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40 Cards in this Set
- Front
- Back
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What are Personality Disorders?
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Personality: long standing patterns of thoughts, behaviors, and emotions
Disorders: characterized by the 4 D’s (deviance, distress, dysfunction, & danger) Personality disorders: long standing patterns of maladaptive thoughts, behaviors, and emotions |
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DSM Criteria for a PD
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Enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s culture, with at least two of the following areas affected
Cognition Affect Interpersonal functioning Impulse control -Pattern is inflexible and pervasive across a broad range of personal and social situations -Pattern is stable and long-lasting and its onset can be traced back to adolescence or early adulthood -Significant distress or impairment |
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DSM’s Cluster System
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Axis II disorders
3 clusters Cluster A: (odd-eccentric)- Paranoid Schizoid Schizotypal Cluster B: (dramatic-emotional)- Antisocial Borderline Histrionic Narcissistic Cluster C: (anxious)- Avoidant, Dependent, Obsessive compulsive |
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Paranoid PD Criteria
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A pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent, as indicated by four or more of the following: (next slide)
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Paranoid PD Criteria
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Suspects, without sufficient basis, that others are exploiting, harming, or deceiving him/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/her. |
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Paranoid PD Criteria
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persistently bears grudges
perceives attacks on his/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 Most similar to: schizophrenia, delusional disorder |
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Schizoid PD Criteria
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Pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings indicated by four or more of the following
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Schizoid PD Criteria
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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 Most similar to: schizophrenia, delusional disorder |
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Schizotypal PD Criteria
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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, as indicated by five or more of the following
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Schizotypal PD Criteria
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ideas of reference (excluding delusions of reference)
odd beliefs or magical thinking that influences behavior and is inconsistent with subcultural norms (e.g., superstitiousness, telepathy, or "sixth sense”) unusual perceptual experiences, including bodily illusions odd thinking and speech (e.g., vague, circumstantial, metaphorical, overelaborate, or stereotyped) |
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Schizotypal PD Criteria
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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 Most similar to: schizophrenia, delusional disorder |
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Antisocial PD Criteria
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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:
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Antisocial PD Criteria
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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 |
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Antisocial PD Criteria
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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 Most similar to: conduct disorder |
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Borderline PD Criteria
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A pervasive pattern of instability of interpersonal relationships, self-image, and affects, as indicated by five or more of the following:
frantic efforts to avoid real or imagined abandonment 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) |
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Borderline PD Criteria
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recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior
affective instability due to a marked reactivity of mood chronic feelings of emptiness inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, recurrent physical fights) transient, stress-related paranoid ideation or severe dissociative symptoms Most similar to: mood disorders |
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Histrionic PD Criteria
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A pervasive pattern of excessive emotionality and attention seeking, as indicated by five or more of the following:
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Histrionic PD Criteria
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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 |
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Histrionic PD Criteria
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has a style of speech that is excessively impressionistic and lacking in detail
shows self-dramatization, theatricality, and exaggerated expression of emotion is suggestible considers relationships to be more intimate than they actually are Most similar to: somatoform disorders, mood disorders |
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Narcissistic PD Criteria
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A pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy, as indicated by five or more of the following:
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Narcissistic PD Criteria
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has a grandiose sense of self-importance (e.g., expects to be recognized as superior without commensurate achievements)
is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love believes that s/he 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 |
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Narcissistic PD Criteria
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has a sense of entitlement
is interpersonally exploitative lacks empathy is often envious of others or believes that others are envious of him or her shows arrogant, haughty behaviors or attitudes Most similar to: cyclothymic disorder |
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Avoidant PD Criteria
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A pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation, as indicated by four or more of the following:
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Avoidant PD Criteria
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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 |
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Avoidant PD Criteria
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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 Most similar to: social anxiety disorder |
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Dependent PD Criteria
What are the components of DBT? |
A pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation, as indicated by five or more of the following:
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Dependent PD Criteria
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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. has difficulty initiating projects or doing things on his/her own (because of a lack of self-confidence in judgment or abilities rather than a lack of motivation or energy) |
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Dependent PD Criteria
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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 Most similar to: separation anxiety disorder, dysthymic disorder |
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Obsessive Compulsive PD Criteria
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A pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency, as indicated by four or more of the following:
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Obsessive Compulsive PD Criteria
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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/her own overly strict standards are not met) is excessively devoted to work and productivity to the exclusion of leisure activities and friendships is over conscientious, scrupulous, and inflexible about matters of morality, ethics, or values (not accounted for by cultural or religious identification) |
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Obsessive Compulsive PD Criteria
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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 shows rigidity and stubbornness Most similar to: obsessive compulsive disorder |
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Research on PDs
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There has been a surprisingly limited amount of research on PDs
Exception are borderline personality disorder (BPD) and antisocial personality disorder (ASPD) Major overhaul of PDs proposed for DSM-V Dimensional system Five types: Antisocial/Psychopathic, Avoidant, Borderline, Obsessive-Compulsive, and Schizotypal types Personality domains: Negative Emotionality, Introversion, Antagonism, Disinhibition, Compulsivity and Schizotypy |
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Antisocial Personality Disorder (ASPD)
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Do all criminals have ASPD?
Are there non-criminals who have ASPD? 1% of the population, mostly male Clinical bias? Mean girl bias: relational aggression Treatment not very successful |
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Borderline Personality Disorder (BPD)
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Statistics
Psychodynamic Perspective & Treatment CBT Perspective & Treatment Psychopharmacology |
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BPD Statistics
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1-2 % population
Female: male 3:1 75% attempt suicide, 10% die by suicide Accounts for 20% + of psych hospitalization |
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Psychodynamic Perspective
What are the psychodynamic behavioral perspectives of BPD? |
Objects relations theorists:
early lack of acceptance by parents leads to loss of self-esteem, increased dependence, & inability to cope with separation split defenses: self not fully integrated transference-focused psychotherapy |
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Behavioral Perspective
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Biosocial Theory
A disorder of emotion regulation Heightened sensitivity to emotion Increased emotional sensitivity Slow return to baseline invalidating social environment |
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Dialectical Behavioral Therapy (DBT)
What are the components of DBT? |
CBT approach
Four modules Mindfulness “what” skills: observe, describe , participate “how” skills: non-judgmentally, one-mindfully, effectively |
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DBT cont’
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Distress Tolerance
Ability to accept oneself and the current situation, no matter how difficult or painful e.g., distract, improve the moment, self-soothe, radically accept Emotion Regulation e.g., opposite action, problem solving, letting to Interpersonal Effectiveness e.g. giving something, getting something, keeping self-respect |
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Recovery & Remission
What is the long-‐term prognosis for borderline patients (hint: last slide)? |
Zanarini and colleagues (2010) followed 290 inpatients who received treatment for BPD over time
Remission: no longer meeting diagnostic criteria Recovery: remission + improvement in social and vocational functioning 50% maintained recovery after 10 years Recovery difficult to attain, but easier to maintain |
