personality disorders Flashcards
(27 cards)
Emotional Vulnerability vs. Self-Invalidation
Individuals experience intense emotional sensitivity and reactivity (vulnerability), but often invalidate their own feelings, denying their legitimacy or suppressing them.
Active Passivity vs. Apparent Competence
They may seem helpless and dependent in private (active passivity), yet present as highly capable and independent in public (apparent competence), which can confuse caregivers or therapists.
Unrelenting Crisis vs. Inhibited Grieving
Life often feels like a series of ongoing emotional crises, but at the same time, individuals may suppress or avoid grieving losses, leading to unresolved pain and further emotional distress.
Self-Destructive Behaviours vs. Self-Respect
There is often a struggle between engaging in harmful behaviours (like self-injury) and a desire to uphold self-worth and self-respect.
Freedom vs. Need for Structure
Individuals may oscillate between craving autonomy and freedom, while simultaneously needing and desiring external structure and control.
Too Much Control vs. No Control
There is a conflict between being overly controlling (to avoid chaos) and experiencing periods of complete lack of control over emotions or behaviour.
What are the six dialectical dilemmas identified by Marsha Linehan in Borderline Personality Disorder, and what do they mean?
Emotional Vulnerability vs. Self-Invalidation – Intense emotions vs. denial of feelings.
Active Passivity vs. Apparent Competence – Helpless privately vs. capable publicly.
Unrelenting Crisis vs. Inhibited Grieving – Constant crises vs. suppressed grief.
Self-Destructive Behaviour vs. Self-Respect – Harmful actions vs. desire for self-worth.
Freedom vs. Need for Structure – Craving autonomy vs. needing rules.
Too Much Control vs. No Control – Overcontrol vs. emotional dysregulation.
In terms of positive and negative symptoms, how are Avoidant Personality Disorder, Schizoid Personality Disorder, and Schizophrenia related, and how can you tell them apart?
Schizophrenia includes both positive (hallucinations, delusions) and negative symptoms (social withdrawal, flat affect).
Schizoid PD mimics schizophrenia’s negative symptoms (emotional detachment, social indifference) but has no psychotic features.
Avoidant PD involves social withdrawal due to anxiety and fear of rejection, not indifference or psychosis.
Key differences lie in the presence of positive symptoms (schizophrenia), emotional detachment (schizoid), or fear-based avoidance (avoidant).
What are people with Avoidant Personality Disorder avoiding?
They are avoiding interpersonal contact because of intense fears of rejection, criticism, and disapproval. Despite desiring close relationships, their hypersensitivity to negative evaluation leads to social withdrawal.
What is the main difference between a compensatory and a primary narcissist?
Primary narcissists believe they are superior and seek admiration based on a genuine sense of entitlement.
Compensatory narcissists display grandiosity to hide inner feelings of inadequacy and low self-worth.
Cluster A: Odd or Eccentric
Paranoid Personality Disorder: Distrust and suspiciousness of others.
Schizoid Personality Disorder: Detachment from social relationships and restricted emotional expression.
Schizotypal Personality Disorder: Acute discomfort in relationships, cognitive/perceptual distortions, and eccentric behaviour.
Cluster B: Dramatic, Emotional, or Erratic
Antisocial Personality Disorder
Disregard for and violation of the rights of others.
Borderline Personality Disorder
Instability in relationships, self-image, and emotions; marked impulsivity.
Histrionic Personality Disorder
Excessive emotionality and attention-seeking behaviour.
Narcissistic Personality Disorder
Grandiosity, need for admiration, and lack of empathy.
Cluster C: Anxious or Fearful
Avoidant Personality Disorder
Social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation.
Dependent Personality Disorder
Excessive need to be taken care of, leading to submissive and clinging behaviour.
Obsessive-Compulsive Personality Disorder (OCPD)
Preoccupation with orderliness, perfectionism, and control (distinct from OCD).
Why is there a push to reduce the number of PDs in future DSM editions?
High comorbidity & overlap among PDs
Weak empirical grounding of current categories
Poor clinical utility and familiarity
Shift toward dimensional trait/severity models
Desire to reduce PD-NOS diagnoses
What are the core features of Schizoid Personality Disorder and how do they compare to Avoidant Personality Disorder? Why is differential diagnosis difficult?
Schizoid PD: Social detachment, emotional coldness, lack of desire for relationships.
Avoidant PD: Social inhibition, fear of rejection, desire for closeness but avoids it.
Difficulty in diagnosis: Both present with social withdrawal, but for different reasons—lack of interest vs. fear of rejection. Distinguishing requires understanding internal motivations.
What are the core features of Dependent Personality Disorder, and which other PDs might exploit them and why?
DPD features: Submissive, clinging, fear of abandonment, difficulty making decisions, excessive need for care.
Exploiting PDs:
Antisocial PD – manipulates and uses others for personal gain.
Narcissistic PD – exploits for admiration and control.
Borderline PD – may exploit fear of abandonment in unstable relationships.
Why: DPD individuals’ submissiveness and fear of rejection make them easy targets for controlling or manipulative personalities.
What’s the difference between Type A personality and Obsessive-Compulsive Personality Disorder (OCPD), and why might both types succeed professionally?
Type A: Competitive, urgent, aggressive (not a disorder).
OCPD: Perfectionistic, rigid, orderly (a DSM personality disorder).
Success factors: Both are driven, disciplined, and focused—traits that align well with structured, high-performance environments.
What changes are proposed in the PD section of the DSM, and are they good changes? Why or why not?
Proposals: Reduce PDs from 10 to 6; adopt a dimensional trait model; include functional impairment.
Pros: More flexible, empirically grounded, reduces comorbidity, personalized.
Cons: May confuse clinicians, harder to standardize, some familiar diagnoses removed.
Compare the explanations of Borderline Personality Disorder by Mahler, Kohut, and Kernberg. What do they have in common?
Mahler: Failure in separation-individuation from the mother leads to unstable identity.
Kohut: Lack of parental empathy leads to a fragmented, dependent self.
Kernberg: Inability to integrate good/bad self-images causes splitting.
Common ground: All view early developmental failures and disturbed attachment as central, leading to a weak or unstable self-concept.
What have twin studies taught us about the heritability of personality features?
Twin studies show that personality traits are moderately heritable, with 40–60% of variability attributed to genetic factors. Identical twins are more alike in personality than fraternal twins, highlighting a genetic influence, though environmental factors also play a significant role.
In what ways are personality and the human face similar?
Both have stable, identifying features.
Both express individuality and social signals.
Both shape how others perceive and relate to a person.
Each reflects unique aspects of identity—one physical, the other psychological.
What is a “stepped care” model?
It’s a system that starts with low-intensity, cost-effective treatments and progresses to more intensive interventions if needed, based on the individual’s response. It ensures efficient and personalized care delivery.
What is the difference between ego-syntonic and ego-dystonic personality disorders?
Ego-syntonic: Traits align with the person’s self-view; they don’t see them as problematic (e.g., Narcissistic PD).
Ego-dystonic: Traits conflict with the self; the person finds them distressing and is more likely to seek help.
Why are PDs hard to Tx?
Traits are long-standing and resistant to change.
Most PDs are ego-syntonic, so clients lack insight or motivation.
Interpersonal dysfunction affects the therapy relationship.
Treatment requires long-term commitment and often progresses slowly.
Comorbidity complicates treatment.
Few evidence-based treatments exist for many PDs.
