week 12 - personality disorders

Question 1

Personality Disorders: Key Characteristics

3 of em

Answer 1

(1) Functional Inflexibility:
Inability to adapt to changing contexts
Rigidly applying same patterns of responding across time & situations
—Even when the response is clearly inappropriate or ineffective

(2) Self-Defeating Patterns of Behaviour
Response patterns that actually worsen the situation
Patterns that are damaging to the person involved
Limited capacity to learn from these experiences

(3) Unstable functioning in the face of stress
Mood instability, cognitive & behavioural difficulties

Question 2

General Criteria of PD (DSM)

Answer 2

Enduring pattern of inner experience & behavior that deviates markedly from the expectations of the individual’s culture

Pattern is manifested in 2 (or more) of the following areas:
Cognition
Affectivity
Interpersonal functioning
Impulse control

Pattern is inflexible & pervasive across a broad range of personal & social situations

Leads to clinically significant distress or impairment in social, occupational, or other important areas of functioning

Pattern is stable & of long duration
–onset can be traced back at least to adolescence or early adulthood.

Question 3

The Impact of Diagnosis

Answer 3

As in all forms of psychopathology, a diagnosis can carry serious consequences for the individual.

This is particularly important for PD

• -Perception of poor prognosis
• -Perception of ‘difficulty’
• -Aversion of clinicians to working with PD

Particularly important given diagnostic unreliability

Question 4

Misuse of the Diagnosis

Answer 4

A diagnosis of Personality Disorder can sometimes be made for the wrong reasons

• For a client that the therapist is not having success in treating
• For a client who challenges the expertise or opinion of the therapist
• “Resistant” clients

Question 5

Criticisms of the PD Concept

Answer 5

DSM Personality Disorders…
Are mostly atheoretical
Show poor inter-rater reliability of diagnosis.
Show poor reliability with factor analytic studies of symptoms/criteria
Vary across culture and over time
Show considerable comorbidity
–When one PD is diagnosed, it is more common to have another PD than not
–90% of narcissistic, paranoid, borderline patients receive another PD diagnosis

Arguments for a dimensional vs categorical approach

Question 6

Comorbidity

Answer 6

Personality disorders show high levels of comorbidity with mood disorders
Mood Disorder: 61.3% at a single timepoint
Depression: 39% at a single timepoint
Depression: 74% lifetime prevalence
Substance Abuse
Anxiety Disorders
Some features can tap into features of other disorders
–BPD: shares dissociation/unstable sense of self with DID
–Social anxiety vs Avoidant PD?

Question 7

Possible Indications of a PD

Answer 7

Does the presenting problem include aspects that are not typical of the presentation of other disorders?

Are there previous multiple inconsistent psychiatric or psychological diagnoses?

Is the person chaotic or excessively emotionally responsive?

Does the person have problems in relationships with others?

Does the person not respond to effective treatments for presenting problems?

How does the therapist react to being with the person?

Question 8

Personality Disorder Clusters

VERY IMPORTANT TO KNOW

Answer 8

Cluster A:
Odd, Eccentric
paranoid PD
schizoid PD
schizotypal PD

Cluster B - Dramatic Emotional erratic
Antisocail PD
Borderline PD
Histrionic Pd
Narcissistic PD

CLuster C = anxious & fearful
Avoidant PD
Dependent PD
Obsessive-Compulsive PD

Question 9

Cluster A:

Odd, Eccentric

Answer 9

paranoid PD
schizoid PD
schizotypal PD

Question 10

Cluster B - Dramatic Emotional erratic

Answer 10

Antisocial PD
Borderline PD
Histrionic Pd
Narcissistic PD

Question 11

CLuster C = anxious & fearful

Answer 11

Avoidant PD
Dependent PD
Obsessive-Compulsive PD

Question 12

Paranoid Personality Disorder

Answer 12

Pervasive distrust & suspiciousness of others such that their motives are interpreted as malevolent

4 or more of:

suspects, without sufficient basis, that others are exploiting, harming, or deceiving them

preoccupied with unjustified doubts about the loyalty or trustworthiness of friends or associates

reluctant to confide in others because of unwarranted fear that the info will be used maliciously against them

reads hidden demeaning or threatening meanings into benign remarks or events

persistently bears grudges, i.e., is unforgiving of insults, injuries, or slights

perceives attacks on character or reputation that are not apparent to others & is quick to react angrily or to counterattack

has recurrent suspicions, without justification, regarding fidelity of spouse or sexual partner

Question 13

Paranoid Personality Disorder

cog themes and Ip strategyies and beliefs

Answer 13

cognitive Theme: people as potential adversaries

Interpersonal Strategy: wariness

Typical Beliefs:
> I cannot trust or confide in other people.
>Other people have hidden motives
I have to be on guard at all times
people will take advantage of me if i give them the chance
other people will deliberately try to demean me
I will be in serious trouble if I let other people think they can get away with mistreating me
If other people find out things about me, they will use them against me

Question 14

Schizoid Personality Disorder

Answer 14

Pattern of detachment from social relationships

Restricted range of expression of emotions in interpersonal settings

4 (or more) of the following:
neither desires nor enjoys close relationships, including being part of a family
almost always chooses solitary activities
has little, if any, interest in having sexual experiences with another person
takes pleasure in few, if any, activities
lacks close friends or confidants other than first-degree relatives
appears indifferent to the praise or criticism of others
shows emotional coldness, detachment, or flattened affectivity

Question 15

Schizoid Personality Disorder

cog theme, beliefs, ips

Answer 15

CT: i need plenty of space
IPS: Isolation

Typical Beliefs
Relationships are problematic.
Life is less complicated without other people.
I am empty inside.
It is better for me to keep my distance and maintain a low profile.
I am a social misfit.
Life is bland and unfulfilling.

Question 16

Schizotypal Personality Disorder

Answer 16

Social & interpersonal deficits marked by acute discomfort with, & reduced capacity for, close relationships

Cognitive or perceptual distortions & eccentricities of behavior

5 (or more) of the following:
ideas of reference (excluding delusions of reference)
odd beliefs or magical thinking that influences behavior; inconsistent with subcultural norms
unusual perceptual experiences, including bodily illusions
odd thinking & speech (e.g., vague, circumstantial, metaphorical, overelaborate, or stereotyped)
suspiciousness or paranoid ideation
inappropriate or constricted affect
Behaviour/appearance is odd, eccentric, or peculiar
lack of close friends or confidants other than 1st-degree relatives
excessive social anxiety that does not diminish with familiarity and tends to be associated with paranoid fears rather than negative judgments about self

(e.g., superstitiousness, belief in clairvoyance, telepathy, or “sixth sense”; in children and adolescents, bizarre fantasies or preoccupations)

Question 17

Schizotypal Personality Disorder

CT, IPS, beliefs

Answer 17

CT: I need to consider my own views, I must not be influenced by anyone
IPS: eccentric thinking

Typical Beliefs
I feel like an alien in a frightening environment.
Since the world is dangerous, you have to watch out for yourself at all times.
There are reasons for everything. Things don’t happen by chance.
Sometimes my inner feelings are an indication of what is going to happen.
Relationships are threatening.
I am defective.

Question 18

Cluster B Personality Disorders

Antisocial Personality Disorder

Answer 18

Pervasive pattern of disregard for & violation of the rights of others

Occurring since 15 yrs of age

3 (or more) of the following:

failure to conform to social norms with respect to lawful behaviors  repeatedly performing acts that are grounds for arrest
Deceitfulness  repeated lying, use of aliases, or conning others for personal profit/pleasure
impulsivity or failure to plan ahead
irritability & aggressiveness repeated physical fights or assaults
reckless disregard for safety of self or others
consistent irresponsibility repeated failure to sustain consistent work behavior or honour financial obligations
lack of remorse  being indifferent to or rationalising having hurt, mistreated, or stolen from another

Question 19

Antisocial Personality Disorder

CT, IPS, typical beliefs

Answer 19

CT: People are there to be taken
IPS: ATtack

Typical Beliefs
Force or cunning is the best way to get things done.
We live in a jungle and the strong person is the one who survives.
People will get at me if I don’t get them first.
It is not important to keep promises or honor debts.
Lying and cheating are OK as long as you don’t get caught.
I have been unfairly treated and am entitled to get my fair share by whatever means I can.
If people can’t take care of themselves, that’s their problem.
Can be associated with Gambling Disorder (use of drug treatment unclear because of high drop out rates, short follow-up times, different measures)

Question 20

Borderline Personality Disorder

Answer 20

Pattern of instability of interpersonal relationships, self-image & affects
Marked impulsivity

Beginning by early adulthood & present in a variety of contexts

5 (or more) of the following:
frantic efforts to avoid real or imagined abandonment.
pattern of unstable & intense interpersonal r’ships characterised by alternating between extremes of idealization & devaluation
identity disturbance: markedly & persistently unstable self-image or sense of self
impulsivity in at least 2 areas that are potentially self-damaging
recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior
affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours & only rarely more than a few days)
chronic feelings of emptiness
inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights)
transient, stress-related paranoid ideation or severe dissociative symptoms

Question 21

BPD - CT, IPS and beleifs

Answer 21

CT: I am vulnerable to rejection
IPT: Subjugation, protest

Typical Beliefs
I can’t cope on my own
I need someone to rely on
I cannot bear unpleasant feelings
If I rely on someone, I’ll be mistreated, found wanting, abandoned
The worst possible thing would be to be abandoned
It is impossible for me to control myself
I deserve to be punished

Question 22

Histrionic Personality Disorder

Answer 22

Pattern of excessive emotionality & attention seeking

Beginning by early adulthood & present in a variety of contexts

5 (or more) of the following:
uncomfortable in situations when not the centre of attention
interaction with others is often characterised by inappropriate sexually seductive or provocative behavior
displays rapidly shifting & shallow expression of emotions
consistently uses physical appearance to draw attention to self
has a style of speech that is excessively impressionistic & lacking in detail
shows self-dramatization, theatricality, & exaggerated expression of emotion
is suggestible, i.e., easily influenced by others or circumstances
considers relationships to be more intimate than they actually are

Question 23

Histrionic - CT, IPS, TBs

Answer 23

CT: I need to impress
IPs: dramatics

Typical Beliefs
In order to be happy I need other people to pay attention to me.
Unless I entertain or impress people, I am nothing.
If I don’t keep others engaged with me, they won’t like me.
The way to get what I want is to dazzle or amuse people.
It is awful for people to ignore me.
I should be the centre of attention.
If I entertain people, they will not notice my weaknesses.
People will pay attention only if I act in extreme ways.

Question 24

Narcissistic Personality Disorder

Answer 24

Pervasive pattern of grandiosity (in fantasy or behavior)

Need for admiration

Lack of empathy

5 or more:
Grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognised as superior without commensurate achievements)
Preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love
believes that he or she is “special” & unique & can only be understood by, or should associate with, other special or high-status people (or institutions)
requires excessive admiration
has a sense of entitlement
is interpersonally exploitative
lacks empathy: is unwilling to recognize or identify with the feelings and needs of others
is often envious of others or believes that others are envious of them
shows arrogant, haughty behaviors or attitudes

Question 25

NPD - CT, IPS, beliefs

Answer 25

CT: I AM SPECIAL
IPS: self-agrandizement

Typical Beliefs
Since I am so superior, I am entitled to special treatment & privileges.
I don’t have to be bound by the rules that apply to other people.
If others don’t respect my status, they should be punished.
Other people should satisfy my needs.
Other people should recognise how special I am.
Since I am so talented, people should go out of their way to promote my career.
No one’s needs should interfere with my own.

Question 26

Avoidant Personality Disorder (cluster C)

Answer 26

Pattern of social inhibition, feelings of inadequacy, & hypersensitivity to –ve evaluation

Beginning by early adulthood & present in a variety of contexts

4 (or more) of the following:
avoids occupational activities that involve significant interpersonal contact, because of fears of criticism, disapproval, or rejection
unwilling to get involved with people unless certain of being liked
shows restraint within intimate relationships because of the fear of being shamed or ridiculed
preoccupied with being criticised or rejected in social situations
inhibited in new interpersonal situations because of feelings of inadequacy
views self as socially inept, personally unappealing, or inferior to others
unusually reluctant to take personal risks or to engage in any new activities because they may prove embarrassing

Question 27

Avoidant Personality Disorder - ct, ips, etc

Answer 27

CT: I may get hurt
IPS: Avoidance

Typical Beliefs
I am socially inept and socially undesirable in work or social situations.
Other people are potentially critical, indifferent, demeaning, or rejecting.
If people get close to me, they will discover the “real” me and reject me.
Being exposed as inferior or inadequate will be intolerable.
I should avoid unpleasant situations at all costs.
Unpleasant feelings will escalate and get out of control.
If I ignore a problem, it will go away.

Question 28

Dependent Personality Disorder

Answer 28

Pervasive & excessive need to be taken care of
Leads to submissive & clinging behaviour & fears of separation
Beginning by early adulthood and present in a variety of contexts

5 (or more) of the following:
difficulty making everyday decisions without an excessive amount of advice & reassurance
needs others to assume responsibility for most major areas of life
difficulty expressing disagreement because of fear of loss of support or approval.
difficulty initiating projects or doing things on their own (because of a lack of self-confidence in judgment or abilities rather than a lack of motivation or energy)
goes to excessive lengths to obtain nurturance & 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 themselves
urgently seeks another relationship as a source of care & support when a close relationship ends
is unrealistically preoccupied with fears of being left to take care of themselves

Question 29

Dependent Personality Disorder

Answer 29

Use of the term dependent implies a negative connotation

A degree of dependency is functional in living in modern society

Western society, especially American society, emphasises the important of determined individualism & self-sufficiency.

Question 30

Dependent Personality Disorder ct, ips etc

Answer 30

ct: I AM helppless
ips: attachment

Typical Beliefs
I am needy and weak.
I need somebody around available at all times to help me carry out what I need to do or in case something bad happens.
I am helpless when I am left on my own.
I am basically alone–unless I can attach myself to a stronger person.
The worst possible thing would be to be abandoned.
I must do nothing to offend my supporter or helper.
I must be subservient in order to maintain his or her good will.
I need others to help me make decisions or tell me what to do.

Question 31

Obsessive-Compulsive PD

Answer 31

Pattern of preoccupation with orderliness, perfectionism, & mental& interpersonal control
At the expense of flexibility, openness, & efficiency

4 (or more) of the following:
Preoccupied with details, rules, lists, order, organisation, or schedules to the extent that the major point of the activity is lost
perfectionism that interferes with task completion (e.g., is unable to complete a project because own overly strict standards are not met)
excessively devoted to work & productivity to the exclusion of leisure activities & friendships (not accounted for by obvious economic necessity)
overconscientious, scrupulous, & inflexible about matters of morality, ethics, or values (not accounted for by cultural or religious identification)
unable to discard worn-out or worthless objects even when they have no sentimental value
reluctant to delegate tasks or to work with others unless they submit to exactly their way of doing things
adopts a miserly spending style toward both self & others; money is viewed as something to be hoarded for future catastrophes
shows rigidity & stubbornness

Question 32

OCD vs OCPD

Answer 32

OCPD-related thoughts & behaviours often mistaken as “being OCD” in lay terms

OCD: Ego-dystonic; irrational
OCPD: Ego-syntonic
—Absence of true obsessions or compulsions

Question 33

OCPD ct, ips etc

Answer 33

CT: errors are bad, I must not err
IPS: perfectionism

Typical Beliefs
I have to depend on myself to see that things get done.
Others tend to be too casual, often irresponsible, self-indulgent, or incompetent.
It is important to do a perfect job on everything.
If I don’t have systems, everything will fall apart.
Any flaw or defect of performance may lead to a catastrophe.
I need to be in complete control of my emotions.
People should do things my way.