Personality Disorders (Lecture Material)

Question 1

What is personality?

Answer 1

Regularities/consistencies in behavior, thinking, perceiving, and feeling that are:
- stable across times and situations
- integrated and cohesive

Question 2

What is the first/main criteria of a disordered personality?

Answer 2

An enduring pattern of inner experience and behavior that deviates markedly from the experiences of the individual’s culture and manifests in cognition, affectivity, interpersonal functioning, and/or impulse control

Question 3

What are the other 3 criteria for a disorder personality?

Answer 3

B- the pattern in inflexible and pervasive across a broad range of personal and social situations

C- the pattern leads to significant distress or impairment of important areas of functioning

D- the pattern is stable and of long duration, with its onset being traced back to adolescence or early childhood

Question 4

What is Cluster A of personality disorders?
What behaviors characterize it?
What 3 disorders did we discuss that fall under this cluster?

Answer 4

Odd-Eccentric

Similar behaviors to schizophrenia, such as flat affect or odd speech patterns, but they don’t reach the same severity as schizophrenia and they differ in their grasp on reality

Paranoid, Schizoid, and Schizotypal Personality Disorders

Question 5

How does Paranoid Personality Disorder differ from Schizophrenia? What are their social histories like?

Answer 5

Defined by the presence of paranoia, but no other schizophrenia symptoms

Often have betrayal and anxiety in their social histories

Question 6

Schizoid Personality Disorder

What defines it?

Answer 6

Defined by the presence of flat affect (having no emotional response to anything good or bad)

Question 7

Schizotypal Personality Disorder
What symptoms define it?

3 are listed

Answer 7

Symptoms of Schizophrenia are not severe enough to warrant diagnosis
- mild perceptual or cognitive distortions such as odd beliefs or illusions
- odd speech patterns
- discomfort with/avoidance of interpersonal relationships

Question 8

What is Cluster B of personality disorders?
What behaviors characterize it?
What 4 disorders did we discuss that fall under this cluster?

3 characteristic behaviors listed

Answer 8

Dramatic-Emotional

• Manipulative and uncaring (showing little regard for others or their own safety; difficulties with empathy and perspective taking)
• Emotional dysregulation
• Inappropriately sexual/seductive behavior or extreme focus on appearance

Histrionic, Antisocial, Narcissistic, and Borderline Personality Disorders

Question 9

What are the main symptoms of Histrionic Personality Disorder?

There are 3 listed

Answer 9

• Exaggerated emotionality that lacks depth
• Discomfort when not the center of attention (constantly seeking reassurance, approval, and praise)
• Inappropriately sexual behavior and extreme focus on appearance

Question 10

What are the core beliefs of those with Histrionic Personality Disorder?

There are 2 listed

Answer 10

If I can’t entertain people, they’ll leave me, and if other people don’t respond to me, they’re rotten

What they’re getting attention for (whether or not it’s bad) doesn’t matter as much as the fact that they’re getting attention

Question 11

What are the learning histories of those with Histrionic Personality Disorder?

Answer 11

Selective interpersonal reinforcement by family and peer relationships leads to excessive attention-seeking behavior

Question 12

What are the symptoms of Antisocial Personality Disorder according to the DSM?

6 are listed

Answer 12

A disregard for and violation of the rights of others, as seen by:
- Failure to conform to social norms with respect to lawful behavior
- Deceitfulness
- Impulsivity
- Irritability or aggressiveness
- Reckless disregard for the safety of others + consistent irresponsibility
- Lack of remorse for behaviors

Question 13

What is the problem with the DSM’s definition of ASPD?

Answer 13

It focuses mainly on antisocial behavior and social deviance, such as acts of aggression and criminality, with little emphasis on personality traits

Not everyone with this disorder is a criminal, and not everyone who commits a crime has this disorder (there are multiple determinants of criminality, such as socio-economic status)

Question 14

What is Moral Insanity?

Answer 14

Not being psychotically deranged or having a deficit in reasoning abilities, but still having a deficit in moral faculties, such as lacking guilt or shame for transgressions

Question 15

What is Psychopathy?

5 traits listed

Answer 15

Focuses on trait-level characteristics that lead to antisocial behavior, such as grandiosity, arrogance, superficiality, inability to form meaningful emotional bonds, and lack of anxiety

Question 16

Is Psychopathy the same thing as ASPD?

Answer 16

ASPD was meant to assess psychopathy, but the diagnostic criteria doesn’t fit because it fails to account for personality

Thus, ASPD and psychopathy are NOT the same thing (you can have one and not the other)
You can not be a criminal and still be dangerous

Question 17

What have we noticed about the prevalence rates of ASPD? Why might these differences arise?

There is an exact percentage here

Answer 17

They’re overrepresented in criminal and substance abuse settings, with 76% of prisoners being diagnosed with it
Rates are higher among men

Both of these patterns are likely due to issues with the diagnostic criteria

Question 18

What have we found about heritability in ASPD?

There are 3 exact percentages here

Answer 18

Heritability for the ASPD diagnosis is fairly low, only 29%, but once we start looking at those specific personality traits (psychopathy), those rates increase to 55% for the mania scale and 61% for the psychopathic deviate scale

Question 19

What does the psychopathic deviate scale measure? The mania scale?

PDS measures 4 things; Mania measures 3

Answer 19

PDS: family discord, authority conflict, social alienation, and low social anxiety
Mania: amorality, social confidence, ego inflation

Question 20

What two early learning environments do we see coming up in the histories of those with ASPD?

Answer 20

Passive/neglectful parenting and Overly harsh parenting

Question 21

How would a passive-neglectful parenting style lead to antisocial behavior?

Answer 21

No demands for responsibility and non-aggression + little response-contingent attention for positive behaviors = no moral compass + engaging in negative behaviors for attention

Question 22

How would an overly harsh parenting style lead to antisocial behavior?

Answer 22

Use of aggression/abuse for discipline = learn to use aggression during conflict and problem-solving + developing a hostile information processing style in social interactions (even neutral ones)

Question 23

What deficits in acquiring learned responses do we see in those with ASPD?

Difference between +/- punishment

Answer 23

They seem incapable of profiting from certain rewarding or punishing experiences and have trouble learning through aversive conditioning

Positive punishment = no motivation to learn
Negative punishment (taking away a reward) = learning

Question 24

What deficits in acquiring fear responses do we see in those with ASPD?

Answer 24

They’re slow to develop conditioned responses to aversive outcomes and seem less influenced by their fear reaction when making decisions
They also don’t seem to be heavily affected by psychological deterrents such as anxiety or fear of consequences

Question 25

What are the baseline levels of physiological arousal in those with ASPD? How might this influence behavior?

Answer 25

Seem to have lower baseline levels of arousal and rapid adaptation to novel stimuli = chronic boredom Seem to have high initial attention but more rapid habituation Boredom is an aversive state which we often need new or thrilling stimuli to get out of Chronic boredom = desire to increase arousal levels via high-risk sensation-seeking behaviors

Question 26

To summarize, how do learning and performance deficits contribute to psychopathic tendencies? | 4 things listed here

Answer 26

Not learning from negative experiences + not being highly influenced by fear or social anxiety + feeling chronically bored + being unable to empathize = antisocial behavior

Question 27

What is the gold standard definition of narcissism?

Answer 27

There isn't one The addition of narcissism as a diagnosis in the DSM-III led to a surge in research with inconsistent definitions, assessment methods, and conceptualizations

Question 28

What is Healthy Narcissism? What are some situations in which narcissistic states may naturally arise?

Answer 28

The capacity to maintain a relatively positive self-image, leading to a desire to seek out opportunities for self-enhancement and regulate the need for validation and attention If we feel that our positive sense of self has been challenged, such as when we feel jealous, we may react defensively or blame others

Question 29

What is the function of Healthy Narcissism? What are its benefits? | 5 benefits listed

Answer 29

Narcissistic states are normal because a positive sense of self is necessary to operate in the world Some degree of narcissism leads to positive outcomes such as: - higher achievement motivation, interpersonal dominance, and sense of personal agency - less neuroticism and depression - higher rates of creativity, empathy, self-esteem, individualism - outgoing, energetic, articulate - use praise as motivation to succeed

Question 30

When does Narcissism become pathological/clinical?

Answer 30

When one's sense of self is constantly being challenged = chronically feeling less than = feeling a need to prove oneself as superior to others

Question 31

What are the two main dimensions or states of narcissim?

Answer 31

Grandiose and Vulnerable

Question 32

What is Grandiose Narcissism? | 3 aspects are listed here

Answer 32

Arrogant, conceited, & domineering attitudes and behaviors - Repressing negative aspects of self - Distorting disconfirming external information with entitled attitudes, inflated self-images, and avoidance of opportunities for failure (don't have the accomplishments/skills to back up their inflated egos) - Engaging in regulatory fantasies of unlimited power, superiority, and perfection

Question 33

What is Grandiose Narcissism characterized by (what signs and symptoms)? | 8 are listed here

Answer 33

Seething anger, manipulativeness, pursuit of interpersonal power or control, lack of remorse, little insight into behavior, exaggerated self-importance, feelings of privilege, and externalizing negative life events

Question 34

What is Vulnerable Narcissism? Do those with the more Grandiose type still go through vulnerable states?

Answer 34

These people want to be the grandiose type, but can't maintain that state given the feedback they get from the world (their grandiose state more easily crumbles) Those with the grandiose type can still go through periods of vulnerability during a strong salient event that seriously challenges or destroys their inflated sense of self Either way, grandiosity is difficult to maintain and will often oscillate or co-occur with vulnerable periods

Question 35

What is Vulnerable Narcissism characterized by (what signs and symptoms)? | 4 are listed

Answer 35

Fragile/hypersensitive self; proneness to narcissistic injury; inability to consistently maintain grandiosity; tendency to dwell on feelings of shame, anxiety, depression, and inadequacy

Question 36

In what ways would treatment-seeking behavior and insight differ in a grandiose state vs a vulnerable state of narcissism?

Answer 36

Slightly higher levels of insight in vulnerable state = more likely to utilize treatment

Question 37

What role does genetics play in Narcissistic Personality Disorder? | 5 exact percentages are used here

Answer 37

Heritability estimates vary widely (as low as 37% to as high as 77%) Rates vary depending on the specific narcissistic traits under investigation Grandiosity has a low rate (23-35%), while healthy narcissism has a slightly higher one (42%)

Question 38

What two learning histories do we see among those with narcissistic personality disorder? How do these environments lead to narcissistic behaviors?

Answer 38

1- Overvaluation by parents that is not balanced with realistic feedback leads to a failure to develop coping mechanisms for dealing with narcissistic injuries 2- Lack of valuation or idealization by parents leads to a failure to perceive oneself as having value and obtaining love for their own sake as opposed to for accomplishments

Question 39

What is Borderline Personality Disorder characterized by? | 2 things

Answer 39

1- Instability in mood, cognition, behavior, sense of self, and interpersonal relationships 2- Profound fears of abandonment, real or imagined, and desperate attempts to avoid abandonment

Question 40

How might the characteristics of BPD manifest? | 5 things

Answer 40

- Intense mood swings or switching from putting someone on a pedestal to putting them down - May have exploitative or manipulative behaviors to keep people around - Parasuicidal behavior or self-harm tendencies - Paranoia about betrayal - Dissociative experiences

Question 41

What do we see in the early learning histories of those with BPD? What is the common theme here? | 5 things + 1 common theme

Answer 41

- Abandonment (parental absences) - More discord between parents - More experiences of being raised by other relatives or in foster home - More physical violence in family - Higher likelihood of experiencing early trauma or neglect An unstable, chaotic, or invalidating early attachment environment

Question 42

What is "good enough mothering"?

Answer 42

Mothering just has to be good enough to teach emotional regulation skills and independence, because if parenting was perfect (you respond perfectly every time your child is distressed), they wouldn't develop self-regulatory systems

Question 43

How does the idea of good enough mothering connect to Linehan's understanding of BPD?

Answer 43

If mothering isn't "good enough" and the child's inner experiences (emotions) are met with inappropriate, erratic, or inconsistent responses from parents, the child will struggle to form a stable self-concept with effective emotional regulation

Question 44

What do scientists believe is being inherited with respect to BPD? | 5 potential things

Answer 44

Predisposing personality traits such as impulse control problems, affective instability, cognitive dysregulation, antisocial traits, and comorbid predisposition for anxiety and mood disorders

Question 45

What is the main limitation of twin studies about BPD? What concordance rates have we found so far? | 2 exact percentages

Answer 45

They have not yet done adoption studies, which limits our empirical understanding of environmental factors and may overemphasize the role of genetics So far, concordance rates are about 75% in MZ twin and 35% in DZ

Question 46

What is Cluster C of personality disorders? What is the defining characteristic? What 3 disorders did we talk about that fall under this cluster?

Answer 46

Anxious-Fearful Extreme concern about criticism and abandonment that leads to impaired relationships Avoidant, Dependent, and Obsessive-Compulsive Personality Disorders

Question 47

What are the features of Avoidant Personality Disorder? | 3 things

Answer 47

1- Feelings of extreme social inhibition, inadequacy, and sensitivity to negative criticism and rejection 2- Avoidance of daily living activities (like work) that involve people (due to a fear of criticism or rejection) 3- Low self-esteem and social isolation

Question 48

What are the features of Dependent Personality Disorder? | 3 things

Answer 48

1- Feelings of helplessness, submissiveness, dependence, reassurance seeking 2- Difficulty making independent decisions (low self-efficacy and feeling like they can’t function on their own) 3- Avoidance of adult activities and tolerance of abuse and maltreatment

Question 49

What is the main characteristic of OCPD?

Answer 49

A pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control at the expense of flexibility, openness, and efficiency, beginning in early adulthood and presenting in a variety of contexts

Question 50

What are the potential symptoms of OCPD? | 6 things (god bless your soul girl)

Answer 50

1- Preoccupation with details, rules, lists, order, organization, or schedules 2- Shows perfectionism that interferes with task completion 3- Excessively devoted to work and productivity to the exclusion of leisure activities and friendships 4- Is over-conscientious, scrupulous, and inflexible about matters of morality, ethics, or values 5- Is unable to discard worn-out clothes or worthless objects even when they have no sentimental value (very frugal) 6- Is reluctant to delegate tasks or to work with others unless they submit to exactly their way of doing things

Question 51

What is the most common personality disorder (evidence on this is mixed)?

Answer 51

OCPD (some evidence of high prevalence in men)

Question 52

What are some of the diagnostic issues with OCPD? | 2 things

Answer 52

1- Lacks a hallmark diagnostic feature 2- Heterogenous category, which has severely impaired our empirical understanding of it

Question 53

What are some of the inconsistent findings we've found in regards to OCPD? I.e. in what realms of understanding? | 4 things

Answer 53

1- Stability over time 2- Specific symptoms potentially having different courses 3- Overlap with OCD 4- Etiological factors and heritability