Chapter 13: Personality Disorders Flashcards
(119 cards)
1
Q
What are Personality Disorders (PDs)?
A
A group of disorders regarded as long-standing, inflexible, and maladaptive personality traits that impair social and occupational functioning
Some, but not all, cause emotional distress.
2
Q
How should personality disorders and dysfunction be conceptualized according to research?
A
As continuous dimensions rather than categories.
Lots of evidence that a demensional appraoch is better, but the DSM decided last minute to continue using a categorical approach in the 5th edition.
3
Q
What does the trait perspective in the personality field focus on?
A
What a person typically does.
4
Q
What does the capability perspective in personality dysfunction emphasize?
A
What a person could do/has the potential to do.
5
Q
What significant change occurred with the publication of DSM-III regarding personality disorders?
A
Personality disorders were placed on a separate axis (Axis II) to improve reliability.
This change made sure clinicans would pay attention to the potential prominence of them more.
6
Q
What is the current status of the axis element for personality disorders in DSM-5?
A
It has removed and is not in the DSM-5
This is because it is now more well known and thought of by clinicans that episodic disorders might be accompanied by a long-lasting personality disorder (do not need the axis anymore to be reminded of them)
7
Q
What are the three indicators proposed by Theodore Millon to distinguish normal vs disordered personality?
A
- Rigid/inflexible behaviour
- Self-defeating behaviour that creates vicious cycles
- Fragility to the self that “cracks” under stress, known as “structural instability.”
8
Q
According to Livesley (1998), what are the three tasks essential for ADAPTIVE functioning?
A
- Form stable, integrated, and coherent representations of self and others
- Develop capacity for intimacy and positive affiliations with other people
- Function adaptively in society by engaging in prosocial behaviours.
Livesley proposed that failure in any of these is enough to create a PD
9
Q
What approach does DSM-5 use for personality disorders?
A
A categorical approach.
10
Q
The DSM-5 contains a new category called general personality disorder. What is the purpose of it and what are the criteria in general?
A
General personality disorder is a new category that establishes if a PD exisits to begin with, and then from there the criteria of a specific personality disorder can be applied.
sort of just think of the general definition of a PD in terms of trying to remember the criteria for general personality disorder (inflexible, causes distress, pattern is stable, etc.)
11
Q
What is the Alternative Model for Personality Disorders (AMPD)?
A
A model introduced in section III of DSM-5 that assesses levels of personality functioning and traits on a dimension
Includes Criterion A and Criteron B to assess the PD with a dimensional appraoch
categorical approach is always used first, but this can be also used by clinians to further the diagnoses
12
Q
What are the two themes assessed by AMPD criterion A?
A
- Self (identity and self-direction)
- Interpersonal (empathy and intimacy).
13
Q
What does AMPD criterion B involve?
A
Rating a person across five broad trait dimensions: negative affectivity, detachment, antagonism, disinhibition, and psychoticism.
14
Q
What is a key argument for the dimensional approach to personality disorders?
A
The fact that personality disorders reflect extreme/rigid response tendencies that differ in level and degree, NOT KIND, (as everyone has varying personality tendenies) from people without disorders.
Basically being on a high level of extreme personality traits is not a strict category, but simply a being an extreme on a ladder of personality characteristics.
15
Q
How is perfectionism currently regarded in the DSM-5?
A
Only as a symptom of obsessive-compulsive personality disorder (OCPD).
Perfectionism deserves more attention in it’s role in personality dysfunction
16
Q
What does the five-factor model of personality include?
A
- Neuroticism
- Extroversion/introversion
- Openness to experience
- Agreeableness/antagonism
- Conscientiousness.
This model is highly influential on personality research, including personality disorders
17
Q
What common traits from the 5-factor model are found among many personality disorders?
A
High neuroticism and low agreeableness.
High and low extraversion are also useful indicators in distinguishing between different types of personality disorders.
18
Q
Which personality disorder has a unique 5-factor profile?
A
Avoidant personality disorder is the only PD with high neuroticism and introversion.
19
Q
What is the HEXACO model?
A
An alternative to the five-factor model with a sixth dimension of honesty-humility (used to assess personality for personality disorders)
20
Q
What does the Dimensional Assessment of Personality Pathology - Basic Questionnaire (DAPP-BQ) assess?
A
It is another dimensional approach to assessing personality disorder
It has 22 scales that assess 18 personality trait dimensions.
21
Q
What problems have lessened the effectiveness of the categorical approach for personality disorders?
A
- The low stability of personality disorder diagnoses (greater stability when dimensional approach is used)
- Difficulty in diagnosing a single, specific personality disorder. (many people often have multiple PD diagonses)
22
Q
Which personality disorders require expanded descriptions according to the text?
A
- Avoidant
- Narcissistic
- Obsessive-compulsive
- Schizoid.
23
Q
What is a main challenge in assessing personality disorders?
A
Many disorders are ego-syntonic, meaning the person with a PD is typically unaware that a problem exists
Ego-syntonic disorders often lead to a lack of insight into one’s own personality and behaviors.
24
Q
How can the assessment of personality disorders be enhanced?
A
By involving significant others in an individual’s life as informants
PD’s need to be diagnosed though clinical interviews due to a lack of the person’s personal awareness
25
What is PDNOS?
Personality Disorder Not Otherwise Specified
## Footnote
This is another term for general personality disorder
26
What is the preferred method for diagnosing personality disorders?
Clinical interviews
## Footnote
*but researchers also do rely on self-report measures
27
What one self-report measure is often used to assess personality disorder symptoms?
MMPI-2 scales that assess 5 dimensional personality constructs that reflect psychopathology known as the **PSY-5**
28
List the 5 dimensions of the PSY-5 (the MMPI-2 scales)
* Negative emotionality/neuroticism
* Lack of positive emotionality
* Aggressiveness
* Lack of constraint
* Psychoticism
29
What is the most widely used measure for personality disorders?
Millon Clinical Multiaxial Inventory - MCMI-IV
It is a 195 item true-false inventory
The updated version of it includes Grossman Facet Scales
30
What were the Grossman Facet Scales added to the MCMI-IV for?
To facilitate the treatment approach of **personalized therapy**
Personalized therapy is therapy that is tailored to each person's unique personality and associated needs.
31
What are two key issues with self-report measures for personality disorders?
* Various self-report measures differ in content and are not equivilant to eachother
* Cut-off points used in self-reports often **overestimate** the number of people who meet diagnostic criteria (more people appear to have a diagonosable disorder than in reality)
32
What percentage of university and college students met criteria for 1 or more PDs according to research?
More than 1 in 6 students met criteria for 1+ PD
33
What were the two most prevalent personality disorders among students according to a study?
* Obsessive-compulsive PD
* Paranoid PD
## Footnote
Also an "epidemic od narcisism" was noticed in young people.
34
What are the three clusters of personality disorders?
1. Odd/Eccentric Cluster (Cluster A)
2. Dramatic/Emotional/Erratic Cluster (Cluster B)
3. Fearful Cluster (Cluster C)
35
What are the three diagnoses in Cluster A?
1. Paranoid Personality Disorder
2. Schizoid Personality Disorder
3. Schizotypal Personality Disorder
## Footnote
These disorders reflect oddness and avoidance of social contact.
36
Define Paranoid Personality Disorder (PPD).
A disorder where a person expects mistreatment by others and becomes suspicious, secretive, jealous, and argumentative.
Common characteristics include not accepting blame and appearing cold and unemotional.
Very reluctant to confide in others
37
What is a common behavior of individuals with Paranoid Personality Disorder in relationships?
They often question the fidelity of a partner without reason.
## Footnote
They have unjustifiable doubts of the trustworthiness or loyalty of others.
38
How does Paranoid Personality Disorder differ from schizophrenia?
PPD does not include hallucinations, and individuals can function socially and occupationally better.
## Footnote
PPD also differs from delusional disorder as full-blown delusions are not present.
39
What gender expereinces paranoid personality disorder (PPD) more? And what disorders does it co-occur with the most?
Occurs most commonly in men
Co-occurs most often with schizotypal, borderline, and avoidant PDs.
40
What characterizes Schizoid Personality Disorder?
Emotional aloofness, **indifference** to praise or criticism, and solitary interests.
Usually loners/hermits.
*the most important thing to remember is the indifferent aspect of this - they genuinely do not care for people at all.*
## Footnote
They rarely have strong emotions and have no interest in sex.
41
What is the prevalence of Schizoid Personality Disorder?
Less than 1%.
## Footnote
Slightly more common in men than women.
42
What is a key characteristic of Schizotypal Personality Disorder?
Eccentricity and oddities of thought and perception, such as magical thinking and illusions and dissociation.
Person is usually socially isolated and speaks in a strange way.
Ex. Abigal thinks she has magical connection to animals and they speak to her. She wears strange clothing and uses metaphors that don't make sense. She wants connection but it is too overwhelming.
## Footnote
Individuals often experience excessive social anxiety and may appear psychotic under stress.
43
What is the prevalence of Schizotypal Personality Disorder?
3%.
## Footnote
Slightly more frequent in men than women.
44
Where did the concept of schizotypal personality disorder develop from?
From Danish studies of the adopted children of schizophrenic parents.
Many symptoms identical to those in phases of schizophrenia occur in schizotypal PD.
45
How does comorbidity affect Schizotypal Personality Disorder?
Comorbidity is higher for schizotypal personality disorder than for any other personality disorder!!
## Footnote
**It is particularly comorbid with borderline and narcissistic personality disorders.**
46
What are potential causes of the difficulties in the Odd/Eccentric Cluster?
Research focuses on the genetic links to schizophrenia (with cluster A disorders being less severe varients of the disorder)
Family studies show higher rates and an increased risk of these disorders among relatives of individuals with schizophrenia.
## Footnote
Genetics play a role, but not entirely exclusively.
47
What is the disorder with the highest heritability estimate and the lowest heritability estimate according to a study?
Lowest heritability estimate in schizotypal PD
Highest heritability estimate in antisocial personality disorder
48
What are the four disorders classified in the dramatic/erratic cluster?
1. Borderline pD
2. Histrionic PD
3. Narcissistic PD
4. Antisocial PD
49
Define Borderline Personality Disorder (BPD).
A disorder characterized by impulsivity, unpredictable behavior, uncertain self-image, intense and unstable relationships, and extreme mood swings
## Footnote
Attitudes towards other people often change drastically in a short period of time
50
A person is argumentative, irritable, sarcastic, quick to take offense, and difficult to live with.
What personality disorder would best fit this?
Borderline Personality Disorder
51
What is the predicted prevalence of Borderline Personality Disorder?
5.9%
## Footnote
*about 1 in 10 people with BPD commit sucicide
52
Fill in the blank: People with BPD often have fears of ------.
abandonment!!
They always need attention and cannot bear to be alone (because they need others to form their identities)
53
When does BPD typically begin?
In early adulthood
## Footnote
Most likely to occur in women, people with a mood disorder, and have parents who have mood disorders
54
List some common comorbidities associated with BPD.
* Substance abuse
* Post-traumatic stress disorder
* Eating disorders
* Other personality disorders from the odd/eccentric cluster
55
What are some predictors that may increase the liklihood of a person with BPD getting better?
Having no prior psychiatric hospitalizations
A higher IQ
A combination of personality characteristics with higher extroversion and agreeableness
An absense of an anxious disorder
56
What does object-relations theory focus on?
How children identify with emotionally significant people (like parents) and how this affects their ego development
This theory is one explination for how borderline personality disorder occurs.
## Footnote
Parents or caregivers become an important part of the person's ego, which can conflict wishes and ideals as an adult.
57
According to Kernberg, the creator of object-relations theory, what causes children to develop insecure egos?
Adverse childhood experiences
This aligns with research on people with BPD, where they report low levels of care by mothers, had a family high in conflict, and physical and sexual abuse
58
What does object-relations theory ultimately think about the origin of borderline personality disorder?
People with BPD have weak egos and need constant resassurance, which results from childhood emotional attachments.
59
What biological factors are associated with BPD?
- Genetic components (having relatives with BPD)
- Poor functioning in frontal lobes
60
What is Linehan's Diathesis-Stress Theory?
It proposes that BPD develops when individuals with a genetic predisposition (diathesis) for emotional dysregulation are raised in invalidating environments.
Theory explains that BPD isn’t just “caused” by trauma but rather by the interaction between innate emotional sensitivity and a failure to develop healthy coping mechanisms due to an invalidating environment.
## Footnote
An invalidating envionment is where the child's wants and feelings are disrespected and efforts to communicate them are disregarded.
61
What two main hypothesis factors interact within Linehan's Diathesis-Stress Theory for BPD?
**Dysregulation and invalidation**
## Footnote
A key piece of advice supporting this theory involves the fact that childhood abuse is more frequent in people with BPD
62
What is Histrionic Personality Disorder (HPD)?
A disorder characterized by overly dramatic behavior, emotional excess, impatience, and dependency on others
63
A person is very sexually seductive and does not take responsibility for their flirting. They also wear very attention-seeking clothes and often have extreme makeup and hair styles.
What disorder would this person likely have?
Histrionic Personality Disorder
They are very shallow, self-centred, and overly concerned with their attractiveness.
64
What is the prevalence of Histrionic Personality Disorder?
2-3%
cormobidity with BPD is high
## Footnote
More common in women than men and higher among divorced people.
65
What parenting style may contribute to the development of Histrionic Personality Disorder according to psychoanalytic theory?
Parental seductiveness, especially from father to daughter
## Footnote
People with HPD raised by parents that talked about sex as something “dirty” but behaved as though it was exciting/desirable
66
What is Narcissistic Personality Disorder (NPD)?
disorder where people are extremely selfish and self-centred; have a grandiose view of their uniqueness, achievements, and talents; and have an insatiable craving for admiration and approval from others.
## Footnote
Narcissistic personality disorder draws its name from Narcissus of Greek mythology
67
What is the prevalence of Narcissistic Personality Disorder?
Less than 1%
## Footnote
NPD most often co-occurs with Borderline Personality Disorder (BPD).
68
What is the Pathological Narcissism Inventory (PNI)?
A self-report scale that examines 7 components of pathological narcissism.
## Footnote
It was developed to capture the true maladjustment of extreme narcissists.
69
What is the dark triad of personality traits?
The dark triad consists of:
- narcissism
- psychopathy
- Machiavellianism (a willingness to take advantage of others)
Introduced by Paulhus and Williams (2002)
## Footnote
People who have narcisism have the other elements of the triad.
70
What is the Dark Tetrad?
An additional dimension of **sadism** has been added to the dark triad, making it a tetrad.
## Footnote
**Sadism involves a tendency to enjoy the cruelty of everyday life.**
71
What is the etiology of Narcissistic Personality Disorder?
Caused by a failure to develop healthy self-esteem which occurs when parents do not value their children's competencies and acheivements
When parents further their own needs or successes rather than directly approve of their children → the result can be a narcissistic personality.
72
What are the differences between Antisocial personality disorder and psychopathy?
APD focuses on anti-social behaviour
Psychopathy (influenced by the writings of Cleckley) emphasizes emotional deficits, such as a lack of fear, regret, or shame.
73
What are the two major components of Antisocial Personality Disorder (APD) according to DSM?
* A conduct disorder is present before age of 15 (over 60% of children with a conduct disorder develop APD)
* The pattern of anti-social behaviour continues in adulthood.
74
Define anti-social personality disorder
A disorder in which a person, also called a “psychopath” or a “sociopath,” is:
- superficially charming and a habitual liar
- has no regard for others, shows no remorse after hurting others
- is unable to form relationships
- does not learn from punishment.
75
What is the estimated prevalence of Antisocial Personality Disorder?
Between 1% and 4%
## Footnote
Prevalence depends on the methods used to determine it.
76
How does the prevalence of anti social personality disorder differ between genders?
Men with APD tend to outnumber women at a 3:1 prevalence ratio.
## Footnote
Women with APD have less violent anti-social behaviours, lower social support, and greater impairment.
77
Who formulated criteria for recognizing psychopathy?
Hervey Cleckley
## Footnote
His criteria focus more on the psychopathic individual’s thoughts and feelings (which is unlike the DSM criteria)
78
Rates of anti-social personality disorder are much higher in what demographics?
Younger adults, men, with lower socio-economic status
79
What is a key characteristic of psychopathy according to Cleckley?
LACK of emotions (both positive and negative).
Psychopaths' lack of anxiety makes it impossible for them to learn from their mistakes.
## Footnote
Even positive feelings are often just an act.
80
What is a common behavior pattern of psychopaths?
Their behavior is performed impulsively.
81
What is the comorbidity of APD with other disorders?
High comorbidity with substance abuse disorders.
82
What is the Psychopathy Checklist-Revised (PCL-R)?
A tool developed by Robert Hare consisting of 20 items assessing psychopathic behaviors across two major factors:
(1) emotional detachment
- selfishness, inflated self-esteem, etc.
(2) unstable anti-social lifestyle.
- implusive, inresponsible
83
How do extreme psychopaths score on the PCL-R?
They tend to receive substantially elevated scores on both Factor 1 (emotioanl detachment) and Factor 2 (unstable/anti-social lifestyle)
84
What did the study on age-related changes in PCL-R scores reveal?
Factor 1 scores (emotional deatachment) remained stable across the lifespan, while Factor 2 (unstable/anti-social lifestyle) scores decreased with age.
(suggesting psychpaths MAY become less impulsive with age!!)
85
What does the PCL-R data suggest about imprisoned psychopaths?
Imprisoned psychopaths are 2.5 times more likely to be granted release than non-psychopaths.
86
**Almost ALL psychopaths are diagnosed with Antisocial Personality Disorder (APD)**, but many people diagnosed with APD do not meet critera for --------------
Psychopathy
(based on the PCL-R)
87
What is a criticism of the DSM diagnoses of APD?
It requires reports of events from many years ago (as a conduct disorder must have been present in adolecense) by people who are known liars.
88
The lack of remorse is only 1 of the 7 criteria for the diagnoses, but only 3 criteria need to be present to make the DSM diagnosis → why is this a criticism of the DSM?
Because a lack of remose is a hallmark trait of psychopathy
BUT some people can get diagnosed with APD without having a lack of remose which is a crucial aspect of the disorder
89
What distinguishes APD from psychopathy according to recent findings?
Differences in **defense reactivity** (assessed by startle blink response) suggest psychopathy is distinguished by a low fear disposition (having little fear/anxiety)
90
Fill in the blank: Psychopaths are NOT immune to -------- (as previously thought)
suicide
91
What do children with psychopathic traits exhibit in terms of brain structure?
**Abnormal prefrontal cortex responsiveness** and decreased grey matter volumes in diffuse paralimbic brain regions.
Concludes that psychopathy in younger people is best viewed as a neurodevelopmental disorder!
92
What family factors are associated with psychopathic behaviors?
* Lack of attention
* Severe parental rejection
* Physical abuse
* Inconsistencies in discipline
* Failure to be taught responsibility towards others
93
What does research suggest about the fathers of psychopaths?
They are likely to display antisocial behavior.
94
What role do genetic factors play in anti social personality disorder?
APD has heritable components and shares common genetic factors with Borderline Personality Disorder (BPD).
95
Early adversity in childhood interacts with the ------ genotype to increase the likelihood of antisocial outcomes, especially in ------.
MAOA
Males
## Footnote
*environment and genetic factors both play strong roles!
96
What is the emotional response of psychopaths to punishments?
They do not experience a conditioned fear response and have low anxiety.
(meaning punishments do not work)
97
What is the only indicator of anxiety that is above average within psychopaths?
their heart rate!
*a psychopaths heart beats faster than normal people when anticipating stress
98
What does the heart rate of psychopaths indicate?
Their heart rate is above average when anticipating stressful stimuli, indicating they may be tuning out the stimulus!
99
True or False: Psychopaths have high electrodermal activity and reactivity.
False.
## Footnote
they have low electrodermal activity/reactivity
100
In a study that monitored the skin conductance of psychophatic and non-psychopathic men, what was the main finding?
Psychopathic men showed less responsiveness to the distress stimuli **(indicating a deficit in empathy!)**
101
What are 3 main ways that psychopaths do not react the way normal people do
1. they have little anxiety
2. they lack empathy so treat others badly
3. they are deficent in using contextual information and planning ahead which leads to impulsivity.
102
What are the three personality disorders in the Anxious/Fearful Cluster?
* Avoidant personality disorder
* Dependent personality disorder
* Obsessive-compulsive personality disorder
103
Define Avoidant Personality Disorder.
A disorder in which individuals have poor self-esteem and are extremely sensitive to potential rejection, remaining aloof despite desiring affiliation and affection.
104
Mary is very reluctant to enter into new relationships unless she knows the other person will be obsessed with her. She also has avoided any sort of jobs that involves interacting with people and hates taking risks.
What disorder would Mary likely have?
Avoidant personality disorder!
105
What is the prevalence of Avoidant Personality Disorder in the general population?
Diagnosed in almost 2% of the general population.
## Footnote
Avoidant personality disorder is a PD on the higher levels of life impairment
106
List three disorders that have high comorbidity with Avoidant Personality Disorder.
* Generalized social phobia
* Dependent personality disorder (very similar - only diff is that avoidant person has a very hard time iniating relationships)
* Depression
107
What syndrome in Japan relates to Avoidant Personality Disorder?
Taijinkyoufu.
## Footnote
Those with this syndrome tend to be ashamed about how they appear to others (ex. fearing that they are ugly or have body odor).
108
Define Dependent Personality Disorder.
A disorder where individuals lack self-confidence and passively allow others to run their lives, avoiding demands to maintain protective relationships.
109
Leena struggles with self-confidence and feels a very intense need to feel taken care of by others. Once Leena has a strong relationship, she will do anything in her power (even ignoring her needs) to maintain those relationships.
What disorder does Leena likely struggle with?
Dependent personality disorder
## Footnote
*often thought of that people with DPD will be very passive, but actually they can potentially actively step up and do things to preserve the relationship
110
What cultural aspect is significant in the diagnosis of Dependent Personality Disorder?
Dependent personality disorder is possibly the most culture-laden diagnostic category, rooted in the individualism of North America.
111
Just like children go through phases where seperation from parents is very distressing, people with --------- personality disorder expereince a similar feeling in their adult relationships!
Dependent personality disorder
112
What is the main focus of individuals with Obsessive-Compulsive Personality Disorder?
They have inordinate difficulty making decisions and are overly concerned with details and efficiency.
Relate very poorly to others because they demand that things be done their way
113
Randa is very serious, sort of a perfectionist, and is very conventional in how she handles situations. Randa also refuses to get rid of any useless objects she has in her home and has been struggling with anorexia. She does not see a problem with her behaviour and thinks everyone else does everything wrong.
What personality disorder do these characteristics align with?
Align with Obsessive-Compulsive Personality Disorder
## Footnote
*often co-occurs with anorexia and depression
114
How does Obsessive-Compulsive Personality Disorder differ from Obsessive-Compulsive Disorder?
OCPD does not include the obsessions and compulsions characteristic of OCD.
## Footnote
The relationship between OCPD and OCD does NOT appear to be strong!
115
What parenting style may lead to the development of Dependent Personality Disorder?
An overprotective and authoritarian parenting style that prevents the development of feelings of self-efficacy
116
What can cause the abnormal attachment behaviors seen in dependent personalities?
Disruption in the early parent-child attachment due to death or seperation, neglect, rejection, or overprotectiveness.
117
What environmental influence is thought to contribute to Avoidant Personality Disorder?
An environment where the child is taught to fear people and situations that are typically regarded as harmless.
Ex. abnormal fears of one of the child's parents may be transmitted through modeling
(the same for development of fears/phobias)
118
What childhood fear may lead to Obsessive-Compulsive Personality Disorder?
A fear of loss of control in childhood that is handled by overcompensation
## Footnote
Ex. a man who is a compulsive workaholic may fear that his life will fall apart if he relaxes and has fun
119
What barriers exist for treatment access for BPD sufferers?
Few therapists are trained in BPD, therapists find them too difficult, and interventions are lengthy.
