Psychopathology Personality Disorders Flashcards
The DSM-5 describes personality disorders as involving “an enduring pattern of inner experience and behavior that
Deviates markedly from the expectations of the individual’s culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time, and leads to distress or impairment” (p. 645). The personality disorders are divided into three clusters: Cluster A disorders involve odd or eccentric behaviors and include paranoid, schizoid, and schizotypal personality disorders. Cluster B disorders involve dramatic, emotional, or erratic behaviors and include antisocial, borderline, histrionic, and narcissistic personality disorders. Cluster C disorders involve anxiety and fearfulness and include avoidant, dependent, and obsessive-compulsive personality disorders.
A diagnosis of a personality disorder can be assigned to a person under the age of 18 when
Symptoms have been present for at least one year. The exception is antisocial personality disorder, which cannot be assigned to people under 18 years of age.
Paranoid Personality Disorder:
This diagnosis requires a pervasive pattern of distrust and suspiciousness that involves interpreting the motives of others as malevolent as indicated by at least four of seven symptoms: suspects without sufficient reason that others are exploiting, harming, or deceiving him/her; is preoccupied with unjustified doubts about the loyalty and trustworthiness of others; is reluctant to confide in others; reads demeaning content into benign remarks or events; persistently bears grudges; perceives attacks on his/her character and reputation and is quick to react with anger or a counterattack; is suspicious without justification about the fidelity of his/her spouse or sexual partner.
Schizoid Personality Disorder:
This disorder involves a pervasive pattern of detachment from social relationships and a restricted range of emotional expression in interpersonal settings with at least four of seven symptoms: doesn’t desire or enjoy close relationships, almost always chooses solitary activities, has little or no interest in sexual relationships, takes pleasure in few activities, lacks close friends or confidents other than first-degree relatives, appears to be indifferent to praise or criticism, is emotionally cold or detached or has flat affect.
Schizotypal Personality Disorder:
A diagnosis of schizotypal personality disorder requires a pervasive pattern of social and interpersonal deficits involving acute discomfort with and reduced capacity for close relationships, distortions in cognition and perception, and eccentricities in behavior as indicated by least five of nine symptoms: exhibits ideas of reference, has odd beliefs or magical thinking that influence behavior, has bodily illusions and other unusual perceptions, exhibits odd thinking and speech, is suspicious or has paranoid ideation, has inappropriate or constricted affect, has peculiarities in behavior and appearance, lacks close friends or confidents other than first-degree relatives, has excessive social anxiety that doesn’t diminish with familiarity. Note that schizotypal personality disorder shares a lack of close relationships with several other personality disorders including schizoid and avoidant personality disorders.
Reasons for the lack of close relationships differ:
Individuals with schizotypal personality disorder may express unhappiness about their lack of friends but say they’re uncomfortable around other people and act in ways that suggest a lack of interest in developing close relationships (e.g., they usually interact with others only when necessary). In contrast, people with schizoid personality disorder have a limited desire for and do not derive pleasure from close relationships, while individuals with avoidant personality disorder desire close relationships but avoid them because they fear being criticized or rejected by others.
Antisocial Personality Disorder:
This disorder involves a pervasive pattern of disregard for and violation of the rights of others since 15 years of age that involves at least three of seven symptoms: fails to conform to social norms with respect to lawful behaviors, is deceitful, is impulsive and fails to plan ahead, is irritable and aggressive, has a reckless disregard for the safety of self and others, is consistently irresponsible, has a lack of remorse. In addition, the person must be at least 18 years of age and have a history of conduct disorder before 15 years of age.
Antisocial Personality Disorder is chronic but
This disorder is chronic, but its symptoms (especially involvement in criminal behavior) often become less severe or remit by the fourth decade of life. Psychiatric comorbidity is common for people with antisocial personality disorder. The National Epidemiologic Survey on Alcohol and Related Conditions (NESARC-III; Goldstein et al., 2017) found that, for individuals with this disorder, a substance use disorder was the most common lifetime comorbid disorder followed by, in order, a mood disorder, borderline personality disorder, and an anxiety disorder.
Antisocial personality disorder is one of the most difficult disorders to treat because
People with this disorder don’t believe they have a problem and rarely seek treatment voluntarily. In addition, no intervention has received consistent empirical support for its effectiveness in reducing the disorder’s core characteristics. However, there’s some evidence that cognitive-behavioral interventions (especially group interventions) may be helpful for reducing re-offending rates and that contingency management that provides reinforcement for desirable behaviors and pharmacological treatment may be helpful for reducing comorbid substance use disorders (National Collaborating Centre for Mental Health, 2010).
Borderline Personality Disorder:
A diagnosis of this disorder requires a pervasive pattern of instability in interpersonal relationships, self-image, and affects as indicated by at least five of nine symptoms: engages in frantic efforts to avoid abandonment, has a pattern of unstable and intense interpersonal relationships that involve fluctuations between idealization and devaluation, has an identity disturbance that involves a persistent instability in sense of self, is impulsive in at least two areas that are potentially self-damaging, has made recurrent suicide threats or gestures or engages in self-mutilating behavior, exhibits affective instability, experiences chronic feelings of emptiness, exhibits inappropriate intense anger, has transient stress-related paranoid ideation or severe dissociative symptoms.
Borderline personality disorder typically has an onset
In late adolescence with symptoms being most severe in early adulthood. However, many individuals subsequently experience a decrease in symptom severity, and there’s evidence that up to 75% no longer meet the full criteria for the diagnosis by age 40 (Paris & Zweig-Frank, 2001).
Common treatment used in Borderline Personality Disorder
A commonly used treatment is Linehan’s (1993) dialectical behavior therapy (DBT), which is a type of cognitive-behavior therapy. It’s based on the assumption that borderline personality disorder is due to emotion dysregulation, which is the result of a combination of biological and environmental factors. DBT consists of (a) group skills training that focuses on increasing the client’s emotion regulation, distress tolerance, relationship effectiveness, and mindfulness; (b) individual psychotherapy that focuses on helping the client maintain motivation and apply DBT skills to events in his/her life; and (c) phone coaching that provides the client with support between therapy sessions.
Histrionic Personality Disorder:
This disorder involves a pervasive pattern of excessive emotionality and attention seeking with at least five of eight symptoms: is uncomfortable when not the center of attention, is inappropriately sexually seductive or provocative when interacting with others, has rapidly shifting and shallow emotions, consistently uses physical appearance to gain attention, exhibits speech that is excessively impressionistic and lacking in detail, shows an exaggerated expression of emotion, is easily influenced by others, considers relationships to be more intimate than they are. As noted in the DSM-5, histrionic and antisocial personality disorders share several features – e.g., “a tendency to be impulsive, superficial, excitement seeking, reckless, seductive, and manipulative”.
People with histrionic personality disorder have
Exaggerated emotions and are manipulative in order to gain nurturance, while those with antisocial personality disorder engage in antisocial behaviors and are manipulative to gain power or material gratification.
Narcissistic Personality Disorder:
A diagnosis of narcissistic personality disorder requires a pervasive pattern of grandiosity, a need for admiration, and a lack of empathy as indicated by at least five of nine symptoms: has a grandiose sense of self-importance; is preoccupied with fantasies of unlimited success, power, beauty, and love; believes he/she is unique and can be understood only by special or high-status people; requires excessive admiration; has a sense of entitlement; is interpersonally exploitative; lacks empathy; is often envious of others or believes others are envious of him/her; exhibits arrogant behaviors and attitudes.
