Psych 303 - Exam III - Personality Disorders

What are the correlational factors with Avoidant Personality Disorder?

- "inhibited temperament" - modest genetic (social phobia) - Low E, high N - emotional abuse as child/not affectionate parents

What are the correlational factors of Obsessive-Compulsive Personality Disorder?

- 20% OCD has OCPD - 20 - 61 % of Anorexia - anxiety disorders - High E, Low A - modest genetic

When is the typical onset for a personality disorder? What is the prevalence rate of any personality disorder?

Onset typically occurs in late adolescence or early adulthood. Prevalence is around 10-12%

What are the three clusters of Personality Disorders? What characteristics mark each cluster?

- Cluster A (represented by odd or eccentric personalities) - Cluster B (dramatic, emotional, or erratic personalities) - Cluster C (fearful or anxious personalities)

What is Dialectical behavior therapy? (DBT)

- Created by linehan - Used for BPD - goal: encourage patients to accept this negative affect without engaging in self-destructive or other maladaptive behaviors

What are the correlational factors of Narcissistic Personality disorder?

- Low A (in general) - unwilling/unable to look into someone else's shoes

Why is treatment of personality disorders difficult?

- Most patients don't believe they have an issue - don't want to cooperate with any potential treatment - patterns are often rigid and long-lasting - causes are hard to pinpoint - little research has been done on many personality disorders

How might paranoid, schizoid, and schizotypal disorders be distinguished?

- Paranoid features both positive and negative symptoms - Schizoid is only negative symptoms, - Schizotypal is primarily positive symptoms (some negative ones)

What are some treatments for BPD?

- SSRIs for short-term relief - Second generation antipsychotics - DBT is most effective - transference-focused psychotherapy - mentalization

What are some challenges with diagnosing personality disorders?

- The criteria are vague - behaviors are heterogeneous - low reliability - overlap between disorders - stigma associated with diagnosis

What is mentalization?

- Used for BPD - goal: help patients develop skills to understand their own feelings/emotions and of others

What are the correlational factors of schizotypal personality disorder?

- attenuated form of SCZ - low E, high N - psychoticism three facets: (1) unusual beliefs/experiences, (2) eccentricity, (3) cognitive and perceptual dysregulation - first degree relatives of SCZ - stress - low SES - family adversity/abuse

What is Transference-Focused Psychotherapy?

- created by Kernberg, a variant of psychodynamic psychotherapy - used for BPD - goal: strengthening the weak egos of these individuals, with particular focus on primary primitive all or none defense mechanism ("splitting")

What are the correlational factors to Dependent Personality Disorder?

- high comorbidity to other personality disorders and to other MH - 30 - 60% genetic - authoritarian parenting - maladaptive schemas

What are some general sociocultural causal factors of personality disorders?

- less variance across cultures than w/i because W and non-western share same five basic personality traits - Narcissistic PD more common in Western, where personal success is encouraged - Histrionic less common in Asian, where sexual attention is frowned on - Histrionic: African A > White - BPD: Hispanic > African A > White - Schizotypcal: African A. > White - emotional dysregulation drastic increase since WWII

What is the correlational factors of Histrionic Personality Disorder?

- little research; many do not believe valid (one of four diagnosis recommended for removal in DSM-5) - high cormorbid with other personality disorders - some evidence for a genetic link with antisocial personality disorder - High E, high N - maladaptive schemas

What are the correlational factors of schizoid personality disorder?

- low O, low E - 55% heritable - maladaptive scheas

What are some neural correlates to Psychopathy?

- low PFC, amyg activity - low amyg volume - problems with fear and socialization

What are the correlational factors of Antisocial Personality Disorder?

- moderately genetic (but the component is unclear) - 45% - Low SES, inner city, poor supervision, young mother, single-parent family, parental conflict, neglect, harsh discipline - evidence of genotype-environment interaction - LOW MAOA activity (diathesis-stress) - substance abuse (sig. genetic) - developmental (oppositional defiant disorder by 6, conduct disoder by 9) - ADHD precursor + conduct disorder (30-50% of ADHD cases)

What are the correlational factors of PPD?

- modest genetic - low A, high N - parental neglect/abuse - TBI - cocaine users

What are some overall treatment suggestions for personality disorders?

- short term treatment - partial-hospialization programs - cognitive approaches - only for Cluster C - SSRIs, MAOIs - active and confrontational psychotherapy - antipsychotics

What are the two subtypes of Narcissistic personality disorder?

1) Grandiose - only associate with high status people (believe they are the only ones that will understand them) - Low A, Low N, High E - parental overvaluation 2) Vulnerable - unstable self-esteem, arrogance as a defense - Low A, High N, - sexual abuse, over-controlling/cold parents

Why are personality disorders hard to diagnose?

1) They reflect a continuum of normal problems of everyday life 2) few clear and distinguishing markers or symptoms 3) highly co-morbid with each other (85% qualify for 2+) 4) less empirical validity 5) few patients think they have an issue

What is the prevalence rate for BPD? Which gender is it more common in?

1.4%, equally likely in men and women

What are the dimensions of Psychopathy?

1a) interpersonal: superficial charm, grandiose self-worth 1b) affective: lack remorse/guilt, shallow 2a) lifestyle: easily bored, impulsivity 2b) antisocial: poor behavior controls inadequate conscience is core to ASPD

What are the key features of Obsessive-Compulsive Personality Disorder?

4 or more of the following: - Preoccupation with details/rules/lists/schedules - perfectionism that interferes with task completion - excessively devoted to work - overly conscientious and inflexible - rigid and stubborn - unable to discard worthless items - miserly - hoard money for future disasters - reluctant to delegate

What are the features of Avoidant Personality Disorder?

4 or more symptoms of either social inhibition or feelings of inadequacy: - avoidant of interpersonal relationships - seeks guarantee of unconditional acceptance - restrained in intimate relationships - anxious and fearful of rejection and criticism - inhibited with new people - sees self as inept or inferior - avoid risks or new things due to fear of embarrassment Note patients in this category typically desire interpersonal relationships; they are just too afraid to do so. (in contrast with schizoid) - 0.5 - 1%; W

What are the key features of Histrionic Personality Disorder?

5 or more of the following, relating to excessive emotionality or attention-seeking: - need to be center of attention - provocative behavior - rapidly shifting, shallow emotional expression - use of physical appearance to draw attention - impressionistic speech that lacks detail - exaggerated displays of emotion - highly suggestible - thinks relationships are more intimate or closer than they are Also, poor quality of relationships and somatic complaints are also common in HPD Note: Emotional displays are exaggerated, but thinking and emotional expression are shallow

What are the key features of Narcissistic Personality Disorder?

5 or more of the following, relating to excessive self-importance: - grandiose sense of self - preoccupation with power, beauty, success, etc - belief they are special and can only be understood by others like them - need for excessive admiration - sense of entitlement - interpersonally exploitative - lacks empathy - envious of others, or believes others are envious of them - arrogant behavior/attitudes - < 1 %, M > F

What are the key features of Dependent Personality Disorder

5 or more symptoms relating to dependence on other people: - difficulty making decisions without help from others - needs others to assume responsibility over their lives - difficulty expressing disagreement due to fear of losing support - lack of self-confidence - goes to excessive lengths to achieve support and nurturance from others - feels uncomfortable and helpless when alone - urgently seeks new relationship when one ends - preoccupied with fears of being alone - 2 %, M=F

What are the features of Schizoid Personality Disorder?

A persistent pattern of detachment from social relationships, marked by four or more of the following: - lack of desire for close relationships - preference for solitary activities - lack of interest in sexual activity - few friends - little pleasure in most activities - indifference to others - coldness, detachment, flattened affect They also display limited range of emotions in interpersonal situations, and may be on the autism spectrum - 1.2%; M > F

What are the key distinguishers between ASPD and psychopathy?

ASPD is a formal DSM-5 diagnosis that focuses on behavior. Psychopathy is construct that focuses more on psychological traits, and usually features aggressive narcissism and charm. Psychopaths may also not necessarily be criminals

What is a personality disorder?

An enduring pattern of inner experience, behavior, or disposition that is a deviation from cultural expectations, that is inflexible and maladaptive and causes distress and impairment in themselves and/or others

What are some correlational factors of BPD?

BPD tends to run families (suggesting some heritability), and early trauma or abuse may also play a role - most researched - AKA emotionaly unstable disorder in ICD-10... misunderstood and stigmatized - 10% dies of suicide - 75% have cognitive symptoms - 75% are women - comorbid with anxiety, mod, substance abuse, personality disorders - High N, Low A, Low C, High O - runs in families (4x) -40% - environmental - 55% - child maltreatment - reduced PFC regulation, increased Amyg

What is Conduct Disorder?

Disorder characterized by aggression to people and animals, destruction of property, theft, deceitfulness, and serious violations of rules. Typically diagnosed in late childhood or early adolescence

What is Oppositional Defiant Disorder?

Disorder characterized by being quick to anger, easily annoyed by others, arguing with authority figures, resistant to comply with requests, spitefulness, blames others for behavior. Typically most common in young children.

What are the key features of Borderline Personality Disorder?

Pattern of instability in interpersonal relationships, self-image and affect marked by 5 or more of the following: - frantic efforts to avoid abandonment - pattern of unstable relationships - unstable self-image - implusivity in areas that are potentially self-harmful - recurrent suicidal gestures, threats, or self-mutilation - problems with anger BPD is also highly comorbid with other disorders, and is the most common personality disorder in psychiatric settings - borderline SCZ - 1%

What are some potential "treatments" for ASPD?

Prevention and rehabilitation may be helpful, especially at earlier ages. However, incarceration is often the only viable alternative, and traditional therapies can actually make ASPD worse - CBT has greatest promise

What might be some potential causes for ASPD?

Problems within families (inconsistent discipline, histories of criminal behavior), under-arousal to cortisol (under arousal hypothesis), cortical immaturity, failure to respond to danger cues (fearlessness hypothesis)

What are the key features of schizotypal personality disorder?

Schizophrenia-like symptoms (on a spectrum) characterized by five or more of the following: - Cognitive/perceptual distortions - odd thinking or speech - suspicious/paranoid ideation - inappropriate or constrained affect - odd or eccentric behavior - lack of close friends - discomfort in close relationships due to suspicions 30-50% also have MDD - 3%; M > F

What are the key features of Antisocial Personality Disorder?

Three or more of the following: - Non-compliance with social norms - Deceitfulness - Impulsivity - Irritable - Disregard for their and others' safety - Consistent irresponsibility - Lack of remorse The person must also be 18+, and had a history of Conduct Disorder before age 15 - 2%; 3:1 M:F - mistakenly used interchangeably with psychopathy

What is the current research correlates on Personality Disorders?

little current prospective research infant's temperament temperament and personality moderately genetic Additionally... - learning - parental psychopathology - ineffective parenting - social stressors/changes - cultural values

What are the features of Paranoid Personality Disorder?

pervasive and unjustified mistrust and suspicion of others, characterized by four of the following: - suspicious about being deceived - doubts loyalty/worthiness of others - reluctance to confide, due to fear of betrayal - looks for hidden meanings in benign situations - hold grudges - angry counter-attacks to perceived slights - CBT does not work - 0.5 - 2.5%; M transient psychotic symptoms, at elevated liability for SCZ