Cluster B: Antisocial, Narcissistic, Borderline, Histrionic Flashcards
•Underlying features (via DSM-IV) for all personality disorders, including common themes, core beliefs/assumptions •Features that can assist in differentiating each personality disorder from other Axis I and II disorders •Moffitt’s taxonomy of antisocial behavior •Subtypes of narcissism (Dickinson & Pincus, 2003) •Linehan’s biosocial theory of borderline personality disorder •Rationale for Dialectical Behavior Therapy and the components of this treatment
Antisocial Personality Prototype
- weakness on pain avoidance/self-preservation
- active approaches: pursuit of pleasure is impulsive, less inhibited
- strong self-orientation, weak other orientation
- self image focuses on autonomy
- inflated, arrogant self appraisal
- may display superficial charm
- may also experience dysphoria (tension, depression, intolerance of boredom)
- more often diagnosed in individuals with low SES, living in an urban setting
- chronic course
Antisocial Personality DSM-IV Features
disregard for and violation of the rights of others since age 15 as indicated by 3 or more characteristics + evidence of conduct disorder with onset before age 15
Antisocial PD: Differentials
Substance-Related Disorders Narcissistic PD (lack of empathy) Histrionic PD (impulsivity) Borderline PD (impulsivity) Paranoid PD Adult Antisocial Behavior
Taxonomy of Antisocial Behavior (Moffit, 1993)
Life Course Persistent
Life-Course Persistent
- continuity across life span
- behavior coherence
- associated with psychological impairments
- interact with environment to maintain continuity
- maintained through cumulative consequences (situations) and contemporary consequences (traits and dispositions)
- psycho-pathological behaviors
Taxonomy of Antisocial Behavior (Moffit, 1993)
Adolescence -Limited
- discontinuity
- lack of consistency between situations
- may be under control of reinforcement contingencies
- behaviors are NOT maintained
- not pathological behavior
Treatment for Antisocial PD
- often mandated for treatment
- focus on irresponsibility and impulsive
- increase control of self-serving impulse actions
- anticipating the consequences
- acting “as if”
- empathy training
CBT, Multi-Systemic Therapy for youth
Naracisstic Personality Disorder DSM_IV
Grandiosity (in fantasy or behavior), need for admiration, and lack of empathy, five or more of the following
- grandiose sense of self-importance
- preoccupation with fantasies of unlimited success, power, brilliance, beauty or ideal love
- believes that he or she is “special”and unique and should only interact with people who are like them
- requires excessive admiration
- a sense of entitlement
- is inter-personally exploitative
- lacks empathy
- is often envious of others or believes that other are envious of them
- arrogant, haughty behaviors or attitude
Subtypes of NPD
Grandiose- over self-enhancement, denial of weakness, entitlement, devaluation of others- more likely to counter attack
Vulnerable- shyness/constraint, grandiose expectations and entitlement, rely more on external feedback from others to manage self-esteem- more likely to use avoidance
NPD Prototype
- Relative balance on pain avoidance-pleasure seeking polarity
- Tend towards passivity
- Strong self-orientation, weak other orientation
- I am special, so I deserve special privileges, I am above the rules
Treatment of NPD
- Accept others as equals
- Develop less sensitivity to status
- Increase interpersonal skills
- Convey acceptance
- Helps to display a degree of admiration
- Focus on present problem
Borderline PD DSM-IV
Instability of interpersonal relationships, self-image, and affects, and marked impulsivity, 5 or more of the following:
- frantic efforts to avoid real or imagined abandonment
- A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation
- identity disturbance: unstable self image
- Impulsivity in at least 2 areas that are potential self-damaging
- Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior
- Affective instability due to marked reactivity of mood
- Chronic feelings of emptiness
- Inappropriate, intense anger or lack of control and anger
- Transient, stress-related paranoid idealization, or severe dissociative Sxs
Borderline PD: Differentials
Mood disorders (often co morbid)
Histrionic PD
Schizotypal and Paranoid PDs (paranoia)
Naracisstic PD (similar angry outbursts)
Antisocial PD ("manipulation")
Dependent PD (fears of abandonment)Borderline Prototype
Conflict between polarities
Vacillate between extremes, dependent on social and interpersonal circumstances
Pleasure-Pain
Passive- Active
“Apparent Competence”- person seems competent on certain days but is inconsistent
Self-Other
Development of BPD- Linehan’s Bio social Theory
BPD is a dysfunction of the emotional regulation system.
Emotional Vulnerability- high sensitivity to emotional stimuli, emotional intensity, slow return to emotional baseline
Biological Underpinnings- difficulties in limbic system reactivity, genetics
Environmental Influences
- invalidating environment/ parenting
Treatment for BPD
Stabilization of conflict between polarities
Develop more stable and consistent relationships
Decrease the extreme emotional and behavior reactions
Importance of Therapeutic Relationship
DBT
Medication- mood stabilizers (moderate effect on reducing anger), antidepressants (moderate effect on reducing anger, small effect on reducing depression)
