Personality disorders Flashcards
(36 cards)
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
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
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
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
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
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
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
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)
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
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
What are the psychosocial theories of Borderline PD?
Negative experiences in childhood: abuse, neglect, separation or loss, trauma
Parental psychopathology
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
What are other etiologies of Borderline PD?
Object-relations theory
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
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
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
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
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
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.
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)
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
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)
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
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
