Chapter 11

How is histrionic PD usually treated?

Focusing on problematic interpersonal relationships is a large part of therapy. Individuals are shown how the short term benefits of manipulating others through emotional crises, charm, sex, seductiveness, or complaining, are costly in the long term, and to use more appropriate ways of negotiating their wants and needs.

How effective is DBT?

DBT helps to reduce suicide attempts, dropout from treatment, and hospitalizations. A follow up after treatment comparing DBT to general therapeutic support showed that DBT group was less suicidal and angry, and better socially adjusted.

What is Gray's (1987) explanation for antisocial personality disorder with brain functioning?

3 major brain systems influences learning and emotional behavior: Behavioral Inhibition System (BIS), Reward system, and fight/flight system. BIS and reward system can explain psychopathic behavior. § BIS is responsible for stopping/slowing when faced with impending punishment, nonreward, or novel situations, and activating this system leads to anxiety and frustration. □ BIS involves noradrenergic and serotonergic NTs. § Reward system is responsible for how we behave towards positive rewards, and is associated with hope and relief. □ Reward system involved with dopaminergic pathway, the pleasure pathway. Imbalance between BIS and reward system can make the fear and anxiety produced by the BIS less apparent, and positive feelings of reward system more prominent. § This explains why psychopaths aren't anxious about committing antisocial acts.

Describe the Newman, Patterson, and Kosson's experiment on how psychopaths process reward and punishment.

A card-playing task on a computer provided rewards and fines for correct and incorrect answers to psychopathic and nonpsychopathic criminal offenders. ○ Originally, rewards were given 90% of the time, and odds were adjusted to give 0% chance of reward. Psychopaths continued to play and lose, whereas those without psychopathy stopped playing. ○ When psychopaths set their sights on a reward goal, they are less likely than nonpsychopaths to be deterred despite signs that the goal is achievable. ○ Failure to abandon an unattainable goal seems to fit the overall picture.

What is conduct disorder and what are its subtypes?

A separate diagnosis for children who engage in antisocial behaviors. Chlidhood-onset: having onset before 10 years of age. Adolescent-onset: absence of criteria before 10 years of age. Callous-unemotional presentation: the young person presents with personality characteristics similar to psychopathic adults. ○ This is used to distinguish from children who do feel remorseful about their behavior.

What are the cultural contributions to paranoid personality disorders?

Certain groups of people with unique experiences are more susceptible to developing this. For example, immigrants hearing a foreign language within earshot may interpret innocuous behavior as ideas of reference.

What support exists for the link between schizotypal PD and schizophrenia?

Characteristics are similar but milder in the PD. Family, twin, and adoption studies show increased prevalence of schizotypal PD among relatives of people with schizophrenia. Cognitive assessment points to mild to moderate decrement in memory and learning capabilities, suggesting damage in left hemisphere.

Describe the experiments which examine the cognitive basis for BPD; how they process information and how it contribute to difficulties.

BPD and normal individuals asked to remember some words and forget others. When words were not related to BPD symptoms, both groups performed equally well, but when presented with BPD relevant words, individuals remembered these words more despite instructions to forget them. There is a memory bias, holding clues to the nature of this disorder.

What is the general treatment course like for BPD individuals?

BPD individuals appear quite distressed and are more likely to seek treatment, even compared to those with anxiety or mood disorders. Anticonvulsants and newer antipsychotics are effective in treating some core symptoms of BPD. Antidepressants have limited usefulness. Complications interfering with treatment include drug abuse, compliance, and suicide attempts, causing many clinicians to be reluctant to work with these individuals.

Describe Gerald Patterson's work regarding children with antisocial PD.

Aggression in children with antisocial PD may escalate partly due to interactions with parents. Parents often give in to the problem behaviors displayed by their children. ○ Problems caused by conflict contribute to aversive behavior, causing avoidance of the issue and continuing problems with the child, who has learned to continue fighting and not give up, and the parent who has learned to withdraw demands from the child. ○ This is known as the "coercive family process", which combines with other factors associated with poor parenting , to maintain aggressive behaviors. § Coercive parenting seems to be related to unemotional traits leading to later psychopathy.

What are common behavioral manifestations of antisocial PD?

Aggressive in taking what they want and indifferent to concerns of others. Lying and cheating are common to the extent that they cannot tell the difference between the truth and their fabrications. They show no remorse or concern over consequences of their actions. Substance abuse occurs with over half of these individuals, usually persisting lifelong.

What are the cluster C disorders and descriptions of each?

Anxious or Fearful Disorders Avoidant personality disorder: Characterized by strong feelings of being inadequate, which can result in inhibition in social situations and sensitivity to any negative feedback. Dependent personality disorder: A strong need to be cared for by others, including patterns of submissiveness and fear of separation. Obsessive-compulsive personality disorder: Characterized by a desire for being perfect both mentally and interpersonally, a need for orderliness, and reduced flexibility and openness.

How prevalent are personality disorders?

As many as 1 in 10 adults may have a personality disorder, making them relatively common. There are differences in prevalence estimates based upon surveying in clinical vs general populations, as well as variability in gender biases.

How is OCPD treated?

Attacking fears underlying the need for orderliness, and feelings of inadequacy. Helping individual relax, using distraction techniques to redirect compulsive thoughts.

What do therapists think about treatment for antisocial PD individuals, and what generally indicates a successful treatment course?

Because these individuals rarely desire treatment, and can even be manipulative with therapists, most clinicians are pessimistic about treatment and even agree that incarceration is necessary to deter future antisocial acts. Some success was found with CBT to reduce likelihood of violence 5 years after treatment. However, success was negatively correlated with "selfish, callous, and remorseless use of others", and those with high scores in these traits were less successful in refraining from violence after treatment.

What is the DSM-5 diagnosis for conduct disorder?

Behaving in particular categories of behavior: Aggression to people and animals ○ Physical cruelty towards others, especially with weapons. ○ Criminal coercion of a victim such as extortion, robbery or rape. Destruction of property ○ Fire setting or other means of deliberate destruction. Deceitfulness or Theft ○ Burglarizing or conning others to obtain goods or avoid obligations. ○ Crimes of deceit which do not involve confrontation. Serious violations of rules ○ Truancy from school ○ Absence/running away from home, before 13 years of age. Individuals must be younger than 18 to meet criteria for conduct disorder.

What are the important aspects of successful treatment of avoidant PD?

Behavioral intervention strategy for anxiety and social skills problems has some success. Problems resemble social phobia and can be treated in similar ways. Therapeutic alliance is an important predictor for treatment success in this group.

What are the factors necessary to understand when treating schizotypal PD?

Between 30-50% of people requesting treatment for schizotypal PD also have MDD, and therefore require treatment for depression. Viewed as a precursor to schizophrenia, this disorder is treated in a similar way, with antipsychotic medication, community treatment, and social skills training. Such a combined approach seemed to reduce symptoms or postpone development of schizophrenia, and is proving to be a promising prevention strategy.

What kinds of gender bias exist and how should this inform how personality disorders are diagnosed?

Bias can occur in different stages of the diagnostic process. Criterion gender bias occurs when the criteria for the disorder is itself biased. ○ Criteria tend not to have a strong gender bias. Assessment gender bias is when the assessment measures and the way they are used is biased. ○ Clinicians tend to use their own biases when using criteria. It is important to understand that just because certain disorders are observed more in men or women doesn't necessarily indicate bias.

How might the genetic vulnerability of fear conditioning interact with environmental experiences to produce antisocial personality disorder?

Biological influences such as damage to amygdala function can interact with experiences such as early childhood adversity. A family under stress from divorce of substance abuse may have an interaction style that encourages antisocial behavior in the child. The antisocial and impulsive behavior of the child may alienate other children who might be better role models and attract others who are also antisocial, culminating in delinquency, poor occupational history, and increasingly worse life circumstances.

What are the advantages and disadvantages of using categorical vs dimensional models to view personality disorders?

Categorical models of behavior are convenient, but this oversimplification is prone to reification of problems, making certain disorders "real". Some argue that personality disorders are primarily determined by society, which decides that a particular way of relating with the world is a problem.

What are the most common risk factors for schizoid personality disorder?

Childhood shyness is a precursor to later adult schizoid personality disorder. ○ This personality trait is inherited and serves as an important determinant in the development of the disorder. Abuse and neglect in childhood are reported among these individuals. Parents of children with autism are more likely to have schizoid personality disorder, suggesting that a biological dysfunction links autism and schizoid, and when combined with early problems with interpersonal relationships produce the social deficits.

What are preventative measures taken to prevent development of antisocial behaviors in children?

Clinicians encourage identification of high risk children to have children before becoming adults. Parent training is the most common treatment strategy for children, causing parents to recognize behavior problems early on, to use praise and privileges to reduce problem behavior, and encourage prosocial behaviors. ○ Significant improvement of behavior in antisocial children. Risk factors for families are high degree of family dysfunction, socioeconomic disadvantage, high family stress, parental history of antisocial behavior, and severe conduct disorder. Given ineffectiveness of treatment for adults, prevention is the best approach to this problem.

What did Crowe (1974) demonstrate about antisocial PD and criminality?

Crowe examined children whose mothers were felons, but adopted by other families, comparing them to adopted children of normal mothers, with separation from mothers at birth. Adopted offspring of felons had significantly higher rates of arrests, convictions, and antisocial personality than offspring of normal mothers, suggesting some genetic influence. However, those adopted children of felons who actually became criminals spent more time in interim orphanages than children of felons who did not become criminals and children of normal mothers. § Perhaps there was a deficit in early, high-quality contact with parents or parent surrogates. There seems to be a genetic predisposition in the presence of certain environmental contexts.

What early genetic and environmental influences may contribute to dependent PD?

Disruptions such as early death of a parent, neglect/rejection by caretakers can cause fear of abandonment. Genetic influences are clearly important but the way they interact with environmental influences is unclear.

What are the cluster B disorders and descriptions of each?

Dramatic, Emotional, or Erratic Disorders Antisocial personality disorder: Characterized by behavior that shows limited regard for other people. Borderline personality disorder: Characterized by a high level of unstable relationships and emotional outbursts, poor self-image, and a difficulty controlling impulses. Histrionic personality disorder: The tendency to display flamboyant emotions with the goal of seeking attention. Narcissistic personality disorder: Pervasive belief that the individual is better than everyone else, which leads to attention-seeking and a lack of concern for others.

What are the changes made in diagnosing antisocial PD based upon personality traits vs behaviors and why is this significant?

Early DSM focused entirely on observable behaviors, but the new DSM moves closer to personality trait based criteria, which can reduce reliability of diagnosis.

What are the major environmental risk factors for developing BPD, and how correlated are these to BPD specifically?

Early trauma, especially sexual and physical abuse, and/or poor parental treatment. Rapid cultural changes can cause problems with identity, emptiness, fears of abandonment, and low anxiety, especially in immigrants. However, childhood traumas can also be risk factors for other disorders like schizoid, somatic symptom, panic, and DID. Also, there are some individuals with BPD who do not have a history of child abuse; it is not necessary or sufficient to produce BPD.

What do brain imaging studies with psychological treatments demonstrate about treating BPD?

Emotional reactions to upsetting photos in women with BPD were improved by decreasing arousal in amygdala and hippocampus over time.

What are the links between histrionic and antisocial PD?

Evidence suggests that they co-occur to a significant degree, with 2/3 of histrionic PD individuals meeting criteria for antisocial PD. Suggestion that histrionic and antisocial PD are sex-typed alternative expressions of the same condition, with a males demonstrating an antisocial pattern and females demonstrating a histrionic pattern.

What characteristics distinguish an individual with avoidant PD?

Extremely low self esteem as well as a fear and anxiety about rejection, as well as a pessimistic outlook of future. Asocial behavior is a result of anxieties about interpersonal relationships and fear of rejection, rather than lack of interest in relationships.

How can narcissistic PD be treated?

Focusing on grandiosity, hypersensitivity to evaluation, and lack of empathy towards others are important. Grandiosity: Cognitive therapy replaces fantasies with focus on the day-to-day pleasures which are realistically attainable. Sensitivity to criticism: Coping strategies such as relaxation training helps them face and accept criticism. Empathy: focusing on other's feelings is a goal. Depression is a vulnerability especially in middle age as well, which is treated accordingly.

What is the consensus for brain damage and antisocial personality disorder and what does this suggest?

General brain damage does not explain why people become psychopaths or criminals, with these individuals scoring as well o neuropsychological tests as normal individuals. Perhaps there are only subtle changes in chemistry or brain structure affecting behavior which cannot be detected by these tests.

Why is psychopathy an important consideration to prepare for the future?

Identifying personality traits such as lack of remorse and impulsivity lead to difficulties staying out of trouble with the legal system. People who score high on measures of psychopathy commit crimes at a higher rate than those with lower scores and are at greater risk for more violent crimes and recidivism.

What is the cognitive style associated with Histrionic PD?

Impressionistic, viewing situations in global, black and white terms. Speech is vague and characterized by exaggeration.

How does schizoid personality disorder manifest itself?

Individuals appear cold and detached, not affected by praise or criticism. ○ However, some are sensitive to other's opinions but unwilling/unable to express their emotions. Social isolation is a default response, which may be intentional, or experienced with extreme pain. Homelessness is prevalent among these individuals, due to a lack of close friendships and lack of dissatisfaction about not having a sexual relationship with another person.

How does paranoid personality disorder manifest itself and what implications are there?

Individuals may be argumentative, complaining, or quiet. This style of interaction is communicated, making others uncomfortable due to their volatility. Sensitivity to criticism, and having an excessive need for autonomy. Having this disorder increases risk of suicide attempts and violent behavior.

How does treatment generally work for those with dependent PD?

Individuals with dependent PD are attentive and eager to give responsibility of their problems to therapist, so there is high cooperativity. Therapy must instill self-confidence in patient to enable independent decision making, especially with making sure that the patient is not overly dependent upon the therapist.

What traits are generally characteristics of borderline PD?

Instability is a core feature, having turbulent relationships, fearing abandonment but lacking control over emotions. Emotional dysfunction is a core feature: emotions are intense and volatile, going from anger to deep depression in a short time. Described as "stably unstable", the instability manifests in impulsivity, leading to drug abuse, self-harm. ○ Self harm is sometimes described as tension-reducing in these individuals. Feeling empty, being chronically bored, and having difficulty with self identity are common.

What seems to be the most common prognosis of being diagnosed with conduct disorder as a child?

Many of these children often become juvenile offenders and tend to be involved with drugs. Lifelong pattern of antisocial behavior is common, and higher likelihood of developing antisocial PD (many adults with antisocial PD or psychopathy had conduct disorder as children).

What did the study comparing delinquent and non-delinquent adolescents demonstrate about antisocial PD?

Many of these delinquents would have received a diagnosis of conduct disorder, which is a possible precursor to antisocial PD as adults. Delinquent boys had higher likelihood to die an unnatural death, possibly due to drug abuse and poor self-care.

What is the theoretical link between OCPD and various crimes?

Many serial killers seem to have OCPD and not other severe mental illnesses, especially by being "masters of control" in manipulating victims and all aspects of a crime. Some sex offenders, particularly pedophiles, have similar brain-functioning to individuals with OCPD. With non-criminal individuals, it is common to find OCPD with gifted children, who may have debilitating perfectionism.

What is Dialectical Behavior Therapy and what can it be used for?

Marsha Linehan developed this psychosocial treatment which helps people cope with stressors that trigger suicidal behavior. Priority in treatment is given to self-harming behaviors, then other behaviors interfering with therapy, then those that interfere with quality of life. Weekly individual sessions to provide support and teach how to identify and regulate emotions. Treatment is similar to PTSD, where traumatic events are reexperienced to help extinguish fears. Clients eventually learn to trust their own responses rather than depend on external validation.

What disordered personality traits tend to be present in men vs women?

Men tend to display traits characterized as more aggressive, structured, self-assertive, and detached. ○ Antisocial personality disorder is present more often in men. Women tend to present with characteristics that are more submissive, emotional, and insecure. ○ Dependent personality disorder is more present in women. Histrionic and borderline personality disorder were identified by clinicians more in women than men, but recent studies find similar prevalence of these disorders.

What are the cluster A disorders and descriptions of each?

Odd or Eccentric Disorders Paranoid personality disorder: The strong tendency to mistrust the motives of others, leading to a high degree of suspiciousness. Schizoid personality disorder: Characterized by social detachment and a lack of emotional expression not due to social anxiety. Schizotypal personality disorder: Social and interpersonal difficulties that are due to social anxiety but also involves distorted views of the world and unusual behavior.

How do personality disorders generally develop?

Originally thought to originate in childhood and continue into adulthood, but this is not completely true. A particularly personality disorder can remit over time, but may be replaced by other personality disorders. It is difficult to study personality disorders from when they begin because many individuals do not seek treatment.

What are the general distinguishing characteristics of an individual with Histrionic PD?

Overly dramatic, expressing emotions by exaggerations. Uncomfortable when they are not in the center of attention, with attention-seeking behaviors, dress, and appearance. Impulsive tendencies, with great difficulty delaying gratification.

What are the main beliefs associated with specific personality disorders? (paranoid, schizotypal, schizoid, histrionic, narcissistic, borderline, antisocial, avoidant, dependent, obsessive-compulsive)

Paranoid: I cannot trust people Schizotypal: It's better to be isolated from others. Schizoid: Relationships are messy and undesirable. Histrionic: People are there to serve or admire me. Narcissistic: Because I am special, I deserve special rules. Borderline: I deserve to be punished. Antisocial: I am entitled to break rules. Avoidant: If people knew the "real" me, they would reject me. Dependent: I need people to survive and be happy. Obsessive-compulsive: People should do better and try harder.

How prevalent are comorbidities with personality disorders and what are the implications of this?

People tend to be diagnosed with more than one personality disorder, so there is a lot of overlap in diagnoses. This might indicate that definitions of disorders are inaccurate, or that categories should be rethought so there are less overlapping definitions.

What is a "personality" and how does this help define what personality disorders are?

Personality traits such as shyness are only true personality traits persist, part of the way that a person behaves in most situations. A personality disorder is a persistent pattern of emotions, cognitions, and behavior which results in enduring emotional distress for the person affected or others, and causing difficulties with work and relationships. Particularly with antisocial personality disorder, the individual may show a blatant disregard for the rights of others yet exhibit no remorse. Sometimes the individual is referred to an another person other than the affected because they themselves cannot make that judgment.

What appears to be the developmental cause of narcissism?

Proper socialization of children involves teaching empathy and altruism, and a profound failure of parents to model empathy early in childhood causes a fixation in a self-centered stage of development.

What does treating schizoid PD look like?

Rarely do individuals seek treatment, except in response to a related crisis. Therapists point out the value in social relationships, starting by taking the role of a friend or significant other in a technique known as role-playing, and helping the patient establish and maintain social relationships. ○ This kind of social skills training is helped by identifying a supportive social network for the individual. They are taught the emotions felt by others to learn empathy.

What are the distinguishing characteristics of Dependent PD?

Reliance upon others to make decisions, and an unreasonable fear of abandonment Submissiveness, timidity, and passivity. ○ In response to different opinions, they often agree with others in order to not be rejected. Comparable to Avoidant PD in low self-esteem, sensitivity to criticism, and need for reassurance, but contrasted from it by the response to cling to others rather than avoid relationships.

What characteristics distinguish individuals with OCPD?

Rigidity with personal values, procedural tasks, spending habits. ○ Hoarding possessions even without sentimental value. ○ Causes poor interpersonal relationships. Fixation on "correctness" to a fault, preventing completion or fully grasping the importance of any task. Dedication to productivity at the expense of leisure.

Which personality disorders were not included in DSM-5 due to controversy?

Sadistic personality disorder: receiving pleasure by inflicting pain on others. Passive-aggressive personality disorder, including people who are defiant and refuse to cooperate with requests, attempting to undermine authority figures.

What are the psychological contributions to paranoid personality disorders?

Schemas, often mistaken assumptions about others, seem to be a way of understanding behavior. ○ These schemas are maladaptive ways to view the world, yet it seems to pervade every aspect of their lives. Early familial upbringing seems to play a primary role, especially if parents teach them to be careful about making mistakes, and impressing upon their children that they are different from other people, to cause them to be vigilant against others.

How does schizotypal compare to schizoid and paranoid PDs?

Schizotypal has aspects of the other two PDs: they are are socially isolated similar to schizoid, but with suspicions and ideas of reference like paranoid. In addition to the commonalities with schizoid and paranoid PDs, they have magical thinking. Schizotypal is on a continuum with schizophrenia, which it is similar to except with the absence of hallucinations and delusions.

Distinguish the clinical diagnosis of schizotypal with schizophrenia.

Schizotypal has psychotic-like symptoms, social deficits, and sometimes paranoia, manifesting as odd and bizarre in their behavior, thoughts, even dress. They have some intact reality testing, being able to recognize that their ideas of reference are unlikely to be true. They have "magical thinking", feelings of having alternate senses or unusual perceptual experiences and illusions, but unlike schizophrenia, they would distinguish these experiences as feelings rather than as actual phenomena.

What kind of disorders seem to result with childhood trauma/mistreatment in men vs. women?

Schizotypal symptoms are more associated with childhood mistreatment in men. PTSD symptoms seem to manifest more with childhood mistreatment in women.

What does the adoption study by Sigvardsson et al (1982)demonstrate about environmental factors causing criminality?

Shared environmental factors, making family members similar, are important to etiology of criminality and even antisocial PD. Low social status of adoptive parents increased risk of nonviolent criminality among females. Individuals with antisocial personality disorder come from homes with inconsistent parental discipline, like children with conduct disorders.

What did Widom's study (1977) reveal about psychopaths?

She recruited subclinical, well functioning, psychopaths with a newspaper article. These psychopaths shared characteristics with imprisoned psychopaths, scoring low on empathy and socialization, with higher parental rates of psychopathology and alcoholism. At least some individuals with psychopathic personality traits avoid repeated contact with the legal system and function successfully in society.

Compare schizoid PD with paranoid and schizotypal PD.

Social deficiencies in schizoid are similar but more extreme than paranoid personality disorder. ○ These both have social isolation, poor rapport, and constricted affect. Compared with the other two Cluster A disorders, they do not have the unusual thought processes like ideas of reference.

According to Millon (1981), how do biological and psychosocial influences contribute to avoidant PD?

Some biological relation to subschizophrenia-related disorders, with greater occurrence of avoidant PD among schizophrenia relatives. Millon (1981) suggests an inherited difficult temperament or personality characteristics, which may cause parents to reject them or fail to provide enough love. ○ Such parental rejection may result in low self-esteem and social alienation, which persists into adulthood. Limited support for psychosocial influences, with parents of disordered individuals remembering parents as more rejecting, guilt engendering, and less affectionate than control group, as well as childhood experiences of isolation and conflict.

What does the triple vulnerability theory entail?

The first vulnerability (or diathesis) is a generalized biological vulnerability. ○ We can see the genetic vulnerability to emotional reactivity in people with borderline personality disorder and how this affects specific brain function. The second vulnerability is a generalized psychological vulnerability. ○ In the case of people with this personality disorder, they tend to view the world as threatening and to react strongly to real and perceived threats. The third vulnerability is a specific psychological vulnerability, learned from early environmental experiences; this is where early trauma, abuse, or both may advance this sensitivity to threats. ○ When stressed, a person's biological tendency to be overly reactive interacts with the psychological tendency to feel threatened. ○ This may result in the outbursts and suicidal behaviors commonly observed in this group.

How does the fearlessness hypothesis frame our understanding of antisocial PD and why is it important according to its proponents?

The higher threshold for experiencing fear means that there is very little subjective feelings which limit them from participating in normally risky behavior.

How does the underarousal hypothesis frame the development of antisocial PD what evidence confirms this?

The low level of cortical arousal leads to stimulating-seeking behaviors, which have a higher threshold for satisfactory arousal for antisocial individuals. Future criminals were found to have lower skin conductance activity, lower heart rate during rest periods, and more slow-frequency brain wave activity, all indicative of low arousal.

Why are cultural considerations important in diagnosing schizotypal PD?

There are often beliefs around religious or spiritual themes, which may only seem unusual to the uncultured clinician, especially when rituals are done with obsessiveness to seem extremely unusual.

What do family and twin studies suggest about genetic causes of BPD?

There is a clear prevalence of BPD among families with the disorder, and a link to mood disorders. Higher concordance rate with identical twins compared to fraternal twins, suggesting genetic basis. Emotional reactivity seems to be associated with serotonin genes. ○ Low serotonergic activity is involved in regulation of mood and impulsivity. Limbic network seems to be most involved in BPD, a brain area which is involved in emotion regulation and dysfunctional serotonin neurotransmission.

What phenomenon exists for the prevalence of antisocial PD with age?

There is a marked decline in rates of antisocial behavior around the age of 40. The conviction rates of male psychopaths and nonpsychopaths were compared, showing constant rates between ages 16-45 in nonpsychopaths, and consistently higher rates for psychopaths as well, up until age 40 when there was a sharp decrease. Decline of antisocial behavior around middle age is yet to be explained.

What are the genetic contributions to paranoid personality disorder and what implications does this have?

There is a strong role of genetics, and some relationship with schizophrenia as well. Some suggest eliminating paranoid personality disorder as a separate disorder.

How linked are OCD and OCPD?

There is only a distant relation between the two disorders. OCPD individuals do not have true obsessions or compulsions. ○ Whereas OCD individuals seem less in control of their O's and C's, OCPD individuals are ruthlessly controlling of themselves and others in maintaining their values and manner of conduct.

What might be some genetic and environmental causes of OCPD?

There is some weak genetic contribution to OCPD, with a predisposition to favor structure. Parental reinforcement of conformity and neatness appears to be an important contribution to severe OCPD.

What are difficulties with treating paranoid personality disorder and how are they addressed?

These individuals are unlikely to seek professional help when they need it, and often only seek therapy with a crisis, or issues with mood, not necessarily for the personality disorder. Therapists provide an atmosphere conducive to developing a sense of trust, using cognitive therapy to counter a person's negative schema about others, and changing their beliefs. Very few individuals receiving treatment for this disorder are reported to have enough adherence to therapy.

What was Kaplan's criticism about the histrionic personality disorder diagnosis?

This disorder is biased against females, with features such as overdramatization, vanity, seductiveness, and overconcern with physical appearance, which represent stereotypes of Western females. Simply seems to be the embodiment of extremely feminine traits, which should not necessarily branded as a mental illness.

What are the arousal hypotheses for explaining the contribution to antisocial PD?

Underarousal hypothesis considers that psychopaths have abnormally low levels of cortical arousal. ○ As demonstrated by the Yerkes-Dodson curve, people with low (or high) arousal tend to experience negative affect and perform poorly, as opposed to those in the middle who are content and perform satisfactorily. Fearlessness hypothesis considers that psychopaths have a higher threshold for experiencing fear than most individuals

What are the characteristic qualities of narcissistic PD?

Unrealistic self-absorption causing lack of sensitivity towards others. Grandiosity in feelings and fantasies, manifested in having excessive expectations for deserving privileges. Envious of others who they view as successful. Depression from failing to live up to self expectations.

What comorbidities are common with BPD?

Up to 2/3 of people with BPD have at least one substance abuse disorder. Mood disorders are common with BPD, with some having MDD and even more having bipolar disorder. Eating disorders are particularly common; many of the people with bulimia also have BPD.

Describe the view of the schizotypal PD as a phenotype.

Whereas schizophrenia is viewed as a genotype, schizotypal PD is viewed as one possible phenotype (expression of the genotype). Schizotypal is viewed as being a product of the schizophrenia genes with a lack of biological influences (i.e. prenatal illness) and environmental stress (poverty and maltreatment), as a milder version of schizophrenia.

What distinction is important to make between psychopathy and antisocial PD traits?

While psychopaths had elevated risk for criminal behaviors, some were found to have few or no legal or interpersonal difficulties, which is distinct from the outward aggressiveness indicative of antisocial PD. IQ seems to be higher among psychopaths who are more successful in skirting the law. ○ Among children identified as being at risk for delinquent behavior, a small percentage actually got in trouble, correlating with those who had a lower IQ.

What did Maureen Ford and Thomas Widiger (1989) demonstrate about diagnosis of personality disorders?

With identical fictitious case histories given to clinical psychologists, with only changes in gender, there were different diagnoses for antisocial and histrionic. ○ Diagnosing antisocial personality disorder among males was more accurate compared to if gender was female. ○ Psychologists incorrectly diagnosed more women as having histrionic personality disorder.

How might fear conditioning be related to development of antisocial personality disorder, and what was the study that demonstrated this idea?

With normal fear conditioning, we learn to avoid the conditioned stimulus because of its association with an unconditioned stimulus, with abnormal fear conditioning, we may not learn to avoid things that harm us. Criminal offenders at the age of 23 were found to have reduced fear conditioning at age 3 (with a 20 year study). Deficits in amygdala function are thought to make individuals unable to recognize cues that signal threat, manifesting as fearlessness. Genetic influences leading to damage in the amygdala interact with environmental influences, learning to fear threats, to produce fearless adults who are harmful to themselves and others.