14 Personality Disorders 1

Question 1

What is a personality disorder as defined by DSM-5?

Answer 1

An enduring pattern of inner experience and behaviour that deviates markedly from the individual’s culture, is pervasive, inflexible and stable over time. Leads to distress or impairment.

Question 2

In what two (or more) areas must a pattern manifest itself in order to qualify as a personality disorder?

Answer 2

1) Cognition (ways of interpreting self, others and events)
2) Affect (range, intensity, lability and appropriateness of emotional response)
3) Interpersonal functioning
4) Impulse control

Question 3

At what age can a personality disorder be diagnosed?

Answer 3

Generally not before age of 18.

Question 4

How have the personality disorders changed from DSM-IV to DSM5?

Answer 4

They haven’t.

Question 5

What is the assumption about PDs made in the categorical approach of the DSM-5?

Answer 5

DSM-5 assumes PDs represent distinct clinical syndromes.

Question 6

What evidence is there that the PDs are not categorical? 4 things

Answer 6

1. High degree of comorbidity and mixed diagnoses among personality disorders
2. Lack of clear boundaries for distinguishing between those with and without a PD
3. Lack of agreement on the conceptualisation of various personality disorders
4. Minimum number of criteria for diagnosis-differing profiles. E.g. 9 criteria, only have to satisfy 4 –can have many different presentations/permutations.

Question 7

What are the 10 personality disorders, in their three clusters?

Answer 7

Cluster A (Odd) –3 disorders
1. Paranoid
2. Schizoid
3. Schizotypal
Cluster B (Dramatic) – 4 disorders
1. Antisocial
2. Borderline
3. Histrionic
4. Narcissistic
Cluster C (Anxious)
1. Avoidant
2. Dependent 
3. Obsessive-Compulsive

Question 8

What is Paranoid PD?

Answer 8

Paranoid personality disorder is a pattern of distrust and suspiciousness such that others’ motives are interpreted as malevolent.

Question 9

What is Schizoid PD?

Answer 9

Schizoid personality disorder is a pattern of detachment from social relationships and a restricted range of emotional expression.

Question 10

What is Schizotypal PD?

Answer 10

Schizotypal personality disorder is a pattern of acute discomfort in close relationships, cognitive or perceptual distortions, and eccentricities of behavior.

Question 11

What is Antisocial PD?

Answer 11

Antisocial personality disorder is a pattern of disregard for, and violation of, the rights of others.

Question 12

What is Borderline PD?

Answer 12

Borderline personality disorder is a pattern of instability in interpersonal relationships, self-image, and affects, and marked impulsivity.

Question 13

What is Histrionic PD?

Answer 13

Histrionic personality disorder is a pattern of excessive emotionality and attention seeking.

Question 14

What is Narcissistic PD?

Answer 14

Narcissistic personality disorder is a pattern of grandiosity, need for admiration, and lack of empathy.

Question 15

What is Avoidant PD?

Answer 15

Avoidant personality disorder is a pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation.

Question 16

What is Dependent PD?

Answer 16

Dependent personality disorder is a pattern of submissive and clinging behavior related to an excessive need to be taken care of.

Question 17

What is Obsessive-Compulsive PD?

Answer 17

Obsessive-compulsive personality disorder is a pattern of preoccupation with orderliness, perfectionism, and control.

Question 18

What are the 7 symptoms of the A criterion of Schizoid PD?

Answer 18

A pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following:

1. Neither desires nor enjoys close relationships, including being part of a family.
2. Almost always chooses solitary activities.
3. Has little, if any, interest in having sexual experiences with another person.
4. Takes pleasure in few, if any, activities.
5. Lacks close friends or confidants other than first-degree relatives.
6. Appears indifferent to the praise or criticism of others.
7. Shows emotional coldness, detachment, or flattened affectivity.

Question 19

When might problems arise for someone with Schizoid PD?

Answer 19

When they have to work in groups.

Question 20

What are the typical features of Schizoid PD? 
Self-view
View of others
Beliefs
Strategy
Affect

Answer 20

Selfview: isolated– autonomous personality – sacrifice intimacy to preserve their autonomy and detachment

View of others: Intrusive, controlling

Beliefs: Relationships are unrewarding and messy –interfere with my freedom. People will control me if I get too close.

Strategy: Keep distance. Threatened by encroachment of space.

Affect: Low level sadness on keeping distance; anxiety if space is encroached upon. Convey impression they have no feelings.

Question 21

What are the 7 symptoms of the A criterion of Paranoid PD?

Answer 21

A pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following:

1. Suspects, without sufficient basis, that others are exploiting, harming, or deceiving him or her.
2. Is preoccupied with unjustified doubts about the loyalty or trustworthiness of friends or associates.
3. Is reluctant to confide in others because of unwarranted fear that the information will be used maliciously against him or her.
4. Reads hidden demeaning or threatening meanings into benign remarks or events.
5. Persistently bears grudges (i.e., is unforgiving of insults, injuries, or slights).
6. Perceives attacks on his or her character or reputation that are not apparent to others and is quick to react angrily or to counterattack.
7. Has recurrent suspicions, without justification, regarding fidelity of spouse or sexual partner.

Question 22

What are the typical features of Paranoid PD? 
Self-view
View of others
Beliefs
Threats
Strategy
Affect

Answer 22

Self-view: Righteous and vulnerable to mistreatment by others

View of others: Devious and treacherous – but in innocent guise

Beliefs: I am vulnerable to other people. Other people cannot be trusted. They have it in for me. Need to be on guard for hidden motives.

Threats: Fear of being manipulated, controlled, put down or discriminated against.

Strategy: Hypervigilant to cues supporting paranoid views. May confront others –hostility is seen as sign of being right.

Affect: Anger over perceived abuse. Anxiety over perceived threats.

Question 23

What are the 9 symptoms of the A criterion of Schizotypal PD?

Answer 23

A pervasive pattern of social and interpersonal deficits marked by acute discomfort with, and reduced capacity for, close relationships as well as by cognitive or perceptual distortions and eccentricities of behavior, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

1. Ideas of reference (excluding delusions of reference).
2. Odd beliefs or magical thinking that influences behavior and is inconsistent with subcultural norms (e.g., superstitiousness, belief in clairvoyance, telepathy, or “sixth sense”; in children and adolescents, bizarre fantasies or preoccupations).
3. Unusual perceptual experiences, including bodily illusions.
4. Odd thinking and speech (e.g., vague, circumstantial, metaphorical, overelaborate, or stereotyped).
5. Suspiciousness or paranoid ideation.
6. Inappropriate or constricted affect.
7. Behavior or appearance that is odd, eccentric, or peculiar.
8. Lack of close friends or confidants other than first-degree relatives.
9. Excessive social anxiety that does not diminish with familiarity and tends to be associated with paranoid fears rather than negative judgments about self.

Question 24

What are the 7 symptoms of the A criterion of Antisocial PD?

Answer 24

A pervasive pattern of disregard for and violation of the rights of others, occurring since age 15 years, as indicated by three (or more) of the following:

1. Failure to conform to social norms with respect to lawful behaviors, as indicated by repeatedly performing acts that are grounds for arrest.
2. Deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure.
3. Impulsivity or failure to plan ahead.
4. Irritability and aggressiveness, as indicated by repeated physical fights or assaults.
5. Reckless disregard for safety of self or others.
6. Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations.
7. Lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another.

Question 25

What percentage of those in prison have Antisocial PD?

Answer 25

75%

Question 26

What are the two age-related criteria for Antisocial PD?

Answer 26

B. Must be over 18. | C. There must be evidence of conduct disorder with onset before 15.

Question 27

``` What are the typical features of Antisocial PD? Self-view View of others Beliefs Strategy Affect ```

Answer 27

Self-view: Loners, autonomous and strong. Abused and mistreated by society so it's OK to victimise others. View of others: Deserving of being exploited because they are weak. Beliefs: Need to look after number one. Agress or be the victim. Rules are there to protect the 'haves' so it's OK to break them. You deserve what you copped. Strategy: 1. Overt ASPD will attack, rob, assault others 2. Con artist Affect: Usually anger that others have what they (the ASPD) deserves

Question 28

What are the 9 symptoms of the A criterion of Borderline PD?

Answer 28

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, as indicated by five (or more) of the following: 1. Frantic efforts to avoid real or imagined abandonment. 2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation. 3. Identity disturbance: markedly and persistently unstable self-image or sense of self. 4. Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating). 5. Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior. 6. Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days). 7. Chronic feelings of emptiness. 8. Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights). 9. Transient, stress-related paranoid ideation or severe dissociative symptoms. E.g. report not really 'being there'

Question 29

``` What are the typical features of Borderline PD? Self-view View of others Beliefs Threats Strategy Affect ```

Answer 29

Self-view: Vulnerable to rejection, betrayal and domination. Deprived of emotional support; powerless; out of control; defective, unlovable, bad. View of others: – idealised: powerful, loving, perfect – devalued: rejecting, controlling, abandoning Beliefs: I can't cope on my own; need someone to rely on; can't bear unpleasant feelings; worst thing is to be abandoned; impossible to control myself; I deserve to be punished. Strategy: Subjugate own needs to maintain connection. Protest/threaten/punish those who threaten rejection. Relieve tension through self-harm. Attempt suicide. Affect: range of emotions.

Question 30

What are the 8 symptoms of the A criterion of Histrionic PD?

Answer 30

A pervasive pattern of excessive emotionality and attention seeking, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following: 1. Is uncomfortable in situations in which he or she is not the center of attention. 2. Interaction with others is often characterized by inappropriate sexually seductive or provocative behavior. 3. Displays rapidly shifting and shallow expression of emotions. 4. Consistently uses physical appearance to draw attention to self. 5. Has a style of speech that is excessively impressionistic and lacking in detail. 6. Shows self-dramatization, theatricality, and exaggerated expression of emotion. 7. Is suggestible (i.e., easily influenced by others or circumstances). 8. Considers relationships to be more intimate than they actually are.

Question 31

``` What are the typical features of Histrionic PD? Self-view View of others Beliefs Threats Strategy Affect ```

Answer 31

Self-view: Glamorous, deserving of attention and impressive View of others: Favourable as long as they can elicit attention, affection and amusement. Beliefs: Core belief that 'I am basically unattractive', 'I need other people to admire me in order to be happy', leading to – If I entertain people I am worthwhile, if I can't they will abandon me. Strategy: Do everything they can to get attention. Affect: Tend to express feelings dramatically: - Anger - punishment - Affection - pouring it out - Sadness - cry

Question 32

What are the 9 symptoms of the A criterion of Narcissistic PD?

Answer 32

A pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following: 1. Has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements). 2. Is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love. 3. 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 (i.e., unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations). 6. Is interpersonally exploitative (i.e., takes advantage of others to achieve his or her own ends). 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.

Question 33

``` What are the typical features of Narcissistic PD? Self-view View of others Beliefs Strategy Affect ```

Answer 33

Self-view: Special, unique, superior with a special place among ordinary people. Entitled, not governed by rules that govern others. View of others: Inferior. There to do bidding. Seek recognition to document their grandiosity and preserve their superior status. Beliefs: If others don't recognise my special status they should be punished. Others should be subservient because I'm so special. Strategy: Activities that reinforce superior status –seek glory and power as a way of reinforcing prestige. Affect: Anger when not noticed or given the respect/admiration they believe they deserve (Narcissistic injury).

Question 34

What's the most commonly found PD in eating disorders?

Answer 34

Avoidant PD

Question 35

What are the 7 symptoms of the A criterion of Avoidant PD?

Answer 35

A pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following: 1. Avoids occupational activities that involve significant interpersonal contact because of fears of criticism, disapproval, or rejection. 2. Is unwilling to get involved with people unless certain of being liked. 3. Shows restraint within intimate relationships because of the fear of being shamed or ridiculed. 4. Is preoccupied with being criticized or rejected in social situations. 5. Is inhibited in new interpersonal situations because of feelings of inadequacy. 6. Views self as socially inept, personally unappealing, or inferior to others. 7. Is unusually reluctant to take personal risks or to engage in any new activities because they may prove embarrassing.

Question 36

``` What are the typical features of Avoidant PD? Self-view View of others Beliefs Threats Strategy Affect ```

Answer 36

Self-view: Socially inept and incompetent View of others: Potentially critical, uninterested Beliefs: I am no good, worthless, unlovable. If people get to know me they'll reject me. Best to avoid risky situations at all costs. Threats: Being discovered – seen to be a fraud; being humiliated or rejected. Strategy: Avoid evaluative situations, avoid attention, new responsibilities at work or advancement. Affect: Dysphoria from lack of pleasure in relationships and anxiety from a fear of sticking their necks out.

Question 37

What are the 8 symptoms of the A criterion of Dependent PD?

Answer 37

A pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following: 1. Has difficulty making everyday decisions without an excessive amount of advice and reassurance from others. 2. Needs others to assume responsibility for most major areas of his or her life. 3. Has difficulty expressing disagreement with others because of fear of loss of support or approval. (Note: Do not include realistic fears of retribution.) 4. Has difficulty initiating projects or doing things on his or her own (because of a lack of self-confidence in judgment or abilities rather than a lack of motivation or energy). 5. Goes to excessive lengths to obtain nurturance and support from others, to the point of volunteering to do things that are unpleasant. 6. Feels uncomfortable or helpless when alone because of exaggerated fears of being unable to care for himself or herself. 7. Urgently seeks another relationship as a source of care and support when a close relationship ends. 8. Is unrealistically preoccupied with fears of being left to take care of himself or herself.

Question 38

``` What are the typical features of Dependent PD? Self-view View of others Beliefs Threats Strategy Affect ```

Answer 38

Self-view: Needy, weak, helpless and incompetent View of others: Strong caretaker is idealised. Function well as long as caretaker is accessible. Beliefs: core belief – "I am helpless alone". Need steady flow of support and encouragement. Need strong person to survive and be happy. Threat: Rejection or abandonment. Strategy: Cultivate a dependent relationship by subordinating themselves. Affect: Anxiety heightened – disruption to the relationship. Depression if their strong figure is removed; euphoria/gratification when their dependent wishes granted.

Question 39

What are the 8 symptoms of the A criterion of Obsessive Compulsive PD?

Answer 39

A pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following: 1. Is preoccupied with details, rules, lists, order, organization, or schedules to the extent that the major point of the activity is lost. 2. Shows perfectionism that interferes with task completion (e.g., is unable to complete a project because his or her own overly strict standards are not met). 3. Is excessively devoted to work and productivity to the exclusion of leisure activities and friendships (not accounted for by obvious economic necessity). 4. Is overconscientious, scrupulous, and inflexible about matters of morality, ethics, or values (not accounted for by cultural or religious identification). E.g. says "this is how it should be!" 5. Is unable to discard worn-out or worthless objects even when they have no sentimental value. 6. Is reluctant to delegate tasks or to work with others unless they submit to exactly his or her way of doing things. 7. Adopts a miserly spending style toward both self and others; money is viewed as something to be hoarded for future catastrophes. 8. Shows rigidity and stubbornness.

Question 40

``` What are the typical features of Obsessive Compulsive PD? Self-view View of others Beliefs Threats Strategy Affect ```

Answer 40

Self-view: Responsible for self and others. Core image of self as inept or helpless. Fear of being overwhelmed so rely on systems. View of others: Too casual, irresponsible, self-indulgent and incompetent. Beliefs: I need order, systems, rules to survive. (I am basically a mess, any flaw and I'm fucked). If I fail in this I'm a failure as a person. If I have a perfect system, I will be happy. Details are crucial. Threat: Any flaws, disorganisation. Strategy: System of rules and shoulds. Exert control over self and others, often overly directive, punishing and disapproving. Affect: Regrets, disappointment and anger toward self and others because of perfectionistic standards.