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Flashcards in Personality Disorders Deck (29):
1

Personality Disorders, General

Chronic interpersonal difficulties
o That the individual is not able to overcome via adaptations

Long-standing maladaptive problems
o Including problems related to identity of sense of self

Unlike regular mental disorders
o Personality disorders typically do not involved acute episodes
• Instead they appear as chronic traits

2

Traits

Behaviors that are stable across time and settings

Occur on a continuum rather than a categorical present or not-present

In the context of psychopathology, personality traits that impair and cause prolonged stress

3

Barriers to Treatment

1. Ego-syntonic

2. Treatment Refractory

3. More distressing for others than those with the personality disorder

4. More likely to be comorbid with other disorders

4

Ego-syntonic

View personality disorders as just something that is a natural part of the oneself

Do not see these as problems with self but rather the problems are caused by problematic behaviors of others

5

Treatment Refractory

Because many feel these problems stem from others, many suffering from personality disorders are unwilling to cooperate with treatments

May require more rapport building than is typically expected in order to increase trust and chance of treatment

Typically takes significantly longer to complete treatment

Underlying personality disorders may account for those who respond poorly to psychotherapy

6

Comorbidity

Specifically mood, anxiety, substance, or other personality disorders

25-85% all of personality disorders are comorbid

Which causes which?

A personality disorder may prevent or impede the therapeutic process

It can decrease the chance of treatment, or increase the related symptoms

7

Personality Disorders: Clinical Features

Pervasive and inflexible

Stable and long duration

Clinically distressing and impairing

Manifested in at least two areas

8

Personality Disorders: Onset

Typically arises in young adulthood
o As one’s personality stabilizes

Treatment for personality disorders typically starts later however
o Only after years of failing to engage in “normal” behaviors do individual realize a problem exists
• Then they are willing to seek help

Many with personality disorders only enter therapy after experiencing depression stemming from prolonged social difficulties

Only at this point would the disorder become evident

9

Personality Disorders: Prevalence

Personality disorders are the most common psychological disorders

10-13% has at least one personality disorder

Most Common: Antisocial personality disorder
• ~4% of all personality disorder cases

10

Personality Disorders: Gender Bias

Males common dx:
*Antisocial
*Narcissistic
*Paranoid

Females common dx:
*Borderline
*Histrionic

Some diagnoses are more gender-neutral
*Dependent
*Avoidant

11

Personality Disorders: Cultural Differences

Non-European countries are less likely to diagnose individuals with a personality disorder

In Taiwan, only 0.4% of the population is diagnosed with one

12

Cluster A

The Odd, Eccentric Cluster

Odd people who live solitary lives with few stable relationships

Paranoid

Schizoid

Schizotypal

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Cluster B

The Dramatic, Emotional, Erratic Cluster

Difficulty maintaining stable relations

Histrionic

Narcissistic

Antisocial

Borderline

14

Cluster C

The Anxious, Fearful Cluster

Pervasive anxiety coupled with chronicity and self-schema issues

These chronic and schema-related issues are what distinguishes anxiety disorders from Cluster C

Clinicians have difficulty distinguishing between anxiety disorders and Cluster C

Avoidant

Dependent

Obsessive-Compulsive

15

Difficulties Doing Research on Personality Disorders

Criteria overlaps between disorders
o e.g. lack of relations is apparent in schizoid and avoidant disorders

Diagnoses require long-standing behaviors
o Requires long-term and reliable histories
o Those with personality disorders may have a bias in describing their clinical histories

Categorical requirements of DSM requires a fixed number of symptoms to diagnose
o But there is a chance that we overlook some if we are following this strict rule

16

Five Factor Model of Personality

Neuroticism

Extraversion

Agreeableness

Openness to Experience

Conscientiousness

Some have proposed that the combination of different extremes may explain personality disorders

Despite this potential advantage of using these dimensional-based system, the DSM still relies on categorical diagnoses

17

Neuroticism

High score: emotion/temperament varies

Low score: emotions do not change in any setting

18

Extraversion

High score: active, optimistic, open

19

Agreeableness

High score: trusting and tender-hearted

Low score: rude, hostile

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Openness to Experience

High score: sensation seeking

Low score: close-minded

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Conscientiousness

High score: strive to achieve, motivated

Low score: less demanding, unreliable

22

Paranoid Personality Disorder

Hypersensitive to negative evaluation

Preoccupied by doubt or infidelity of others

Read into hidden meaning

Easily find threats when looking at the hidden meaning of the behaviors of others

Guarded and on alert for threat

Hold grudges for long durations

*Cannot diagnosis someone with this disorder if (s)he is a member of a prosecuted group

23

Paranoid PD: Treatment

Use hierarchy of threatening situations

Honest rapport is critical

Increase feelings of self-efficiency via
• Cognitive restructuring
• Social-sills training

24

Schizoid Personality Disorder

Emotionally cold

Flat affect

Little or no social interaction
• And no desire to increase this behavior

Summarized: social and physical anhedonia
• Although the individual is not complaining of these symptoms

25

Schizotypal Personality Disorder

Odd beliefs/thoughts

Magical thinking

Perceptual apparitions

Suspicious of others

Social anxiety

The disorder is on the schizophrenia spectrum
• The key difference: there is no active psychosis
• No hallucinations, delusions, or thought-disorder

26

Schizotypal Personality Disorder: Treatment

Teach the ability to critically evaluate ideas

Decrease anxiety and inappropriate social behavioral and increase social situations

Assist engaging in daily tasks and social networks

27

Histrionic Personality Disorder

Center of attention

Over-concerned with attractiveness

If not given attention, attempts to draw back others back to them

28

Narcissistic Personality Disorder

Grandiosity

Preoccupied with receiving attention

Self-promoting

Lack of empathy

Tendency to enjoy psychotherapy
*they get to spend 1 hour talking about themselves

29

Borderline Personality Disorder

Impulsive

Inappropriate behavior

Drastic mood shifts

Unstable self-images

Intense anger

Suicidality

Drastic reactions to stressors

Comorbid with anxiety and depression

Difficulty engaging in self-regulation
• Including eating behaviors

Self-mutilation

“Black-and-white” thinking

Treatment
• DBT is the most successful protocol in treating BPD
• SSRIs and other mood stabilizers are helpful