Topic 4: Personality Disorders & Mood Flashcards
1
Q
What is the DSM-IV?
A
A classification of 5 categories for personality disorders.
2
Q
What is axis I of the DSM-IV?
A
Clinical Psychological Disorders.
3
Q
What is axis II of the DSM-IV?
A
Personality Disorders + Intellectual Disabilities. (These could worsen the axis I disorder prognosis).
4
Q
What is axis III of the DSM-IV?
A
Medical conditions and physical disorders. E.g., this could mean that they are not able to have certain medication.
5
Q
What is axis IV of the DSM-IV?
A
Psychosocial and environmental factors.
6
Q
What is axis V of the DSM-IV?
A
Functional level. (Looking at their capabilities of working/looking after themselves).
7
Q
What did DSM 5 (2013) group together?
A
Grouped 1-3 together to remove the qualitative distinction between personality disorders and other psychological disorders.
8
Q
Since the DSM 5 (2013) groups together axis 1-3, what does this do?
A
Grouping 1-3 together means that it removes the qualitative distinction between personality disorders and other psychological disorders. This recognises all the disorders as clinical disorders and are worth of specific focus for treatment within their own right.
9
Q
What is the justification for the DSM-IV for putting Personality Disorder on its own axis?
A
Increase the clinical/research attention as it was very important. They generally tend to be less understood/historically have been less researched.
10
Q
What is the definition of personality disorders? (5 characteristics)
A
Enduring pattern of inner experience and behaviour.
Deviations from cultural expectations.
Experiences and behaviours are pervasive (influence many aspects of life) and inflexible (stable and unchanging).
They cause distress/impairment.
They are not due to another disorder e.g., drugs/intoxication etc.
11
Q
What type of disorders are cluster A?
A
Odd/eccentric disorders.
12
Q
What are examples of Cluster A personality disorders?
A
Paranoid, schizoid, schizotypal.
13
Q
What type of disorders are cluster B?
A
Dramatic/emotional or erratic disorders.
14
Q
What are examples of disorders that are in cluster B?
A
Antisocial, borderline, histrionic and narcissistic.
(emotional, dramatic or erratic disorders)
15
Q
What are cluster C disorders?
A
Anxious/fearful disorders.
16
Q
What are examples of cluster C disorders?
A
Avoidant, dependent, obsessive-compulsive.
17
Q
What did Haslam (2007) suggest about personality disorders?
A
Co-occurrence of PDs is common. Many people meet the criteria for multiple at any one time. This can be within clusters or across clusters.
18
Q
What did Lofti et al., (2018) suggest about personality disorders?
A
Highly questionable validity and utility of diagnostic groups. Because there is overlap between what individuals can experience.
19
Q
What is paranoid PD? (A)
A
Paranoia; mistrust of others; has irrational suspicions. Extreme mistrust in other people with lack of evidence.
Pre-occupied with doubts; reluctance to confide; misinterprets innocent remarks, and holds grudges against people. Misperception that innocent things are actually attacks on them personally.
20
Q
What is Schizoid PD? (A)
A
Detachment from interpersonal relationships; emotional coldness; indifference to praise/criticism of others.
Has few friends; chooses solitary activities. Does not necessarily need social engagement.
21
Q
What is Schizotypal PD? (A)
A
Distortions in thinking, feelings and perceptions
e.g. ideas of reference, magical thinking, perceptual illusions. → Positive symptoms of schizophrenia.
There may be phantom pains/misperceptions of touch.
Discomfort in social situations; suspicions and paranoia.
22
Q
Is cluster A or cluster B more diverse?
A
Cluster B is more diverse.
23
Q
What is antisocial (dissocial) PD? (B)
A
Lack of empathy and remorse; disregard for others.
Failure to conform to norms/laws; impulsivity; deceitfulness; irresponsibility, and disregard for safety of self/others.
Increased risk of getting into trouble with the law.
24
Q
What is histrionic PD? (B)
A
Excessive need for approval; need to be centre of attention. Shallow/over-dramatic emotions; sees relationships as more intimate than they are. Misinterpretation of relationships.
(almost the opposite of antisocial PD)
25
What is narcissistic PD? (B)
Inflated self-importance and sense of entitlement; belief they are special; seeks attention and admiration from others.
Fantasises of success; arrogance; envy of others; low in empathy.
26
What is Borderline (Emotionally Unstable) PD?
Unstable personal relationships; frantic attempts to avoid real/imagined abandonment; lack of well-formed identity; feelings of emptiness/worthlessness; Instability of feelings.
Frequent suicidal, self-harming, self-mutilating behaviours; Impulsivity in self-damaging behaviours.
27
How is BPD portrayed in the media?
Sensationalised media portrayal.
28
What is Avoidant PD? (C)
Social inhibition; avoids and withdraws from social situations.
Low self-worth; fear rejection, disapproval and criticism; feel socially-inept; reluctant to engage in new things for fear of embarrassment.
29
What is the Dependent PD? (C)
Persistent psychological dependence on others; lack confidence in ability to take responsibility; has difficulty doing things alone.
Tends to agree with others; seeks out new relationships.
30
What is Obsessive-compulsive PD? (C)
Preoccupation with orderliness, rules, moral codes, caution and perfectionism; excessive devoted to work; inflexibility and overly-conscientious.
31
What is the continuity hypothesis?
There is no discontinuity between normality and illness.
32
In terms of the continuity hypothesis, why is considering personality and personality disorders distinctly potentially not appropriate?
Since there is connection between personality and personality disorders, considering them completely separately may be redundant.
33
What did the Salesman and Page (2004) study reveal about the connection between traits and personality disorders?
Meta-analysis of 12 studies.
Looked at the level of personality disorders and the Big-5 traits.
Some disorders have correlations with the Big-5 traits. The associations with the personality trait seem to fit with the symptoms of the disorder.
34
What is a Big-5 Profile Approach?
Conceptual profiles by which facets relate to the diagnostic characteristics for disorders.
35
What was identified from the Wider et al., (1994) conceptual profile for Paranoid PD?
For paranoid PD, we can see that there are specific facets that are relevant for this disorder. E.g., anger hostility etc.
36
What are the facets associated with Obsessive-compulsive Personality disorder?
High Competence (C1)
High ‘Order’ (C2)
High Dutifulness (C3)
High Achievement-striving (C4)
High Deliberation (C6)
37
What are the facets associated with Dependent PD?
High Anxiety (N1)
High Self-consciousness (N4)
High Vulnerability (N6)
High Altruism (A3)
High Compliance (A4)
High Modesty (A5)
38
What are the facets associated with Avoidant PD?
Low Gregariousness (E2)
Low Assertiveness (E3)
High Anxiety (N1)
High Self-consciousness (N4)
High Vulnerability (N6)
39
What are the facets associated with Schizoid PD?
Low Warmth (E1)
Low Gregariousness (E2)
Low Positive emotionality (E6)
40
What did McCrae et al., (2001) suggest about using these Big-5 Profiles to diagnose PD's?
Profiles may indicate risk (but not diagnosis) of PD. May be useful for ruling out a PD, or characterising a known PD. You cannot just diagnose someone based on these profiles.
41
How did McCare et al., (2001) test the Big-5 approach?
| (hint - interview)
* 1926 patients from psychiatric hospitals:
* Personality Disorder Interview.
* Personality Disorder Questionnaire (PDQ).
* NEO-PI-R.
* Calculated ‘profile agreement’ scores for each patient.
* Significant correlations – but only “modest to moderate.”
* Potential need to revise the current diagnostic classification system for personality disorders (DSM-IV).
42
What were the limitations in drawing conclusions from the results of the McCrae et al., (2001) study?
Even though the correlations are significant, they are not extreme correlations (they were only modest-moderate) and so the facets do not necessarily provide a full account of these disorders.
43
What are the limitations of the DSM-IV PD classification system?
| (3)
* Extensive co-morbidity. Indicate the categories may not be categorised correctly as there is overlap.
* Low temporal/inter-assessor reliability. Often patients getting different diagnosis from different diagnoses from different doctors and different diagnoses at different points in their life.
* Not based on empirical personality models.
44
What are the 4 step approach that takes a dimensional rather than categorial approach to classify PDs? (E.g., Widiger, Costa & McCrae (2002)).
1. Assess personality facet profile (NEO-PI-R).
2. Assess personality-related social/occupational impairments and distress. Determining whether any of the extreme personality traits/facets were causing problems for the individual.
3. If dysfunction & distress clinically significant – diagnose PD.
4. Optional step, (determine if the profile matches with PD category descriptor).
45
What additional section was added to the DSM-5 model in 2013?
* Retention of all 10 PDs and Clusters in main DSM-5.
* But: additional ‘emerging measures and models’ section
46
What is the additional 'emerging measures and models' section of the DSM-5?
Section III, based on two criterion.
* Criterion A: Severity
* Significant impairments in functioning of:
Self (identity or self-direction).
Interpersonal (empathy or intimacy).
* Criterion B: Style
* One or more pathological personality trait domains or facets (measured with ‘Maladaptive Trait Model’: Krueger et al. 2012). Clinical significance.
* New model contains just 6 of the personality disorder categories.
47
What is Dissociative Identity Disorder (DID)?
A mental disorder defined by the presence of two or more distinct identities or personalities.
Disruptive sense of identity and difficulty in identifying sense of self.
- Amnesia for prior or recent events.
- Cause distress and/or functional impairment. (Impairment of everyday functioning).
- Not due to e.g. substance use, cultural practice or imaginative play.
48
In the DSM, is DID considered as a personality disorder?
In the DSM it is not considered as a personality disorder but listed as one of several dissociative disorders.
49
What are the typical experiences of someone with DID? (Hallam, 2007).
* Primary ‘host’ personality plus one or more alters. Host is the most commonly experienced personality. Usually, the host personality is more passive whereas the alters are likely to be more uninhibited in their characteristics.
* Alters take turns to control behaviour.
* Distinctive patterns of thinking and behaving. May appear to take control of the person.
* Different names, ages, genders etc.
* Memory loss for experiences as other alters. Confusing for the person. They may wake up in somewhere unusual.
50
What are the links between childhood sexual/physical abuse and DID?
Reports of severe childhood sexual/physical abuse is common.
51
What is meant by patients with DID being high in suggestibility?
Highly responsive to social influences, increased capacity to be absorbed in activities and easily hypnotised. Likely to be influenced more easily by others suggestions.
52
How are DID patients clustered?
* Geographically. E.g., most in North America.
* By therapist. Small number of therapists accountable for most cases.
53
Has there been an increase in diagnosis of DID? Why?
* Up to 1980: Fewer than 200.
* Current: 10s of thousands.
* Increase may be due to an influential book ‘Sybil.’ Raised awareness.
54
Are reports of DID becoming more extreme?
Yes, from 2/3 alters to >100 (including animals).
More extreme abuse.
55
What is the post-traumatic model of DID?
Primitive response to trauma. Theory to understand DID.
* Dissociation of consciousness to escape initial trauma. Thoughts and feelings from the trauma can be separated from consciousness so they can cope. These separations then develop into personalities with their own thoughts/feelings i.e., alters.
* Dissociation becomes response mechanism for future stress.
→ Suggestibility pre-disposes to dissociation.
56
What is the Socio-Cognitive Model of DID?
* Hypnosis and leading questions cause patient to reinterpret experiences.
* Mood swings expressed as multiple personalities.
* A culture-bound phenomenon (not ‘faking’). Patient’s are just responding to the narrative presented to them, making sense of the difficult experiences and symptoms that they have.
* →Suggestibility increases susceptibility. They are vulnerable to interpreting their symptoms in how the therapist presents to them.
* → Accounts for clustering of cases and rise in prevalence and severity. More relevance = more people seeking therapies = more likely to be affected by the therapy. However, a counter argument would be that the rise in awareness is just making therapists better at diagnosing it.
57
What did Spanos (1994) suggest that gave evidence towards the Socio-Cognitive Model of DID?
Experimental, hypnotic manipulations can ‘reveal’ apparent hidden self or past life identities in psychologically healthy individuals. Induce personalities even in healthy individuals.
58
What evidence did Paris (2012) provide (about Sybil) for the Socio-Cognitive Model of DID?
Transcripts of ‘Sybil’s’ therapy sessions show that the multiple personality narrative was imposed upon her. In interactions with previous therapists there was no report of these multiple personalities. Potentially suggesting that it was this interaction with the one therapist that resulted in the development of this disorder.
59
What are the debates/controversy around DID?
* The causes of the disorder.
* It’s validity as a scientific concept.
60
What did Pope et al. (2006) suggest about DID being accepted by the scientific community?
'A brief fad that was never accepted by the scientific community.'
61
What did Paris (2012) suggest about the DID and the DSM-5?
“Only DSM-5 has failed to notice that this diagnosis fails to meet criteria for a valid diagnosis”.
62
What did Spiegel et al., (2011) suggest about the link between dissociative disorders and neural mechanisms?
Small study, underwent a brain scan in their host state. Abnormalities in the blood flow to the orbitofrontal region of the brain. Different neural patterns to other disorders, therefore there it should be considered a distinct disorder.
There is increasing evidence linking dissociative disorders to trauma and specific neural mechanisms.
63
What did Brown & Aster (2012) specifically define mood as?
Affective ‘states of mind’ that underlie our subjective mental life.
64
Is it generally accepted that mood and emotion are the same thing or more separated?
Most of the literature agrees that these things are separate.
65
What were the two parts of the experiment that Beedie, Terry and Lane (2005) carried out?
| Into the seperation of mood and emotion
‘Folk Psychology’ Perspective and comparison with the academic literature.
66
What is the 'folk psychology perspective'?
Asked 106 participants from a range of (non-psychology) professions (snowball sampling): What do you believe is the difference between an emotion and a mood?
67
How did Beedie, Terry and Lane (2005) compare with the previous literature?
Looked at 65 published articles distinguishing between mood and emotion.
68
In Beedie, Terry and Lane (2005) study, what stipulations did they state to the participants to ensure that the results were more valid?
* There is no right or wrong answer, please simply write down your personal view.
* Please do not ask friends or colleagues for their opinion to assist you in deciding your answer.
* Please do not use any form of reference text to help you answer the question (e.g. dictionaries, textbooks, internet etc.)
* The question asks for the difference between two types of human feeling. If you do not think that there is a difference, please simply state that opinion.
69
What is the difference in the anatomy of emotion and mood?
Emotion: related to the heart. Mood: related to the mind.
70
What is the difference in experience between emotion and mood?
Emotion: felt. Mood: thought.
71
What is the difference in physiology of emotion and mood?
Emotion: distinct physiological patterning.
Mood: no distinct physiological patterning,
72
What is the difference in the cause between emotion and mood?
Emotion: caused by a specific event or object.
Mood: cause is less well defined.
73
What is the difference between emotion and mood in terms of being aware of the cause?
Emotion: individual tends to be aware of the cause.
Mood: individual may be unaware of the cause.
74
What is the difference between the intentionality of the emotion and mood?
Emotion: about something.
Mood: not about anything in particular.
75
What is the difference in clarity between mood and emotion?
Emotion: clearly defined.
Mood: diffuse and nebulous.
76
What is the difference in regards to the control of emotion and mood?
Emotion: not controllable.
Mood: controllable.
77
What is the difference in the display of emotion and mood?
Emotion: displayed.
Mood: not displayed.
78
What is the difference in intensity between emotion and mood?
Emotion: intense.
mood: mild.
79
What is the difference in stability between emotion and mood?
Emotion: fleeting and volatile.
Mood: stable.
80
What is the difference in timing between mood and emotion?
Emotion: rises and dissipates quickly.
Mood: rises and dissipates slowly.
81
What is the difference in duration between emotion and mood?
Emotion: brief. Mood: enduring.
82
What are the differences in the consequences between emotion and mood?
Emotion: largely behavioural and expressive.
Mood: largely cognitive.
83
What are the limitations in defining emotions and mood as distinct concepts?
* Some criteria require testing.
* Interactions between the two.
* Not universally agreed. Further testing what be needed to separate one from the other. The literature is relatively varied.
* Terminology used inconsistently in the literature.
84
What are mood states?
Sporadic emotional states, lasting for minutes or hours that are manifested though physiological signals e.g. increased heart rate, and behavioural signals, e.g. smiling. Chamorro-Premuzic (2013).
85
Why is it important to study individual differences in mood?
Mood varies over time.
Mood changes from day to day but there can still be characteristic patterns in the mood that we show.
Mood traits: dispositions of mood. Reflect capacity and tendency to experience mood states.
86
What did Costa et al., (1987) find about the stability of mood?
Mood is moderately stable (r approx. 0.44) over time.
87
What has been found about the individual differences in mood?
Ratings how positive the individual feels (left) each persons mood varies across the day. Even though there are differences within individuals there are also differences between people in the general mood that they experience.
In general, some people may just feel more positive/negative than others.
People’s moods tended to be moderately stable. (Costa et al., 1987).
Some people’s moods are very variable over time, whereas other people are characteristically more stable in their patterns. So this shows that individuals have differences in the variability of their mood states.
E.g., McConville and Cooper (1992): characteristic patterns of variability of mood states.
88
What two factor structure of mood model did Watson and Tellegen propose (1985)?
Reviewed previous factor analysis studies of mood adjective ratings.
Two (at least partly) orthogonal dimensions underlying mood experience:
Positive Affect (PA). Extent to which an individual experiences a positive life. Less energy for lower.
Negative Affect (NA). Extent to which individuals experience unpleasant arousal. Low negative = calm/placcid/relaxed.
89
For the two factor structure of mood model that Watson and Tellegen proposed (1985), what are some of the limitations?
- Most dominant theory, but some disagreement in defining the dimensions. Particularly the negative: other researchers have conceptualised this different. Independent: orthogonal, according to this theory positive and negative affect are completely different, therefore you can experience high levels of positive affect and high levels of negative affect which may seem rather counterintuitive.
90
What experiment was carried out by Larsen et al. (2001) in examining the co-activation of happiness and sadness?
* 189 Participants.
* ‘Emotional state’ ratings before and after watching ‘tragic comedy’ film. Elicits both positive and negative feelings: positive through comedy, but set in a tragic background.
Larsen et al. (2001): Evidence for bittersweet feelings on:
* ‘Dorm’ move out day.
* Graduation.
* After film: evidence of co-activation:
* ‘Bittersweetness.’
This study provides support that positive and negative feelings (sad/happy) can occur at the same time.
91
How did the study by Conrad et al. (2019) on songs provide evidence for the co-activation of moods?
Conrad et al. (2019): 16% of songs that people listen to on repeat reflect bittersweet feelings. Gives evidence for the co-activation for positive and negative feelings. Sizeable proportion related to bittersweet feelings:
“It makes me feel sad. But not the bad kind of sad, and I like singing with it.” Both sad and positive feelings being experienced at the same time.
92
What is generally accepted about the co-activation of positive and negative feelings?
* Co-activation of positive and negative feelings (even ‘Happiness’ and ‘Sadness’) is possible (though probably not common). Possible but not frequent.
93
What is the 3D model of mood proposed by Matthew, Jones and Chamberlain (1990)?
3 dimensions. each dimension as a continuum.
Tense arousal (goes from anxious/jittery/fearful/stressed to calm/relaxed/peaceful/placid).
Energetic arousal (goes from active/alert/vigorous to idle/sleepy/sluggish/tired).
Hedonic tone (goes from pleased/cheerful/happy to low-spirited/gloomy/sad).
* Factor analysed responses to 48 item ‘University of Wales Institute of Science & Technology Mood Adjective Checklist’ (UMACL).
* Represent as a continuum rather than as separate things.
* Got people to rate these words, then carried out a factor analysis and then based on this came up with a 3D model of mood.
* Three-dimensional model of mood. Still similar to the other model just more of a continuum.
* Hedonic tone modestly associated with arousal scales. The pleasure experienced, mapped onto happiness. Suggested that the levels of tense/energetic arousal can be affected by the hedonic tone and vice versa.
94
Can hedonic tone affect level of arousal for the other components of the 3D model of mood?
Levels of arousal can influence the hedonic tone.
95
What did Diener (2000) define happiness as?
‘Happiness’ = positive affect – negative affect.
96
What is the usual method for assessing mood?
Most methods for assessing individual differences in mood involve retrospective judgements
97
What are the biases that can be associated with retrospective judgements when recalling mood?
- Your current mood, effect how you would rate your previous mood.
- Your most extreme mood state during the period covered (‘peak’ mood).
- Your mood state at the end of the period covered (‘end’ mood).
- Beliefs, stereotypes, and expectations about mood patterns.
98
How did Areni and Burger (2008) assess mood stereotypes?
Do beliefs about our typical moods fit with cultural stereotypes about days of the week? E.g., Monday @ lowest mood.
Do people’s beliefs about days of the week affect mood recalling?
* 202 participants recruited into an online study.
* All in full-time employment.
Think of the time when you first wake up in the morning…
* On what morning of the week are you typically in your best mood?
* On what morning of the week are you typically in your worst mood?
Think of that period in the evening after dinner but before you go to sleep…
* On what evening of the week are you typically in your best mood?
* On what evening of the week are you typically in your worst mood?
Data clearly shows that people’s belief about their own mood did fit the stereotypes of mood changing throughout the week.
99
What was the second study that Areni and Burger did (2008) that occurred over a week to assess mood?
* 351 participants. Larger sample.
Days 1-7: Daily momentary mood assessments.
* What is your mood like right now? No memory, pure measure of their current mood.
Day 8: Mood stereotypes.
* What is your mood like on a typical Wednesday/Thursday/etc?
Day 8: Retrospective mood assessments.
* What was your mood like last Wednesday/Thursday? Etc.
* Little evidence that mood stereotypes reflect real moods.
* For Mondays: Mood stereotypes were a better predictor of remembered mood than actual moods were.
100
What was shown by Schwartz and Clore (1983) in terms of how the weather affected recall of mood?
* Telephone interview with participants on sunny or rainy days. Happier rating on sunny days rather than rainy days.
* ‘How happy do you feel at this moment? (1-10). (in blue).
* ‘How happy do you feel about your life as a whole?’ (1-10). (in red).
* Our moods can be impacted by something such as the whether.
101
What is the Peak-End Theory? (Redelmeier and Kahneman, 1996).
* Patients’ retrospective ratings were strongly influenced by Peak (extreme) and End (level of pain at the end) experiences. Memory of pain is influenced by peak and end.
* Lower correlations with duration of experiences (‘duration neglect’). So like if the whole experience was not very painful but there was a small part that was, this would influence the rating and cause it to be much higher than what the actual experience was.
102
What experiment on women going through labour that Chajut et al. (2014) carried out that supported the Peak-End Theory?
- 324 pregnant women (mean age = 30.4 years) recruited on entering delivery dept.
- Momentary pain was reported every 20 minutes until birth.
- Retrospective pain ratings (of entire labour) taken 2 days and then months later.
- Average of peak and end pain ratings stronger predictors of remembered pain ratings than actual average levels of pain experienced. Higher than the average pain that they had actually experienced. Very close to the peak and end experiences of pain.
103
What did Ganzach and Yaor (2019) discover about the recall of positive/negative affects?
Asymmetries in recall of positive vs negative affect
Negative influenced more by peak experiences; positive by end experiences. Not really sure why. But may be due to the evolutionary advantage of remembering negative experiences.
104
What are contemporaneous mood assessment and what are the advantages?
Collected contemporaneously with the experience.
How happy do you feel right now? Rather than retrospectively.
* Accurate snapshot of mood state.
* Free of (memory-related) cognitive biases.
* Temporal precision.
105
What are the disadvantages of contemporaneous mood assessment?
* A single snapshot only.
* Interfere with everyday activities. Could be frustrating/annoying. Maybe being asked to given a mood rating will affect your mood.
* Tells you nothing about people’s memories of their experiences:
…which influence future behaviour;
… inform our sense of wellbeing;
.. and contribute to our sense of who we are!
