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Flashcards in Personality Disorders Deck (48):

what is personality

Collection of traits that
represent enduring patterns
of thought, emotion and
behavior that makes you
– It's the way one views,
understands and relates to
the outside world, as well as
how one sees him or


Categorical and Dimensional Models

• Five factor model of personality (“Big Five”)
– Openness to experience
– Conscientiousness
– Extraversion
– Agreeableness
– Emotional stability
• Cross-cultural research establishes the
universal nature of the five dimensions


Big Five

– Openness to experience
– Conscientiousness
– Extraversion
– Agreeableness
– Emotional stability
-Neuroticism (even tempered vs. moody)


fun fact about Personality disorders

-more controversial than any other DSM-5 disorder
-can't be diagnosed with PD until you are 18yrs+


What is a personality disorder?

– Inflexible pattern of inner experience & outward behavior
– Pattern is persistent; seen in most interactions, differs from
the experiences and behaviors usually expected, and
continues for years
– Can lead to psychological pain for the individual
– May cause difficulties in work and relationships
• These patterns are not typically marked by changes in
intensity or periods of clear improvement


DMS-5 Criteria

The DSM-5 identifies ten personality disorders and
separates these into three groups or “clusters”:
– Odd or eccentric behavior
• Paranoid, schizoid, and schizotypal personality disorders
– Dramatic, emotional, or erratic behavior
• Antisocial, borderline, narcissistic, and histrionic personality
– Anxious or fearful behavior
• Avoidant, dependent, and obsessive-compulsive personality


odd & eccentric behavior cluster one

• Paranoid, schizoid, and schizotypal personality disorders


dramatic, emotional, or erratic behavior cluster two

Antisocial, borderline, narcissistic, and histrionic personality


anxious or fearful behavior cluster three

• Avoidant, dependent, and obsessive-compulsive personality


Paranoid Personality Disorder

A. pervasive pattern of distrust and suspiciousness of other such that their
motives are interpreted as malevolent beginning in early adulthood and
indicated by four or more of the following:
– suspects, without sufficient basis, others are exploiting, deceiving,
or harming him
– preoccupied with unjust doubts about loyalty of friends or associates
– won’t confide in others lest info be used against him
– reads hidden demeaning or threatening meanings into benign
remarks or events
– bears a grudge, is unforgiving of slights
– perceives attacks on his character that others don’t and is quick to
– recurrent suspicions about fidelity of spouse or sexual partner
B. Does not occur exclusively within schizophrenia


Know the most about

-Antisocial (all in jail)
-Borderline (all in patient hospital care)


Paranoid Personality Disorder overview and clinical features

– Pervasive and unjustified mistrust and suspicion
– Preoccupied with doubts about loyalty or trustworthiness
– Reluctant to confide in others (used against them)
– Bears grudges
– Reads into “hidden meaning” of benign remarks


the causes of paranoid personality disorder

– Biological and psychological contributions are unclear
– Early learning that the world is a dangerous place
very little genetic component


Treatment options for paranoid personality disorder

– Few seek professional help on their own
– Treatment focuses on development of trust
– Cognitive therapy to counter negativistic thinking
– Lack good outcome studies


Schizoid Personality Disorder

A. Pervasive pattern of detachment from social relationships
and restricted range of emotions in interpersonal settings
beginning in early adulthood and indicated by 4 or more:
– Almost always chooses solitary activities
– Has little interest in sex
– Takes pleasure in few if any, activities
– Lacks close friends or confidants (other than family)
– Appears indifferent to praise or criticism
– Neither desires nor enjoys close relationships, including
– Shows emotional coldness, detachment, or flattened
B. Does not occur exclusively within schizophrenia


overview and clinical features of Schizoid Personality Disorder

– Pervasive pattern of detachment from social relationships
– Very limited range of emotions in interpersonal situations
– Emotional coldness, detachment
– Socially awkward
– Indifferent to criticism or praise
Hermits of the world - & like jobs where they don't have to talk to anyone


the causes of Schizoid Personality Disorder

– Etiology is unclear
– Preference for social isolation resembles autism
-little genetic component


treatment options for Schizoid Personality Disorder

– Few seek professional help on their own
– Focus on the value of interpersonal relationships
– Building empathy and social skills
– Lack good outcome studies


Schizotypal Personality Disorder

A. Pervasive pattern of social and interpersonal deficits, reduced capacity
for close relationships, cognitive or perceptual distortions, eccentric
behavior beginning and early adulthood indicated by 5 or more of the
– Ideas of reference
– Odd beliefs or magical thinking
– Unusual perceptual experiences (respond to people's energy)
– Vague, metaphorical or stereotyped speech
– Suspiciousness or paranoid ideation
– Inappropriate or constricted affect
– Behavior or appearance that is odd or eccentric
– Lack of close friends or confidants
– Excessive social anxiety that does not diminish with familiarity
B. Does not occur exclusively during the course of schizophrenia
Eccentrics of the world


delusion of reference

when people feel like they are getting messages from TV or News


idea of reference

(ppl who really believe in their horoscope) problem when it becomes default way to connect with others or in the way of functioning


Schizotypal PD

• Behave oddly & have unusual
beliefs (such as aliens).
• Cling to these beliefs so
strongly that it prevents them
from having relationships.
• Upset by their difficulty in
forming and keeping close
relationships (different from
schizoid personality disorder
patients who do not want to
form relationships).


overview and clinical features of schizotypal personality disorder

– Odd and unusual behavior and appearance
– Most are socially isolated, highly suspicious
– Magical thinking, ideas of reference, and delusions
– Many meet criteria for major depression


the causes of schizotypal personality disorder

– A phenotype of a schizophrenia genotype?
• Similar but more mild symptoms


treatment options for schizotypal personality disorder

– Main focus is on developing social skills
– Treatment also addresses co-morbid depression
– Medical treatment similar to schizophrenia
– Treatment prognosis is generally poor
(typically patient doesn't like it b/c others can't understand it)


Antisocial personality disorder

-diagnosed in terms of behaviors (need 5)
• Failure to conform to social norms with respect to lawful
behaviors as indicated by repeatedly performing acts that are
grounds for arrest
• Deceitfulness, as indicated by repeated lying, use of aliases, or
conning others for personal profit or pleasure
• Impulsivity or failure to plan ahead
• Irritability and aggressiveness, as indicated by repeated physical
fights or assaults
• Reckless disregard for safety of self or others
• Consistent irresponsibility, as indicated by repeated failure to
sustain consistent work behavior or honor financial obligations
• Lack of remorse, as indicated by being indifferent to or
rationalizing having hurt, mistreated, or stolen from another


psychopaths vs. sociopaths

psychopaths (more behavior, genetic)
sociopaths (more environmental, LEARNED behaviors like crime pays off, more impulsive)


psychopaths vs. antisocial

psychopaths (behaviors)
sociopaths (personality)
psychopaths are typically not in jail-very intelligent, know it's wrong but don't care, have parasitic lifestyles


parasitic lifestyles

the couch surfer aka lives on host then moves on when asked to contribute


unique things about antisocial

antisocial is the only disorder that you have to have evidence earlier in life --> conduct disorder like torturing animals, pyromania, burglary, etc
inconsistent parenting


causes of antisocial personality

• Gene-environment interaction
– Genetic predisposition
– **Environmental triggers
• Arousal hypotheses
– Underarousal, takes a lot for people to feel something
– Fearlessness


you can have antisocial PD & not be a psychopath but..

if you're a psychopath you probably have antisocial PD
-psychopathy and sociopathy are not diagnosis but a trait related to antisocial


Hare (1991) Psychopathy

Glibness and Superficial Charm
– Grandiose self worth
– Proness to boredom - need for
– Pathological Lying
– Conning manipulative
– Lack of Remorse
– Parasitic lifestyle
• Good predictive validity


Histrionic Personality

• Excessive emotionality and
attention seeking
• Needing to be center of
– Dress, style, etc.
• Seductive/ inappropriate
• Impressionistic Cognitive style
– Grandiose language to describe
ordinary events
• Approval & praise = life blood
theater people of the world, stereotypically female way of manipulating (over diagnosed & bias)


Histrionic Personality Disorder

A pervasive pattern of excessive emotionality and attention seeking,
beginning in early adulthood and indicated y 5 or more:
– Uncomfortable in situations where not the center of attention
– Interaction with others is often characterized by inappropriate
sexual behavior
– Rapidly shifting and shallow expression of emotions
– Consistently uses physical appearance to draw attention to self
– Style of speech that is impressionistic and lacking in detail
– Shows self-dramatization, theatricality, and exaggerated emotion
– Is suggestible and easily influenced by others or circumstances
– Considers relationships to be more intimate than they actually are


Causes of Histrionic

• Genes + early childhood events
• Dx more often in women than in men


Treatment of Histrionic

– Problematic interpersonal relationships
• Attention seeking
– Little empirical support


Borderline Personality Disorder

• Hallmark Features
– Emotional dysregulation
• Inappropriate anger
• Dysphoria/Depression
– Unstable interpersonal relationships
• Frantic efforts to avoid abandonment
• Idealization vs. devaluation
– Impulsive behaviors (spending, sex, binge eating,
reckless driving, substance use)
• Self harm (6% suicide rate)
• Substance use (67%)


DMS-5 Diagnostic Criteria for Borderline Personality Disorder

A pervasive pattern of instability of interpersonal relationships, self-image, and
affects, and marked impulsivity beginning by early adulthood and present in a
variety of contexts, as indicated by five (or more) of the following:
1. Frantic efforts to avoid real or imagined abandonment.
2. A pattern of unstable and intense interpersonal relationships characterized by
alternating between extremes of idealization and devaluation
3. Identity disturbance: markedly and persistently unstable self-image or sense of
4. Impulsivity in at least two areas that are potentially self-damaging (e.g.,
spending, sex, substance abuse, reckless driving, binge eating). Note: Do not
include suicidal or self-mutilating behavior covered in Criterion 5.
5. Recurrent suicidal behavior, gestures, or threats, or self-mutilating
6. Affective instability due to a marked reactivity of mood (e.g., intense
episodic dysphoria, irritability, or anxiety usually lasting a few hours
and only rarely more than a few days)
7. Chronic feelings of emptiness
8. Inappropriate, intense anger or difficulty controlling anger (e.g.,
frequent displays of temper, constant anger, recurrent physical fights)
9. Transient, stress-related paranoid ideation or severe dissociative


normal self harm

tattoos and piercings


comorbid disorders with borderline personality disorder

– Depression – 20%
• Suicide – 6%
– Bipolar – 40%
– Substance abuse – 67%
– Eating disorders
• 25% of bulimics have BPD


treatment for borderline personality disorder

– Highly likely to seek treatment
– Antidepressant medications
– Dialectical behavior therapy
• Reduce “interfering” behaviors
– Self-harm
– Treatment
– Quality of life
– Outcomes


Narcissistic Personality Disorder

A pervasive pattern of grandiosity, need for admiration, and lack of
empathy, beginning in early adulthood and indicated by 5 or more
of the following:
– Grandiose sense of self-importance
– Preoccupied with fantasies of success, power, beauty, or ideal
– Believes themselves to be“special” and should only affiliate
with high-status people or things
– Requires excessive admiration
– Has sense of entitlement
– Is interpersonally exploitive (takes advantage of others)
– Lacks empathy
– Is often envious of others and believes others are envious of
– Shows arrogant, haughty behaviors or attitudes
CEOs of the world


some degree of narcissistic is good but..

only a disorder when maladaptive and impairment
can look like psychopathy but are not breaking laws/impulsivity
takes time, mental burden, less dignity


Obsessive-Compulsive Personality

• No intrusive obsessions or compulsions but
preoccupation with order and control.
• Is preoccupied with details, rules, lists, order,
organization, or schedules to the extent that the major
point of the activity is lost
• Loss of flexibility, openness, & efficiency
• Perfectionism interferes with task completion
• Doing things “right” impairs
• Prioritizing feels debilitating



• Excessively devoted to work and productivity
• Inflexible about matters of morality, ethics, or values
• Reluctant to delegate tasks or to work with others
• Miserly spending style
• Shows significant rigidity and stubbornness
• Attentive to relative status in dominance-submission
• excessive deference to an authority they respect
• excessive resistance to authority that they do not respect.
problem with interpersonal relationships
if they see you junior to them you don't matter


Causes of Obsessive-Compulsive Personality

– Limited research
– Weak genetic contributions
• Predisposed to like structure?


Treatment of Obsessive-Compulsive Personality

– Similar to OCD (exposure to failure)
– Address fears related to the need for orderliness
– Limited data on treatment outcome