PSYU3337 Personality Disorders Flashcards
What does Cluster A include?
Paranoid, schizoid, schizotypal
What does cluster B include?
Antisocial, borderline, histrionic, narcissistic
What does cluster C include?
Avoidant, dependent, obsessive compulsive
What are the 5 personality trait dimensions?
Openness to experience
Conscientiousness
Extraversion
Agreeableness
Neuroticism
What is a personality disorder?
Persistent pattern of emotions, cognitions and behaviour that results in enduring emotional distress for the person affected or for others, and may cause difficulties with work and relationships.
Pervasive and inflexible traits, which are stable and maladaptive.
Ego-synotnic: feels consistent with one’s identity (barrier to treatment)
10-12 % of the population meet criteria for PD, but the measures we use to assess PD aren’t very reliable
How are they organized?
Cluster A = odd or eccentric cluster (4%)
Cluster B = dramatic, emotional, erratic cluster (4%)
Cluster C = fearful or anxious (7%)
Challenges of diagnosing
- there are overlapping features across disorders and categories
- high comorbidity with other disorders
- symptoms are subjective
- misdiagnosis is common
- personality researchers can’t agree on a dimensional system for PDs
5 factor model - pathology
–> the 5 factor model is most used, but we need to create pathological measures from those
Is there a pathological version of openness? not really
Conscientiousness = disinhibition
Extraversion = extreme introversion
Agreeableness = antagonism
Neuroticism (pathological) = negative affectivity
Paranoid Personality Disorder
Pervasive and unjustified mistrust and suspicion
(bears grudges, reads threatening meaning into neutral events, recurrent suspicions about fidelity, unjustified doubts about loyalty)
The individual is not usually psychotic
Prevalence = 1-2%
1:1 ratio
Causes and treatment of Paranoid personality disorder
Not well studied
- might have a modest genetic transmission
- associated with parental neglect
- exposure to violent adults as children
- traumatic brain injury
- chronic coke use
Treatment
- cognitive therapy to counter negativistic thinking
- lack of RCTs
Schizoid personality disorder
Pervasive pattern of detachment from social relationships AND very limited range of emotions in interpersonal situations
(does not desire close relationships, little interest in sex, does not take pleasure in activities, lacks friends, appears indifferent to praise / criticism)
1%, more common in men
Causes of Cluster A schizoid personality disorder
Not well studied (PDD make them less likely to participate in studies)
- significant overlap with autism spectrum disorder
- may precede a psychotic illness
- modest genetic transmission in affiliative system
Treatment:
- value of interpersonal relationships
- build empathy and social skills
- lack of RCTs
Cluster A: schizotypal personality disorder
Pervasive pattern of social and interpersonal deficits - marked by acute discomfort with close relationships AND COGNITIVE/PERCEPTUAL distortions AND eccentricities in behaviour
- magical thinking
- paranoid ideation
- inappropriate or constricted affect
- lack of close friends
- excessive social anxiety that does not diminish with familiar people
1%, more common in males
Causes and treatment of schizotypal personality disorder
Most studied out of the Cluster A disorders
- appears to be part of the schizophrenia spectrum
- modest genetic transmission (often occurs in first degree relatives of people with schizophrenia), cihldhood maltreatment or trauma, low ses (bidirectional)
Treatment:
- low doses of antipsychotic s
- SSRIs
- address comorbid depression using CBT
- lack of RCTs
Cluster B: antisocial personality
Pervasive pattern of disregard for and violation of the rights of others by the age of 15
(failure to conform to social norms, deceitfulness, impulsivity, irritability and aggression, reckless disregard for safety, consistent irresponsibility, lack of remorse)
has to be at least 18 years old
Prevalence = 2-3% overall
5:1 ratio of men to women
Causes of Antisocial Personality Disorder
- heavy emphasis on observable behaviours
Causal factors
- modest genetic transmisison
- having a young mother
- low family income
- single parent household
- delinquent siblings
- neglect
- large family size
- harsh discipline
Gene-environment interaction:
- Monoamine Oxidase A gene (MAOA gene) is involved in breaking down NT –> low MAOA activity + maltreatment = higher risk of ASPD
development of antisocial personality disorder
- often see things going on before the age of 16
- oppositional defiant disorder (children)
- conduct disorder (>9 years)
- ASPD
or ADHD and conduct disorder –> personality disorder
Cluster B: borderline personality disorder
Pervasive pattern of instability of interpersonal relationships, self-image, affect, and marked impulsivity
–> abandonment issues
–> unstable and intense relationships
–> identity disturbance
–> impulsivity
–> recurrent suicidal behaviour
–> affective instability
–> inappropriate anger
Prevalence = 1-2% overall, making up 10% of outpatients and 20% of inpatients
BPD causes and treatment
Lots of comorbidity
- 25% make a suicide attempt
- has high emphasis on past experience in emotional, physical and sexual abuse compared to other personality disorders
- most reserach of all PDs
Causes:
- modest genetic transmission
- childhood abuse and other bad childhood experiences
Treatment:
- antidepressants (little evidence to support their use other than helping with comorbid depression)
- dialectical behaviour therapy (dual reality of acceptance of difficulties and need for change), focus on interpersonal effectiveness, focus on distress tolerance
Histrionic Personality Disorder
- pattern of excessive emotionality and attention seeking, beginning by early adulthood and present in a variety of settings
(uncomfortable when not the focus of attention, inappropriate sexually seductive / provocative behaviours, rapidly shifting shallow expression of emotions, excessively impressionistic style of speech, theatrical, easily influenced by others)
1% overall
- more common in women
Causes and treatment of Histrionic PD
causes = unknown
treatment
- focus on attention seeking and long-term conseqeunces
- problematic interpersonal behaviours
- little evidence treatment is effective
Cluster B: narcissistic personality disorder
- pervasive pattern of grandiosity, need for admiration, lack of empathy, beginning by early adulthood and present across contexts
(sense of self importance, fantasises about unlimited success / power, believes they are special and can only be understood by other high status people, requires admiration, entitled, lacks empathy, envious of others)
1%, more common in men
Causes and treatment of narcissistic personality disorder
- causal factors: parental overvaluation
- emotional, physical and sexual abuse
- intrusive, controlling and cold parenting styles
Treatment:
- focus on grandiosity, empathy, unrealistic thinking
- emphasize realistic goals and coping skills for dealing with criticism
Cluster C: Avoidant personality disorder
Pervasive pattern of social inhibitiion, feelings of inadequacy, hypersensitivity to negative evaluation
(avoids interpersonal contact because of fears of criticism, disapproval, rejection - needs to be certain that they are liked, shows restraint with relationships for fear of being shamed, preoccupied with criticism, views self as socially inept, reluctant to take personal risks)
2-3% prevalence
more common in women
Causes and treatments of Avoidant Personality Disorder
Causes:
- modest genetic contribution
- emotional abuse, rejection or humiliation from parents
Treatment: focus on social skills, entering anxiety provoking situations
C: dependent personality disorder
Pervasive and excessive need to be taken care of that leads to submissive and clingy behaviours and fears of separation
- difficulty making decisions without reassurance from others
- needs others to assume responsibility
- difficulty expressing disagreement
- uncomfortable / helpless when alone
- urgently seeks another relationship as a source of care/support
1 % overall
more comomn in women
Causes and treatments of DPD
lack of research
- small to moderate genetic contribution
- authoritarian and overprotective parents
Treatment:
lack of evidence that any treatment works
C: obsessive compulsive personaity disorders
Pervasive pattern of preoccupation with orderliness, perfectionism, mental and interpersonal control, at the expense of flexibility, openness and efficiency
- preoccupied with rules, lists, details
- perfectionism
- devoted to productivity at the exclusion of leisure activities
- overconscientious, scrupulous and inflexible about morals, ethics, values
- unable to discard worthless objects
- reluctant to delgate work to others
- miserly spending stye
2% overall
more common in men
cause and treatment of Obsessive Compulsive PD
treatment: targeting rumination, procrastination and feelings of inadequacy
