Problem 9: Personality Disorders

Question 1

Personality Disorder

Answer 1

= stable and enduring patterns of thought, feeling, and behavior that emerge in adolescence/early adulthood

• deviate from the norms of one’s culture
• pervasive and inflexible across many aspects of life
• lead to distress or impairment

Question 2

Cluster A

Answer 2

schizoid, schizotypal, and paranoid personality disorders

= odd or eccentric disorders, because the behavior of persons diagnosed with these disorders seems strange or unusual

Question 3

Cluster B

Answer 3

antisocial, borderline, histrionic, and narcissistic personality disorders

–> dramatic and erratic disorders, because the behavior of persons diagnosed with these disorders seems impulsive and unstable

Question 4

Cluster C

Answer 4

avoidant, dependent, and obsessive-compulsive personality disorders

–> anxious and fearful disorders, because the behavior of persons diagnosed with these disorders seems nervous and worried

Question 5

Schizoid Personality Disorder

Answer 5

• extreme detachment from social relationships
• limited expression of emotions
• no interest in interpersonal relationships
• little joy in non-social settings either

Question 6

Schizotypal Personality Disorder

Answer 6

• detachment from social relationships
• extreme discomfort with relationships
• highly superstitious, fascinated with paranormal
• may have bizarre perceptual experiences

Question 7

Paranoid Personality Disorder

Answer 7

• very strong suspiciousness of others’ motives
• suspect others are trying to harm them
• quick to take offense
• tendency to hold grudges against others

Question 8

Antisocial Personality Disorder

Answer 8

• tendency to disregard the right of others
• deceitful, lying to others for gain
• feel no remorse
• tend to be aggressive, impulsive, irresponsible

Question 9

Borderline Personality Disorder

Answer 9

• extreme instability in self-image and relationships
• extreme impulsivity
• intense and unstable love/hate relationships
• tendency to be extremely moody/temperamental

Question 10

Histrionic Personality Disorder

Answer 10

• exaggerated display of emotions
• excessive attention seeking
• intense need to be at center of attention
• use physical appearance to draw attention
• easily influenced by others

Question 11

Narcissistic Personality Disorder

Answer 11

• grandiosity: consider oneself superior
• selfish lack of concern for others
• fantasize about high status
• arrogant style

Question 12

Avoidant Personality Disorder

Answer 12

• social inhibition and shyness
• feelings of inadequacy
• oversensitivity to possible neg. evaluation
• lack of social contact (afraid of rejection)

Question 13

Obsessive-Compulsive Personality Disorder

Answer 13

• preoccupations with orderliness, perfection and control
• tends to be so preoccupied with details that the entire point of activity is lost
• put work ahead of personal relationships

Question 14

Problems with the DSM-5 Personality Disorders

Answer 14

1. symptoms of one disorder do not necessarily go together
2. two disorders may have overlapping symptoms
   –> comorbidity: many persons are diagnosed with two or more personality disorders at the same time
3. clusters of PDs do not match factor analysis results
4. personality should be seen as a continuum not a category

Question 15

Alternative System for Personality Disorders

Answer 15

Impaired Personality Functioning and Pathological Personality Traits

Question 16

Impaired Personality Functioning: Self-Problems

Answer 16

Identity:
1. A person might not have a sense of himself or herself as a unique person, if he or she identifies too strongly with some other person(s), or alternatively if he or she is too much concerned with being independent of certain others.
2. A person might have self-esteem that is highly unstable, being easily threatened by negative experiences, or might have a distorted appraisal of his or her strengths and weaknesses.
3. A person might not be able to regulate his or her emotions or even to recognize what emotions he or she experiences.

Self-direction:
1. A person might not be able to select realistic or meaningful goals in his or her life.
2. A person might lack any internal standards for behavior of the kind that would allow him or her to gain fulfillment through cooperation with others.
3. A person might be unable to reflect constructively on his or her own experiences or motivations.

Question 17

Impaired Personality Functioning: Interpersonal Problems

Answer 17

Empathy:
1. A person might be unable to understand the experiences or motivations of other people.
2. A person might be unable to understand or unwilling to consider the perspectives of others.
3. A person might have little understanding of how his or her own behavior affects others.

Intimacy:
1. A person might be lacking in positive, sustained relationships with people in general.
2. A person might be unable to engage in close, caring relationships with any other persons.
3. A person might be unwilling or unable to cooperate with others.

Question 18

Pathological Personality Traits

Answer 18

Negative Affectivity: intense and frequent experience of negative emotions

Detachment: withdrawal from social interactions and from other people

Antagonism: acting in ways that create difficulties for other people

Disinhibition: behaving on impulse, without thinking of consequences

Psychoticism: unusual, bizarre thoughts and perceptions

Question 19

Psychodynamic Psychotherapy

Answer 19

• helping patient to express emotions
• helping to identify recurring behavioural patterns and examine important relationships

Aim: improve patient’s self-understanding –> improve functioning

Question 20

Cognitive Behavioral Therapy (CBT)

Answer 20

–> based on idea that PD involve dysfunctional views about self, environment, and future

Aim: understanding irrational beliefs a patient holds and show that traits are maladaptive

Question 21

Dialectic Behavior Therapy (DBT)

Answer 21

• specifically for borderline patients

Aim: making patient aware of thoughts and feelings (developing mindfulness)

–> patients find it easier to handle the thoughts and feelings causing distress

Question 22

Prevalence of Personality Disorder

Answer 22

between 4% and 15%

–> higher in criminal offenders (2/3)
–> higher in people in contact with health-care services

Question 23

ICD-10

Answer 23

–> the ICD-10 disorders are very similar to the DSM-5 ones

main difference:
- schizotypal category is regarded as a part of the spectrum of schizophrenia and not classified with the personality disorders
- narcissistic personality disorder is not present in the classification
- borderline and impulsive personality disorders are subcategories of emotionally unstable personality disorder

Question 24

ICD-11

Answer 24

–> the proposed ICD-11 classification abolishes all type-specific categories of personality disorder apart from the main one: the presence of personality disorder itself

Diagnosis:
1. establish whether the patient satisfies the general definition of personality disorder
2. identify the severity of personality disturbance

Advantage:
removes the confusing comorbidity of different categories of personality disorder
–> the proportion of patients with unspecified personality disorder should be substantially reduced

Question 25

Genetic Influences

Answer 25

Personality traits in childhood stabilize throughout life beyond age 30 years --> roughly 50% heritable, with little variance accounted for by shared environmental factors, the remainder being attributable to individuals’ unique experiences and how their genetic make-up interacts with the environment --> genetic factors and environmental constancies probably underpin the continuity of personality, whereas changing environmental effects imply plasticity and thereby the opportunity for clinical intervention

Question 26

Stability and Change

Answer 26

Personality across the normal-abnormal range is... o moderately stable during childhood o increases in stability from adolescence to emerging adulthood o changes more slowly from age 30 years

Question 27

Psychosocial Intervention

Answer 27

= mixture of group and individual treatments, integrated with other services available to the patient could be optimum for a good outcome aim: reduce acute life-threatening symptoms and improve distressing mental state symptoms --> mainly for borderline personality disorder

Question 28

Pharmacotherapy

Answer 28

= behavioral traits associated with a personality disorder might be associated with neurochemical abnormalities of the CNS --> focuses on specific aspects of personality disorder's pathological effects, such as affective instability and cognitive-perceptual disturbances

Question 29

Dark Triad

Answer 29

Narcissism, Psychopathy, and Machiavellianism

Question 30

Psychopathy

Answer 30

shaped by impulsivity, low empathy, and anxiety, a lack of guilt or remorse, emotional shallowness, a belief in the superiority of oneself, and a parasitic lifestyle which can involve criminal activities

Question 31

Machiavellianism

Answer 31

= the willingness to exploit others --> belief in the effectiveness of manipulative tactics in dealing with other people --> a cynical view of human nature --> a moral outlook that puts expediency above principle

Question 32

Dark Triad and Career Success

Answer 32

narcissism was positively related to salary --> objective career success Machiavellianism was positively related to leadership position and career satisfaction --> objective and subjective career success psychopathy was negatively related to salary, leadership responsibility, and career satisfaction --> objective and subjective success

Question 33

Dirty Dozen

Answer 33

= a concise 12-item measure of the Dark Triad - fast life strategy: disagreeableness, short-term mating, low levels of conscientiousness - social exploitation - aggression: physical, verbal, and hostility - manipulation - instability - men score higher than women --> sociosexuality