Week 10 - Personality Disorders Flashcards
(17 cards)
Personality disorders overview
Persistent emotions/cognitions/ behaviours that lead to enduring emotional distress and may cause work/relationships difficulty
Pervasive, inflexible, stable, maladaptive, ego-syntonic
Develop slowly
10-12% of pop. meet criteria for a PD
3 clusters - A (eccentric - 4%), B (dramatic - 4), C (anxious - 7%)
Personality disorder challenges
High comorbidity among PDs and with other disorders
High heterogeneity
Common misdiagnosis
Subjective symptoms
Treats personality as categorical
Five factor model
No good or bad traits, depends on amount and context (many facets within each factor)
Dimensions
- Openness > psychoticism
- Conscientiousness > disinhibition
- Extraversion > detachment
- Agreeableness > antagonism
- Neuroticism > emotional stability
Alternative model for PDs
Criterion A - impaired function
Criterion B - pathological personality traits
This model predicts functioning slightly better than categorical model
Paranoid personality disorder (cluster A)
Pervasive and unjustified mistrust and suspicion (4+):
1. suspects with no basis
2. preoccupied with loyalty doubts
3. reluctant to confide
4. reads hidden meaning in events
5. bears grudges
6. perceives attacks on character and quick to counter
7. suspicions about spouse fidelity
Not well studied
Causal factors - modest genetic, parental neglect, violence exposure in childhood, TBI, cocaine use
Treatment - CBT to counter thoughts (lack of RCTs)
Prevalence - 1-2%
Schizoid personality disorder (cluster A)
Pervasive detachment from social relationships AND limited emotions interpersonally (4+):
1. No desire for close relationships
2. Chooses solitary activities
3. Little sex interest
4. Takes pleasure in few activities
5. Lacks friends
6. Indifferent to praise/criticism
7. Flat affect
Not well studied, big ASD overlap, symptoms may precede psychosis
Causal factors - modest genetic, impairment in affiliative system
Treatment - focus on relationship value, build social skills (lack of RCTs)
Prevalence - 1% (more common in men)
Schizotypal personality disorder (cluster A)
Pervasive interpersonal deficits marked by acute discomfort AND cog/perceptual distortions AND eccentricity (5+)
1. Ideas of reference
2. Magic thinking
3. Unusual perceptual experiences
4. Odd thinking/speech
5. Paranoia
6. Inappropriate affect
7. Odd appearance/behaviour
8. Lack of close friends
9. Excessive social anxiety
Doesn’t exclusively occur with schizophrenia, bipolar or autism
Better studied, appears part of schizophrenia spectrum
Causal factors - modest genetic, childhood maltreatment (M especially), low SES
Treatment - anti-psychotics, SSRIs, CBT for comorbid depression (lack of RCTs)
Prevalence - 1% (more common in men)
Antisocial personality disorder
Disregard for and violation of rights of others by 15 (3+)
1. Failure to conform to law norms
2. Deceitfulness
3. Impulsivity
4. Irritability/aggression
5. Reckless disregard for safety
6. Consistent irresponsibility
7. Lack of remorse
At least 18, conduct dx by 15, doesn’t only occur in schizophrenia or bipolar
Causal factors - moderate genetic, harsh discipline, childhood maltreatment, neglect, abuse, parental conflict, delinquent peers
Prevalence - 2-3% (3%M, 1%F, could be as high as 5:1)
Few seek treatment
ASPD predictive of poor prognosis
ASPD and psychopathy
Psychopathy may be form of antisocial PD
ASPD - emphasis on behaviour, more inclusive, more criminality
Psychopathy - emphasis on personality traits, narrower
ASPD gene-environment interaction
Monoamine Oxidase A (breaks down NTs)
Low MAOA + maltreatment = more risk
High MAOA + maltreatment = less risk
Low MAOA + no maltreatment = less risk
ASPD predictor disorders
Oppositional defiant disorder > conduct disorder > ASPD
ADHD + conduct disorder > ASPD
ASPD the result on interacting factors
- Genetics - temperament, hyperactivity, attentional difficulties
- Environment - parenting, disrupted family, poverty, deviant peers
Borderline personality disorder
Instability in interpersonal relationships, self-image, affect AND marked impulsivity (5+)
1. Frantically avoids abandonment
2. Unstable/intense relationships (large swings)
3. Identity disturbance
4. Self-damaging impulsivity
5. Suicidal behaviour
6. Affective instability/reactivity
7. Emptiness
8. Anger
9. Paranoid ideation/dissociation
More research than any other PD
Causal factors - modest genetic, child abuse, child environment (poverty, martial discord, divorce, parent drug use, family violence)
Comorbidity - depression (80%), bipolar (10%), substances (67%), schizotypal, narcissistic, dependent
Suicide - 25% attempt, 8-10% succeed
Prevalence - 1-2% (10% outpatients, 15-20% inpatients, 1F:1M)
Treatment - antidepressants (little evidence), dialectical behaviour (accept need to change, interpersonal, distress tolerance)
Histrionic personality disorder
Excessive emotionality and attention seeking, beginning in early adulthood (5+)
1. Uncomfortable when not focus of attention
2. Inappropriate seductive/provocative behaviour
3. Rapidly shifting shallow emotions
4. Physical appearance to draw attention
5. Impressionistic/superficial speech
6. Self-dramatization
7. Easily influenced
8. Considers relationships that more intimate than they are
Lack of research, unknown causal factors
Prevalence - 1% (possibly more common in F)
Treatment - focus on attention-seeking, long -term consequences, problematic interpersonal behaviour (little evidence treatment helps)
Narcissistic personality disorder
Grandiosity, need for admiration, lack of empathy, beginning by early adulthood (5+)
1. Grandiose sense os self-worth
2. Fantasies of success, power, beauty
3. Believe they are special and only understood by special people
4. Requires admiration
5. Entitlement
6. Takes advantage of others
7. Lacks empathy
8. Envious and believes others envy them
9. Arrogant
Lack of research
Causal factors - grandiose narcissism (parental over-evaluation), vulnerable narcissism (abuse, controlling, cold parenting
Prevalence - 1% (maybe more common in M)
Treatment - focus on grandiosity/ empathy/unrealistic thinking, emphasise realistic goals (little evidence for treatment)
Avoidant personality disorder
Social inhibition, inadequacy feelings, sensitive to negative eval. beginning by early adulthood (4+)
1. Avoids significant interpersonal contact due to criticism fears
2. Unwilling to get involved unless certain of being liked
3. Restraint in intimate relationships
4. Preoccupied with criticism/rejection
5. Inhibited in new situations due to inadequacy feelings
6. Self-concept of socially inept, inferior
7. Reluctant to take risks due to embarrassment fear
Causal factors - modest genetic, emotional abuse/rejection/ humiliation from parents
Prevalence - 2-3% (more common in F)
Treatment - similar to social phobia
Dependant personality disorder
Need to be taken care of leading to submissive/clingy behaviour and separation fear (5+)
1. Difficulty making decisions without reassurance
2. Needs others to assume responsibility
3. Difficulty disagreeing
4. Difficulty doing things on their own
5. Excessive lengths to obtain nurturance
6. Uncomfortable or helpless when alone
7. Urgently seeks new relationship when one ends
8. Preoccupied with fears of being left alone
Lack of research
Causal factors - small to moderate genetic, overprotective parents
Prevalence - 1% (more common in F)
Treatment - no evidence
Obsessive-compulsive personality disorder
Preoccupation with orderliness, perfectionism, control, at the expense of flexibility (4+)
1. Preoccupied with details that overall point is lost
2. Interfering perfectionism
3. Excessively devoted to work/productivity
4. Overconscientious about morality
5. Unable to discard worthless objects
6. Reluctant to delegate
7. Miserly spending style
8. Rigidity/stubbornness
Lack of research
Causal factors - modest genetic
Prevalence - 2% (more common in men)
Treatment - target rumination, procrastination, inadequacy (little evidence it works)
