Week 10 Personality disorders

Question 1

The general features that characterize most personality disorders are…

Answer 1

chronic interpersonal difficulties, problems with one’s identity or sense of self, and an inability to function adequately in society

Question 2

A personality disorder is diagnosed when

Answer 2

there is an enduring pattern of behavior or inner experience that is pervasive and inflexible, stable across time, and of long duration. It must also cause either clinically significant distress or impairment in functioning and be manifested in at least two of the following areas: cognition, affectivity, interpersonal functioning, or impulse control.

Question 3

antisocial personality disorder often results in

Answer 3

extreme and often unethical “acting out” against society.

Question 4

Cluster A: Includes…and people with these disorders often seem…

Answer 4

paranoid, schizoid, and schizotypal personality disorders. People with these disorders often seem odd or eccentric, with unusual behavior ranging from distrust and suspiciousness to social detachment.

Question 5

Cluster B: Includes…people with these disorders share a tendency to….

Answer 5

Histrionic, narcissistic, antisocial, and borderline personality disorders. Individuals with these disorders share a tendency to be dramatic, emotional, and erratic.

Question 6

Cluster C: Includes…people with these disorders often show…

Answer 6

avoidant, dependent, and obsessive-compulsive personality disorders. In contrast to the other two clusters, people with these disorders often show anxiety and fearfulness.

Question 7

One of the primary issues (with cluster organisation) is …

Answer 7

that there are simply too many overlapping features across both categories and clusters

Question 8

prevalence estimates tend to be remarkably similar. Somewhere between ___ and ___percent of people meet criteria for at least one personality disorder when the time period being asked about is the person’s behavior over the last 2 to 5 years

Answer 8

10
12

Question 9

Paranoid. Definition, gender ratio, prevalence, and cluster:

Answer 9

Suspiciousness and mistrust of others; tendency to see self as blameless; on guard for perceived attacks by others

M=F,
1.5%,
A

Question 10

Schizoid. Definition, gender ratio, prevalence, and cluster:

Answer 10

Impaired social relationships; inability and lack of desire to form attachments to others
1.2%
M>F
A

Question 11

Schizotypal. Definition, gender ratio, prevalence, and cluster:

Answer 11

Peculiar thought patterns; oddities of perception and speech that interfere with communication and social interaction
1.1%
M>F
A

Question 12

Histrionic. Definition, gender ratio, prevalence, and cluster:

Answer 12

Self-dramatization; overconcern with attractiveness; tendency to irritability and temper outbursts if attention seeking is frustrate
1.2%
F>M
B

Question 13

Narcissistic. Definition, gender ratio, prevalence, and cluster:

Answer 13

Grandiosity; preoccupation with receiving attention; self-promoting; lack of empathy
<1%
M>F
B

Question 14

Antisocial. Definition, gender ratio, prevalence, and cluster:

Answer 14

Lack of moral or ethical development; inability to follow approved models of behavior; deceitfulness; shameless manipulation of others; history of conduct problems as a child
1% females, 3% males
M>F

Question 15

Borderline. Definition, gender ratio, prevalence, and cluster:

Answer 15

Impulsiveness; inappropriate anger; drastic mood shifts; chronic feelings of boredom; attempts at self-mutilation or suicide
1.4%
M=F
B

Question 16

Avoidant. Definition, gender ratio, prevalence, and cluster:

Answer 16

Hypersensitivity to rejection or social derogation; shyness; insecurity in social interaction and initiating relationships
2.5%
F>M
C

Question 17

Dependent. Definition, gender ratio, prevalence, and cluster:

Answer 17

Difficulty in separating in relationships; discomfort at being alone; subordination of needs in order to keep others involved in a relationship; indecisiveness
1%
F>M
C

Question 18

Obsessive Compulsive. Definition, gender ratio, prevalence, and cluster:

Answer 18

Excessive concern with order, rules, and trivial details; perfectionistic; lack of expressiveness and warmth; difficulty in relaxing and having fun
2.1%
M>F
C

Question 19

___ person in ___ has a diagnosable personality disorder of some kind

Answer 19

1
10

Question 20

Prevalence of A/B/C

Answer 20

A: 4%
B: 3.5%
C: 7%

Question 21

One problem is that diagnostic criteria for personality disorders are not as…

Answer 21

sharply defined as they are for most other diagnostic categories, so they are often not very precise or easy to follow in practice.

Question 22

Another problem in drawing conclusions about causes of personality disorders occurs because researchers have more confidence in ______ studies

Answer 22

prospective

Question 23

DSM-5 Criteria for. . . Paranoid Personality Disorder

Answer 23

A. A pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following:

1. Suspects, without sufficient basis, that others are exploiting, harming, or deceiving him or her.
2. Is preoccupied with unjustified doubts about the loyalty or trustworthiness of friends or associates.
3. Is reluctant to confide in others because of unwarranted fear that the information will be used maliciously against him or her.
4. Reads hidden demeaning or threatening meanings into benign remarks or events.
5. Persistently bears grudges (i.e., is unforgiving of insults, injuries, or slights).
6. Perceives attacks on his or her character or reputation that are not apparent to others and is quick to react angrily or to counterattack.
7. Has recurrent suspicions, without justification, regarding fidelity of spouse or sexual partner.

B. Does not occur exclusively during the course of schizophrenia, a bipolar disorder or depressive disorder with psychotic features, or another psychotic disorder and is not attributable to the physiological effects of another medical condition.

Question 24

DSM-5 Criteria for. . . Schizoid Personality Disorder

Answer 24

A. A pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following:

1. Neither desires nor enjoys close relationships, including being part of a family.
2. Almost always chooses solitary activities.
3. Has little, if any, interest in having sexual experiences with another person.
4. Takes pleasure in few, if any, activities.
5. Lacks close friends or confidants other than first-degree relatives.
6. Appears indifferent to the praise or criticism of others.
7. Shows emotional coldness, detachment, or flattened affectivity.

B. Does not occur exclusively during the course of schizophrenia, a bipolar disorder or depressive disorder with psychotic features, another psychotic disorder, or autism spectrum disorder and is not attributable to the physiological effects of another medical condition.

Note: If criteria are met prior to the onset of schizophrenia, add “premorbid,” i.e., “schizoid personality disorder (premorbid).”

Question 25

Schizoid personality traits have been shown to have fairly high heritability of around ___ percent

Answer 25

55

Question 26

Cognitive theorists propose that individuals with schizoid personality disorder exhibit cool and aloof behavior because of maladaptive underlying schemas that lead them to view themselves a…

Answer 26

self-sufficient loners and to view others as intrusive

Question 27

Those with schizotypal personality disorder are similar to those with schizoid personality disorder, except they also have

Answer 27

cognitive and perceptual distortions, as well as oddities and eccentricities in their communication and behavior

Question 28

Oddities in thinking, speech, and other behaviors are the most stable characteristics of __________ personality disorder

Answer 28

schizotypal

Question 29

A number of studies on patients, as well as on college students with _______ personality disorder (e.g., Raine, 2006; Siever et al., 1995), have shown the same deficit in the ability to track a moving target visually that is found in schizophrenia

Answer 29

schizotypal

Question 30

DSM-5 Criteria for. . . Schizotypal Personality Disorder

Answer 30

A. A pervasive pattern of social and interpersonal deficits marked by acute discomfort with, and reduced capacity for, close relationships as well as by cognitive or perceptual distortions and eccentricities of behavior, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

1. Ideas of reference (excluding delusions of reference).
2. Odd beliefs or magical thinking that influences behavior and is inconsistent with subcultural norms (e.g., superstitiousness, belief in clairvoyance, telepathy, or “sixth sense”; in children and adolescents, bizarre fantasies or preoccupations).
3. Unusual perceptual experiences, including bodily illusions.
4. Odd thinking and speech (e.g., vague, circumstantial, metaphorical, overelaborate, or stereotyped).
5. Suspiciousness or paranoid ideation.
6. Inappropriate or constricted affect.
7. Behavior or appearance that is odd, eccentric, or peculiar.
8. Lack of close friends or confidants other than first-degree relatives.
9. Excessive social anxiety that does not diminish with familiarity and tends to be associated with paranoid fears rather than negative judgments about self.

B. Does not occur exclusively during the course of schizophrenia, a bipolar disorder or depressive disorder with psychotic features, another psychotic disorder, or autism spectrum disorder.

Note: If criteria are met prior to the onset of schizophrenia, add “premorbid,” e.g., “schizotypal personality disorder (premorbid).”

Question 31

It has also been proposed that there is a second subtype of schizotypal personality disorder that is not genetically linked to schizophrenia, characterized by…

Answer 31

cognitive and perceptual deficits and is instead linked to a history of childhood abuse and early trauma

Question 32

Schizotypal personality disorder in adolescence has been associated with elevated exposure to…

Answer 32

stressful life events and low family socioeconomic status

Question 33

DSM-5 Criteria for. . . Histrionic Personality Disorder

Answer 33

A pervasive pattern of excessive emotionality and attention seeking, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

1. Is uncomfortable in situations in which he or she is not the center of attention.
2. Interaction with others is often characterized by inappropriate sexually seductive or provocative behavior.
3. Displays rapidly shifting and shallow expression of emotions.
4. Consistently uses physical appearance to draw attention to self.
5. Has a style of speech that is excessively impressionistic and lacking in detail.
6. Shows self-dramatization, theatricality, and exaggerated expression of emotion.
7. Is suggestible (i.e., easily influenced by others or circumstances).
8. Considers relationships to be more intimate than they actually are.

Question 34

Thus, spouses describe patients with either grandiosity or vulnerability as being “bossy, intolerant, cruel, argumentative, dishonest, opportunistic, conceited, arrogant, and demanding,” +

Answer 34

high on grandiosity = “aggressive, hardheaded, outspoken, assertive, and determined,”

high on vulnerability = “worrying, emotional, defensive, anxious, bitter, tense, and complaining”

Question 35

DSM-5 Criteria for. . . Narcissistic Personality Disorder

Answer 35

A pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy, beginning by early adult-hood and present in a variety of contexts, as indicated by five (or more) of the following:

1. Has a grandiose sense of self-importance (e.g., exagger-ates achievements and talents, expects to be recognized as superior without commensurate achievements).
2. Is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love.
3. Believes that he or she is “special” and unique and can only be understood by, or should associate with, other special or high-status people (or institutions).
4. Requires excessive admiration.
5. Has a sense of entitlement (i.e., unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations).
6. Is interpersonally exploitative (i.e., takes advantage of others to achieve his or her own ends).
7. Lacks empathy: is unwilling to recognize or identify with the feelings and needs of others.
8. Is often envious of others or believes that others are envious of him or her.
9. Shows arrogant, haughty behaviors or attitudes.

Question 36

The outstanding characteristic of people with antisocial personality disorder (ASPD) is their tendency to…

Answer 36

persistently disregard and violate the rights of others through a combination of deceitful, aggressive, and antisocial behaviors

Question 37

DSM-5 Criteria for. . . Antisocial Personality Disorder

Answer 37

A. A pervasive pattern of disregard for and violation of the rights of others, occurring since age 15 years, as indicated by three (or more) of the following:

1. Failure to conform to social norms with respect to lawful behaviors, as indicated by repeatedly performing acts that are grounds for arrest.
2. Deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure.
3. Impulsivity or failure to plan ahead. 4. Irritability and aggressiveness, as indicated by repeated physical fights or assaults.
4. Reckless disregard for safety of self or others. 6. Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations.
5. Lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another.

B. The individual is at least age 18 years. C. There is evidence of conduct disorder with onset before age 15 years.

D. The occurrence of antisocial behavior is not exclusively during the course of schizophrenia or bipolar disorder.

Question 38

ASPD risk factors:

Answer 38

low family income, inner-city living, poor supervision by parents, having a young mother, being raised in a single-parent family, conflict between parents, having a delinquent sibling, neglect, large family size, and also harsh discipline from parents…

delinquent peers, physical or sexual abuse, and various academic or social experiences

Question 39

monoamine oxidase A gene (MAOA gene), is involved in the breakdown of neurotransmitters like norepinephrine, dopamine, and serotonin—all neurotransmitters affected by the stress of maltreatment that can lead to aggressive behavior, and potentially important to which disorder

Answer 39

Anti-social personality disorder

individuals with low MAOA activity were far more likely to develop ASPD if they had experienced early maltreatment than were individuals with high MAOA activity and early maltreatment and indi-viduals with low levels of MAOA activity without early maltreatment

Question 40

The number of ________ behaviors exhibited in childhood is the single best predictor of who will develop an adult diagnosis of ASPD, and the younger the age at which problems start, the higher the risk

Answer 40

antisocial

Question 41

borderline personality disorder (BPD) is characterised by

Answer 41

Behavior characterized by impulsivity and instability in their interpersonal relationships, their self-image, and their moods.

A central characteristic is affective instability

Question 42

DSM-5 Criteria for. . . Borderline Personality Disorder

Answer 42

A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

1. Frantic efforts to avoid real or imagined abandonment. (Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.)
2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.
3. Identity disturbance: markedly and persistently unstable self-image or sense of self.
4. Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating). (Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.)
5. Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior.
6. Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days).
7. Chronic feelings of emptiness.
8. Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights).
9. Transient, stress-related paranoid ideation or severe dissociative symptoms.

Question 43

Genes may account for ___ per-cent of the variance in BPD

Answer 43

40

Question 44

environmental factors are thought to account for the largest proportion ( __ percent) of variance in borderline traits

Answer 44

55

Question 45

Individuals with avoidant personality disorder show extreme social inhibition and introversion, leading to,…

Answer 45

life-long patterns of limited social relationships and reluctance to enter into social interactions.

Question 46

DSM-5 Criteria for. . . Avoidant Personality Disorder

Answer 46

A pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following:

1. Avoids occupational activities that involve significant inter-personal contact because of fears of criticism, disapproval, or rejection.
2. Is unwilling to get involved with people unless certain of being liked.
3. Shows restraint within intimate relationships because of the fear of being shamed or ridiculed.
4. Is preoccupied with being criticized or rejected in social situations.
5. Is inhibited in new interpersonal situations because of feelings of inadequacy.
6. Views self as socially inept, personally unappealing, or inferior to others.
7. Is unusually reluctant to take personal risks or to engage in any new activities because they may prove embarrassing.

Question 47

Numerous studies have found substantial overlap between these two disorders, leading some investigators to conclude that avoidant personality disorder may simply be a somewhat more severe manifes-tation of generalized social anxiety disorder, but

Answer 47

This is consistent with the finding that there are cases of social anxiety disorder without avoidant personality disorder but very few cases of avoidant personality disorder without social anxiety disorder

Question 48

Individuals with dependent personality disorder show…

Answer 48

an extreme need to be taken care of, which leads to clinging and submissive behavior. They also show acute fear at the possibility of separation or sometimes of simply having to be alone because they see themselves as inept

Question 49

DSM-5 Criteria for. . . Dependent Personality Disorder

Answer 49

A pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

1. Has difficulty making everyday decisions without an excessive amount of advice and reassurance from others.
2. Needs others to assume responsibility for most major areas of his or her life.
3. Has difficulty expressing disagreement with others because of fear of loss of support or approval. (Note: Do not include realistic fears of retribution.)
4. Has difficulty initiating projects or doing things on his or her own (because of a lack of self-confidence in
   judgment or abilities rather than a lack of motivation or energy).
5. Goes to excessive lengths to obtain nurturance and support from others, to the point of volunteering to do things that are unpleasant.
6. Feels uncomfortable or helpless when alone because of exaggerated fears of being unable to care for himself or herself.
7. Urgently seeks another relationship as a source of care and support when a close relationship ends.
8. Is unrealistically preoccupied with fears of being left to take care of himself or herself.

Question 50

Estimates are that somewhere between ___ and ___ per-cent of the variance in dependent personality disorder symptoms might be attributable to genetic factors

Answer 50

30 and 60

Question 51

Perfectionism and an excessive concern with orderliness and control characterize,,,

Answer 51

individuals with obsessive-compulsive personality disorder (OCPD).

Question 52

Theorists who take a five-factor dimensional approach to understanding OCPD note that these individuals have excessively high levels of ______

Answer 52

conscientiousness

Question 53

DSM-5 Criteria for. . . Obsessive-Compulsive Personality Disorder

Answer 53

A pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following:

1. Is preoccupied with details, rules, lists, order, organization, or schedules to the extent that the major point of the activity is lost.
2. Shows perfectionism that interferes with task completion (e.g., is unable to complete a project because his or her own overly strict standards are not met).
3. Is excessively devoted to work and productivity to the exclusion of leisure activities and friendships (not accounted for by obvious economic necessity).
4. Is overconscientious, scrupulous, and inflexible about matters of morality, ethics, or values (not accounted for by cultural or religious identification).
5. Is unable to discard worn-out or worthless objects even when they have no sentimental value.
6. Is reluctant to delegate tasks or to work with others unless they submit to exactly his or her way of doing things.
7. Adopts a miserly spending style toward both self and others; money is viewed as something to be hoarded for future catastrophes.
8. Shows rigidity and stubbornness.

Question 54

Dialectical behavior therapy (DBT) developed by
Marsha Linehan, is a…

Answer 54

unique kind of cognitive and behavioral therapy specifically adapted for BPD

Question 55

BPD treatments

Answer 55

Dialectical behaviour therapy
CBT
Mentalisation
Transference-focused psychotherapy

Question 56

Schizotypal personality disorder treatments

Answer 56

Low doses of antipsychotics
SSRI
Nothing approaching a cure though.

Question 57

Avoidant PD treatments

Answer 57

CBT
Psychodynamic therapies (some that are active and confrontational)
Short-term inpatient
Antidepressants ((MAOI) and SSRI categories)

Question 58

The prevalence of psychopathy is unknown because no epidemiological studies have assessed this. However, for males in North America, the prevalence is estimated to be about ___ to ___ percent, and for females less than ___%.

Answer 58

1 to 2
1

Question 59

Four dimensions of psychopathy

Answer 59

1A Interpersonal
1B Affective
2A Lifestyle
2B Antisocial

Question 60

1a. The interpersonal dimension reflects a personality style that is characterized by

Answer 60

glibness/superficial charm,
a grandiose sense of self-worth,
pathological lying, and
the conning manipulation of others.

Question 61

1b. The affective dimension reflects traits such as

Answer 61

lack of remorse or guilt,
callousness/lack of empathy,
shallow affect, and
a failure to accept responsibility for one’s behavior.

Question 62

2a. The lifestyle dimension reflects a

Answer 62

need for stimulation,
a tendency to be easily bored,
impulsivity,
irresponsibility,
a lack of reasonable long-term goals,
as well as a parasitic lifestyle.

Question 63

2b. the antisocial dimension reflects the aspects of psychopathy that

Answer 63

involve poor behavior controls,
early behavior problems,
delinquency, and
criminality.

Question 64

a significant number of inmates show the antisocial and aggressive behaviors necessary for a diagnosis of ASPD but do not show enough selfish, cal-lous, and exploitative behaviors to qualify for a diagnosis of _____

Answer 64

psychopathy.

Question 65

In contrast, the reduction in amygdala volumes of the ______ ______is much less marked and not significantly different from the controls

Answer 65

successful psychopaths

Question 66

Why are heroes and psycho-paths are “twigs from the same branch”?

Answer 66

Because successful psychopaths are higher than unsucsessful psychopaths on fearless dominance, (which is linked to superior cognition and heroism)

Question 67

The affective and interpersonal dimensions are positively related to _____ _____

Answer 67

verbal intelligence

Question 68

the lifestyle and antisocial dimensions are negatively related to _____

Answer 68

intelligence

Question 69

The causes of psychopathy include:

Answer 69

• 43-56% heritability - e.g. early signs of callous/unemotional traits in these children were highly heritable
• negative parenting
• Parental rejection/inconsistency/loss
• Deficient amydala (deficient in the conditioning of at least subjective and certain physiological components of fear)
• lack of fear-potentiated startle
• abnormalities in their selective attention (response modulation deficit)
• Emotional deficits (beyond anxiety - psychopaths are not only less affected by distress in others but they find the idea of others experiencing pain to be pleasing in some way)

Question 70

CBT targets the folliowing in psycopathy (5) [only modest changes, but better in young]

Answer 70

(1) increasing self-control, self-critical thinking, and social perspective taking;
(2) increasing victim awareness;
(3) teaching anger management;
(4) changing antisocial attitudes; and
(5) curing drug addiction.