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Flashcards in Personality Disorders Deck (27)
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What are Personality Disorders?

A group of disorders marked by persistent, inflexible, maladaptive patterns of thought and behaviour that develop in adolescence or early adulthood and significantly impair an individual’s ability to function


What are the characteristics of a personality disorder?

 Enduring pattern of behaviour that deviates markedly from expectations within the culture Associated with unusual ways of interpreting events, unpredictable mood swings or impulsive behaviour Result in impairments in social and occupational functioning Represent stable patterns of behaviour that can be traced back to adolescence or early childhood Previously characterized as Axis II disorders because they represent long-standing, pervasive and inflexible patterns of behaviour


What are the primary clusters of personality disorders?

 DSM-IV-TR (APA, 2000) organised personality disorders into three clusters: Odd/Eccentric Personality Disorders Dramatic/Emotional Personality Disorders Anxious/Fearful Personality Disorders


Odd/Eccentric Personality Disorders (Cluster A)Disorder Characteristics

ParanoidSuspiciousness and mistrust of others; tendency to see self as blameless; on guard for perceived attacks by othersSchizoidInability and lack of desire to form attachments to others; impaired social relationshipsSchizotypalReduced capacity for close interpersonal relationships, eccentric behavior, and peculiar thought patterns


Dramatic/Emotional Personality Disorders (Cluster B)Disorder Characteristics

Histrionic Excessive emotionality and attention seekingbehavior; sexually provocative and seductive; theatrical; overly concerned re: own attractivenessNarcissisticGrandiosity and need for admiration;self promoting; lack of empathyAntisocial Disregard for and violation of rights of others;Lack of moral development; deceitfulness;shameless manipulation of othersBorderline Instability in interpersonal relationships, affect,and self-image, impulsiveness; chronic feelings ofboredom; attempts at self-mutilation or suicide


Anxious/Fearful Personality Disorders (Cluster C)Disorder Characteristics

Avoidant Social inhibition and hypersensitivity to negativeevaluation; shyness; intimate relationshipsdifficult without guarantee of acceptance DependentExcessive need to be taken care of leading tosubmissive and clinging behavior; indecisiveness– need others to make decisions for them orreassure them; to avoid losing approval, neverdisagreeObsessiveExcessive concern with perfectionism,Compulsive order, rules, and trivial details; lack of expressivenessand warmth; difficulty in relaxing and having fun


What are some conceptual issues with personality disorders?

 Personality Disorders may not be discrete disorders but represent extremes of normal personality (Costa & McRae, 1990) Many of the characteristics of different personality disorders overlap (e.g. impulsivity)


What are the characteristics of anti social personality disorder?

 The term sociopath or psychopath is sometimes used to describe this personality type APD is now defined mainly in terms of violations of social norms Is highly associated with criminal and violent behaviour Prison populations have between 50-70% of inmates diagnosable with APD (Fazel & Danesh, 2002)


What are the characteristics of borderline personality disorder?

 Features an enduring pattern of instability in personal relationships and lack of well-defined self-image Fear of abandonment is a central feature which leads to conflict-ridden relationships Associated with regular mood swings and aggressive behaviour Highly comorbid with Axis I disorders such as depression and anxiety disorders


What Is ‘Disordered’ About Personality Disorders

 People with personality disorders are often referred for treatment because of the consequences of their behaviour: Some are unable to form lasting, close relationships Many often develop comorbid Axis I disorders Their behavioural style may be a risk to themselves or others Many behavioural styles interfere with an individual’s ability to achieve in occupational or educational spheres


Gender Differences in Personality Disorders

 75% of individuals diagnosed with Borderline Personality Disorder are female (Widiger & Trull, 1993) Risk of avoidant, dependent and paranoid personality disorder is also greater in women


Cultural Differences in Personality Disorders

 Little evidence to suggest that the prevalence of personality disorders differs across cultures There may be some ethnic differences – BPD is higher in Hispanic than Caucasian & African Americans (Grant et al., 2004)



 Because most symptoms of personality disorders differ, there will be no over-arching theory of causation personality disorders One characteristic that is common to all is that their behaviour patterns are enduring, suggesting that inherited or developmental factors are important


Cluster B: Antisocial Personality Disorder

 Because APD is closely related to criminal and antisocial behaviour attempts have been made to: Identify childhood behaviours that may predict later adult APD Identify the developmental factors that cause APD Ascertain whether there is an inherited component to APD Identify any biological or psychological processes that may be involved in APD


Childhood & Adolescent Behavioural Precursors of APD

 The best predictor of APD is a diagnosis of conduct disorder during childhood Adolescent smoking, alcohol use, illicit drug use, police trouble and sexual intercourse before 15-years are strong predictors of APD Some theorists also suggest that ADHD is a predictor of APD (but see next slide)


Developmental Factors - APD

 Antisocial behaviour may be learnt from parents (Paris, 2001) Parents may reinforce antisocial behaviour (Capaldi & Patterson, 1994) Lack of parental love may nurture antisocial behaviour (Gabbard, 1990) Inconsistent parenting may be important during the development of APD (Marshall & Cooke, 1999)


Genetic Factors – APD

 APD appears to run in families Twin studies suggest higher concordance rates in MZ than DZ twins (Lyons et al., 1995) Incidence of APD in an adopted child is better predicted by APD in the biological than adopted mother (Ge et al., 1996)


Cognitive Models - APD

 Individuals with APD may possess dysfunctional schemas that determine their antisocial reactions (Young et al., 2003) When responding to important events, individuals with APD may switch quickly and unpredictably between schemas to make their behaviour seem erratic (Horowtiz et al., 2001)


Physiological & Neurological Factors – APD

 Individuals with APD exhibit physiological characteristics that may explain their APD: Have significantly lower levels of anxiety and lower levels of physiological reactivity Respond to emotional stimuli with slow autonomic arousal and low levels of EEG activity Frequently fail to exhibit fear learning in aversive classical conditioning procedures (Lykken, 1995)


Risk Factors for BPD

 A history of difficulties in childhood, including childhood physical, verbal and sexual abuse, childhood neglect or rejection, inconsistent or loveless parenting, and inappropriate parental behaviour (e.g. substance misuse or sexual promiscuity) Academic underachievement, low intelligence and poor artistic skills


Biological Theories of BPD

 Evidence for a genetic component (twin studies indicate concordance rates of 35% and 7% for MZ and DZ twins respectively) (Torgersen et al., 2000) 44% of individuals with BPD belong to a broader bipolar disorder spectrum Individuals with BPD have a number of brain abnormalities e.g. dysfunctions in brain dopamine  Neuro-imaging techniques reveal abnormalities in a number of brain areas


Psychological Theories of BPD

 Object Relations Theory argues that individuals with BPD have received inadequate support and love from important others, resulting in an insecure ego which is likely to lead to lack of self-esteem and fear of rejection. Splitting A defence mechanisms in which aspects of others which are evaluated in a polarised fashion. As with APD, individuals with BDP may acquire a set of dysfunctional schemas that maintain their erratic and emotional behaviour (Young et al., 2003)


Dialectical Behaviour Therapy (DBT)

 Developed in the 1990s by Marsha Linehan, particularly for the treatment of BPD Based on a biosocial theory of BPD (Linehan, 1993, cited in Palmer, 2002) Dialectical refers to contrasting views or positions taken by the client Emphasis on integrating opposing behaviours & on interconnectedness Brings together aspects of CBT and principles of Zen Buddhism e.g. acceptance Aims to foster the development of emotional regulation & tackle areas of skills deficit Linehan published Cognitive Behaviour Treatment of Borderline Personality Disorder in 1993 Outpatient delivery Intervention lasts around one year Individual sessions, group skills training sessions and telephone support, plus weekly consultation group 4 modules  Emotion regulation, mindfulness, distress tolerance, interpersonal effectiveness


Schema Therapy

 Developed by Young, Klosko & Weishaar (2003) Schema theory outlines three specific stages: Clients need to be convinced that their maladaptive schemas are actually a cause of their symptoms Attempts to identify and prevent schema avoidance responses Examination of the life events that have given rise to maladaptive schemas


Schema Domains & Early Maladaptive Schemas

 Disconnection & Rejection Mistrust/abuse  Abandonment/instability Defectiveness/shame Emotional deprivation Social isolation/alienation Impaired Autonomy & Performance Failure Dependence/incompetence Enmeshment/undeveloped self Vulnerability to harm or illness


Schema Domains & EMSs

 Impaired Limits Entitlement/grandiosity Insufficient self-control/self-discipline Other-Directedness Subjugation  Self-sacrifice Approval seeking Overvigilance & Inhibition Punitiveness Emotional inhibition Negativity/pessimism Unrelenting standards


Schema Responses/Coping Styles

 Avoidance Overcompensation Surrender