L7 - Antisocial, narcissistic PD and psychopathy Flashcards
(37 cards)
learning objectives (4)
- learn the diagnostic features of ASPD, NPD and psychopathy
- Think critically on the overlap between cluster B personality disorders and how they are diagnosed
- Reflect on the potential consequences of these PDs
- Learn about potential treatment and effectiveness
Narcissism DSM-5 symptoms (9)
- Grandiose sense of self
- Need for admiration
- Arrogant
- Entitled
- Fantasies of success, power etc.
- Envious of others
- Feels “special”
- Lack of empathy
- Exploitative
Prevalence
- Community: 0-6,2%
- Forensic studies: higher prevalence (27,7%)
- Higher prevalence in men than in women (50-70%)
–> understudied due to low prevalence
Types of narcissism (2)
- Grandiose (in line with NPD in DSM)
- Vulnerable (some overlap with BPD in DSM)
Grandiose narcissism characteristics (5)
- Dominance
- Self-assurance
- Immodesty
- Exhibitionism (center of attention)
- Aggression
Vulnerable narcissism characteristics (8)
- Underhighlighted in the DSM - doesn’t quite match up with diagnostic criteria
- Introversion
- Negative emotions
- Interpersonal coldness
- Hostility
- Need for recognition
- Entitlement
- Egocentricity (more shown in close interpersonal relationships - far more closed to the person, still problematic)
dimensional approach to narcissistic PD (definition + dimensions)
dimensional approach is better able to catch the different nuances that are present in narcissistic personality disorders
A) identity
B) self-direction
C) empathy
D) intimacy
narcissism
Identity (3)
- Uses others for self-definition and self-esteem regulation
- Exaggerated self-appraisal
- Emotion regulation fluctuates with self-esteem
narcissism
self-direction (3)
- High/low personal standards
- Goal setting based on gaining approval
- Unaware of own motivations
narcissism
empathy (3)
- Excessivley attentive to reactions of others (on the self)
- Impaired ability to recognize /identify
- Over- or underestimating own effect on others
narcissism
intimacy (2)
- Superficial relationships
- Restrained mutuality (little genuine interest - getting attention but not giving it)
2 pthways of the model for narcsissism
2 pathways that lead to gaining attention (?)
- both can be used depending on the circumstances
- admiration (pump yourself up)
- rivalry (push other’s down)
narcissism
client interaction (6)
- Client
- What you see depends on the type, pathway they plan to take - different presentations in therapy
- Doesn’t listen, only talks
- Avoids answering the question
- Turns everything towards themselves and how it affects them (when it crosses a problematic line in therapeutic settings is blurred)
- Constantly looks dor confirmation
- Reacts strongly to confrontation
narcissism
Clinician interaction (3)
- You
- Might get bored
- Might get competitive/frustrated/annoyed
- Might feel sorry (reparation reflex)
why is it important to keep track of your feelings in the therapeutic relationship?
- Your feeling/reaction tells a lot about the pathology itself
- E.g., vulnerable narcissists being really good at getting your sympathy - you feel sorry for them
Antisocial personality disorder DSM-5 characteristics (8)
- Disregard for and violation of the rights of others since age 15
- Not confirming to social norms / repeated unlawful behavior
- Deceitfulness (lying, conning)
- Impulsivity
- Irritability and aggressiveness (mostly these emotions show - not other emotions like fear)
- Reckless desregard for safety of self and others
- Consistent irresponsibility
- Lack of remorse
ASPD prevalence
Community: 0,2- 3,3%
Forensic studies: higher prevalence (30%)
Higher prevalence in men than in women
Psychopathy - the mask of sanity - characteristics 1/2 (6)
- Superficial charm and good “intelligence” (come across as eloquent and well-spoken - not necessarily intelligent in the traditional sense)
- Absence of delusions and other signs of irrational thinking
- Unreliability
- Untruthfulness and indincerity
- Lack of remorse or shame
- Inadequately motivated antisocial behavior (sometimes people have good reason for being antisocial - stealing when being poor - this is adequate but with this pd we refer to inadequate motivations)
Psychopathy - the mask of sanity - characteristics 2/2 (6)
- Poor judgement and failure to learn by exeperience
- Pathological egocentricity and incapacity for love
- General poverty in major affective reactions
- Specific loss of insight
- Unresponsiveness in general interpersonal relations
- Fantastic and uninviting behavior with drink and sometimes without
modern day definitions of psychopathy / facor 1
Factor 1: (primary psychopathy if these symptoms dominate)
affective:
1. lack of guilt/remorse,
2. emotionally shalow
3. callous (lack of empathy)
4. failure to accept responsibility for actions
interpersonal:
1. glibness/superficial charm
2. grandiose
3. pathological lying
4. conning/manipulative
modern day definitions of psychopathy / factor 2
Factor 2: (secondary psychopathy if these symptoms dominate)
antisocial:
1. poor behavioral control
2. early behavioral problems
3. juvenile delinquency
4. revocation of conditional release
5. criminal versatility
lifestyle:
1. need for stimulation
2. lack of realistic long term goals
3. parasitic lifestyle
4. impulsivity
5. irresponsibility
Other factors that don’t fall into the other 2 psychopathy factors
- promiscuous sexual behavior
- many short-term relationships
how do we diagnose psychopathy?
- Often need for secondary source of information
- Need for external validation of information because people lie and stretch stories
- File information from a criminal investigation
- Information from clinical/criminal records
- Information from family or other sources
- Psychopathy checklist - revised
- 20 items scored from 0 (not present) to 2 (clearly present)
- Score >26 or >30 = pathology
- Need for training to administer this test
ASPD dimensional approach (identity)
- egocentrism
- self-esteem derived from personal gain, power, or pleasure
