Ch.10: Personality Disorders
Using a cognitive perspective, which of the following statements typifies the type of maladaptive schema someone with dependent personality disorder might hold?
"I can function only if I have access to somebody competent."
Key features in BPD
-Affective instability -Impulsivity
subtypes of narcissistic personality disorder
-Grandiose narcissism -Vulnerable narcissism
Personality disorders more common in women
-Histrionic -Avoidant -Dependent
Personality disorders equally common in both genders
-Paranoid -Borderline
Personality disorders more common in men
-Schizoid -Schizotypal -Narcissistic -Antisocial -Obsessive-compulsive
Demetrius always questions the loyalty of his friends and is suspicious of the motives of others. He is quick to hold a grudge and is easily angered. Demetrius's behavior is most consistent with a diagnosis of __________ personality disorder.
paranoid
Which of the following causal factors has been identified as contributing to the development of grandiose narcissism?
parental overvaluation
It has been suggested that individuals with personality disorders are less responsive to psychological treatment because __________.
people with personality disorders have rigid, ingrained personality traits that often lead to poor therapeutic relationships
The five-factor model uses a dimensional approach in evaluating personality disorders. A dimensional approach to evaluating personality assumes that __________.
personality (and personality disorder) traits fall along a continuum of intensity
One hypothesis of the psychological contribution to the development of personality disorders is that __________.
personality traits may originate in disturbed parent-child attachment relationships
Emily tells her therapist that her husband is dishonest, conceited, arrogant, and demanding but also frequently expresses feelings of shame and self-doubt. Based on these behaviors, Emily's therapist feels that her client is married to a __________.
vulnerable narcissist
Facets of agreeableness
trust, straightforwardness, altruism, compliance, modesty, tender-mindedness
The five-factor model is a _________
model of normal personality that includes an expanded description of the five basic personality dimensions
What percentage of persons living in the United States has a diagnosable personality disorder?
10 to 12 percent
The heritability of schizoid personality disorder has been found to be around __________.
55 percent
It is estimated that __________ of people diagnosed with a personality disorder have another disorder as well.
75 percent
Psychopathy
A condition involving the features of antisocial personality disorder and such traits as lack of empathy, inflated and arrogant self-appraisal, and glib and superficial charm.
Criteria A for dependent personality disorder
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: -Has difficulty making everyday decisions without an excessive amount of advice and reassurance from others. -Needs others to assume responsibility for most major areas of his or her life. -Has difficulty expressing disagreement with others because of fear of loss of support or approval. (Note: --Do not include realistic fears of retribution.) -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). -Goes to excessive lengths to obtain nurturance and support from others, to the point of volunteering to do things that are unpleasant. -Feels uncomfortable or helpless when alone because of exaggerated fears of being unable to care for himself or herself. -Urgently seeks another relationship as a source of care and support when a close relationship ends. -Is unrealistically preoccupied with fears of being left to take care of himself or herself.
Criteria A for paranoid personality disorder
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: -Suspects, without sufficient basis, that others are exploiting, harming, or deceiving him or her. -Is preoccupied with unjustified doubts about the loyalty or trustworthiness of friends or associates. -Is reluctant to confide in others because of unwarranted fear that the information will be used maliciously against him or her. -Reads hidden demeaning or threatening meanings into benign remarks or events. -Persistently bears grudges (i.e., is unforgiving of insults, injuries, or slights). -Perceives attacks on his or her character or reputation that are not apparent to others and is quick to react angrily or to counterattack. -Has recurrent suspicions, without justification, regarding fidelity of spouse or sexual partner.
Criteria A for schizoid personality disorder
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: -Neither desires nor enjoys close relationships, including being part of a family. -Almost always chooses solitary activities. -Has little, if any, interest in having sexual experiences with another person. -Takes pleasure in few, if any, activities. -Lacks close friends or confidants other than first-degree relatives. -Appears indifferent to the praise or criticism of others. -Shows emotional coldness, detachment, or flattened affectivity.
Criteria A for antisocial personality disorder
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: -Failure to conform to social norms with respect to lawful behaviors, as indicated by repeatedly performing acts that are grounds for arrest. -Deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure. -Impulsivity or failure to plan ahead. -Irritability and aggressiveness, as indicated by repeated physical fights or assaults. -Reckless disregard for safety of self or others. -Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations. -Lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another.
Criteria A for histrionic personality disorder
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: -Is uncomfortable in situations in which he or she is not the center of attention. -Interaction with others is often characterized by inappropriate sexually seductive or provocative behavior. -Displays rapidly shifting and shallow expression of emotions. -Consistently uses physical appearance to draw attention to self. -Has a style of speech that is excessively impressionistic and lacking in detail. -Shows self-dramatization, theatricality, and exaggerated expression of emotion. -Is suggestible (i.e., easily influenced by others or circumstances). -Considers relationships to be more intimate than they actually are.
Criteria A for narcissistic personality disorder
A pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following: -Has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements). -Is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love. -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). -Requires excessive admiration. -Has a sense of entitlement (i.e., unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations). -Is interpersonally exploitative (i.e., takes advantage of others to achieve his or her own ends). -Lacks empathy: is unwilling to recognize or identify with the feelings and needs of others. -Is often envious of others or believes that others are envious of him or her. -Shows arrogant, haughty behaviors or attitudes.
Criteria A for borderline personality disorder
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: -Frantic efforts to avoid real or imagined abandonment. (Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.) -A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation. -Identity disturbance: markedly and persistently unstable self-image or sense of self. -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.) -Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior. -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). -Chronic feelings of emptiness. -Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights). -Transient, stress-related paranoid ideation or severe dissociative symptoms.
Criteria A for obsessive compulsive personality disorder
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: -Is preoccupied with details, rules, lists, order, organization, or schedules to the extent that the major point of the activity is lost. -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). -Is excessively devoted to work and productivity to the exclusion of leisure activities and friendships (not accounted for by obvious economic necessity). -Is overconscientious, scrupulous, and inflexible about matters of morality, ethics, or values (not accounted for by cultural or religious identification). -Is unable to discard worn-out or worthless objects even when they have no sentimental value. -Is reluctant to delegate tasks or to work with others unless they submit to exactly his or her way of doing things. -Adopts a miserly spending style toward both self and others; money is viewed as something to be hoarded for future catastrophes. -Shows rigidity and stubbornness.
Most temperamental and personality traits have been found to have a(n) __________.
moderate heritability
Criteria A for schizotypal personality disorder
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: -Ideas of reference (excluding delusions of reference). -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). -Unusual perceptual experiences, including bodily illusions. -Odd thinking and speech (e.g., vague, circumstantial, metaphorical, overelaborate, or stereotyped). -Suspiciousness or paranoid ideation. -Inappropriate or constricted affect. -Behavior or appearance that is odd, eccentric, or peculiar. -Lack of close friends or confidants other than first-degree relatives. -Excessive social anxiety that does not diminish with familiarity and tends to be associated with paranoid fears rather than negative judgments about self.
Criteria A for avoidant personality disorder
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: Avoids occupational activities that involve significant interpersonal contact because of fears of criticism, disapproval, or rejection. Is unwilling to get involved with people unless certain of being liked. Shows restraint within intimate relationships because of the fear of being shamed or ridiculed. Is preoccupied with being criticized or rejected in social situations. Is inhibited in new interpersonal situations because of feelings of inadequacy. Views self as socially inept, personally unappealing, or inferior to others. Is unusually reluctant to take personal risks or to engage in any new activities because they may prove embarrassing.
dialectical behavior therapy
A unique kind of cognitive and behavioral therapy specifically adapted for treating borderline personality disorder.
The number of antisocial behaviors exhibited in childhood is the single best predictor of an adult diagnosis of __________.
ASPD
Which basic personality traits from the five-factor model seem most important in the development of paranoid personality disorder?
Antagonism and neuroticism
Which culture would be expected to have the lowest rates of women diagnosed with histrionic personality disorder?
Asian
Epidemiological study
Attempts to establish the pattern of occurrence of certain (mental) disorders in different times, places, and groups of people.
Which child exhibits behaviors that might be predictive of an antisocial personality disorder (ASPD) as an adult?
Ben, who at age 6 was described as hyperactive, hostile, and defiant with authority figures
Cluster B disorders
Characterized by a tendency to be dramatic, emotional, and erratic; histrionic, narcissistic, antisocial, and borderline personality disorders
Cluster C disorders
Characterized by anxiety and fearfulness; avoidant, dependent, and obsessive-compulsive personality disorders
Cluster A disorders
Characterized by odd or eccentric behavior, with unusual behavior ranging from distrust and suspiciousness to social detachment; paranoid, schizoid, and schizotypal personality disorders
Hannah has been diagnosed with a personality disorder. She has a tendency to be dramatic, emotional, and erratic. What DSM cluster does Hannah's pattern of behaviors fall under?
Cluster B
Which personality cluster is the most common, with a prevalence rate of around 7 percent?
Cluster C
Which of the following offers the greatest promise for the treatment of psychopathic personality disorder?
Computer-based cognitive remediation focused on response modulation
Antisocial personality disorder
Disorder characterized by continual violation of and disregard for the rights of others through deceitful, aggressive, or antisocial behavior, typically without remorse or loyalty to anyone.
Criteria B for schizoid personality disorder
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.
Criteria B for schizotypal personality disorder
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.
Criteria B for paranoid personality disorder
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.
Narcissistic personality disorder
Exaggerated sense of self-importance, preoccupation with being admired, and lack of empathy for the feelings of others.
Histrionic personality disorder
Excessive attention seeking, emotional instability, and self-dramatization.
Schizotypal personality disorder
Excessive introversion, pervasive social interpersonal deficits, cognitive and perceptual distortions, and eccentricities in communication and behavior.
Dependent personality disorder
Extreme dependence on others, particularly the need to be taken care of, leading to clinging and submissive behavior.
Personality disorder
Gradual development of inflexible and distorted personality and behavioral patterns that result in persistently maladaptive ways of perceiving, thinking about, and relating to the world.
Which combination of basic personality traits from the five-factor model is most influential in the development of obsessive-compulsive personality disorder?
High conscientiousness and low compliance
Borderline personality disorder
Impulsivity and instability in interpersonal relationships, self-image, and moods.
Schizoid personality disorder
Inability to form social relationships or express feelings and lack of interest in doing so.
Which of the following is true about non-suicidal self-injury (NSSI)?
It is relatively common, with about 17 percent of adolescents reporting lifetime NSSI.
Which of the following reasons best summarizes why histrionic personality disorder was one of the four diagnoses recommended for exclusion from the DSM-5?
It is very highly comorbid with borderline, antisocial, narcissistic, and dependent personality disorder diagnoses, suggesting it may not be a unique diagnosis.
Which of the following personality disorders is more common in Western cultures?
Narcissistic.
The DSM-5 task force proposed numerous revisions to personality disorders, including the use of a hybrid dimensional-categorical model, which would have contained both categorical and dimensional components. Which of the following best reflects the changes that were actually reflected in the DSM-5?
No changes were accepted officially, and personality disorders in the DSM-5 are identical to those in the DSM-IV-TR.
Edmund has been diagnosed with a Cluster A disorder. What is likely a significant characteristic of Edmund's personality?
Oddness or eccentricity
Obsessive-compulsive personality disorder
Perfectionism and excessive concern with maintaining order, control, and adherence to rules.
Paranoid personality disorder
Pervasive suspiciousness and distrust of others.
Criteria B for antisocial personality disorder
The individual is at least age 18 years.
Which of the following best describes why the DSM-5 task force proposed removing the cluster organization of personality disorders?
There are too many overlapping features across personality disorder clusters.
When is a personality disorder diagnosis warranted?
When 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.
Patrick's biggest problem is that he has difficulties getting along with others. Although he shows no signs of obvious mental illness, he has longstanding problems with his sense of self and seems unable to function effectively or meet the demands of adult life. Patrick's behavior patterns are most suggestive of a diagnosis of __________.
a personality disorder
Dialectical behavior therapy is ________
a promising, problem-focused treatment for borderline personality disorder.
Traits of vulnerable narcissism
a very fragile and unstable sense of self-esteem; arrogance and condescension is merely a façade for intense shame and hypersensitivity to rejection and criticism
The goal of dialectical behavior therapy (DBT) in the treatment of borderline personality disorder is for the patient to __________.
accept negative affect without resorting to self-destructive or other maladaptive behaviors
For persons with severe personality disorders, treatment may be most effective in settings or situations where __________.
acting-out behaviors can be contained
Which of the following dimensions developed from Hare's checklist reflects traits such as lack of remorse or guilt, callousness/lack of empathy, shallow affect, and a failure to accept responsibility for one's behavior?
affective
Rachel, who has been diagnosed with borderline personality disorder (BPD), is well-known by her peers for her intense emotional responses to various environmental triggers. She recovers slowly from upsets, and her behavior is characterized by drastic and rapid shifts from one emotion to another. This observed behavior pattern is called __________.
affective instability
Facets of neuroticism
anxiety, angry hostility, depression, self-consciousness, impulsiveness, vulnerability
Research findings across cultures reveal that the five-factor personality traits __________.
are common to both Western and non-Western cultures, including African and Asian cultures
Persons with obsessive-compulsive personality disorder (OCPD) __________.
are different from individuals diagnosed with obsessive-compulsive disorder in that those with OCPD do not have true obsessions or compulsive rituals
The histrionic seeks __________, while the narcissist needs __________.
attention; admiration
Some studies suggest that treatment success may be most promising for __________ personality disorders.
avoidant and dependent
Symptoms of paranoid personality disorder are often found with individuals who chronically abuse __________.
cocaine
Facets of conscientiousness
competence, order, dutifulness, achievement striving, self-discipline, deliberation
Misdiagnosis is more common with personality disorders than with other psychological disorders. This may occur because with personality disorders, __________.
criteria are defined by inferred traits or consistent patterns of behavior rather than by more objective behavioral standards
Carrie becomes frantic when her husband goes out of town for a business trip. She is very passive and submissive in her marriage and seems incapable of making independent decisions. Based on these observations, what diagnosis best represents Carrie's behaviors?
dependent personality disorder
Robert Hare's 20-item Psychopathy Checklist-Revised (PCL-R) provides clinicians with a way to __________.
diagnose psychopathy on the basis of the Cleckley criteria
In a prospective study designed to examine factors associated with illness onset, __________.
groups of people are observed before a disorder appears and are followed over a period of time to see which individuals develop problems
Studies that are designed to establish the prevalence (number of cases) of a particular disorder in a very large sample of people living in the community are called __________ studies.
epidemiological
When experiencing high levels of stress, individuals with paranoid personality disorder may __________.
experience transient psychotic symptoms lasting from a few minutes to several hours
Traits of grandiose narcissism
extreme grandiosity, aggression, and dominance
Facets of personality in schizoid personality disorder
extremely high levels of introversion (especially low on warmth, gregariousness, and positive emotions) and low on openness to feelings (one facet of openness to experience) and on achievement striving
Facets of openness
fantasy, aesthetics, feelings, actions, ideas, values
Studies have identified overlap between avoidant personality disorder and __________, leading some investigators to conclude that avoidant personality disorder may simply be a somewhat more severe manifestation of the other.
generalized social phobia
Facets of extraversion
gregarious, warm, assertive, active, excitement-seeking, positive emotionally
Schizoid and avoidant personality disorders are similar in that, in the case of both diagnoses, people are socially isolated. However, they are different in that the person with a diagnosis of schizoid personality disorder __________, whereas the person diagnosed with avoidant personality disorder __________.
has little desire to form close relationships; wants interpersonal contact but is hypersensitive to criticism
Facets of personality in histrionic personality disorder
high excitement seeking and low self-consciousness
Facets of personality in paranoid personality disorder
high levels of antagonism (low agreeableness) and neuroticism (angry-hostility)
Facets of personality in BPD
high neuroticism, low agreeableness, low conscientiousness, and high openness to feelings and actions
The diagnosis of __________ personality disorder has historically been associated with women, even though some criteria include traits that are more commonly observed in men than in women (e.g., low self-consciousness).
histrionic
Personality aspects in schizotypal personality disorder
introversion and neuroticism
Individuals diagnosed with schizoid personality disorder show high levels of __________ and score low on __________ when personality traits are assessed using the five-factor model.
introversion; facets associated with openness to experience and conscientiousness
In comparing the criteria for antisocial personality disorder (ASPD) with that of an earlier diagnosis of psychopathy, it has been agreed that the two diagnoses have a lot of overlap. However, the diagnosis of ASPD __________, whereas the diagnosis of psychopathy __________.
is more inclusive and reflects a lot of criminality; is narrower and much more focused on personality structure
individuals with low MAOA activity were far ________ likely to develop ASPD if they had experienced early maltreatment than were individuals with high MAOA activity and early maltreatment and individuals with low levels of MAOA activity without early maltreatment.
more
In Western cultures, personal ambition and success are encouraged and reinforced. Consequently, the percentage of persons diagnosed with __________ personality disorder is higher than in other, non-Western cultures.
narcissistic
Which of the traits identified in the five-factor model is comprised of the following six facets: anxiety, angry-hostility, depression, self-consciousness, impulsiveness, and vulnerability?
neuroticism
Henry has a personality disorder. His psychotherapist has suggested that Henry developed his personality disorder during early childhood as the result of excessive gratification of his impulses by his parents. Henry's therapist has explained the development of Henry's disorder using a __________ theoretical perspective.
psychodynamic
Which clinical condition appears to be the single best predictor of violence and recidivism of convicted and imprisoned persons?
psychopathy
For both borderline and dependent personality disorders, fear of abandonment is prominent as a clinical feature. However, the borderline personality __________, while the dependent personality __________.
reacts with feelings of emptiness or rage if abandonment occurs; is submissive and urgently seeks out a new relationship to fill the void
Studies evaluating psychiatric patients and college students diagnosed with schizotypal personality disorder have shown a deficit in the ability to track a moving target visually. This deficit is also found in individuals diagnosed with __________.
schizophrenia
Frances is a college student majoring in Classics and Greek language. She earns good grades and works part-time. Frances is known to practice white magic. She participates in rituals and spell-casting. She can often be heard talking in Elvish in an attempt to connect with characters from Lord of the Rings. Frances's behavior is most consistent with a diagnosis of __________.
schizotypal personality disorder
When Patrick and colleagues (1993) compared the fear-potentiated startle of psychopathic and non-psychopathic prisoners while viewing pleasant, unpleasant, and neutral slides, they found that __________.
the psychopathic prisoners did not show the startle effect, although non-psychopathic prisoners did
The primary goal of Kernberg's transference-focused psychotherapy is __________.
strengthening the weak egos of persons with borderline personality disorder, with a particular focus on adapting their primitive defense mechanism of splitting
In a study looking at successful and unsuccessful psychopaths living in a community, __________ showed greater heart rate reactivity under stress than other groups evaluated.
successful psychopaths
Based on research conducted by Widom, the difference between successful psychopaths and unsuccessful psychopaths is that __________.
successful psychopaths remain cool under pressure, as a result of low activity in the amygdala
Which component of psychopathy would you expect to decrease with age?
the antisocial behavioral dimension
Since World War II, there has been an increase in the prevalence of emotional and impulsive behavior. It is hypothesized that this change could be the result of __________.
the increased breakdown of the family and other traditional social structures