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Flashcards in Personality disorders Deck (36):
1

What are personality disorders?

Heterogeneous group of disorders coded on Axis II of the DSM
Regarded as…
long-standing, pervasive, and inflexible patterns of behaviour and inner experience that…
deviate from cultural expectations
causes impairment in social and occupational
can cause emotional distress

2

What are the clusters of PDs?

Cluster A
paranoid, schizoid, and schizotypal
oddness and avoidance of social contact
Cluster B
anti-social, borderline, histrionic, and narcissistic
dramatic, emotional, or erratic
extrapunitive and hostile
Cluster C
avoidant, dependent, and obsessive-compulsive
appear fearful

3

What are the characteristics of Paranoid PD?

suspicious of others
expect to be mistreated or exploited by others
reluctant to confide in others
tend to blame others
can be extremely jealous

4

What are the characteristics of Schizoid PD?

no desire for or enjoyment of social relationships
appear dull, bland, and aloof
rarely report strong emotions
have no interest in sex
experience few pleasurable activities
indifferent to praise and criticism

5

What are the characteristics of Schizotypal PD?

interpersonal difficulties of schizoid personality
high social anxiety
eccentric symptoms (behaviour and appearance) identical to prodromal and residual phases of schizophrenia

6

What are some of the symptoms of Schizotypal PD?

Odd beliefs or magical thinking (e.g., belief they have telepathic powers, superstitious, clairvoyance, ‘others can feel my feelings’
Recurrent illusions (e.g., sense the presence of a force not actually there – “I felt that my dead mother was in the room with me.”), depersonalization, derealization.
Odd speech (using words in unusual or unclear fashion, e.g., digressive, vague, overelaborate)
Ideas of reference (misinterpret event as having particular personal meaning)
Suspiciousness or Paranoid ideation

7

What is the etiology of schizotypal PD?

Genetically linked to schizophrenia
Perhaps less severe variant
Could be linked to a history of PTSD and childhood maltreatment

8

What are the characteristics of Borderline PD?

core features are impulsivity and instability in relationships, mood, and self-image
attitudes and feelings toward others vary dramatically
emotions are erratic and can shift abruptly
argumentative, irritable, sarcastic, quick to take offence, etc.
Can be transient episodes of paranoia, dissociation
Traits:
Very high neuroticism
Low on trust, compliance (agreeableness)
Dichotomous thinking (splitting)

9

What are the three main dimensions of Borderline PD?

Three main dimensions:
Affect instability
Inappropriate anger, drastic mood shifts
reactive mood
feelings of emptiness
Dysfunctional relationships
Unstable and intense relationships
Efforts to avoid abandonment
Impulsivity
Impulsive self-damaging behaviors
Attempts at self-mutilation or suicide

10

What are the biological theories of Borderline PD?

Biological factors:
Strong genetic component found in twin studies
Heritability of impulsivity and affective instability
Reduced response to serotonin in orbital, ventromedial and cingulate cortices linked to impulsive aggressivity
Increased noradrenergic responsiveness linked to affective instability
poor functioning of the frontal lobes

11

What are the psychosocial theories of Borderline PD?

Negative experiences in childhood: abuse, neglect, separation or loss, trauma
Parental psychopathology

12

What are the Diathesis-stress theories of Borderline PD?

Linehan’s diathesis-stress theory
Genetic/biological diathesis: affective instability and impulsivity traits
Stress: trauma, parental failure or psychopathology, loss/rejection

13

What are other etiologies of Borderline PD?

Object-relations theory

14

What are the treatments for Borderline PD? How do therapists deal with the tendency for patients to have troubles establishing trust; alternatively idealizing then vilifying them?

Dialectical behavior therapy: tolerance of negative affect, interpersonal skills, emotion regulation
Often uses group therapy
combines client-centered acceptance with a cognitive-behavioural focus
Object Relation: strengthen ego, address directly the splitting defense
Medication:
SSRIs useful for mood
Antipsychotic (low doses)
Mood stabilizers

15

What are the characteristics of Histironic PD?

overly dramatic and attention-seeking
use physical appearance to draw attention
display emotion extravagantly
self-centred
overly concerned with their attractiveness
inappropriately sexually provocative and seductive
speech may be impressionistic and lacking in detail

16

What are the characteristics of Narcissistic PD?

grandiose view of own uniqueness and abilities
preoccupied with fantasies of great success
require almost constant attention and excessive admiration
lack empathy
envious of others
arrogant, exploitive, entitled

17

What are the characteristics of Antisocial PD?

Two major components: 1) Conduct disorder present before 15 and 2) Pattern of anti-social behaviour continues in adulthood
irresponsible and anti-social behaviour
work only inconsistently
break laws
irritable
physically aggressive
impulsive and fail to plan ahead

18

What is psychopathy?

Key characteristic— poverty of emotions both positive and negative
lack of remorse
no sense of shame
superficially charming
manipulates others for personal gain
lack of anxiety

19

What is the relationship and differences between antisocial PD and psychopathy?

You can have APD and not be psychopathic but you can't be psychopathic and not have ADP.
Major distinction appears to be in symptomology.
“Lack of remorse,” a core symptom of psychopathy, is not required for diagnosis of APD.

20

What are the etiologies for APD and psychopathy?

Role of the Family:
Lack of affection
Severe parental rejection
Physical abuse
Inconsistencies in disciplining
Failure to teach child responsibility toward others
Biological:
Criminality and APD have heritable components
(twin and adoption studies)

21

What is different about psychopaths' emotions?

unresponsive to punishments / no conditioned fear responses
have higher than normal levels of skin conductance in resting situations
skin conductance is < reactive when confronted or anticipate intense or aversive stimuli
heart rate normal under resting conditions but in when anticipating intense or aversive stimuli heart rate higher than norms

Response Modulation, Impulsivity, and Psychopathy
slow brain waves and spikes in the temporal area
< activity in the amygdala/hippocampal formation

22

How was conduct disorder diagnosed?

Presence of at least 3 of the following:
Aggression – people and animals
Theft
Vandalism
Lying
Bullying
Running away
Truancy or staying out all night (before 13)

23

How does Cleckley describe psychopathy?

Lack of remorse
Poverty of emotions (positive and negative)
Inadequate conscience development
Irresponsible and impulsive behavior
Ability to impress and exploit others
Pathological liars

24

What are Hare's two major factors of psychopathy?

Affective/interpersonal: selfish, remorseless individual with inflated self-esteem and who exploits others.
Superficial charm, Grandiose sense of self-worth, Manipulative, Lack of empathy, Shallow affect

Antisocial lifestyle (behavior): marked by impulsivity and irresponsibility.
Failure to conform, Aggression, Deceitful/lying, Disregard for others

25

What are the biological theories of psychopathy?

Genotype-environment interaction.
Amygdala Dysfunction
Amygdala involved in aversive conditioning and response to fearful and sad faces
Psychopathy associated with:
Reduced amygdala volume
Reduced amygdala response to negative stimuli

26

What are the psychosocial theories of psychopathy? (not previously mentioned)

Physical abuse
Marital discord
Substance use
Fathers likely to have antisocial personalities.

27

What is the treatment for APD and psychopathy?

Usually unsuccessful, due in part to:
Lack of motivation
Deceitfulness

Early intervention may be more effective.

Antisocial behaviour decreases in middle age.

28

What is the Stress reactivity theory of psychopathy?

Convicted psychopaths usually found to have:
Lower autonomic stress reactivity
Lower resting state autonomic activity

Thought to play a role in development of psychopathy.

Not seen in “successful” psychopaths.

29

What is the Low-fear hypothesis of psychopathy?

Conditioning
Low fear response: skin conductance to unpleasant events
Failure to avoid punishment, learn from it, consequences don’t lead to develop conscience

30

What is the Frontal hypothesis theory?

Executive dysfunction/function deficits thought to underlie some psychopathic features.
Limitation - Studies supporting the frontal hypothesis mainly included violent offenders
No executive dysfunction found in “successful psychopaths”

31

What are the characteristics of Avoidant PD?

fearful in social situations
keenly sensitive to possibility of criticism, rejection, or disapproval
reluctant to enter relationships unless sure will be liked

32

What are the characteristics of Dependent PD?

lack self-reliance
overly dependent on others (sense of autonomy)
intense need to be taken care of
uncomfortable when alone
subordinate own needs

33

What are the characteristics of Obsessive-Compulsive PD?

perfectionistic approach to life
preoccupied with details, rules, schedules, etc.
serious, rigid, formal, and inflexible
unable to discard worn out and useless objects
does not include the obsessions and compulsions that define OCD

34

What is the etiology of cluster C PDs?

Unknown
Little data exist
Speculation about causes has focused on parent-child relationships

35

What are the limitations in studies of the etiology of psychopathy and APD?

1. harsh or inconsistent disciplinary practices could be reactions to child’s anti-social behaviour which may in turn fuel development of full blown antisocial behavior.
2. many individuals who come from disturbed backgrounds do not become psychopaths

36

What are the problems with diagnosing conduct disorder?

Relies on patient’s reports of past life events, but they are often pathological liars.
Many psychologists argue that a diagnostic concept in the field of psychopathology shouldn’t be linked with criminality.
Psychopathy may be a more informative concept.