Chapter 12: Personality Disorders Flashcards
(166 cards)
1
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Personality
A
Captures patterns of acting, thinking, and feeling that characterize a given individual and distinguish that person from others
1
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Personality traits
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Reflect aspects of our behaviour that are relatively consistent across time and situations
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Neuroticism
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Captures the degree to which an individual is prone to experiencing unpleasant emotions like anxiety, sadness, and fear
3
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Extraversion
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captures the extent of a person’s preference for social interactions vs solitary activity
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Openness to experience
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Captures how curious an individual is and how receptive they are to new ideas, approaches, and events
5
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Conscientiousness
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Taps propensity for organization, punctuality, and achievement motivation
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Agreeableness
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Reflects individual differences in people’s preferences for co-operation and social harmony
7
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Five Factor Order (FFM)
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OCEAN example
8
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Dimensional Networks
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Founded on the premise that personality traits are continuously distributed in populations and personality pathology reflects extreme variants of typical personality traits
9
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Categorical approach
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The diagnostic approach taken by the DSM, in which an individual is deemed either to have a disorder or not have a disorder
10
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Polythetic Criterion set
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An individual may be diagnosed with only a certain subset of symptoms without having to meet all criteria
11
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PD unspecified Personality Disorder
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-More commonly applied than any other PD Diagnosis, indicating that most of the people suffering personality pathology do not neatly fit into the categorical presentations outlined in the DSM
12
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Limitation of the current categorical model is that polythetic criterion sets yield heterogenous groups
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BPD (Bipolar personality disorder) diagnosis requires presence of any 5/9 possible symptoms
13
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Personality disorders are maladaptive and enduring pattersn(s) of behaviour defined by 6 general criteria
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Criteria A: Behavioural patterns must manifest in at least two of the following areas= cognition, emotions, interpersonal functioning, or impulse control
Criteria B: Such patterns must be rigid and consistent across a broad range of personal and social situations
Criteria C: Patterns should cause clinically significant distress in social, occupational, or other important areas of functioning
Criteria D: Symptoms must be stable and of lengthy duration, with onset in adolescence or earlier
Criterion E: Behavioural patterns cannot. be accounted for by another mental disorder
Criterion F: Patterns are not due to acute substance use (drugs or alcohol) or of another medical condition
14
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Personality Disorders are organized in 3 clusters
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Cluster A: Odd or eccentric features and includes paranoid, schizoid, and schizotypical PDs
Cluster B: Dramatic, emotional, or erratic features) includes antisocial, borderline, histrionic, and narcisstic PDs
Cluster C (anxious or fearful features) consists of avoidant, dependent, and obsessive compulsive PDs
15
Q
Personality Disorders
A
-Paranoid personality disorder
-Schizoid personality disorder
-Schizotypal personality disorder
-Antisocial, etc
16
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Paranoid personality
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disorder is defined by a pattern of distrust and suspiciousness such that others’ motives are interpreted as malevolent.
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Schizoid personality disorder
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is defined by a pattern of detachment from social relationships and a restricted range of emotional expression.
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Schizotypal personality disorder
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is a pattern of acute discomfort in close relationships, cognitive or perceptual distortions, and eccentricities of behavior.
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Antisocial personality disorder
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is a pattern of disregard for, and violation of, the rights of others.
20
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Borderline personality disorder
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is a pattern of instability in interpersonal relationships, self-image, and affects, and marked impulsivity.
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Histrionic personality disorder
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is a pattern of excessive emotionality and attention seeking.
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Narcissistic personality disorder
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is a pattern of grandiosity, need for admiration, and lack of empathy.
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Avoidant personality disorder
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is a pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation.
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Dependent personality disorder
is a pattern of submissive and clinging behavior related to an excessive need to be taken care of.
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Obsessive-compulsive personality disorder
is a pattern of preoccupation with orderliness, perfectionism, and control.
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Personality change due to another medical condition
is a persistent personality disturbance that is judged to be due to the direct physiological effects of a medical condition (e.g., frontal lobe lesion).
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Other specified personality disorder and unspecified personality disorder is a category provided for two situations:
(1) the individual’s personality pattern meets the general criteria for a personality disorder, and traits of several different personality disorders are present, but the criteria for any specific personality disorder are not met; or (2) the individual’s personality pattern meets the general criteria for a personality disorder, but the individual is considered to have a personality disorder that is not included in the DSM-5 classification (e.g., passive-aggressive personality disorder).
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Personality change due to another medical condition
Captures persistent personality disturbance that results directly from a medical condition (eg traumatic brain injury) or known organic cause
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Base rates
A statistic used to describe the percentage of a population that demonstrates some given characteristic
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Etiology Factors
Factors that influence or promote the development of a disease
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DSM is "etiologically agnostic"
meaning that the manual largely describes pathological presentations without sufficiently addressing risk and vulnerability factors
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Much research is based on
Research conducted with relatively restricted groups
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PDs are culturally relative
Means that the functions and acceptability of various behaviours that vary by culture, rather than being universal truths; as such, an individual's beliefs and activities should be understood in terms of their own age
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Demographic factors can bias PD diagnosis:
member of marginalized groups, racialized groups, or BIPOC communities are both under and over diagnosed
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Suspiciousness is a key
Feature of paranoid PD
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Cluster A: Odd and Eccentric Disorders
Includes paranoid, schizoid, and schizotypal personality disorder
-The DSM presents each as a distinct condition, yet all involve unusual and eccentric patterns of thinking and behaviour that often lead to social problems
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Ecological Momentary Assessment (EMA)
A research method where participants are surveyed multiple times during a short window (single day) for a sustained period (eg weeks) during their daily life
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Paranoid PD features are strongly associated with
Cognitive difficulties
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Schizoid traits
Associated with blunted affect and lack of caring relationships
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Schizotypal traits
Are most associated with poor social functioning
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Schizotypal and paranoid PD are associated with
Negative affect, paranoid symptoms, and psychotic like experiences
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Schizotypal PD
is the only disorder categorized as both a PD and schizophrenia spectrum disorder in the DSM
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Paranoid personality disorder
Translates to "out of one's mind"
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Initially paranoid is a person
Exhibiting suspiciousness, hostility, and systemized delusions
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Systemized delusions
Are logical and coherent, yet based on false grounds (beliefs that are highly improbable but not impossible)
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PPD
Characterized by patterns of pervasive mistrust, suspiciousness, resentment of others
They are hypersensitive to interpersonal cues, assume innocuous stimuli- have a special meaning for them (self referential thinking) and are inclined to interpret others' motivations as spiteful or malevolent
-hypervigilance, where persons with paranoid ideation are inclined to attribute negative events to outside sources—specifically to other people
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Suspiciousness factor
(1) global suspicion of harm, exploitation, or deception from others without sufficient basis; (2) preoccupation with unjustified doubts of loyalty or trustworthiness of friends or associates; (3) reluctance to confide in others due to unwarranted fear that disclosed information will be used against them; and (4) perceiving benign remarks or events as carrying hidden threats or demeaning meaning.
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Hostility factor captured
(1) persistently bearing grudges; (2) perceiving attacks on one’s character or reputation that are not apparent to others, and being quick to counterattack or react aggressively; and (3) recurrent unjustified suspicions of infidelity from a romantic or sexual partner.
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Deficits in cognitive-affective information processing
may constitute one pathway to PPD development
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Children maltreatment is associated with hostile attribution
meaning maltreated children may be more to erroneously interpret neutral interpersonal cues as hostile, and respond aggressively
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Youth with PPD
more likely to initiate fight, less cooperative, and less likely to be leaders
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Key feature of many psychiatric conditions
Paranoia
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Delusional disorder with a specified persecutory type
Is characterized by systemized delusions that involve themes of others cheating, conspiring against, or having harmful or malicious intent toward the affected individual
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Schizotypal personality disorder
Experience of paranoia
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PTSD and paranoia
Each involves hyper vigilance and pervasive feelings of being under threat
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Many people with PPD are reluctant
to present for treatment due to symptoms of mistrust
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Schizoid personality disorder divided into three categories
schizoid personality disorder, schizotypal personality disorder, and avoidant personality disorder
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Schizotypal PD
took on symptoms related to eccentricity,
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Avoidant PD
those associated with avoidance and sensitivity.
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Social Isolation
remained a core feature of both schizoid and avoidant PD
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Schizoid PD and isolation
to be driven by disinterest in interpersonal relationships
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Social Withdrawal in avoidant PD
hypothesized to result from fear of rejection or negative evaluation.
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Schizoid PD
defined by detachment, withdrawal from social relationships, and a restricted range of emotional expression in social settings
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At least four of the seven symptoms are required for diagnosis
1) no desire or enjoyment of close relationships, including family; (2) indifference to praise or criticism from others; (3) little to no interest in having sexual experiences with others; (4) almost always choosing solitary activities; (5) lack of close friends/confidants other than first-degree relatives; (6) displaying emotional coldness, detachment, or flat affect; and (7) taking pleasure in few, if any, activities
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Schizoid PD
having reduced sensitivity to pleasure from bodily, sensory, or interpersonal experiences, and claims affected individuals prefer mechanical or abstract tasks (e.g., computer or mathematical games
-may appear socially inept and aloof
-difficulty picking up interpersonal cues, rarely reciprocating social gestures (e.g., facial expressions or nods), and displaying a constricted range of emotional expressions
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Schizoid PD and other conditions
rarely occurs in the absence of another psychiatric condition— particularly other PDs
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PPD and ASPD
schizoid PD symptoms are positively associated with violent behaviour
predict recidivism among incarcerated individuals
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Social symptoms that define schizoid PD
are common to a number of other clinical (e.g., depression, PPD, avoidant PD; APA, 2013) and non-pathological presentations (e.g., reduced sexual interest among persons identifying as asexual
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Schizoid symptoms
may reflect a mild form of schizotypal PD,
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Treatment and schizoid PD
are unlikely to seek intervention
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Schizotypal Personality Disorder original called
dementia praecox, early accounts describe schizotypal features as odd or unconventional behaviours
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Schizotypal PD
is characterized by patterns of eccentric behaviour (e.g., unusual mannerisms), cognitive and perceptual distortions (e.g., believing in clairvoyance, hearing a voice whispering one’s name), and impaired interpersonal functioning
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Schizotypy
A person with the genetic liability for schizophrenia, but who may or may not progress to the full blown psychotic illness
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Schizotypal PD diagnosis
requires at least five of nine possible symptoms, beginning by early adulthood
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Psychotic disorders
are characterized by persistent psychotic episodes
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Schizotypal PD
associated with transient psychotic symptoms (lasting minutes to hours) that are lower in severity and frequency
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Schizotypal is grouped into three dimensions of functioning
cognitive and perceptual (similar to positive symptoms of schizophrenia), interpersonal (overlapping with negative symptoms of schizophrenia), and disorganization
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DSM-5 diagnosis
(1) non-delusional ideas of reference, (2) odd beliefs and magical thinking, (3) paranoia, and (4) unusual perceptual or somatic experiences
-Odd beliefs and magical thinking may manifest as being extremely superstitious or believing in telepathy. Paranoia may express as unsubstantiated fears of others having harmful intentions, and unusual perceptual or somatic experiences may involve seeing, hearing, or feeling sensations that others cannot
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Adaptive manifestations of cognitive and perceptual schizotypal PD symptoms are sometimes referred to as
benign or positive schizotypy
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Schizotypal PD is primarily characterized by
interpersonal deficits and disorganization
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Interpersonal symptoms include
paranoia and (1) lacking close friends outside one’s immediate family, (2) persistent social anxiety even with familiarity (usually due to paranoia rather than fear of judgment), and (3) constricted or inappropriate affect
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Constricted affect in schizotypal PD
is thought to be characterized by aloofness and restricted affective expression
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Disorganized symptoms
include (1) odd/eccentric behaviours and appearance and (2) odd thinking/speech (Schultze-Lutter et al., 2019). Odd behaviours and appearance may manifest as unusual mannerisms (e.g., excessively avoiding eye contact) and unconventional attire (e.g., poorly fitting clothes with ink stains; APA, 2013), whereas odd speech may manifest as a vague, metaphorical, or excessively elaborate communication style.
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Factors that are associated
-Genetic factors
-both over- and underactive dopaminergic activity appear uniquely associated with schizotypal symptoms. Specifically, the Valine/Valine genotype is associated with low dopamine levels in the prefrontal cortex and is linked to negative and disorganized schizotypal symptoms. Hyper-dopaminergic activity is associated with cognitive-perceptual schizotypal features
-Trauma and stress
-Childhood sexual abuse= strongest association with cognitive perceptual symptoms
-Severe emotional neglect= interpersonal symptoms
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Schizotypal PD are at a greater risk to develop
Schizophrenia
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Treatment
-Antipsychotics
-Anxiety and paranoia appear most responsive to psychotropic medication among schizotypal PD samples
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Cluster B includes
includes antisocial, borderline, histrionic, and narcissistic personality disorders
=dramatic, overly emotional, or erratic
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Antisocial Personality Disorder (ASPD)
is characterized by a pervasive pattern of disregard for, and violation of, other persons’ rights
-broad higher-order class of externalizing psychopathology, alongside other forms of psychopathology that share features like aggression, low frustration tolerance, and behavioural disinhibition
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Externalizing Psychopathology
A broad class of psychopathology that captures disorders and clinical problems involving aggression, low frustration tolerance, and behavioural disinihibition. Externalizing problems tend to cause issues for others surrounding the affected person.
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ASPD symptoms include
problems conforming to social norms, engaging in unlawful behaviours, deceitfulness, impulsivity, irritability, and physical aggression
-display disregard for their own safety and/or the safety of others, consistently engage in irresponsible behaviour (e.g., failing to meet financial obligations), and present without remorse for their wrongdoings
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Criminal Offending and ASPD
elevated engagement with the justice system may arise as a consequence of ASPD features (e.g., callous disregard for others, impulsivity, and poor self-regulation).
-Lack remorse for wrongdoings or display indifference when having hurt or mistreated another person
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ASPD is conflated with psychopathy
A constellation of personality traits and temperaments that lead to antisocial behaviour, callousness, and grandiosity combined with poor self-regulation.
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Descriptions of psychopathy focus heavily on callous unemotional personality traits
(e.g., superficial charm, callousness, shallow affect, lack of empathy or guilt) and fearlessness
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ASPD is more likely to be diagnosed among
Men compared to women
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ASPD commonly co occurs with other disorders
including substance use disorders, major depression, ADHD, anxiety disorders, and other Cluster B PDs
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ASPD features must begin in
Childhood or early adolescence
-individuals must show evidence of conduct disorder (CD) with onset prior to the age of 15 (APA, 2013). CD is characterized by similar, albeit less severe and pervasive, antisocial features as seen in adult ASPD
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A number of dispositional characteristics
-(e.g., disinhibition, impulsivity, negative emotionality) appear to predispose individuals to antisocial behaviours
-Negative affectivity is the dispositional tendency to experience negative, unpleasant affective states (e.g., anger, anxiety, fear, disgust), and is associated with a range of mental disorders, including ASPD
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ASPD and heightened emotional reactivity to threat
may prompt aggressive and impulsive responses
-display low levels of emotional reactivity in response to threat, and low autonomic arousal- a physiological marker of fearlessness
-high threshold for detecting threat and experiencing fear, which may underlie their proclivity for risky behaviours, poor anticipation of negative consequences, and, especially, callous disregard for others’ rights
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Proposed treatment guidelines include
group-based CBT and cognitive programs used in criminal rehabilitation (i.e., reasoning rehabilitation and enhanced thinking skills).
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Randomized Controlled Trials
Provide some preliminary support for the efficacy of CBT and mentalization-based therapy, and schema therapy among this population
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Borderline Personality Disorder
extreme interpersonal sensitivity, difficulty modulating intense emotions, and aggressive, impulsive, or self-defeating behaviours
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Disorder has high rates of self inflicted injury
Intentional self-inflicited bodily harm.
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Functional Impairment
is often so severe among this population that many require public assistance, such as support from psychiatric disability
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BPD Criteria
(1) frantic efforts to avoid real or imagined abandonment (e.g., holding on to someone to prevent them from leaving, begging for another person to stay, repeatedly calling or texting another person); (2) a pattern of unstable and intense interpersonal relationships characterized by alternating idealization and devaluation (i.e., shifting between holding a person in very high esteem and very low esteem); (3) markedly and persistently unstable self-image or sense of self; (4) impulsivity in at least two areas that are potentially self-damaging (e.g., excessive spending, reckless driving, substance use, unsafe sexual behaviour, or binge eating); (5) recurrent deliberate self-injurious behaviours and/or threats of suicide; (6) affective lability and marked mood reactivity (e.g., frequent, intense, and rapid emotional responses that are maladaptive for the individual); (7) chronically feeling empty; (8) inappropriate and intense anger or difficulty controlling anger (e.g., regular displays of temper by yelling, throwing objects, slamming doors, and/or recurrent physical fights); and, finally, (9) transient, stress-related paranoid ideation or severe dissociative symptoms (e.g., feeling unreal, losing one’s sense of time).
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Functional Impairment
Limitations a person experiences due to their illness, as people with a disease may not carry out certain social and occupational functions in their daily lives.
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Affective Lability
Exaggerated changes in mood or affect in quick succession.
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BPD and relationships
behaviours that pose significant challenges to others
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BPD is associated with
Frequent visits to emergency, primary care, inpatient, and outpatient psychiatric care settings
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BPD arrises from complex interactions
between individual-level vulnerabilities and environmental risk factors that result in core dysfunctions in self-regulation
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Biosocial theory proposes that BPD emerges
-emotionally vulnerable youth being raised in an invalidating caregiving environment
-invalidating environments haphazardly punish emotional expressions while intermittently reinforcing extreme emotional displays—each of which disrupts youth acquisition of self-regulatory skills
-Invalidation often amplifies negative emotionality and teaches the child to ignore and mistrust their own emotional experiences and responses.
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BPD co occurs at an
elevated rate with attention deficit/hyperactivity disorder, anxiety, depression, ASPD, and substance use disorders
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Treatment and BPD
Client dropout and intervention failure were incredibly common, with the vast majority of clients receiving outpatient treatment from an average of six different therapists
-Dialectical behaviour therapy (DBT), mentalization-based treatment (MBT), and transference-focused psychotherapy (TFP) are the most commonly used evidence-based approaches for BPD
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DBT
comprehensive outpatient treatment developed for adults with BPD and repetitive SII
-includes weekly individual therapy and skills-based group sessions where clients learn mindfulness skills, emotion regulation skills, distress tolerance skills, and interpersonal skills. Between sessions clients may contact their therapists for brief skills-focused coaching calls to help generalize what they are learning in therapy to their daily life.
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MBT and BPD
attempts to improve “mentalizing,” or the ability to understand one’s own and others’ internal states
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In outpatient MBT
clients typically attend one individual and one group therapy session per week. TFP operates on the assumption that the therapeutic relationship and making observations/interpretations about client-therapist interactions can help address interpersonal dysfunction and identity-related
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Histrionic personality disorder (HPD)
is poorly understood and remains less studied than most PDs
-pervasive patterns of exaggerated emotional expressions and excessive attention-seeking behaviours
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HPD diagnosis
requires significant functional impairment and at least five of the following eight symptoms: discomfort when not the centre of attention; inappropriate seductive or provocative behaviours; shallow and rapidly shifting emotional expressions; frequent use of physical appearance to draw attention to oneself; vague and impressionistic style of speech; dramatic, theatrical, and exaggerated emotional expressions; easily suggestible; and considering relationships to be more intimate than they are
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HPD and interpersonal relationships
experience difficulty developing and maintaining interpersonal intimacy, and tend to perceive relationships as being more intimate than they are
-Sexually seductive behaviours in socially inappropriate contexts
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Women and HPD
report more persistent thoughts about sex, lower sexual desire, less frequent initiation or refusal of a sexual act, and endorse fewer steps taken to prevent pregnancy
-lower confidence in relating sexually to others and are more likely to experience negative attitudes toward sex, experience orgasmic dysfunction, and have an extramarital affair
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HPD and attention seeking
individuals with HPD show a strong desire for, and tendency to seek out, the attention of others—often using physical appearance
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HPD and etiology factors
is likely influenced by transactions between multiple risk and vulnerability factors
-Genetic factors
-Trauma and parenting practices
-Substance use disorders
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Treatment and HPD
functional analytic psychotherapy (a therapeutic approach using behavioural principles like shaping through positive reinforcement to treat presenting problems
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Narcissism
descriptions of a narcissistic personality centred on grandiosity, arrogance, and aggression, whereas Kohut (1966) emphasized shame, depression, and low self-esteem.
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Narcissism and diagnosis
grandiose sense of self-importance, preoccupation with success and power, exhibitionism, cold indifference or anger in response to criticism, entitlement, exploitativeness, inability to empathize with others, and a pattern of relationships characterized by extreme shifts in idealization and devaluation
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Other criteria for NPD
The most essential features are maintaining a grandiose sense of self-importance, a need to be admired by others, and a lack of empathy (APA, 2013). Other criteria include beliefs that one can only be understood by other high-status individuals, beliefs of entitlement, exploitation of others for personal gain, frequent and intense feelings of envy, and preoccupation with ideas of success (e.g., power, beauty, wealth;
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NPD is associated with
impaired intra- and interpersonal functioning, yet certain individuals are remarkably successful in professional and/or social arenas
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NPD has two primary presentations
Grandiose and vulnerable
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Grandiose presentation can be further divided into
an extraverted dimension (admiration-seeking) and an antagonistic dimension (rivalry-seeking
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Vulnerable NPD presentation
presentation is thought to capture individuals with less overtly grandiose behaviours, hypersensitivity to negative evaluations, and more co-occurring internalizing symptoms
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Most well symptoms of NPD
lack of empathy and grandiose sense of self-importance.
-believe they are less skilled at perceiving and accurately identifying others’ mental states
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Individuals and Facial emotion recognition tasks
Perform poorly on these tasks
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NPD is also characterized by
a grandiose sense of self-importance—often expressed as bragging about personal achievements
-both highly motivated to maintain grandiose self-evaluations and particularly sensitive to feedback that threatens such beliefs (e.g., social rejection
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In response to failure, individuals with grandiose NPD
features may use strategies to preserve their positive self-image, such as diminishing the importance of their failure and avoiding responsibility
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NPD
also demonstrate excessive concern with achieving success and power in various life domains
-High achieving, high socioeconomic status, hold high status jobs, and are in supervisory roles
-regard themselves as superior and of higher status compared with their peers
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Persons with NPD
May both selectively seek out opportunities for relationships with high status individuals and exhibit antagonism or hostility toward persons they consider socially or professionally superior
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Association between narcissism
and intentionally changing one’s own affective expression to influence others’ actions or emotional responses (e.g., “I can simulate emotions to make others feel guilty”
-Often associated with elevated prosocial behaviours
-They experience significant interpersonal problems
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Narcissism is also linked to
parental coldness, invalidation, and making excessive, developmentally inappropriate demands
-Propose that excessive praise and criticism may each lead children to rely on external sources for validation
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Cluster C
avoidant, dependent, and obsessive-compulsive personality disorders. Anxiety is a central feature in each condition.
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Avoidant Personality Disorder
is characterized by maladaptive avoidance of social experiences, driven by perceptions of inadequacy and extreme sensitivity to negative evaluation and rejection
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Bleuler and APD
He believed avoidance stemmed from a tendency to overstimulated by the outside world and that individuals would engage in reclusive behaviours to prevent intense negative affective
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APD
hypersensitivity to rejection, unwillingness to develop social relationships, social withdrawal, desire for affection and acceptance, and low self-esteem
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Schizoid PD vs APD
Although both disorders involved social avoidance, individuals with schizoid PD lacked a fundamental motivation and desire to connect with others, whereas APD is marked by an unmet desire for social affection and acceptance
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APD and other facts
avoidance of occupational activities for fear of criticism or rejection, restraint in intimate relationships for a similar fear of being criticized or ridiculed, and unwillingness to connect with others unless there is a certainty of being liked (APA, 2000). Other criteria describe impairments in self-related functioning, such as a preoccupation with fear of rejection, inhibition in new social situations due to feelings of inadequacy, negative self-views (i.e., believing oneself is inferior or socially inept), and reluctance to take personal risks for fear of embarrassment
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APD entails an interpersonal disorder
associated with impairment in major life domains
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Primary feature of APD is extreme social avoidance
Studies consistently find that individuals with APD report interpersonal distress and poor social functioning
-also tend to be colder, more submissive, and possibly less assertive in their social interactions—although support for the latter finding is mixed
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Other core features of APD
Anxiety, fear, and low self-esteem
-Underlie behavioural avoidance and inhibition
- trait anxiety is more closely tied to APD pathology than avoidance of social intimacy
-Individuals with APD may still possess a desire to be connected to others
when alone, individuals experienced even greater anxiety, a heightened sense of rejection, and feelings of isolation
-individuals with APD are not necessarily satisfied with being alone, rather, they find it anxiety-provoking to be close to others.
-Feelings of inadequacy, inferiority, and low self-esteem plague persons with APD
-Intense fear of being laughed at (gelotophobia)
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Co occurence and ADP
associated with greater severity of social phobia symptoms, worse interpersonal problems, and general functional impairment
147
Treatment of CBT
typically targets maladaptive beliefs and incorporates social skills training as well as behavioural experiments to challenge fears
-Group CBT has demonstrated efficacy with improving fears of negative evaluation and provides unique opportunities for social interaction among individuals with APD
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Dependent personality Disorder
dependency captures relying on others for nurturance, support, and guidance
-Hold persistent intense desires to be cared for by others
-characterized by submissive attitudes and behaviours, extreme reliance on others, and maladaptive pursuits of interpersonal connection
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Behavioural features of DPD
include physically clinging to others, frequent reassurance-seeking, and inappropriate bids for help (e.g., asking others to make everyday decisions on one’s behalf; APA, 2013). Some researchers suggest these behaviours are motivated by underlying fear of abandonment
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Freud and DPD
description of dependency in his theory of psychosexual development and attributed these problems to disrupted parent/infant interactions
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DPD and three broad criteria
overreliance on others to make decisions on one’s behalf, or passivity in relationships (e.g., making few demands of others); prioritizing others’ needs over one’s own in a subservient way; and a lack of self-confidence
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DPD and symptoms
(1) difficulty making everyday decisions without others’ guidance or reassurance; (2) needing others to assume responsibility over most major life areas; (3) difficulty expressing disagreement with others for fear of losing support; (4) difficulty taking initiative due to low self-confidence; (5) extreme motivation to obtain support and nurturance from others; (6) feelings of discomfort or helplessness when alone; (7) immediately seeking out a new relationship when others end; and (8) consistent fear of being left by another to take care of oneself
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Two main types of maladaptive dependency
submissive (characterized by difficulty making decisions and fearfulness), and exploitable, characterized by a desire to please others and avoid conflict
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DPD co occurs with a range of psychopathology
including mood, anxiety, personality, and eating disorders (particularly bulimia nervosa;
-Appears to most frequently accompany panic disorder, social phobia, and OCD
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Causes and DPD
highlights parenting style as a potential source of risk. Attachment theory has heavily influenced DPD literature
- found attachment anxiety (defined as sensitivity to, and worry about, rejection and relationship loss) was moderately correlated with DPD features in a clinical sample
156
Treatment and DPD
individuals with DPD and other Cluster C personality disorders show greater treatment progress when receiving short-term care
-Two RCTs indicate a humanistic-experiential approach called clarification-oriented psychotherapy (COP) is efficacious for reducing maladaptive DPD traits and increasing self-efficacy
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Obsessive Compulsive Personality Disorder
Freud’s conceptualization of anal-retentive personality was defined by patterns of pathological orderliness, stinginess, meticulousness, and stubbornness. The unusual name reflects Freud’s etiological theory. He believed that the underlying pathology for this personality type arose from problems navigating potty-training during the anal stage of his developmental model, where a child would literally retain their stool in order assert control over their parent
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OCPD
-primarily characterized by patterns of perfectionism and preoccupation with control and orderliness
-often rigidly adhere to rules/procedures and take great pains to avoid mistakes. Persons suffering from this condition frequently complete tasks with painstaking care, getting lost in trivial details, and repeatedly scan for possible mistakes. Affected individuals may fail to meet deadlines due to maladaptive efforts to meet perfectionistic standards. Persons with OCPD tend to be extremely critical of their own and others’ mistakes, and may have difficulties forming close relationships due to excessive devotion to work and productivity.
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DSM-5-TR and OCPD criteria
(1) preoccupation with details, rules, order, lists, organization, or schedules to the point that the main purpose of the activity is lost; (2) perfectionism that interferes with task completion; (3) excessive devotion to work and productivity to the point of excluding leisure activities and friendships (not accounted for by economic necessity); (4) excessive conscientiousness, scrupulousness, and inflexibility regarding values, morality, and ethics (not accounted for by culture or religion); (5) unwillingness to discard worn-out or worthless objects, including objects without sentimental value; (6) reluctance to delegate tasks or work with others unless they completely adhere to the individual’s own way of doing things; (7) extreme frugality with ones’ own and others’ money; and (8) rigidity and stubbornness.
(need at least 4/8 symptoms).
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OCPD and etiology
-Family environment
-Freud theorized that anal-retentive personality resulted from issues involving premature, punitive, and/or extremely strict toilet training. Later psychoanalytic theories focused more broadly on psychosocial factors during early development
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Comorbidity rates between OCPD and OCD are very high
22.9% and 47.3%
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Symptoms of OCPD are presumed to be
Lack of emotional responsiveness to events or situations that would normally elicit a strong negative emotional response such as heightened anxiety or depression.
-They do not view their symptoms as problematic
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OCD is egodystonic
Means that these people are distressed by their symptoms
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Difference between OCPD and OCD
individuals with OCPD do not appear to experience obsessive symptoms and demonstrate greater capacity to delay rewards compared to those with OCD (Pinto et al., 2014). Thus, obsessions appear to be specific to OCD, whereas rigidity and excessive self-control appear specific to OCPD
