Personality Disorders Flashcards
(101 cards)
1
Q
personality
A
personality captures patterns of acting, thinking, and feeling that characterize a given individual and distinguish that person from others
2
Q
five factor model
A
Neuroticism, which captures the degree to which an individual is prone
toward experiencing unpleasant emotions like anxiety, sadness, and fear
Extraversion, which captures the extent of a person’s preference for
social interactions versus solitary activity
Openness to Experience, which captures how curious an individual is and
how receptive they are to new ideas, approaches, and events
Conscientiousness, which taps propensity for organization, punctuality,
and achievement motivation
Agreeableness, which reflects individual differences in people’s
preferences for co-operation and social harmony
3
Q
dimensional frameworks
A
(1) personality traits are continuously distributed in
populations, and (2) personality pathology reflects extreme variants of typical personality
traits.
4
Q
categorical approach
A
maladaptive personality functioning is assumed to manifest as a
number of discrete disorders, each defined by a polythetic criterion set - specified
number of symptoms from a larger list
5
Q
weaknesses of the categorical approach
A
co-occurrence among personality disorders is excessive—far higher than what would be expected if each disorder emerged from unique underlying factors.
PD Unspecified Personality Disorder is more commonly applied than any other
PD diagnosis
polythetic criterion sets yield heterogeneous groups - five out of nine possible
symptoms—allowing for 246 unique combinations - may reduce the clinical utility
of applying a diagnosis at all
6
Q
hybrid dimensional-categorical approach
A
traditional PD framework includes 10 diagnoses, the alternative model
retains only six
defines personality disorders by impairments in personality functioning and pathological
personality traits
7
Q
three criterion of the alternative model
A
- Criterion A: a 0–4 scale of personality functioning in self identity and self-direction and
interpersonal domains (empathy and intimacy) - Criterion B: a dimensional system in which 25 traits are organized into five overarching
domains (antagonism vs agreeableness; detachment vs extraversion; disinhibition vs
conscientiousness; negative affectivity vs emotional stability; and psychoticism vs
lucidity) - Criterion C: a prototypal system of six personality disorder types (avoidant, schizotypal,
antisocial, narcissistic, obsessive-compulsive, and borderline)
8
Q
current DSM taxonomy
A
- Criterion A: Behavioural patterns must manifest in at least two of the following areas:
cognition, emotions, interpersonal functioning, or impulse control. - Criterion B: Such patterns must be rigid and consistent across a broad range of personal
and social situations. - Criterion C: Patterns should cause clinically significant distress in social, occupational, or
other important areas of functioning. - Criterion 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 (e.g., drugs or alcohol) or of
another medical condition.
9
Q
other reasons for personality disorder diagnoses
A
- DSM includes diagnoses for personality change due to another medical condition, other
specified personality disorder, and unspecified personality disorder. - other specified PD when a person meets criteria for a general PD, exhibits symptoms
from a number of personality disorders, yet criteria for any single PD are not met. - Unspecified PD is applied when individuals meet general PD criteria, yet their core
symptoms are not captured by existing specific PD diagnoses
10
Q
Cluster A disorders
A
Cluster A is defined by odd or eccentric features and includes paranoid, schizoid, and schizotypal PDs
11
Q
Cluster B disorders
A
(dramatic, emotional, or erratic features) includes antisocial, borderline, histrionic, and narcissistic PDs.
12
Q
Cluster C disorders
A
(anxious or fearful features) consists of avoidant, dependent, and
obsessive–compulsive PDs.
13
Q
how should disorders be grouped instead?
A
group disorders by similar phenotypic features (i.e., how behavioural symptoms look on the surface) rather than by shared developmental factors or by a common underlying
structure
14
Q
limitations affecting available research
A
base rates of these disorders are low and epidemiological research is fairly limited.
PDs are also associated with a number of inaccurate and harmful stereotypes
Personality disorders are more stigmatized relative to other psychiatric diagnoses
more likely to struggle with forming a therapeutic alliance, more likely to perceive these clients as attention seeking, dangerous, manipulative
Due to associated stigma, many clinicians are reluctant to diagnose PDs—particularly
among youth
broadest limitation is that most PDs are simply understudied
15
Q
cultural considerations of personality disorder
A
- Researchers often rely on convenience samples from Westernized, educated,
industrialized, rich, and democratic nations - these disorders occur cross-culturally
- U.S. and Colombia report prevalence estimates of 7.6% and 7.9%, respectively,
whereas western Europe and Nigeria report far lower estimates of 2.4% and 0.9% - variability in study design and sample characteristics makes it difficult to determine
whether available estimates reflect true cross-national differences in PD prevalence - in the UK, White individuals have higher total PD prevalence rates in hospital settings
compared with Black or Asian individuals - Inconsistencies between inpatient and community samples may reflect problems with
health care accessibility for marginalized groups
16
Q
cluster A - ecological momentary assessment
A
- ecological momentary assessment (EMA)
o paranoid features – cognitive diffculties
o schizoid traits – blunted affect, lack of caring relationships
o schizotypal traits – poor social functioning - schizotypal PD is the only disorder categorized as both a PD and schizophrenia
spectrum disorder in the DSM
17
Q
paranoid personality disorder history
A
- paranoia originated in ancient Greece and translates to “out of one’s mind”
- nineteenth century - applying the term paranoid to persons exhibiting suspiciousness,
hostility, and systematized delusions - systematized delusions are logical and coherent, yet based on false grounds (i.e., beliefs that are highly improbable but not impossible
- Emil Kraepelin conceptualized paranoia as stemming from pathological misinterpretation
of real events
18
Q
paranoid personality disorder - clinical features
A
- patterns of pervasive mistrust, suspiciousness, and resentment of others
- hypersensitive to interpersonal cues, assume innocuous stimuli have a special meaning
for them, inclined to interpret others’ motivations as spiteful or malevolent
19
Q
paranoid personality disorder - DSM diagnosis
A
DSM-5-TR diagnosis requires at least four of seven symptoms, beginning by early
adulthood
of the seven DSM criteria, unjustified suspicion of infidelity was the least
commonly endorsed symptom and the least sensitive indicator for PPD
20
Q
paranoid personality disorder - four suspiciousness symptoms
A
(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.
21
Q
paranoid personality disorder - three hostility symptoms
A
(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.
22
Q
paranoid personality disorder - prevalence
A
- mild symptoms of paranoia are relatively common in the general population (i.e.,
20%–30% - PPD affects only 1.21% to 4.4% of people
- women may be more frequently affected, yet the disorder may be more severe among
men
23
Q
paranoid personality disorder genetic factors
A
- individuals with PPD appear to share more genetic similarities with delusional disorder
and unipolar depression than with schizophrenia
24
Q
paranoid personality disorder - social factors
A
o Childhood maltreatment is associated with hostile attribution biases
- deficits in cognitive-affective information processing may constitute one pathway to PPD development
25
Paranoid Personality Disorder – Diagnostic Overlap and Comorbidity
seldomly appears as a stand-alone disorder
delusional disorder with a specified persecutory type
schizotypal personality disorder is also defined in part by experiences of paranoia
26
Schizoid Personality Disorder – History
- term schizoid was introduced in 1908 to describe a condition characterized by social
detachment, pursuit of vague interests, and both emotional sensitivity and emotional
numbness
27
Schizoid Personality Disorder – early DSM 5
- schizoid personality disorder was introduced in the DSM-I
o first two editions, this condition was conceptualized as a form of schizophrenia
characterized by shyness, emotional sensitivity, avoidance of intimate
interpersonal relationships, eccentric behaviours, and an inability to directly
express aggression or hostility
o DSM-III - divided the clinical features described above into three distinct
disorders: schizoid personality disorder, schizotypal personality disorder, and
avoidant personality disorder
28
Schizoid Personality Disorder – Clinical Features and Supporting Data
- defined by detachment, withdrawal from social relationships, and a restricted range of
emotional expression in social settings
29
Schizoid Personality Disorder - Diagnostic criteria
- four of the following seven symptoms
o (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
30
Schizoid Personality Disorder – Prevalence
- 1% to 5%
- thought to occur more commonly among males
31
Schizoid Personality Disorder – Etiology
appears to share some genetic vulnerability with schizophrenia, yet to a lesser degree than schizotypal PD
heritability estimate of 0.29, indicating that a substantial portion of the variance in
schizoid PD is attributable to non-genetic factors
major depressive disorder (MDD) in childhood and adolescence prospectively predicts schizoid PD later in adulthood
32
Schizoid Personality Disorder – Diagnositc Overlap and Comorbidity
- DSM criteria demonstrate low internal consistency and poor diagnostic
efficiency—meaning symptoms are generally not sensitive or specific to schizoid PD
- schizoid PD rarely occurs in the absence of another psychiatric condition— particularly
other PDs - 0.3%
schizoid PD and schizotypal (27–80% co-occurrence), avoidant (10–88%), paranoid
(0–62%), and antisocial PDs (0–40%
33
Schizotypal Personality Disorder – History
- term schizotypal captures schizophrenia-like symptoms that fall below the threshold for a psychotic episode - dementia praecox
- schizotypal features can, but often do not, develop into schizophrenia
- term “borderline schizophrenia” first appeared in the second edition of DSM
34
Schizotypal Personality Disorder – Clinical Features and Supporting Data
- 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
- much of the existing literature is based on samples with schizotypy and schizotypal PD
features, rather than with persons above the diagnostic threshold
o schizotypy captures a constellation of traits thought to create vulnerability for
schizophrenia
35
Schizotypal Personality Disorder - Diagnostic Criteria
- five of nine possible symptoms, beginning by early adulthood - transient psychotic
symptoms (lasting minutes to hours) that are lower in severity and frequency
o three dimensions of functioning - cognitive and perceptual (similar to positive
symptoms of schizophrenia), interpersonal (overlapping with negative symptoms
of schizophrenia), and disorganization
o cognitive and perceptual - (1) non-delusional ideas of reference, (2) odd beliefs and magical
thinking, (3) paranoia, and (4) unusual perceptual or somatic experiences
o interpersonal - (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
o disorganized - (1) odd/eccentric behaviours and appearance and (2) odd thinking/speech
36
Schizotypal Personality Disorder – Prevalence
- 0.8%
- lifetime prevalence estimates of 3.9%
- slightly more men affected than women
37
Schizotypal Personality Disorder - genetics
- heritability estimates are 0.61
- Family studies report prevalence rates of 4.2% to 14.6% for schizotypal PD among first-
degree relatives of individuals with schizophrenia
- both over- and underactive dopaminergic activity appear uniquely associated with
schizotypal symptoms - Valine/Valine genotype is associated with low dopamine levels in the prefrontal
cortex and is linked to negative and disorganized schizotypal symptoms
38
Schizotypal Personality Disorder - childhood factors
- individuals with schizotypal PD were 10.45 times more likely to report experiencing any
form of childhood trauma
- severe childhood sexual abuse had the strongest association with cognitive-perceptual
symptoms (e.g., ideas of reference)
- severe emotional neglect was most strongly associated with interpersonal symptoms
(e.g., constricted affect)
39
Schizotypal Personality Disorder - Diagnositc Overlap and Comorbidity
- having schizotypal PD is associated with a 2.5 times higher likelihood of having a
substance use disorder, 7.6 times the likelihood of having any anxiety disorder, 7.5 times
the likelihood of having any mood disorder, and 6.7 times the likelihood for having PTSD
one year later
- 26.5 times and 13.6 times higher likelihood of having a lifetime history of BPD and NPD,
respectively
- greater risk for developing schizophrenia - 33.1% of schizotypal PD cases developed
into schizophrenia over the course of 20 year
40
Schizotypal Personality Disorder - treatment
antipsychotics, and produce mixed results, anxiety and paranoia appear
most responsive to psychotropic medication, psychotherapeutic intervention (including
CBT, cognitive remediation, psychodynamic therapy, and social skills training) also
yields mixed findings.
41
Antisocial Personality Disorder
- pervasive pattern of disregard for, and violation of, other persons’ rights
- broad higher-order class of externalizing psychopathology
- carrying the diagnosis is also associated with deleterious outcomes
42
Antisocial Personality Disorder – History
- formalized as a diagnosis in the DSM-III (1980) following evidence that delinquent
behaviours in childhood are often stable into adulthood
- original diagnostic criteria overlapped considerably with other PDs and descriptions of
psychopathy
43
Antisocial Personality Disorder – Clinical Features and Supprting Data
- ASPD is commonly observed among incarcerated samples (47% of males and 21% of
females) - more prevalent among individuals who serve longer criminal sentences (46%)
- elevated engagement with the justice system may arise as a consequence of ASPD
features
o but perpetrating physical violence (a common cause for arrest) appears to
differentiate ASPD from manifestations of anger and aggression common to
other Cluster B disorders
- irresponsibility is the most commonly endorsed symptom among ASPD participants
(63%)
44
ASPD and Psychoapthy
- descriptions of psychopathy focus heavily on callous–unemotional personality traits
- ASPD criteria, which instead prioritize observable behaviour
- currently unclear whether psychopathy and ASPD are best conceptualized as distinct
entities or as two points on a shared continuum
45
ASPD Prevalence
- prevalence estimates ranging between 2% and 3% in the general population, and up to
60% in forensic settings
- ASPD is two to eight times more likely to be diagnosed among men as compared to
women
- Women with ASPD engage in fewer violent crimes and are less likely to report
aggression, reckless disregard for others, and impulsivity
46
ASPD comorbidity
- commonly co-occurs with other forms of psychopathology, including substance use
disorders, major depression, ADHD, anxiety disorders, and other Cluster B PDs
- Lifetime risk of suicide is also higher in individuals with ASPD—particularly among those
with co-occurring anxiety disorders
47
ASPD ethology - genetics
- Approximately 50% of the variance in ASPD is accounted for by genetic factors
- specific genes implicated in ASPD development actually confer general risk for
externalizing behaviour broadly
48
ASPD ethology - psychological factors
- individuals must show evidence of conduct disorder (CD) with onset prior to the age of
15
- 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
o Negative affectivity is positively associated with poor impulse control, emotional
lability, aggression
49
ASPD treatment
proposed treatment guidelines that include group-based CBT and cognitive programs used in criminal rehabilitation, most individuals with ASPD present and receive
treatment for co-occurring disorders
50
Borderline Personality Disorder – History
- term borderline emerged from psychoanalytic theorists in the 1930s and reflects a misconception of the era that all psychopathology was fundamentally with ps
ychotic or neurotic in nature.
- “the borderline of psychosis and neurosis”
51
Borderline Personality Disorder – Clinical Features and Supprting Data
- one of the most debilitating and heavily stigmatized psychiatric conditions
- exceptionally high rates of self-inflicted injury (SII), co-occurring illness, and impaired
social functioning
- Functional impairment is often so severe among this population that many require public
assistance, such as support from psychiatric disability
- approximately 8% to 10% of people diagnosed with BPD will die by suicide
52
Borderline Personality Disorder - Diagnostic Criteria
diagnostic criteria include (1) frantic efforts to avoid real orimagined abandonment, (2) a
pattern of unstable and intense interpersonal relationships characterized by alternating idealization
and devaluation, (3) markedly and persistently unstable self-image or sense of self, (4) impulsivity
in at least two areas that are potentially self-damaging, (5) recurrent deliberate self-injurious
behaviours and/or threats of suicide, (6) affective lability and marked mood reactivity, (7)
chronically feeling empty, (8) inappropriate and intense anger or difficulty controlling anger, (9)
transient, stress-related paranoid ideation or severe dissociative symptoms
o more than 90% of affected individuals endorse the affect dysregulation criterion,
40% to 90% engage in SII
53
BPD Prevalence
- affects an estimated 1% to 5% of the general population
- 12% to 25% of psychiatric outpatients, and a startling 22% to 50% of inpatients
54
BPD - genetics
- complex interactions between individual-level vulnerabilities and environmental risk
factors that result in core dysfunctions in self-regulation
- heritable component around 0.40 - two key biological predispositions: trait negative
affectivity and trait impulsivity
55
BPD - social factors
- biosocial theory proposes that BPD emerges, in part, due to emotionally vulnerable
youth being raised in an invalidating caregiving environment
o a child’s emotional expressions are often rejected, invalidated, and disregarded
- a history of neglect (92%), physical abuse (25% to 73%), and/or sexual abuse (40% to
76%)
56
BPD Diagnostic Overlap and Comorbidity
- co-occurs at an elevated rate with attention deficit/hyperactivity disorder, anxiety,
depression, ASPD, and substance use disorders
- BPD co-occurred with a lifetime mood or substance use disorder in over 70% of their
sample
57
BPD - Dialectical behaviour therapy (DBT)
comprehensive outpatient treatment developed for
adults with BPD and repetitive SII - weekly individual therapy and skills-based group
sessions where clients learn mindfulness skills, emotion regulation skills, distress
tolerance skills, and interpersonal skills.
58
BPD - mentalization-based treatment (MBT)
attempts to improve “mentalizing,” or the ability to
understand one’s own and others’ internal states
59
BPD - transference-focused psychotherapy (TFP)
therapeutic relationship and making observations/interpretations about client-therapist interactions can help address
interpersonal dysfunction and identity-related problems
60
Histrionic personality disorder - history
histrionic derives from the Latin word histrio, meaning actor or theatre performer
evolved from the now-abandoned medical concept of hysteria—defined by hyperbolic,
uncontrollable emotional outbursts
initially believed that hysteria originated in the uterus and thus exclusively affected
women
early 1930s, Franz Wittle and Wilhelm Reich provided some of the first descriptions of a
hysterical personality
appeared in the DSM by its second edition
61
Histrionic Personality Disorder - Clinical Features and Supporting Data
- 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
- strong desire for, and tendency to seek out, the attention of others—often using physical
appearance
- some argue HPD is a sex-specific counterpart of ASPD
62
Histrionic Personality Disorder - diagnostic criteria
- 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
63
HPD Prevalence
- 1% to 3% of the general population
- some studies report rates as low as 0.3%
- rates are approximately 6% in clinical samples versus 20.5% in incarcerated samples
64
HPD Etiology - genetics
- virtually non-existent research
- Heritability estimates for HPD range from 0.62 to 0.79, suggesting a relatively high
genetic contribution to the disorder
65
HPD Etiology - social factors
- HPD was correlated with permissive parenting by fathers, yet the direction of this effect
remains unclear
- childhood trauma, as measured by retrospective self-report, predicted HPD (with a
relatively small effect size) and other PDs
66
HPD Diagnostic Overlap and Comorbidity
- co-occurs frequently with substance use disorder particularly among men
67
HPD Treatment
- significant reductions in HPD symptoms following treatment with functional analytic
psychotherapy - a therapeutic approach using behavioural principles like shaping
through positive reinforcement to treat presenting problems
- cognitive-behavioural intervention for violence reduction and found individuals with HPD
showed significant reductions in using negative conflict management strategies and
exhibited a better treatment response
68
Narcissistic Personality Disorder – History
- term narcissism stems from an Ancient Greek myth in which a man named Narcissus fell
in love with the sight of his own reflection
- Kernberg’s (1970) descriptions of a narcissistic personality centred on grandiosity,
arrogance, and aggression
- Kohut (1966) emphasized shame, depression, and low self-esteem
- NPD first appeared in the DSM-III
69
NPD Classification and Taxonomy
- 5/9 symptoms
- most essential features are maintaining a grandiose sense of self-importance, a need to
be admired by others, and a lack of empathy
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
70
NPD - clinical presentation
NPD is associated with
impaired intra- and interpersonal functioning, yet certain individuals are remarkably
successful in professional and/or social arenas
71
grandiose NPD presentation
o grandiose presentation - individuals with a strong sense of entitlement, overt
grandiose behaviours (e.g., arrogance), and intentions to control or harm others -
further divided into an extraverted dimension (admiration-seeking) and an
antagonistic dimension (rivalry-seeking)
72
vulnerable NPD presentation
o vulnerable presentation - thought to capture individuals with less overtly
grandiose behaviours, hypersensitivity to negative evaluations, and more co-
occurring internalizing symptoms
- vulnerable features of NPD appear more strongly associated with psychopathology and
neuroticism - this dimension of NPD may indicate greater distress associated with the
disorder
73
NPD Clinical Features and Supprting Data
- empirical work on NPD has primarily focused on evaluating the psychometric properties
of DSM criteria
- a large portion of available research targets narcissistic traits in community samples; far fewer studies examine NPD symptoms or utilize clinical populations
- most well-studied NPD symptoms are lack of empathy and grandiose sense of self-
importance - studies indicate that deficits are apparent in both willingness and capability
- persons with NPD believe they are less skilled at perceiving and accurately identifying
others’ mental states
- some of the socio-emotional dysfunction associated with NPD may occur outside
individuals’ awareness
74
NPD Prevalence and Comorbidity
- approximately 0.5% to 6.2% of the general population, ranges anywhere from 1% to
17% in clinical samples
- approximately 6% of forensic populations
- more commonly diagnosed among men (7.7%) as compared to women (4.8%)
75
NPD Etiology - genetics
- Heritability estimates for NPD range from 24% to 45%
76
NPD etiology - psychological factors
Individuals who have high scores on measures of grandiose narcissism show a strongvapproach motivation bias
77
NPD etiology - childhood factors
- Kohut and Kernberg’s models, which argue NPD arises from maladaptive parenting
practices
- extreme parental affection and excessive unconditional praise (e.g., emphasizing
superiority over others) are central contributors to narcissism
o narcissism is also linked to parental coldness, invalidation, and making
excessive, developmentally inappropriate demands
78
NPD Treatment
- more likely to seek out treatment for co-occurring conditions (e.g., substance use, mood
disorders) and interpersonal difficulties, making it difficult to recognize and treat NPD-
specific pathology
- No RCTs have assessed treatment outcomes among these individuals
79
Avoidant Personality Disorder
- maladaptive avoidance of social experiences, driven by perceptions of inadequacy and extreme sensitivity to negative evaluation and rejection
- may be an extreme variation of normal shyness
80
Avoidant Personality Disorder – History
- Bleuler composed one of the earliest descriptions of avoidant personality pathology in
1911 - avoidance stemmed from a tendency to be overstimulated by the outside world
and that individuals would engage in reclusive behaviours to prevent intense negative
affective
- 1945 that a psychoanalyst named Karen Horney proposed that interpersonal problems
and attachment difficulties underlie avoidance
- Millon (1981) - distinguished between active (i.e., deliberately avoidant) and passive
(i.e., lacking motivation/sensitivity) social avoidance.
- first introduced in the DSM-III
81
Avoidant Personality Disorder - Clinical Features and Supporting Data
- an interpersonal disorder, characterized by a tendency to fear and avoid social
interactions
- primary feature of APD is extreme social avoidance
- tend to be colder, more submissive, and possibly less assertive in their social
interactions
- Anxiety, fear, and low self-esteem are core features of APD pathology
- individuals with APD may still possess a desire to be connected to others
- report lower self-esteem than other clinical conditions (like BPD)
82
Avoidant Personality Disorder - diagnostic criteria
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, 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
83
Avoidant Personality Disorder - Prevalence and Comorbidity
- lifetime prevalence of APD ranges from 1.7% to 2.4%
- APD co-occurs with social phobia anywhere from 32% to 63% of the time
- APD co-occurs with and is a significant predictor of depression
84
Avoidant Personality Disorder – Etiology
- modest genetic contribution (i.e., heritability estimates range from 31% to 67% across
samples
- specific risk factors may differentially shape APD and social anxiety trajectories
- Some research links adverse childhood experiences (i.e., neglect, abuse, childhood
trauma, parental overprotection, childhood teasing) and early-occurring anxiety disorders
to APD development
85
Avoidant Personality Disorder – Treatment
- CBT typically targets maladaptive beliefs and incorporates social skills training as well as
behavioural experiments to challenge fears
- Evidence for psychodynamic therapy is mixed
- Schema therapy has received some support for treating individuals with APD (80%
higher recovery rates compared with treatment as usual - targets patterns of cognitions,
emotions, and actions thought to arise out of unmet childhood needs
86
Dependent Personality Disorder
- term dependency captures relying on others for nurturance, support, and guidance
- submissive attitudes and behaviours, extreme reliance on others, and maladaptive
pursuits of interpersonal connection
- physically clinging to others, frequent reassurance-seeking, and inappropriate bids for
help
87
Dependent Personality Disorder – History
- Freud articulated a description of dependency in his theory of psychosexual
development
88
Dependent Personality Disorder - diagnostic criteria
- 5/8 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
89
Dependent Personality Disorder - Clinical Features and Supporting Data
- emphasize patterns of passivity, submissiveness, and accommodation to others
- Some have proposed a passive-submissive type characterized by expressing
helplessness and vulnerability, and an active-emotional type characterized by making
others feel indebted, emphasizing one’s own value, and aggression
90
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
91
Dependent Personality Disorder - Prevalence and Comorbidity
- Prevalence estimates in the general population range from 0.37% to 0.49%
- some studies reporting higher rates and more severe DPD features among women as
compared to men
- co-occurs with a range of psychopathology, including mood, anxiety, personality, and
eating disorders (particularly bulimia nervosa)
-
DPD appears to most frequently accompany panic disorder, social phobia, and obsessiv
e-compulsive disorder
92
Dependent Personality Disorder – Etiology - genetics
- Heritability estimates for DPD range widely, from 0.27 to 0.66
93
Dependent Personality Disorder – Etiology - parenting
- highlights parenting style as a potential source of risk. Attachment theory has heavily
influenced DPD literature
- DPD group more often reported early family environments characterized by restrictive
rules, low openness, and low emotional expression
- propose links between authoritarian parenting and DPD by citing indirect evidence that
authoritarian parenting creates fewer opportunities to develop competencies and
establish agency
94
Dependent Personality Disorder – Treatment
- show greater treatment progress when receiving short-term care
- large-scale RCTs evidence positive treatment outcomes with CBT, short-term dynamic
therapy, and relational therapy
- High treatment engagement is also associated with better outcomes for individuals with
DPD when being treated for a co-occurring disorder
95
Dependent Personality Disorder - clarification-oriented
psychotherapy
is efficacious for reducing maladaptive DPD traits and increasing
self-efficacy
96
Obsessive-Compulsive Personality Disorder – History
- “anal” – freud - believed that the underlying pathology for this personality type arose
from problems navigating potty-training during the anal stage of his developmental
model
- clinical presentation he described was included in the first edition of the DSM as
compulsive personality disorder
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Obsessive-Compulsive Personality Disorder - Clinical Features and Supporting Data
- 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
- complete tasks with painstaking care, getting lost in trivial details, and repeatedly scan
for possible mistakes
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Obsessive-Compulsive Personality Disorder - diagnostic criteria
4/8 symptoms - 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
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Obsessive-Compulsive Personality Disorder – Prevalence
estimates ranging from 3% to 9.7%
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Obsessive-Compulsive Personality Disorder – Etiology
Some theorists argue that authoritarian parenting styles characterized by strict demand for unwavering obedience, orderliness, and deference contribute to OCPD
one study found genetic influences accounted for 78% of the variance in OCPD
(Torgersen et al., 2000), another found such factors only accounted for 27%
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Obsessive-Compulsive Personality Disorder - treatment
some preliminary evidence for certain psychotropic medications (e.g.,
carbamazepine and fluvoxamine
however, pharmacological and psychological RCTs are lacking.
