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1

What is a personality disorder?

-stable and enduring patterns of thoughts, feelings, behavior (personality trait)
-emerge in adolescence or early adulthood
-deviate from norms
-pervasive and inflexible
-lead to distress/impairment

2

structure Diagnostic and Statistical Manual of Mental Disorders, volume 5 DSM-5

-10 personality disorders
-classified into 3 groups/clusters according to their similarity of their symptoms

3

Cluster A - odd, eccentric (3)

-Schizoid
-Schizotypal
-Paranoid

4

Schizoid

-extreme detachment and lack of interest in social or personal relationships
-very limited expression of emotions in interpersonal settings
-prefer almost always to be alone
-emotional detachment
-no affection for others
-indifferent to praise/criticism
-even in nonsocial settings
-> little joy/pleasure

5

Schizotypal

-discomfort in close relationships
-eccentric behaviors and thoughts
-having unusual ideas of reference
-perceiving special meaning in everyday events or objects
-highly fascinated with paranormal / having bizarre perceptual experiences
-example: seeing what is happening somewhere far away

6

ekzentriker

-person die deutlich von der sozialen norm abweicht

7

Paranoid

-extreme distrust and suspiciousness of others
-quick to take offence/feel insulted

-antecedent for schizophreny

8

Cluster B - dramatic, emotional, erratic (4)

1) Antisocial
2) Borderline
3) Histrionic
4) Narcissistic

9

Antisocial

-disregard for and violation of the rights of others
-lying to others
-conning (betrügen) others
-feel no remorse for actions
-aggressive
-irresponsible
-impulsive
-reckless

10

Borderline

-extreme impulsivity (drug abuse, eating binges, sexual escapades, spending sprees (kaufrausch), self harming)
-instability of relationships, self-image and emotions
-intense and unstable relationships
-worry frantically (wie wahnsinnig) about possibility of being abandoned

11

Histrionic

-excessive attention seeking
-exaggerated expression of emotions
-use physical appearance to draw attention
-seductive, sexually provocative style
-easily influenced by others

12

Narcissistic

-excessive sense of self-importance and entitlement
-grandiosity
-seeing oneself as being entitled to special treatment
-arrogant style
-often exploit others
-failing to appreciate others needs

13

Type C - anxious, fearful (3)

1) Avoidant
2) Dependent
3) Obsessive- compulsive

14

Avoidant

-extreme shyness
-low self-esteem
-strong fear of rejection, criticism, disapproval
-unwilling to participate socially unless certain of being liked
-lack of social contact (different reasons than schizoid and schizotypal)

15

Dependent

-excessive need to be taken care of
-submissive, clinging behavior
-fears of separation
-require great deal of advice
-need other people take responsibility for important features of their lives
-often go through great lengths to maintain support/nurturance

16

Obsessive- compulsive

-excessive preoccupation with order, perfection and control
-fail to complete tasks/projects
-highly stubborn
-inflexible
-tendency to hoard money and objects unnecessarily
-NOT the same as obsessive-compulsive disorder (repeated washing hands, tapping etc)

17

Problems with the DSM-5 Personality Disorders
-1)

1) symptoms of a given disorder do not necessarily 'go together'
-a person with one symptom is no more likely than anyone else to have another symptom

-two persons diagnosed with the same disorder might not have any symptoms in common

18

Problems with the DSM-5 Personality Disorders
-2)

2) two disorders may have overlapping symptoms, and may tend to be diagnosed together
-comorbidity-> joint occurrence of two or more disorders
-tends to make system inefficient
-would be better to develop a system in which the various disorders showed little/no overlap

19

Problems with the DSM-5 Personality Disorders
-3)

3) 'clusters' of disorders do not match factor analysis results

20

Problems with the DSM-5 Personality Disorders
-4)

4) a personality disorder should be seen as a continuum, not as a category
-having a personality disorder is a matter of degree
-shouldn't be only having or not having

21

Alternative system for personality disorders - ICD 11

-new system has 2 essential features:
-one get assessed on those:

-impaired personality functioning

-presence of pathological personality traits

22

Impaired personality funcitioning (2)

1) 'Self' problems (identity and self-direction)
2) Interpersonal problems (empathy and intimacy)

23

1) self problems - identity problems

-identity problems
->not having a sense of self as unique person
-> unstable self esteem
-> easily threatened by negative experiences
-> distorted appraisal of strengths/weaknesses
-person might not be able to regulate emotions/ recognize what emotions he/she experiences

24

1) self problems- self-direction problems

-not being able to set realistic/meaningful goals
-unable to reflect constructively on experience/motivations

25

2) Interpersonal problems - empathy

-unable to understand others' experiences/motivations
-unable to understand/consider others' perspectives
-little understanding of how behavior affects others

26

2) interpersonal problems - intimacy

-lacking in positive, sustained relationships
-unable/unwilling to cooperate with others

27

pathological personality traits
- new system ICD 11

-new system recognizes 25 specific personality traits as being potentially pathological -> when an individual shows a high level of the trait
-> classified into 5 broad
domains

28

5 domains of new personality trait system

1) negative affectivity
2) detachment
3) antagonism
4) disinhibiton
5) psychoticism

-> can be compared to Big 5

29

1) negative affectivity

-emotional lability
-anxiousness
-separation insecurity
-perseveration (continuing a behavior that is no longer effective)
-submissiveness
-hostility
-restricted affectivity (emotional coldness)
-depressivity
-suspiciousness

30

2) Detachment

-withdrawal
-anhedonia (lack of enjoyment/pleasure)
-intimacy avoidance
-restricted affectivity
-depressivity
-suspiciousness