337 personality

Question 1

Big Five factors

Answer 1

• neuroticism (even-tempered vs. temperamental/moody)
• extraversion (talkative, assertive, active vs. passive, reserved, quieter)
• openness to experience (imaginative, curious, creative vs. hsllaow, imperceptive)
• agreeableness (kind, trusting, warm vs. hostile, selfish, distrustful)
• conscientiousness (organized, thorough, reliable vs. careless, negligent, unreliable)

Question 2

personality

Answer 2

• enduring pattern of perceiving, relating to the environment
• the range of responses one can generate in a situation (behaviour, affect, cognitions), the expression of personality traits vary depending on the situation
• temperament develops early and personality begins at 18 years old, both are relatively stable

Question 3

personality pathology

Answer 3

• rigidity in responses
• same traits, but people generate the same responses over and over without adapting to the situation

Question 4

DSM history of personality disorders

Answer 4

• introduced in DSM-III as longstanding maladaptive ways of relating to the world as opposed to more transient/phasic syndromes like MDD
• largely ignored until 1980 Axis II
• not conceptualized as diathesis-stress, but as part of your personality that happens gradually and interferes with how you operate in the world (range in severity)

Question 5

personality disorder

Answer 5

• enduring pattern of inner experience and behaviour that:
• deviates from cultural expectations (social value)
• pervasive and inflexible
• onset in adolescence or early adulthood
• stable over time
• leads to distress or impairment (can be to the individual or to others)

Question 6

Cluster A PDs

Answer 6

• odd/eccentric
• people who seem odd with unusual behaviour that ranges from eccentric detachment to extreme paranoia and withdrawal
• paranoid PD
• schizotypal PD
• schizoid PD
• least well-studied

Question 7

Cluster B PDs

Answer 7

• dramatic/emotional/erratic
• tendency to be dramatic and emotional, impulsive, antisocial behaviour, attract attention in social situations, often show up in treatment or referred legally
• antisocial PD
• borderline PD
• histrionic PD
• narcissistic PD

Question 8

Cluster C PDs

Answer 8

• anxious/fearful
• present like anxiety disorders
• avoidant PD
• dependent PD
• obsessive-compulsive PD
• avoidant and dependent have fears and anxieties as primary features, OCPD has rules and orderliness (not as much anxiety)

Question 9

prevalence of PDs

Answer 9

• 4-15% in gen pop (lots of variability depending on population and study)
• higher rates in inpatient settings
• high rates of comorbidity with other PDs (the norm) and major disorders (mood, anxiety, substance use)

Question 10

controversies about PDs

Answer 10

• is there a difference between Axis I and II disorders in terms of distress, phasic/stable patterns?
• are personality disorders a difference in degree or in kind?
• how can one be diagnosed with 2+ PDs if we only have one personality - suggests that are categories might not be appropriate

Question 11

problems with assessment of PDs

Answer 11

• insight: person lacks good insight, but how do you decide which informant to interview
• informant reports tend to vary, which informant is best, use of informants still rare in clinical practice
• current mood states can exacerbate PD symptoms (people come in for Tx when they’re distressed)
• using different instruments can result in different diagnoses
• categorical inter-rater reliability is good, but test-retest is weak (perhaps not as stable as we think)
• PDs can be successfully treated (again, not as stable as we think)

Question 12

hybrid dimensional-categorical model

Answer 12

• PDs as an extreme constellation of traits that are each along a continuum
• proposed as a revision in DSM-5 but rejected
• Five Factor model = almost all disorders are high in neuroticism (may not be specific enough for PD functioning), designed for normal populations and may not translate to clinical
• Five Factor model works well for some PDs like BPD, histrionic, dependent, OCPD but not for others like schizoid and schizotypal

Question 13

proposed revision for DSM-5

Answer 13

• keep antisocial, avoidant, borderline, narcissistic, obsessive-compulsive, schizotypal
• eliminate dependent, histrionic, schizoid, paranoid because of a lack of research about them (correlates, prevalence)

Question 14

gender and cultural diagnosis issues

Answer 14

• potential for misdiagnosis based on clinician’s perspective (few behavioural indicators in symptoms, no discrete time period which makes behaviours very context-dependent)
• clinicians reluctant to diagnose women with antisocial, men with histrionic (aggression in ASPD may be expressed differently in men and women based on culture, histrionic explicitly gendered)
• BPD appears to manifest differently in men and women (more diagnosed in women)
• more men have dx of psychopathy than women despite being in prison for the same crimes

Question 15

comorbidity and diagnostic overlap in PDs

Answer 15

• people with diagnoses for BPD are likely to also meet criteria for avoidant and histrionic
• antisocial has symptom overlap with schizoid and narcissistic (cluster B disorders conceptualized very similarly to each other)
• high comorbidity with major disorders (avoidant/dependent = anxiety and depression, BPD = unipolar and bipolar, PTSD, ASPD/BPD/NPD = SUD, avoidant = eating disorders, OCPD = anorexia, binge eating)

Question 16

diagnostic heterogeneity

Answer 16

• different combinations can result in very different presentations
• BPD: more affective profile (unstable relationships, impulsivity, suicidal bx, affective instability, anger problems) vs. avoiding abandonment, unstable relationships, identity disturbance, emptiness, paranoia

Question 17

PDs as interpersonal disorders

Answer 17

• problems seem to arise primarily from problems with interpersonal relationships
• may have secondary anxiety, depression but these arise from problematic ways of interacting with the world
• ‘difficult patients’ because their problematic interactions extend to how they engage with the therapist
• people do have these longstanding problems, which makes PDs very clinically compelling

Question 18

paranoid PD

Answer 18

• pervasive suspiciousness
• tendency to see self as blameless
• on guard for perceived attacks by others
• will have a lot of conflict with others, looking for others to blame
• more commonly diagnosed in men
• some genetic overlap with psychosis and schizophrenia; primary difference is severity (paranoia vs. delusion)
• overlap with avoidant and BPD

Question 19

schizoid PD

Answer 19

• near total lack of interest in intimate involvement with others (no social skills, no desire to obtain them)
• limited emotional responsiveness (rarely experience intense emotions and don’t understand them in others)
• perceived as cold, indifferent (‘loners’)
• diagnostic overlap with schizotypal
• related to asocial disorders (like autism, but in autism people have a desire for social contact)

Question 20

schizotypal PD

Answer 20

• cognitive and perceptual distortions
• eccentricity of thought or speech (odd beliefs, odd speech, magical thinking like clairvoyance or telepathy, ideas of reference)
• contact with reality is maintained
• has paranoid features and tendency toward social isolation (people perceive them as weird)
• overlap with schizophrenia (difference in degree of severity - not delusional), similar lab testing (eye tracking, working memory, inhibiting attention), familial co-aggregation
• could be prodromal schizophrenia (teens with schizotypal are at increased risk for schizophrenia)

Question 21

histrionic PD

Answer 21

• highly dramatic, lively, extraverted
• high excitement seeking, low self-consciousness
• preoccupation with appearance
• irritability and temper outbursts if attention seeking is frustrated
• almost exclusively women, but if using a checklist, you don’t see the same sex differences
• prevalence 2-3%
• tend to be attractive to other people, but have difficulty maintaining stable relationships
• tend to be sexually provocative (seeking closeness)
• overlap with NPD (seeking to be the center of attention), but histrionic have greater capacity for building relationships
• often comorbid with BP - predicts poorer course of BP

Question 22

narcissistic PD

Answer 22

• grandiosity
• preoccupation with receiving attention
• self-promoting, lack empathy, easily offended
• highly variable clinical presentation (there could be two subtypes)
• vulnerable subtype (masking criticism and self-doubt, self-loathing, more withdrawn) and grandiose subtype (grandiose, extraverted)
• lack of empathy and grandiosity unites all presentations
• overlap with BPD, histrionic, ASPD
• hypercritical and retaliatory if not validated - male students were more likely to engage in sexual aggression when rejected
• prevalence less than 1%, could be more present in males (or diagnostic bias with histrionic for females)
• grandiose subtype associated with parental overvaluation
• vulnerable subtype associated with abuse, cold and controlling parents

Question 23

avoidant PD

Answer 23

• avoiding interpersonal contact (extreme sensitivity to criticism and disapproval)
• avoiding intimacy even if they desire it
• extreme loneliness, low self-esteem, excessive self-consciousness
• view themselves as socially inept and inferior
• contrast with schizoid: want interpersonal contact, more emotionally expressive
• DDx with SAD (substantial overlap, but you can find SAD without avoidant but rare to find avoidant without SAD)
• shared genetic vulnerability with SAD (fear of evaluation is heritable, distinct diagnoses may not be necessary)

Question 24

dependent PD

Answer 24

• inability to function independently (fearful, clingy, submissive)
• submissive role in relationships, passivity (allowing others to take control of many aspects of their lives like clothes, hair, etc.)
• difficulty expressing disagreement
• go to extreme lengths to please people
• feel vulnerable and useless when alone
• overlap with separation anxiety, also BPD
• may be more likely to be involved in abusive relationships
• see higher rates of depression in male relatives of proband with dependent PD, and higher rates of panic in female relatives
• more prevalent in individualistic cultures (prizing independence)

Question 25

obsessive-compulsive PD

Answer 25

• inflexibility and desire for perfection
• preoccupation with rules and order
• often moralistic and judgmental
• viewed as rigid, stubborn, cold
• reluctance to delegate, more cheap/reluctant to throw things out
• one of the oldest disorder concepts, but very limited research since 1980
• very little overlap with OCD, about 20% (no obsessions or rituals, no distress, egosyntonic)
• OCD more likely to be comorbid with avoidant or dependent PD
• perfectionism, hoarding, preoccupation with details are common features with OCPD and OCD
• OCPD more common in men than OCD

Question 26

takeaways from Clark paper

Answer 26

• personality generally thought of as stable and unchanging (and it is fairly stable after your 20s)
• PD diagnostic change is larger when measuring categorically (but changes still seem to be due to decreasing pathology)
• PD improvement is more likely to lead to improvement in comorbid major disorders, not the other way around
• acute criteria (willingness to interact with people) are what make PD manifestations less stable because they respond to Tx and diminish with maturation or stress resolution
• longer-term maladaptive characteristics are more stable (level of social inhibition)
• persistent dysfunction in PDs may be because the traits are very extreme, so it naturally takes them longer to stabilize