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Abnormal Psych > Ch15 (lesson 18): personality disorders > Flashcards

Ch15 (lesson 18): personality disorders Flashcards

1
Q

DSM-5 clusters of personality disorders

A
  • Cluster A (odd/eccentric)
  • Cluster B (Dramatic/ Erratic)
  • Cluster C (Anxious/Fearful)
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2
Q

Cluster A (Odd/eccentric)

A
  • Paranoid Personality Disorder
  • Schizoid Personality Disorder
  • Schizotypal Personality Disorder
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3
Q

Cluster B (Dramatic/Erratic)

A
  • Antisocial Personality Disorder
  • Borderline Personality Disorder
  • Histrionic Personality Disorder
  • Narcissistic Personality Disorder
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4
Q

Cluster C (Anxious/Fearful)

A
  • Avoidant Personality Disorder
  • Dependent Personality Disorder
  • Obsessive Compulsive Personality Disorder
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5
Q

Personality Disorders (PD)

A
  • Longstanding, pervasive, Inflexible, extreme, and persistent patterns of behavior/ inner experience
    • unstable positive sense of self
    • unable to sustain close relationships
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6
Q

reasons for considering changes to PD criteria

A
  • High comorbidity- Half who met criteria for one DSM-IV-TR Personality Disorder met diagnostic criteria for another Personality Disorder
  • some of the DSM-IV-TR Personality Disorders are rare (<2%)
  • Many ppl w serious personality probs don’t fit any of Personality Disorder diagnoses
  • Ppl w a Personality Disorder can vary from one another in nature of personality traits and severity of condition
  • to capture subsyndromal symptoms better
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7
Q

Alternative DSM-5 Model for Personality Disorders

A

includes 6 distinct diagnoses

  • Borderline Personality Disorder
  • Obsessive-Compulsive Personality Disorder
  • Avoidant Personality Disorder
  • Schizotypal Personality Disorder
  • Antisocial Personality Disorder
  • Narcissistic Personality Disorder
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8
Q

location in DSM-5- Alt model for Personality Disorders

A
  • Working Group recommended this model
  • lack of consensus resulted in move to Section III- Emerging Measures and Models
  • Better aligns w Personality Theory (Big Five)
  • in the alt model, Personality Disorders are considered when person shows persistent and pervasive impairments in func from early adulthood
  • two types of dimensional personality scores:
    • 5 personality trait domains
    • 25 (more specific) personality trait facets)
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9
Q

test-retest stability for personality disorders and Major Depressive Disorder

A
  • although definition suggests should be stable over time, they appear to increase into adolescence and decline over time
  • many still have symptoms after remission, symptoms wax and wane
  • baseline diagnosis predicts lower func and more depression even 10-15 yrs later
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10
Q

Paranoid Personality Disorder

A

Presence of 4+ signs of distrust/suspiciousness beginning in early adulthood in mult contexts:

  • Pervasive unjustified suspiciousness of being harmed/deceived, exploited
  • unwarranted doubts about loyalty/trustworthiness of friends/associates
  • reluctance to confide in others due to suspiciousness
  • tendency to read hidden meanings into begnin actions of others
  • angry reactions to perceived attacks of character/ reputation
  • unwarranted suspiciousness of fidelity of partner
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11
Q

Schizoid Personality Disorder

A

4+ signs of interpersonal detachment and restricted emotions from early adulthood:

  • lack of desire for/ enjoyment of close relationships
  • prefers solitude
  • little interest in sex
  • few/no pleasurable activities
  • lack of friends
  • indifference to praise/criticism
  • flat affect, emotional detachment
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12
Q

Schizotypal Personality Disorder

A
  • ppl with Schizotypal Personality Disorder show problems similar to schizophrenia
    • eccentric thoughts and behaviors, interpersonal detachment, suspiciousness
  • Highly heritable (60%)
  • cog and neuropsychological deficits
  • enlarged ventricles
  • less temporal gray matter
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13
Q

DSM-5 criteria of Schizotypal Personality Disorder

A
  • Ideas of reference
  • Peculiar beliefs or magical thinking (eg: belief in extrasensory perception)
  • unusual perceptions (eg: disorted feelings about body)
  • peculiar patterns of thought and speech
  • suspiciousness/ paranoia
  • innapropriate/ restricted affect
  • odd/eccentric behavior/appearance
  • anxiety around other people, doesn’t diminish w familiarity
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14
Q

Antisocial Personality Disorder

A
  • Atleast 18
  • Evidence of conduct disorder before 15
  • perasive pattern of disregard for rights of others since 15 shown by 3+:
    • repeated law breaking
    • deceitfulness/lying
    • irritability/ aggressiveness
    • reckless disregard for own/others safety
    • irresponsibility as seen in unreliable employment/financial history
    • lack of remorse
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15
Q

Etiology of Antisocial Personality disorder- research issues

A
  • problems w research
    • conducted w mostly criminals
    • different measurements (APD vs psychopathy)
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16
Q

Genetics- etiology of APD

A
  • heritable 40-50%
  • genetic risk for APD, psychopathy, conduct disorder, and substance abuse related
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17
Q

family enviro- etiology off APD

A
  • lack of warmth, highly neg, parental inconsistency predict APD
  • Poverty, exposure to violence
  • Family enviro interacts w genetics
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18
Q

Characteristics- Etiology of Antisocial Personality disorder

A
  • Fearlessness
    • lack of fear/anxiety
    • low baseline levels of skin conductance; less reactive to aversive stimuli
  • Impulsivity
    • Lack of response to threat when pursuing rewards
  • Deficits in empathy
    • not in tune w emotional reactions of others
  • Prevalence greater in men
  • comorbid substance abuse v common
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19
Q

ASD vs Psychopathy- 2 differences

A
  • PCL-R covers many of the criteria for APD, but differs in that it includes more affective symptoms (shallow affect, lack of empathy)
  • differs in requirement that person develop symptoms before 15
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20
Q

Borderline Personality Disorder

A

5+ in many contexts, beginning in early adulthood:

  • frantic efforts to avoid abandonment
  • unstable interpersonal relationships in which others are idealized or devalued
  • unstable sense of self
  • Self-damaging, impulsive behaviors in areas such as spending, sex, reckless driving, binge eating
  • recurrent suicidal behavior/gestures/ injurious behavior
  • chronic feeling of emptiness
  • recurrent bouts of intense/poorly controlled anger
  • during stress, tendency to experience transient paranoid thoughts and dissociative symptoms
21
Q

prevalence and comorbidty of BPD

A
  • later in life, most no longer meet diagnostic criteria
  • comorbidity high w PTSD, MDD, Substance use, eating disorders, and schizotypal PD
    • comorbidity predicts less chance of remission
22
Q

Etiology of BPD- neurobiological

A
  • Genetic component
    • highly heritable (60%)
    • may play role in impulsivity and emotional dysregulation
  • decreased functioning of serotonin system
  • increased activation of amygdala
23
Q

Etiology of BPD- Social Environmental Factors

A
  • Parental separation, verbal and emotional abuse during childhood
  • Linehan’s Diathesis-Stress Theory
    • ppl w BPD have difficulty controlling emotions (emotional dysregulation)
      • possible biological diathesis
    • family invalidates or discounts emo experiences and expression
    • interaction btwn extreme emotional reactivity and invalidating family –> BPD
24
Q

Histrionic Personality Disorder

A

5+ signs of excessive emotionality/attention seeking:

  • Strong need to be center of attention
  • Inappropriate sexually seductive behavior
  • Rapidly shifting expression of emotions
  • Use of physical appearance to draw attention to self
  • speech that is excessively impressionistic and lacking in detail
  • exaggerated, theatrical emotional expression
  • overly suggestible
  • misreads relationships as more intimate than they are
25
Q

Narcissistic Personality disorder

A

5+ shown in early adulthood in many contexts:

  • grandiose view of one’s importance
  • preoccupation w one’s success, brilliance, beauty
  • belief that one is special and can be understood only by other high-status people
  • extreme need for admiration
  • tendency to exploit others
  • lack of empathy
  • envious of others
  • arrogant behavior or attitudes
26
Q

Etiology of Narcissitic Personality disorder- 2 models

A
  • Kohut’s Self-Psychology Model
  • Social Cognitive model
27
Q

Etiology of NPD- Kohut’s Self-Psychology model, and parenting

A

parenting:

  • in childhood, narcissist valued as a means to increase parent’s own self-esteem
    • not valued for his or her own competency/self worth
  • Parental emotional coldness and overemphasis on child’s achievements reported by narcissists

Kohuts model:

  • projects self-importance, self-obsorbtion on the surface
  • masks fragile self esteem
  • get sense of self-worth f through quests for respect of others
  • inflated self-worth and denigration of others are defenses against shame
28
Q

Etiology of NPD- Social Cognitive model

A
  • Narcissist has low self-esteem
  • Interpersonal relationships are a way to bolster sagging self-esteem rather than increase closeness to others
  • lab studies reveal cog biases that maintain narcissism
    • exclusion activated neural regions sensitive to pain
29
Q

fragile self esteem in narcissistic personality disorder

A
  • debate as to whether it is core to the diagnosis
  • might be present only for subset of those w disorder
    • the more fragile self-worth, higher level of neuroticism and depression
30
Q

Avoidant Personality disorder

A

pervasive pattern of social inhibition, feelings of inadequacy, hypersensitivity to criticism shown by 4+ starting in early adulthood, many contexts

  • avoidance of occupational activities that might involve sig interpersonal contact, bc fears of criticism/disapproval
  • unwilling to get involved w ppl unless certain of being liked
  • restrained in intimate relationships bc fear of being shamed/ridiculed
  • preoccupation w being criticized or rejected
  • inhibited in new interpersonal situations bc feelings of inadequacy
  • views self as socially inept or inferior
  • unusually reluctant to try new activities bc may be embarrassing
31
Q

Etiology of Avoidant Personality Disorder (comorbidity)

A
  • High comorbidity w social anxiety disorder
    • related to Japanese syndrom claled tijin kyofusho (“interpersonal fear”)
  • high comorbidity w major depression
32
Q

Dependent Personality Disorder

A

excessive need to be taken care of, atleast 5+ beginning in early adulthood,

  • difficulty making decisions w/out excessive advice and reassurance from others
  • need for others to take responsibility for most major areas of life
  • Difficulty disagreeing w others for fear of losing support
  • difficulty doing things on own/starting projects due to lack of self-confidence
  • doing unpleasant things to obtain approval/support of others
  • feelings of helplessness when alone bc of fear of being unable to care for self
  • urgently seeking new relationship when one ends
  • preocc w fears of having to take care of self
33
Q

Obsessive-Compulsive personality disorder

A

Intense need for order and control shown by 4+ beginning in early adulthood in many contexts:

  • Preocc w rules, details, organization to extent that the point of an activity is lost
  • excessive devotion to work w exclusion of leisure and friendships
  • inflexibility about morals and values
  • difficulty discarding worthless items
  • reluctance to delegate unless others conform to ones standards
  • miserliness
  • rigidity and stubbornness
34
Q

Etiology of Obsessive-Compulsive Personality Disorder (comorbidity, difference btwn OCD)

A
  • OCPD differs from OCD
    • doesn’t have obsessions/compulsions
  • Most freq comorbid w avoidant PD
  • also can be comorbid w OCD, has some genetic vulnerability in common
  • less intp difficulties than other personality disorders
  • little research on etiology
35
Q

why might people w personality disorders seek treatment

A
  • for conditions other than their personality disorder
    • BPD may come in for substance abuse
    • Dependent Personality disorder may come in for Depression
  • Personality disorders predict slower improvement in psychotherapy
36
Q

treatment of choice for Personality disorders

A
  • psychotherapy- personality traits can be changed
  • focus on maladaptive cognitions
  • often supplemented w medication to quel impulsive or depressive symptoms
37
Q

some maladaptive cognitions of personality disorders

A

Avoidant- if people know the real me, they will reject me

Obsessive-compulsive personality- people should do better and try harder

narcissistic: I am better than others

antisocial: I am entitled to break rules

38
Q

treatment of Schizotypal PD

A
  • antipsychotic and antidepressent meds
39
Q

avoidant pd treatment

A
  • same treatment as social anxiety disorder
    • antidepressent meds
    • social skills training
    • cog behavioral
      • exposure
40
Q

antisocial/ psychopathy treatment

A
  • CBT or psychodynamic
41
Q

treatment of Borderline PD

A
  • Difficult to treat
    • intp probs play out in therapy
    • attempts to manipulate therapist
  • Medications
  • Dialectical Behavioral therapy
  • Transference- focused therapy
  • mentalization therapy
  • schema-focused cognitive therapy
42
Q

transference-focused therapy

A

(treatment of BPD)

  • emphasis on relationship to therapist, powerful feelings clients may develop towards therapist
  • consider parallels btwn response to therapist and other relationships
43
Q

mentalization therapy

A

(treatment of BPD)

  • focuses on helping client be more reflective about their own feelings + those of others
  • avoid acting automatically w/out thinking when emotions/intp stressors occur
44
Q

Dialectical Behavioral Therapy

A
  • acceptance and empathy plus CBT
  • emotion-regulation techniques
  • social skills training

concept of dialectics refers to tension between a phenomenon (thesis) and its opposite (antithesis), resolved by creating a new phenomenon (synthesis)
- dialectical tension btwn accepting client as is and helping them change

45
Q

four stages for dbt for BPD

A
  • first stage: addressing dangerously impulsive behaviors (suicidal)
  • second stage: modulating extreme emotionality and coaching client to tolerate emotional distress
  • stage three: improving relationships and self-esteem
  • promote connectedness and happiness
46
Q

medications- treating BPD

A
  • antidepressants
  • mood stabilizers
47
Q

schema-focused cognitive therapy

A

identify maladaptive assumptions that underlie cognitions

48
Q
A

Abnormal Psych (16 decks)

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