Abnormal Psychology ch 13

Nothing is known about the neurological bases of the fearful/anxious personality disorders, but the similarity between these disorders and the anxiety disorders may indicate that the __________ is involved.

amygdala

Schizotypal differs from schizoid personality disorder in that the former includes __________________ *Although these two disorder may be similar, as research suggest half of those with schizoid personality disorder are also diagnosed with schizotypal personality disorder

cognitive-perceptual symptoms

In schizotypal personality disorder, according to the DSM-5, there are nine symptoms which can be organized into three distinct groups:

cognitive-perceptual, interpersonal, disorganized

Those with antisocial personality disorder who are most likely to respond to treatment have a ____________ disorder, and this capacity for anxiety may suggest they are not psychopaths

comorbid anxiety

One of the diagnostic criteria for antisocial personality disorder is evidence of ____________ in childhood

conduct disorder

1. The clingy behaviors are intended to elicit attention, reassurance and decisive behaviors from other people 2. These behaviors are part of a chronic pattern of helpless behavior 3. Patients are chronically plagued by self-doubt and consistently underestimate their abilities 4. They are highly indecisive across all decisions, from the life-altering to the mundane 5. Any criticism or disapproval represents proof of their basic negative beliefs about themselves 6. They are more comfortable in relationships where the other person takes the initiative 7. They have a limited social circle

dependent personality disorder

Magical thinking Unusual perceptual experiences Ideas of reference Paranoid ideation

cognitive-perceptual

First-degree relatives of patients with Cluster _____ personality disorders are more likely to develop a schizophrenia-related disorder than are people who are not related to such patients

A

the types of dramatic/erratic personality disorders

Antisocial Borderline personality disorder Histrionic personality disorder Narcissistic personality disorder

types of cluster C (fearful/anxious) personality disorders

Avoidant, dependent, obsessive-compulsive

Emotional dysregulation and impulsive and dramatic behaviors are common to all Cluster ___ personality disorders

B

The DSM-5 lists ten personality disorders, divided into three clusters

Cluster A, B, C

Cluster ______ personality disorders share the feature of anxiety or fear. *There is little overlap among the diagnostic criteria for these three disorders (Avoidant, Dependent, Obsessive-compulsive)

Cluster C

The neurological factors that contribute to schizophrenia have been found to contribute to schizotypal personality disorder:

Genes and prenatal environment and birth complications Abnormalities in brain structure (frontal and temporal lobes) Abnormalities in dopamine, serotonin, and glutamate function

Antisocial personality disorder specific temperament dimensions:

High reward dependence Low harm avoidance Low persistence

Generally thought of as a milder form of schizophrenia

schizotypal personality disorder

a set of emotional and interpersonal characteristics marked by a lack of empathy, an unmerited feeling of high self-worth, and a refusal to accept responsibility for one's actions: has a narrower focus than does antisocial personality disorder

Psychopathy

1. These patients violate rules or laws and may lie or act aggressively, hurting others 2. They may act impulsively, putting themselves or others in harm's way 3. They shirk their responsibilities 4. They exhibit a fundamental lack of guilt or regret, seemingly lacking a conscience or a sense of empathy 5. This is one of the most reliably diagnosed of the personality disorders as the diagnostic criteria are the most behaviorally specific and include overt criminal behaviors

antisocial personality disorder

A challenge of treatment is the patient's lack of motivation They are not disturbed by their behavior and have little if any motivation to change Usually the treatment is court-ordered Effectiveness depends on comorbidity, and whether the individual has the motivation to change

antisocial personality disorder

Neurological factors include: 1. Unusually small frontal lobes and unusually small hippocampi 2. Greater than normal amounts of white matter in the corpus callosum 3. The frontal and temporal lobes tend to show less activation than normal, especially during classical conditioning tasks, tasks that require inhibiting responses, and tasks that require processing emotional pictures and words 4. Dopaminergic and serotonergic abnormalities

antisocial personality disorder

Psychological factors include: Problems with classical and operant conditioning processes as these persons view others as "marks" and look for opportunities to exploit them

antisocial personality disorder

Social factors include: 1. The risk factor of a child relationship with his or her parents or primary caretakers 2. Children who are abused or neglected have a high risk of developing conduct disorder and antisocial personality disorder 3. Other factors include poverty, family instability, and adoptive parents' criminality

antisocial personality disorder

The term psychopath has been often used interchangeably with ________________; however the two terms are not exactly the same. more universal concept than antisocial personality disorder

antisocial personality disorder

Those who exhibit this pattern before age 18 and consistently violate the basic rights of others or violate societal norms, where such behavior is inappropriate to the individual's age are given the diagnosis of conduct disorder

antisocial personality disorder

characterized by a persistent disregard for the rights of others

antisocial personality disorder

manifests itself in childhood or adolescence, but the symptoms must have arisen by age 15, although the diagnosis cannot be made until 18 years old

antisocial personality disorder

1. Patients are characterized as shy, isolated, timid, or lonely 2. They have a predominant concern of embarrassing himself or herself during social interactions 3. They are hypervigilant for any indication of criticism or rejection 4. They behave in tense and fearful ways because of their social fears and anxieties 5. They report the lowest quality of life 6. Symptoms overlap with social phobia

avoidant personality disorder

marked by extreme social inhibition (i.e. extreme shyness) that usually stems from feeling inadequate and being overly sensitive to negative evaluation.

avoidant personality disorder

1. A key criterion is emotional dysregulation 2. idealization of the other person at the beginning of the relationship, spending a great deal of time with the person, revealing much, and creating intense intimacy are other prominent features 3. Extreme sensitivity to any hint of abandonment 4. May feel chronically empty, lonely, and isolated and engage in parasuicidal behaviors for relief from emotional numbness or a means of attention 5. More commonly diagnosed in women and may have comorbid depression

borderline personality disorder

characterized by volatile emotions, an unstable self-image, and impulsive behavior in relationships

borderline personality disorder

neurological facts: 1. Unusually small frontal lobes, hippocampus, and amygdala 2. Dysfunction of the anterior cingulate 3. More strongly activated amygdala 4. Difficulty performing tasks that require reliance on the frontal lobes 5. Low levels of serotonin, and serotonin receptors are not sensitive 6. The HPA axis is unusually responsive, resulting in excess amounts of cortisol 7. These various brain abnormalities are consistent with Linehan's theory that those with borderline personality disorder are likely to be neurologically vulnerable to emotional dysregulation.

borderline personality disorder

psychological features: 1. The key feature is dysregulation of emotion, of sense of self, of cognition, and of behavior 2. These behaviors may be inadvertently reinforced by family members' attention. 3. Substance use or abuse, binge eating, and parasuicidal behaviors are more directly self-destructive and may be reinforced by the temporary relief they may get.

borderline personality disorder

social factors: 1. Interpersonal dysregulation as relationships are typically intense, chaotic, and difficult 2. This interpersonal dysregulation may arise because of patients' emotional and cognitive dysregulation - once they feel dependent, they fear abandonment

borderline personality disorder

Personality disorders are characterized by odd or eccentric behaviors that have elements related to those of schizophrenia

cluster A

Personality disorders are characterized by emotional, dramatic, or erratic behaviors that involve problems with emotional regulation

cluster B

Personality disorders are characterized by anxious or fearful behaviors

cluster C

1. The DSM-5 treats personality disorders as categorically distinct from normal personality- Researchers view personality on a ____________ 2. The DSM criteria creates an ____________ on the continuum between normal and abnormal 3. The DSM clusters were organized by __________________-The specific personality disorders are not clearly distinct from one another 4. The process by which the criteria were determined is yet another criticism as well as the high comorbidity among the personality disorders

continua, arbitrary cutoff, superficial commonalities,

characterized by submissive and clingy behaviors, based on fear of separation

dependent personality disorder

The psychological treatment of choice for borderline personality disorder is _____________ developed by ___________

dialectical behavior therapy (DBT), Marsha Linehan

Odd/eccentric behaviors Odd speech

disorganized

cluster B personality disorders involve impulsive, dramatic, and erratic behaviors, which arise because of difficulty regulating their emotions *These patients also tend to have other Axis I disorders of substance-related disorders, mood disorders, anxiety disorders, or eating disorders

dramatic/erratic personality disorder

Patients may exhibit more subtle indications of the disorder: Seeking out novelty and excitement May have difficulty delaying gratification and become easily and excessively frustrated by life's challenges Patient's have poor insight into their symptoms *Patients desire attention while those with antisocial personality disorder seek power or material gain, and those with borderline personality disorder want nurturance.

histrionic personality disorder

There has been little formal research, but clinical observations have led to theories about the contributing factors: Patients are thought to believe themselves to be special, view other people as potential admirers, and are sensitive to negative evaluation. There is a sense of entitlement that drives the manipulative behavior.

histrionic personality disorder

characterized by attention-seeking behaviors and exaggerated and dramatic displays of emotion

histrionic personality disorder

No close friends because of a preference for being alone Constricted affect Social anxiety Paranoid ideation

interpersonal

As a group, people with personality disorders obtain ______ education and are more likely to have never married or to be separated or divorced About _____ who die by suicide are thought to have had a personality disorder Among those who attempt suicide, about ____ are thought to have a personality disorder

less, 30%, 40%

There has been little formal research, but the same clinical observations and theories of histrionic personality disorder also apply to _______________________ Both types of patients share a belief in themselves as special and impressive, view other people as potential admirers, and are sensitive to negative evaluation. However, those with __________________ have distinct biases in their views of themselves versus others, tend to hold maladaptive beliefs, and rely on maladaptive strategies.

narcissistic personality disorder

characterized by an inflated sense of importance, an excessive desire to be admired, and a lack of empathy They tend to overvalue themselves and undervalue people who disappoint them, and are relatively insensitive to others' feelings and points of view.

narcissistic personality disorder

treating _________________: CBT or psychodynamic therapy is used to help patients recognize and then modify their maladaptive beliefs and strategies.

narcissistic personality disorder

-It is associated with the least disability and the highest obtained educational level -Decision making is a painful, long process -They have rigid and inflexible thinking -They may become angry, irritable, or upset when they are unable to control a situation -Some workaholics may have this disorder -They have normally formal and serious relationships, preoccupied with logic and intellect, are overly conscientious, and are intolerant of emotional or illogical behavior in others

obsessive-compulsive personality disorder

Psychological factors have been identified, namely fear and anxiety underlie these disorders. Temperament high in the dimension of harm avoidance may be a contributor. Cognitive and behavioral factors are thought to contribute to all three personality disorders.

obsessive-compulsive personality disorder

Social factors include anxious or avoidant attachment style

obsessive-compulsive personality disorder

characterized by preoccupations with perfectionism, orderliness, and self-control as well as low levels of flexibility and efficiency.

obsessive-compulsive personality disorder

1. All patients in the _____________ personality cluster are suspicious about the motives and likely behaviors of other people, increasing the tendency to avoid others and isolate themselves 2. They also pay attention to, remember, and interpret stimuli in ways which reinforce their beliefs and isolation 3. Their odd behaviors may increase the likelihood of other people mistreating them

odd/eccentric

1. Cluster A personality disorders involve odd or eccentric behaviors and ways of thinking 2. These patients are likely to develop an Axis I disorder that involves psychosis, such as schizophrenia or delusional disorder 3. the 3 disorders in this cluster are considered to be on the less severe end of the schizophrenia-related disorders (paranoid, schizoid, schizotypal)

odd/eccentric personality disorder

The psychological factors include cognitive deficits such as: Problems with attention, memory, and executive function *Social interactions

odd/eccentric personality disorder

The social factors include: Physical abuse or neglect Insecure attachment to parents Discrimination

odd/eccentric personality disorder

1. These patients are better able to evaluate whether their suspicions are based on reality than are people with paranoid schizophrenia 2. The sources of their perceived threats are known individuals not strangers or bizarre signals 3. They cannot be easily persuaded that their paranoid beliefs do not reflect reality 4. They tend to be difficult to get along with because their suspiciousness leads them to be secretive, argumentative, or hold a grudge

paranoid personality disorder

characterized by persistent and pervasive mistrust and suspiciousness, accompanied by a bias to interpret other people's motives as hostile

paranoid personality disorder

types of odd/eccentric personality disorders

paranoid, schizoid, schizotypal

1. Clinicians may diagnose a patient with a personality disorder based both on what the patient says and on __________ in the way that he or she says it 2. Having patients complete personality inventories or ____________ aid in assessment 3. Obtaining ____________ information from family members also provides information for assessment of personality disorders 4. Clinicians should take into account the individual's ______________

patterns, questionnaires, collateral, culture, ethnicity, and social background

defines the enduring traits and characteristics that lead a person to behave in relatively predictable ways across a range of situations

personality

are a category of psychological disorders characterized by a pattern of inflexible and maladaptive thoughts, feelings, and behaviors that arise across a range of situations and lead to distress or dysfunction

personality disorders

Having conduct disorder in childhood is strongly associated with antisocial personality disorder in adulthood Although most men with antisocial personality disorder had serious conduct-related problems as children, most boys with conduct problems do not go on to develop antisocial personality disorder However, the more symptoms of conduct disorder a boy has, the more likely it is that he will develop antisocial personality disorder in young adulthood Another risk factor for conduct disorder progression to antisocial personality disorder is low SES

role of conduct disorder

1. Patients often lack social skills and may not pick up on or understand the normal social cues 2. They may react passively to adverse events 3. They appear to be emotionless and often don't express anger, even when provoked 4. They are not suspicious and are indifferent of other people 5. They function best when isolated from others, generally don't marry or express a desire for sexual intimacy

schizoid personality disorder

is characterized by a restricted range of emotions in social interactions and few - if any - close relationships

schizoid personality disorder

characterized by eccentric thoughts, perceptions, and behaviors, in addition to having very few close relationships

schizotypal personality disorder

the most thoroughly researched among the Cluster A personality disorders

schizotypal personality disorder

Children who develop schizotypal personality disorder are more likely to have experienced _____________________ than are those who went on to develop other personality disorders

trauma, abuse, and neglect

Medication is usually prescribed only for comorbid disorders such as depression or a substance-use disorder The psychosocial treatments vary depending on the setting: less violent in outpatient/violent in jails and prisons Psychopathy has a poor prognosis and the treatments are not likely to alter behavior or reduce symptoms- managing a violent patient, rather than treating the personality problem is the more realistic goal

treating antisocial personality disorder

1. This is among the most challenging of the personality disorders to treat because of the patient's parasuicidal or suicidal thoughts and behaviors. *It can also be challenging because of the patient's intense anger directed at the clinician. 2. Various medications may be used to treat the comorbid disorder or to target certain symptoms. -SSRIs to diminish emotional lability and anxiety -Antipsychotics -Mood stabilizers

treating borderline personality disorder

1. help patients recognize and then modify their maladaptive beliefs and strategies. 2. CBT or psychodynamic therapy is used to help patients increase their capacity to tolerate distress, develop more adaptive ways of responding to frustration, and recognize the negative impact their actions have on relationships.

treating histrionic personality disorder

Unfortunately, there has been very little research conducted to evaluate treatments for these personality disorders Most patients tend not to be interested in treatment and are often reluctant if urged or forced into it 1. Cognitive-behavioral therapy may be beneficial for increasing social skills and other adaptive skills 2. Lower doses of antipsychotic medications are used to treat schizotypal personality disorder

treating odd/eccentric personality disorders

Obsessive-compulsive personality disorder is distinguished from OCD by the absence of ______________________ *Those with obsessive-compulsive personality disorder are preoccupied with details and are inflexible.

true obsessions and compulsions