Personality Disorders - Book Notes

Front 1

Personality disorder

Back 1

inflexible and maladaptive patterns of personality that begin by early adulthood and result in either social or occupational problems or distress to the individual

Front 2

dsm overall personality disorder criteria

Back 2

A. An enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual's culture, as evident in 2 or more of the following domains:
1. cognition (ways of thinking about the self and others)
2. emotional responses
3. interpersonal functioning
4. impulse control
B. Maladaptive pattern much also be inflexible and pervasive across a broad range of personal and social situations
C. Clinically significant
D. Stable, long duration that can be traced back to adolescence or childhood

Front 3

why personality disorders are important

Back 3

1. they are associated with significant social and occupational impairment
2. the presence of pathological traits during adolescence is associated with an increased risk for the subsequent development of other mental disorders
3. in some cases, personality disorders are the beginning stages of more serious psychopathology
4. a comorbid personality disorder can interfere with the treatment of a disorder, such as depression

Front 4

personality disorders + symptoms

Back 4

1. social motivation
2. cognitive perspectives regarding self and others
3. temperament and personality traits
4. context and personality

Front 5

symptoms + social motivation

Back 5

problems in
1. affiliation - the desire for close relationships with others (usually absence of affiliation)
2. power - the desire for impact, prestige, or dominance (usually exaggerated need for power)

Front 6

symptoms + cognitive perspectives regarding self and others

Back 6

personality disorders are associated with distortions of the mental processes that determine our knowledge of ourselves and our world
- unstable self image
- extreme grandiosity
- misperception of the intentions and motives of others
- social distance - becoming too intimate or maintaining too much distance from others
- inability to empathize with others

Front 7

symptoms + temperament and personality traits

Back 7

temperament is a person's most basic, characteristic style of relating to the world, esp those styles that are evident during the first year of life. personality disorders are maladaptive variations of regular traits, such as high levels of anger-hostility, impulsiveness, and excitement seeking and low levels of trust, compliance, and tendermindedness.

Front 8

symptoms + context and personality

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not evident in all situations and qualification involves the consequences of exhibiting a particular trait.

Front 9

Cluster A personality disorders

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the behavior of people in this cluster is typically odd, eccentric, or asocial
includes paranoid, schizoid, and schizotypal personality disorders.

Front 10

paranoid personality disorder

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An enduring pattern of thinking and behavior characterized by a pervasive tendency to be inappropriately suspicious of other people's motives and behaviors. People who fit the description for this disorder expect that other people are trying to harm them, and they take extraordinary precautions to avoid being exploited or injured
- trouble maintaining relationships with friends and family
- often overreact aggressively
- the suspicions of people with paranoid personality disorder do not reach delusional proportions - they are not delusional

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schizoid personality disorder

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An enduring pattern of thinking and behavior characterized by pervasive indifference to other people, coupled with a diminished range of emotional experience and expression. People who fit this description prefer social isolation to interactions with friends or family
- seen as being cold an aloof, but they say they do not experience any strong emotions, such as anger, sadness, or happiness

Front 12

schizotypal personality disorder

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An enduring pattern of discomfort with other people coupled with peculiar thinking and behavior. The latter symptoms take the form of perceptual and cognitive disturbances. Considered by some experts to be part of the schizophrenic spectrum
- not emotional restriction (schizoid) or social withdrawal (paranoid)
- may report bizarre fantasies and have hard to follow speech
- not psychotic or out of touch with reality

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Cluster B personality disorders

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the behavior of people in this cluster is dramatic, emotional, and erratic, associated with marked difficulty in sustaining interpersonal relationships
includes antisocial, borderline, histrionic, and narcissistic personality disorders

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antisocial personality disorder

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A pervasive and persistent disregard for, and frequent violation of, the rights of other people. In the DSM IV, it is defined in terms of a persistent pattern of irresponsible and antisocial behavior that begins during childhood/adolescence
- in adulthood, a failure to fulfill occupational/ family responsibilities
- conflict with others is common

Front 15

borderline personality disorder

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An enduring pattern of thinking and behavior whose essential feature is a pervasive instability in mood, self-image, and interpersonal relationships. Manifestations of this disorder include frantic efforts to avoid real or imagined abandonment. People who fit this description frequently hold opinions of significant others that vacillate between unrealistically positive and negative extremes.
- people who find it hard to be alone and instead form intense, unstable relationships with others and are manipulative
- identity disturbance - hard to maintain a self-image of their positive and negative personality traits
- uncertain about personal values
- in men

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histrionic personality disorder

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An enduring pattern of thinking and behavior that is characterized by excessive emotionality and attention-seeking behavior. People with this disorder are self-centered, vain, and demanding. Their emotions then to be shallow and may vacillate erratically.
- people who love being the center of attention
- when interacting with other people, their behavior is seductive or provocative
- intact sense of self
- in women

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narcissistic personality disorder

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An enduring pattern of thinking and behavior that is characterized by pervasive grandiosity. Narcissistic people are preoccupied with their own achievements and abilities.
- grandiosity, need for admiration, and inability to empathize with other people

Front 18

Cluster C personality disorders

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Marked anxiety or fearfulness
includes avoid ant, dependent, and obsessive-compulsive personality disorders

Front 19

avoidant personality disorder

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An enduring pattern of thinking and behavior that is characterized by pervasive social discomfort, fear of negative evaluation, and timidity. People with this disorder tend to be socially isolated outside of family circles. They want to be liked by others, but they are easily hurt by even minimal signs of disapproval from other people
- want to be liked by others but are extremely shy
- often indistinguishable from social phobia but maybe people with APD are more socially withdrawn. people with SP may have a lot of friends but they don't want to perform in front of them

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dependent personality disorder

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An enduring pattern of dependent and submissive behavior. These people are exceedingly dependent on other people for advice and reassurance. Often unable to make everything decisions on their own, they feel anxious and helpless when they are alone
- easily hurt by criticism and lack self confidence
- unlike avoidant (who have trouble initiating a relationship) because they have trouble separating from relationships

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obsessive-compulsive personality disorder

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An enduring pattern of thinking and behavior that is characterized by perfectionism and inflexibility. These people are preoccupied with rules and efficient. They are excessively conscientious, moralistic, and judgmental.
- people set really high standards for themselves
- need for control and intolerance for uncertainty

Front 22

prevalence of personality disorders

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- lifetime prevalence for all personality disorders: 10%
- highest rates for obsessive-compulsive personality disorder, antisocial personality disorder, and avoidant personality disorder: 3-4%
- antisocial personality disorder: 3%
- other types: 1-2%
- narcissistic personality disorder: < 1%
- 50% of people who meet criteria for one personality disorder also meet criteria for another axis 2 disorder
- 75% of people with personality disorders also meet criteria for axis 1 disorder

Front 23

prevalence of personality disorders + gender differences

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- relative equal in men and women overall
- antisocial personality disorder is 5% men and 2% women
- borderline and dependent more common among women
- obsessive-compulsive more common among men

Front 24

schizotypal personality disorder + dsm criteria

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A. 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, indicated by 5 or more of the following
1. ideas of reference
2. odd beliefs or magical thinking that influences behavior
3. unusual perceptual experiences, including bodily illusions
4. odd thinking and speech
5. suspiciousness or paranoid ideation
6. inappropriate or constricted affect
7. behavior of appearance that is odd, eccentric, or peculiar
8. lack of close friends or confidants, other than family
9. excessive social anxiety that does not go away with familiarity and tends to be associated with paranoid fears rather than negative judgments about self

Front 25

schizotypal personality disorder + causes

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first degree relatives of patients with schizophrenia are very likely to have schizotypal personality disorder, so it seems that it is genetically related

Front 26

schizotypal personality disorder + treatment

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- ego syntonic, so many people do not seek treatment; a lot of people drop out before treatment is done; usually, people who show up to hospitals show up because of another disorder, like alcohol dependence or depression, not the personality disorder
- treatment using antipsychotics or SSRIs is suggested as well as supportive, educational treatment that aims at getting them better social skills

Front 27

borderline personality disorder + dsm criteria

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A pervasive patter 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 5 or more of the following:
1. frantic efforts to avoid real or imagined abandonment
2. a pattern of unstable and intense interpersonal relationships characterized by alternative between extremes of ideation and devaluation
3. identity disturbance; unstable self-image
4. impulsiveness in at least 2 areas that are self-damaging
5. recurrent suicidal or self-mutilating behavior
6. affective instability due to a marked reactivity of mood
7. chronic feelings or emptiness
8. inappropriate, intense anger
9. transient, stress-related paranoid ideation or severe dissociative symptoms

Front 28

Kernberg's explanation of borderline personality disorder

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- faulty development of ego-structure
- splitting: the tendency to see people and events as entirely good or entirely bad

Front 29

borderline personality disorder + causes

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- genetic factors
- borderline patients suffer from the negative consequences of parental loss, neglect, and mistreatment during childhood
- people with documented evidence of childhood abuse and neglect were 4 x more likely to develop symptoms of a personality disorder

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borderline personality disorder + treatment

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- dialectical behavior therapy (BDT) - the therapist employs strategies that help the patient appreciate and balance apparently contradictory needs to accept things as they are and to work toward changing patterns of thinking and behavior that contribute to problems in the regulation of emotions. learning to be comfortable with strong emotions

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antisocial personality disorder + dsm criteria

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A. a pervasive pattern of disregard for and violation of the rights of others, occurring since age 15, as indicated by 3 or more of the following:
1. failure to conform to social norms; breaking the law
2. deceitfulness - lying, conning
3. impulsivity or failure to plan ahead
4. irritability/aggressiveness - repeated fights/assults
5. recklessness or disregard for safety of self and others
6. consistent irresponsibility
7. lack of remise
B. 18 years old
C. onset of disorder before age 15

Front 32

more antisocial personality disorder

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- psychopath: someone who is intelligent and superficially charming but also chronically deceitful, unreliable, and incapable of learning from experience
- failure to conform to social norms and respect the law

Front 33

antisocial personality disorder + causes

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1. biological factors - highest rates of conduct disorder and antisocial behavior are found among the offspring of antisocial biological parents who are raised in an adverse adoptive environment
2. social factors - physical abuse and childhood neglect; antisocial/difficult during childhood, so the parent has to deal harshly, the child doesn't learn appropriate social skills, and it escalates.
3. psychological factors - emotionally impoverished, psychopaths do not show an exaggerated startle response like normal people; difficulty shifting attention to consider negative consequences

Front 34

antisocial personality disorder + treatment

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- usually forced into treatment by the legal system
- when treatment is used, it is seldom effective