences
Moderate genetic influences (32% higher than other disorder)
Family, twin, adoption studies support a genetic link
↑ ASPD rate in adopted children of biological mothers with criminal history
Gene x environment
↑ ASPD rate in adopted children of biological mothers with criminal history x who spent more time in an orphanage (a year or two there)
Neurobiological influences
Underarousal hypothesis (not enough)
Low levels of arousal - to get to the proper level, they need to have more stimulation.
Need more stimulation 🡪 sensation-seeking and risk-taking (+ lack of long term planning so just jumping into stuff, not much restrain, inhibition)
Fearlessness hypothesis
Higher threshold for experiencing fear (it takes them much more to feel fear). Inability to learn and respond from negative consequences. No remorse, no empathy
Neuropsychological influences
BIS-BAS disbalance
Weak Behavioral Inhibition System vs Overactive Behavioral Activation System. ↓ prominent anxiety and ↓behavioral inhibition (impulsivity)
Psychological influences
Do not let go of goals
Emotionally distant and mistrustful ~ ↑ violent crime
Social influences Parental attitudes early in life (psychodynamic theory) Low parental involvement Inconsistent discipline Stress
what are the treatment about antisocial personality disorder?
Few documented treatments
CBT
Violent acts reduced 5 years later, except for those who are particularly “selfish, remorseless”
Psychotherapy in childhood
Parent training
Children less responsive to treatment if high stress and family dysfunction
what are Borderline personality disorder?
A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity, beginning by early adulthood and present in a variety of contexts
- Frantic efforts to avoid real or imagined abandonment - A pattern of unstable and intense interpersonal relationships - Identity disturbance - Recurrent suicidal behavior - Chronic feelings of emptiness
More common than other personality disorders
Worldwide lifetime prevalence: ~2%
More common in women Prognosis better than other personality disorders 88% remission after 10 years of therapy Core: impulsivity, emotional instability High comorbidity with mood disorders
Bordeline personality disorder have high comorbidity with…?
mood disorder
what is the etiology about antisocial personality disorder?
Biological influences
Psychological influences
Social influences
Biological influences
Moderate genetic influences
Possible shared link with mood disorders
Psychological influences
Memory bias
Social influences Early trauma (more common in women)
what are the treatment for antisocial personality disorder?
Few studies on treatment efficacy
Complicated by comorbidity
Medication
Lithium
Antidepressants
Antipsychotics
Dialectical Behavior Therapy (DBT)
Identify and regulate emotions
Cope with stressors that trigger suicidal ideation
Name some of the histrionic personality disorder: criteria
A pervasive pattern of excessive emotionality and attention seeking, beginning by early adulthood
- 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.
- Considers relationships to be more intimate than they actually are
- More common in women: Uterus used to be blamed
Histrionic personality disorder: treatment
Few studies on treatment efficacy
Psychotherapy:
Try to minimize attention-getting behaviors
Try to improve interpersonal relationships
Name some of the narcissistic personality disorder: criteria
A pervasive pattern of grandiosity, need for admiration, and lack of empathy, beginning by early adulthood and present in a variety of contexts, as indicated by ≥5 of the following:
- Has a grandiose sense of self-importance.
- 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.
4.Requires excessive admiration.
5.Has a sense of entitlement.
6.Is interpersonally exploitative.
7.Lacks empathy: is unwilling to recognize or identify with the
feelings and needs of others.
8.Is often envious of others or believes that others are envious of him or her.
9.Shows arrogant, haughty behaviors or attitudes.
Narcissistic personality disorder: etiology
Weak genetic influences
Psychological influences
Failure of empathetic mirroring
Self-centered
Stemming early in life
Social influences
Parenting (overindulgent or over-controlling) attitudes
Societal pressure on individualism, competitiveness, and successNarcissistic personality disorder: treatment
Psychotherapy
Address grandiosity, sensitivity to evaluation, and lack of empathy
Remove fantasies
Treat and prevent depression
How can you describe the avoidant personality disorder?
anxious, fearful cluster.
Inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation, beginning by early adulthood
What is the etiology for avoidant personality disorder?
Biological influences: Moderate genetic influences &
behavioral inhibition temperament
Psychological influences: Behavioral inhibition temperament & low self-esteem
Social influences: Parenting (rejecting, neglecting, unaffectionate) attitudes → no attachment
Connection with social anxiety disorder?
- Similar characteristics, shared traits
- Ego platonic: seems normal…so it is normal that -people judge you - avoidant personality.
- It distress, know it is not normal - anxiety disorder:
What are the treatment for avoidant personality disorder?
Psychotherapy
- Address thoughts of rejection through exposure to feared situation
- Improve social skills
- Role playing
- CBT: 50-60 % useful but high relapse
Dependent personality disorder, what are some criteria?
A pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation
such as…
Has difficulty making everyday decisions without an excessive amount of advice and reassurance from others. Has difficulty initiating projects or doing things on his or her own.
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.
What is the etiology for dependent personality disorder?
Moderate genetic influences
Psychological influences:
- Personality trait of sociotropy→traits characterized by excessive investment in positive social interactions (strong needs for acceptance of others)
- Opposite of independent, no autonomy
- Social influences: Trauma in childhood
