Week 9 Lecture 9 - Personality Disorders - Jo Fielding (DN)

Question 1

What is personality?

Answer 1

• Qualities, traits of character/behaviour
  
  • peculiar to a specific person
• Enduring patterns of perceiving, relating to, & thinking about the environment & oneself that are exhibited in a wide range of social & personal contexts.

Question 2

When is personality disordered?

Answer 2

Enduring pattern of behaviour & inner experience

deviates from expectations of a person’s culture in at least 2 of the following areas:

• cognition
• affectivity
• interpersonal functioning
• impulse control

Question 3

How do personality disorders differ from many of the other disorders we have studied in this unit?

Answer 3

• Chronic
• tend to originate in childhood
• persist throughout the lifespan
• invade every aspect of persons life

4:00

Question 4

How does DSM-5 classify Personality Disorders?

Answer 4

Cluster A: odd or eccentric behaviours

• Paranoid
• Schizoid
• Schizotypal

Cluster B: emotional, erratic or dramatic behaviours

• Borderline
• Histrionic
• Narcissistic
• Antisocial

Cluster C: fear, anxiety

• Avoidant
• Dependent
• Obsessive-Compulsive

Question 5

What was one of the reasons for promotion of an alternative model in DSM-5?

Answer 5

Comorbidity of personality disorders

14:05

Question 6

What is the DSM-5 criteria for Cluster A: Paranoid

Answer 6

Pervasive distrust & suspiciousness of others, motives interpreted as malevolent.

Indicated by 4 (or more) of the following:

• 1. Suspiciousness of being exploited, harmed, deceived
• 2. Doubts about loyalty /trustworthiness of others
• 3. Reluctance to confide in others because - suspiciousness
• 4. Reads hidden meanings into innocuous actions of others
• 5. Bears grudges for perceived wrongs
• 6. Angry reactions to perceived attacks on character/reputation
• 7. Unwarranted suspiciousness of fidelity of partner

Question 7

Which other Personality Disorders are comborbid with Paranoid Personality Disorder?

Answer 7

Schizotypal, borderline, avoidant all have similar diagnostic criteria

it is the underlying bit that distinguishes them

Question 8

How does Cluster A: Paranoid Personality Disorder** differ from Schizophrenia**?

Answer 8

• no hallucinations
• only a general impairment in work & social
• dont have cognitive disorganised seen in Schizophrenia

12:30

Question 9

What factors have been implicated in the aetiology of Cluster A: Paranoid Personality Disorder

Answer 9

we dont know a lot about cause

• Genetic -
  
  • common if family member with schizophrenia
• Psychological
  
  • difficult to get info out of them
  • childhood (faulty perceptions as they see the world as malevolent)
  • difficult to entangle fact from fiction
• Cultural
  
  • misinterpreting others views/opinions of them

Question 10

Why is treatment difficult for Cluster A: Paranoid Personality Disorder

Answer 10

• Trust
  
  • hard to develop
  • unlikely to seek help unless crisis
  • may seek help for comorbid conditions (depression) not for the personality disorder itself
• Therapists not optimistic about treatment
  
  • difficult to keep them around long enough to effect positive change

17:00

Question 11

What is the DSM-5 criteria for Cluster A: Schizoid Personality Disorder

Answer 11

Pervasive pattern of detachment from social relationships, & a restricted range of expressions of emotion in interpersonal settings.

Indicated by 4 (or more) of following:

• 1. Lack of desire/enjoyment close relationships
• 2. Almost always chooses solitary activities
• 3. Little interest in sex
• 4. Few / no pleasurable activities
• 5. Lack of friends
• 6. Indifferent to praise / criticism from others
• 7. Flat affect, emotional detachment

18:10

Question 12

What factors have been considered in the Aetiology of Cluster A: Schizoid Personality Disorder?

Answer 12

• childhood experiences
• parents with autism may have child who develops Schizoid
  
  • possible biological basis

more frequently diagnosed in males

21:00

Question 13

Which personality types have similar diagnostic criteria to Schizoid Personality Disorder, so are often comorbid?

Answer 13

Schizotypal Personality Disorder

Avoidant Personality Disorder

Paranoid Personality Disorder

21:10

Question 14

What are some likely precursors to Schizoid Personality Disorder?

Answer 14

Childhood shyness

Abuse

Parents of kids with Autism may develop Schizoid PD

21:30

Question 15

What is likely to prompt someone with Schizoid PD to seek treatment?

What would treatment/therapy usually involve?

How effective is treatment?

Answer 15

Normally a crisis - or another individual distressed by them

• e.g., job loss, extremem depression
• Not likely to just go and seek help for the PD

Treatment approaches:

• teaching them to empathise with others
• social skills training
• Role play: learning to identify & engage with social networks

Effectiveness

not alot of evidence as it is hard to get individuals to

22:00

Question 16

What is the DSM-5 criteria for Cluster A: Schizotypal Personality Disorder

Answer 16

Pervasive pattern of social & interpersonal deficits – acute discomfort with, & reduced capacity for close relationships as well as by cognitive, or perceptual distortions & eccentricities.

Indicated by 5 (or more) of the following:

• 1. Ideas of reference
• 2. Peculiar beliefs / magical thinking
• 3. Unusual perceptions
• 4. Peculiar patterns thought or speech
• 5. Suspiciousness / paranoia
• 6. Inappropriate / restricted affect
• 7. Odd / eccentric behaviour / appearance
• 8. Lack of close friends
• 9. Anxiety about other people

Question 17

How does Cluster A: Schizotypal Personality Disorder compare/differ to Schizophrenia?

Answer 17

• Schizotypal exists on a continuum with schizophrenia

However Schizotypal

• no hallucinations & delusions (more of a sense rather than actually seeing/hearing)
• psychotic-like - but can test reality (have some insight)

25:45

Question 18

What are ideas of reference?

Answer 18

belief that things relate to them

Question 19

How do the unusual perceptions in Schizotypal PD differ from those in Schizophrenia?

Answer 19

Schizotypal - more like a sense that someone is there

Schizophrenia - will actually see or hear

Question 20

What factors have been implicated in the aetiology of Cluster A: Schizotypal Personality Disorder

Is there a gender difference in aetiology?

Answer 20

• Genetic contribution possible
  
  • twin studies show increased prevalence in relatives with Schizophrenia
    
    • (as with other 2 Cluster A disorders (Paranoid & Schizoid)
  • may be a phenotype of the schizophrenia genotype
    
    • evidence its a precursor for schizophrenia
• Neurobiological
  
  • brain changes
  • increased ventricles, decreased grey matter in temporal lobes
  • similar to schizophrenia
• Environmental contributions
  
  • Childhood mistreatment
    
    • more typically in men
  • PTSD
    
    • more typically in women

27:00

Question 21

Which other Personality Disorders are comborbid with Cluster A: Schizotypal Personality Disorder?

Which other non-PD disorder also commonly co-exists?

Answer 21

Most likely to be comorbid

• Paranoid Personality Disorder (cluster A)
• Avoidant Personality Disorder (cluster C)
• (Symptoms overlap)

Depressive disorder also common in people with Schizotypal PD

26:30

Question 22

What neurobiological similarity exists between Schizotypal PD & Schizophrenia?

Answer 22

• similar brain changes
  
  • enlarged ventricles
  • reduced grey matter in temporal lobe

27:20

Question 23

Why does Jo refer to the symptoms of Personality Disorders as ‘Psychotic-like’

Answer 23

because there is no full blown psychosis in the personality disorders

28:50

Question 24

Psychotic-like symptoms are characterised as either positive or negative

Which of the Cluster A Personality Disorders have positive symptoms &/or which have negative symptoms?

Answer 24

Cluster A:

• Positive (e.g. Ideas of reference, magical thinking, perceptual disturbances)
  
  • Paranoid & Schizotypal
• Negative (e.g. Social isolation, poor rapport, constricted affect)
  
  • Paranoid & Schizoid

Question 25

Which of the Cluster A Personality Disorders was proposed to be dropped in DSM-5 (although did not eventuate)?

Answer 25

* Paranoid & Schizoid (the first two) were proposed to be dropped (due to such overlapping symptoms) * just leaving Schizotypal (the third of the Cluster A PD's) * this may happen in future DSM revisions

Question 26

What is one of the **most common** **Personality Disorders** found in **clinical settings**?

Answer 26

Borderline Personality Disorder 9. 3% of clinical settings 33: 15

Question 27

What is the DSM-5 criteria for **Cluster B: Borderline** Personality Disorder

Answer 27

Pervasive pattern of **instability** of i**nterpersonal relationships**, **self-image**, & **affects**, & marked **impulsivity.** Indicated by 5 (or more) of the following: * 1. Frantic efforts to avoid abandonment * 2. Unstable interpersonal relationships –others idealised / devalued * 3. Unstable sense of self * 4. Self-damaging, impulsive behaviours * 5. Recurrent suicidal behaviour, gestures, self-injury * 6. Affective instability * 7. Chronic feelings of emptiness * 8. Recurrent bouts of intense / poorly controlled anger * 9. During stress, experience transient paranoid thoughts / dissociative symptoms

Question 28

What is the best **predictor of suicide** in individuals with **Borderline** Personality Disorder?

Answer 28

Emotional instability 33:15

Question 29

Which other **non-Personality Disorders** are **comborbid** with **Borderline Personality Disorder**? Which **Cluster** of **Personality Disorders** are likely to **co-exist** with Borderline PD? Is there a gender difference in Borderline PD?

Answer 29

**Non-PD Comorbidities** * PTSD * Major depression * Bipolar disorder * Bulimia * Substance use disorderer **PD Comorbidity** * Cluster A (Odd, eccentric) **Gender difference** * more common in females (75%) 33: 30

Question 30

What factors have been considered in the **Aetiology** of Cluster B: **Borderline Personality Disorder**?

Answer 30

**Genes** * genes account for 60% variance in development of BPD * Twin studies - higher concordance in monozygotic twins **Serotonergic system dysfunction** * linked to instability, suicide & impulsivity **Neuroimaging studies** * look at limbic network involvement (involved in emotion regulation) * increased activity in amygdala * decreased activity in PFC * PFC normally downregulates an excitable amygdala **Environmental** * early childhood trauma * sexual & physical abuse * significantly more likely to develop BPD, especially girls * not causative as there are people with BPD without abuse * thus complex relationship * though abuse seems to make one vulnerable (predisposed) * Temperament * Neurological impairment 42:00

Question 31

What is '**splitting'** in relation to Borderline Personality Disorder?

Answer 31

* a defence mechanism that dichotomises everything into either good or bad * part of Object relations theory (Kernberg) * splitting leads to extreme views of others behaviour * then difficulty in regulating emotional response (as everything is at extremes) * others seen as supporting or not supporting 45:05

Question 32

What two **theories** exist for **Borderline Personality Disorder**?

Answer 32

**Object relations theory** * Inconsistent childhood experiences * ‘splitting’ – good or bad * extreme views of others behaviour **Diathesis-stress theory** * Biological vulnerability \> invalidating environment * e.g emotional dysregulation * \> demands/outburst * \> punishment * \> suppressed emotions * \> emotional outburst = attention! * viscious cycle 45:50

Question 33

What are the **treatment outcomes** for **Borderline Personality Disorder**? What is the likely treatment **time-course** for **Borderline Personality Disorder**?

Answer 33

**Treatment Outcomes** * positive, successful outcomes if can get them into therapy **Time Course ** * long & drawn out * 10 years 34:00

Question 34

What are **treatment options** for **Borderline Personality Disorder?**

Answer 34

**Pharmacological** * Anticonvulsants/antipsychotics – core symptoms * Antidepressants – aggression/depression **Dialectical Behaviour Therapy** * Empathy/acceptance, cognitive problem-solving, emotion regulation, social skills training * Stop black/white thinking * Prioritise treatment: Harm, Therapy, QOL * decreases suicide attempts, drop outs even after just 5 days of treatment * but treatment it is a long term prospect **Schema Focused Cognitive Therapy** * Works to identify maladaptive assumptions * Increase use of healthy schemas **Pharmacological** * Anticonvulsants/antipsychotics – core symptoms * Antidepressants – aggression/depression 48:15

Question 35

What is the DSM-5 criteria for **Cluster B: Histrionic** Personality Disorder

Answer 35

Pervasive pattern of **excessive emotionality** & **attention seeking.** Indicated by 5 (or more) of the following: * 1. Strong need to be centre of attention * 2. Inappropriate sexually seductive behaviour * 3. Rapidly shifting expression of emotions * 4. Use of physical appearance to draw attention to self * 5. Speech excessively impressionistic & lacking in detail * 6. Exaggerated, theatrical emotional expression * 7. Overly suggestible 8. Misreads relationships as more intimate

Question 36

What are some **classification issues** with **Histrionic Personality Disorder**? Cluster B: (emotional, erratic, or dramatic)

Answer 36

* **Bias association** with women (even though it is actually equally common in men & women) * vanity etc thought to lead to this bias * **Comorbidity**: 2/3 of people have comorb Antisocial Personality Disorder (also Cluster B) * Antisocial PD more commonly diagnosed in males * some have wondered if Histrionic & Antisocial Disorders are sex-type alternatives of the same underlying condition * also comorbis with Borderline PD (also Cluster B) * **Symptom overlap** with * Borderline PD (Cluster B) * Narcissistic PD (Cluster B) * Dependent PD (Cluster C) because of these classification issues, there was a strong push to remove Histrionic or put it in another category in DSM-5 note: the difference between 'symptom overlap' and 'comorbid' 102: 40

Question 37

What other PD and non-PD's are **comorbid** with **Histrionic Personality Disorder**? Cluster B: (emotional, erratic, or dramatic)

Answer 37

Depression Antisocial Personality Disorder (also Cluster B) Borderline Personality Disorder (also Cluster B)

Question 38

What are **treatment options** for **Histrionic Personality Disorder**? Cluster B: (emotional, erratic, or dramatic)

Answer 38

* Focus on problematic interpersonal relationships * Recognition of long-term costs * Taught more appropriate ways of negotiating wants & needs

Question 39

What is the DSM-5 criteria for **Cluster B: Narcissistic** Personality Disorder

Answer 39

Pervasive pattern of **grandiosity** (in fantasy or behaviour), **need for admiration** & **lack of empathy**. Indicated by 5 (or more) of the following: * 1. Grandiose view of importance * 2. Preoccupation with success, brilliance * 3. Belief one is special & understood only by other high-status people * 4. Extreme **need for admiration** * 5. Strong sense of **entitlement** * 6. Tendency to exploit others * 7. Lack of empathy * 8. Envious of others * 9. Arrogant behaviour / attitudes

Question 40

How does the **lack of empathy** in Narcissistic **PD** differ to that in Antisocial PD?

Answer 40

* Lack of empathy not to same degree as in APD, comes from a different place * Narcissistic - because they are more focussed on self * Antisocial - from a disrespect for others 105:50

Question 41

What is the **defining feature** of **Narcissistic Personality Disorder**? Cluster B: (emotional, erratic, or dramatic)

Answer 41

unreasonable sense of self-importance e.g., Sheldon lol

Question 42

Why are people with **Narcissistic Personality Disorder** often **depressed**?

Answer 42

because people around them generally don't stand around admiring them as they expect they should people do not live up to their expectations, e.g., they do not treat them as they expect the deserve to be treated 106:45

Question 43

Are there **gender differences** in **Narcissistic Personality Disorder**? What other Personality Disorder most commonly **co-exists** with Narcissistic PD?

Answer 43

* Mostly male (50 - 75%) * Most commonly comorbid with Borderline PD (also Cluster B) 107:00

Question 44

What factors have been considered in the **Aetiology** of **Narcissistic Personality Disorder**?

Answer 44

* **Parental style** * Failure by parents to **model empathy** * **Self-psychology model** (Kohut) * Characteristics mask a fragile self-esteem * bolster self worth by having others admire them * Parenting at extremes * Parental coldness * \> diminishing sense of self * Over-emphasis on achievement * \> over-elevated sense of self * **Social-cognitive model** (Morf & Rhodewalt, 2001) * Interpersonal relationships = means to bolster self-esteem * Cognitive biases help maintain grandiose beliefs * focus is on self & being the best * not gaining or mainting closeness of others * **Sociological view** * Christopher Lash - book called 'The Culture of Narcissism' * "me generation" 107:40

Question 45

What are **treatment options** for **Narcissistic Personality Disorder**? Cluster B: (emotional, erratic, or dramatic)

Answer 45

* **Goal** is to help them to **focus on others** * Options are **limited** because they are **hypersensitive to evaluation** * difficult for clinician to point out imperfections when they only want to be perfect * **Cognitive therapy** – replace fantasies * focus on day to day pleasurable experiences based in reality * **Coping strategies** * helping them accept criticism * relaxation training as they can be quite anxious 1:10:30

Question 46

Which of the Personality Disorders are the most difficult to treat?

Answer 46

Antisocial Personality Disorder

Question 47

What is the DSM-5 criteria for **Cluster B: Antisocial** Personality Disorder

Answer 47

Pervasive pattern of **disregard** for & **violation of the rights of others** occurring since **age 15**. Indicated by 3 (or ore) of the following: * 1. Repeated law breaking * 2. Deceitfulness, lying * 3. Impulsivity * 4. Irritability & aggressiveness * 5. Reckless disregard for own safety & that of others * 6. Irresponsibility as seen in unreliable employment or financial history * 7. Lack of remorse

Question 48

What are defining features of Antisocial PD?

Answer 48

disregard for others violation of others rights lack of remorse 1:13:15

Question 49

What are some unique criteria that must be met for a diagnosis of Antisocial Personality Disorder?

Answer 49

* 18 years old * had prior diagnosis of conduct disorder 1:13:20

Question 50

What is **prevalence, gender & comorbidity **of **Antisocial Personality Disorder**? Cluster B: (emotional, erratic, or dramatic)

Answer 50

**Aetiology** * delinquency (conduct disorder precursor) **Prevalence** * Associated with low SES and urban living **Gender** * Much more common in males • * 3% in males and 1%in females **Comorbidity** * 75% meet criteria for another disorder * Substance abuse common ~60% 

Question 51

What other names has Antisocial Personality Disorder been known by over the years? Which of these is stilled used by health professionals today, even though it is not in DSM-5?

Answer 51

Moral Insanity, Egopathy, Sociopathy & Psychopathy Psychopathy is still used 1:14:45

Question 52

What **broad** **factors** have been considered in the **Aetiology** of Antisocial Personality Disorder?

Answer 52

* **Delinquency** (conduct disorder precursor) * **Criminals \> **3/4 have Antisocial Personality Disorder * **Genetic influences** * **Social factors** * **Neurobiological factors** 1:14:45 & 1:17:00 -

Question 53

What **Neurobiological factors** thought to be involved in the aetiology of **Antisocial Personality Disorder**?

Answer 53

**Autonomic NS** \> less response to anxiety * decreased skin conductance to aversive stimuli * decreased startle to negative stimuli * don't see conditioned fear response so punishment is ineffective **Underarousal** \> low levels of cortisol = seek stimulation **Imbalance between inhibition & reward systems** * Inhibition = septo-hippocampal system * noradrenergic/serotonergic systems * Reward = mesolimbic system • * dopaminergic system & limbic areas of brain * Fear/anxiety less apparent, positive feelings more prominent

Question 54

What **Social factors** thought to be involved in the **aetiology** of **Antisocial Personality Disorder**?

Answer 54

* Family environment predictive of antisocial behaviour: * High negativity, low warmth, inconsistency * Poverty, exposure to violence

Question 55

What **Genetic factors** are thought to be involved in the **aetiology** of **Antisocial Personality Disorder**?

Answer 55

* Twin, adoption studies – high heritability * APD, psychopathy, CD, substance abuse - related * Genetic, behavioural, family influences really hard to disentangle

Question 56

How did the concept of **Psychopathy** come about? What was its basis?

Answer 56

* Derived from the work of a psychiatrist called Hervey Cleckley * he identified a constellation of characteristics - personality traits * Key characteristic - **poverty of emotions** * Antisocial behaviour performed impulsively * Focussed on **how the person thinks** not on how they behave

Question 57

What may be presumed when a person with Antisocial Personality Disorder displays positive feelings?

Answer 57

* that it is an act * they are presumed to not experience the highs & lows of emotion * Key characteristic: poverty of emotions 1:15:50

Question 58

Why doesn't the threat of incarceration diminish behaviour in Antisocial Personality Disorder?

Answer 58

* they appear immune to anxiety or pangs of conscience * so unable to profit from punishment to curb impulses * dont see conditioned fear responses in these individuals 1:19:35

Question 59

What is **Antisocial Personality Disorder** so difficult to **treat**? Cluster B: (emotional, erratic, or dramatic)

Answer 59

* **Compliance issues** * don't want treatment * extrememly manipulative * difficult to tell if they are responding to treatment or just playing the game * history of failing to comply with **Social Norms** * unacceptable actions with no remorse * Long term outcomes are poor * Clinicians are not optimistic * many think the only otpion is to incarcerate them 1:14:00 & 122:00

Question 60

What is the focus of treatment for Antisocial Personality Disorder?

Answer 60

Focus on high-risk children * Recognise problems early * conduct disorder in adolescence * antisocial behaviours in young children * treatment can be attempted before its too late Most common treatment * Parent training * Using praise/privilege to reduce problem behaviour & encourage prosocial behaviour * this treatment is quite promising Most clinicians will not engage with them once they are adults - unfortunately viewed as hopeless cases 122:30

Question 61

What is the Psychopathy Checklist (PCL-R)? What does it consist of? Whose work was it based on?

Answer 61

* standard tool for differentiating between someone with Antisocial Personality Disorder & someone who is a Psychopath * interviews, criminal records, social worker reports * based on the work of psychiatrist Hervey Cleckley 1: 17:00

Question 62

Conduct Disorder is a pre-requisite for a diagnosis of Antisocial Personality Disorder What is the DSM-5 criteria for **Conduct Disorder**

Answer 62

**Repetitive** & **persistent pattern** of behaviour in which the **basic rights** of **others** **or** major age-appropriate **societal norms** or rules are **violated**. 3 (or more) criteria under following categories in the last 12 months with at least 1 present in the last 6 months: * 1. Aggression to people & (animals) * 2. Destruction of property * 3. Deceitfulness or theft * 4. Serious violation of rules Disturbance causes clinically significant impairment in social, academic, occupational functioning 124:10

Question 63

What are the **defining features** of **Conduct Disorder**?

Answer 63

* violation of major age-appropriate norms/rules * agression * destruction * deceitfulness * theft

Question 64

What is the main difference between Conduct Disorder & Antisocial Personality Disorder?

Answer 64

lack of remorse/empathy in Antisocial Personality Disorder 126:40

Question 65

What is the DSM-5 criteria for **Cluster C: Avoidant** Personality Disorder

Answer 65

DSM5 criteria: Pervasive pattern of **social inhibition**, feelings of **inadequacy**, & **hypersensitivity** to **negative evaluation**. Indicated by 4 (or more) of the following: * 1. Avoidance of occupational activities - significant interpersonal contact * 2. Unwilling to get involved with people unless certain of being liked * 3. Restrained in intimate relationships -fear of being shamed or ridiculed * 4. Preoccupation with being criticised / rejected * 5. Inhibited in new interpersonal situations - fear of inadequacy * 6. Views self as socially inept / inferior * 7. Unusually reluctant to try new activities - may prove embarrassing

Question 66

What factors have been considered in the **Aetiolog**y of **Avoidant Personality Disorder**?

Answer 66

* **Genetic** * heritability 27-35% * Related to schizophrenia-related disorders * Integrated biological & psychosocial factors * Difficult temperament \> rejection by parents \> perception of rejection \> low self-esteem, social alienation * Modeling? 130: 20

Question 67

What are **treatment options** for **Avoidant Personality Disorder**? Cluster C: (fear, anxiety)

Answer 67

* Behavioural intervention techniques * Anxiety & social skills problems * Similar to treating social phobia * exposure, role play, modeling, cognitive therapy * Collaborative approach * Connection between therapist & client best predictor of success

Question 68

**How** does the **asocial behaviour differ** between Avoidant Personality (Cluster C fear anxiety) and Schizoid Personality Disorder (Cluster A: odd, eccentric)

Answer 68

* **Avoidant Personality Disorder** * **Asocial** because of **interpersonal anxiety** or **fear of rejection** * **Schizoid Personality Disorder** * Asocial because **apathetic & disinterested** in relationships 129:40

Question 69

What is the DSM-5 criteria for **Cluster C: Dependent** Personality Disorder

Answer 69

Pervasive & **excessive need to be taken care of** that leads to **submissive** & **clinging** behaviour & f**ears of separation**. Indicated by 5 (or more) of the following: * 1. Difficulty making decisions without excessive advice & reassurance Need for others to take responsibility for most major areas of life * 2. Difficulty disagreeing with others - fear losing their support * 3. Difficulty doing things on own - lack of self-confidence * 4. Doing unpleasant things as a way to obtain the approval & support Feelings of helplessness when alone - lack of confidence in ability * 5. Urgently seeking new relationships when one ends * 6. Preoccupation with fears of taking care of self

Question 70

How does **Dependent Personality Disorder** *compare* with **Avoidant Personality Disorder**? (Both Cluster C: fear, anxiety)

Answer 70

* same feelings of inadequacy, * sensitivity to criticism, * need for reassurance * ‘Cling to’ rather than avoid relationships

Question 71

What defines Dependent Personality Disorder? (Cluster C fear anxiety)

Answer 71

Unreasonable fear of abandonment 134:30

Question 72

Are there **gender differences** in Dependent Personality Disorder? What other disorders are **comorbid** with Dependent Personality Disorder?

Answer 72

* No gender differences * Comorbid * Borderline PD (Cluster B: emotional, errtic, or dramatic) * Schizoid PD (Cluster A: odd, eccentric) * Avoidant PD (Cluster C: fear,anxiety) * Mood & anxiety disorders

Question 73

What non-PD and PD **comorbidities** exist with **Avoidant Personality Disorder**?

Answer 73

* 80% experience depression * Borderline PD (Cluster B) * Schizotypal PD (Cluster A) Social phobia – more chronic version? 130:00

Question 74

What factors have been considered in the **Aetiology** of **Dependent Personality Disorder**?

Answer 74

* **Attachment theory** * We are all born dependent * Disruption to early bonding (e.g., death of parent) * constant anxiety about ‘losing’ significant others * Over-protective & authoritarian parenting styles * prevent development of self-efficacy 134:55

Question 75

What **issues** can **negatively impact treatment** of **Dependent** Personality Disorder? What is the **major goal** of therapy? Cluster C: (fear, anxiety)

Answer 75

* **Overdependence on therapist** * can appear to be ideal patients (doing exactly as asked) * reinforces dependence * defeats major goal of therapy * **Major goal** * help client become more independent & personally responsible 136:00

Question 76

What is the DSM-5 criteria for **Cluster C: Obsessive-Compulsive** Personality Disorder

Answer 76

Pervasive pattern of **preoccupation** with **orderliness, perfectionism**, & mental & interpersonal **control**, at the expense of flexibility, openness, & efficiency. Indicated by 4 (or more) of the following: * 1. Preoccupation with rules, details, & organisation * 2. Extreme perfectionism interferes with task completion * 3. Excessive devotion to work - exclusion of leisure / friendship * 4. Inflexibility about morals & values * 5. Difficulty discarding worthless items * 6. Reluctance to delegate unless others conform to one’s standards * 7. Miserliness * 8. Rigidity & stubbornness

Question 77

What factors have been considered in the **Aetiology** of **Obsessive Compulsive** Personality Disorder?

Answer 77

* Weak genetic contribution * may be predisposition to favour structure in life * Parental reinforcement of conformity / neatness * Fear of loss of control so overcompensating

Question 77

What are **treatment options** for **Obsessive Compulsive** Personality Disorder? Cluster C: (fear, anxiety)

Answer 77

* Directed at fear of inadequacy * CBT is similar to that used in OCD * Redirect compulsive thoughts * Relaxation / distraction / reality testing

Question 78

Which Personality Disorder did Jo present as **'Masters of Control'** in the lecture? What kinds of people have been associated with this PD?

Answer 78

Obsessive Compulsive Personality Disorder * Serial killers * Sex offenders – similar brain function * Gifted children – debilitating perfectionism 137:45

Question 79

Are there **gender differences** in Obsessive-Compulsive Personality Disorder?

Answer 79

Yes, its more common in **males** than females

Question 80

What disorder is commonly **comorbid** with Obsessive-Compulsive Disorder?

Answer 80

Avoidant Personality Disorder (also Cluster C: fear, anxiety)

Question 81

How does Obsessive-Compulsive Personality Disorder compare with OCD?

Answer 81

* distantly related * don't get obsessions & compulsions