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138 Cards in this Set

  • Front
  • Back
Personality disorders are defined by problems with what two areas?
forming a stably positive sense of self, and sustaining close and constructive relationships
In what three ways are the traits in a personality disorders different from normal traits?
they are extreme, inflexible, and maladaptive
The symptoms of personality disorders are characterised in what two ways?
they are pervasive and persistent
The presence of a personality disorder predicts what for many different conditions?
poorer treatment outcomes
How many personality disorders are in the DSM-IV-TR?
How many perosnality disorders are proposed for the DSM-5?
Which four perosnality disorders in the current DSM-IV-TR are being left out of the DSM-5?
paranoid, schizoid, histrionic, and dependant
Which six personality disorders are being maintained for the DSM-5?
Obsessive-compulsive, narcissistic, schizotypal, antisocial and borderline
What 5 concerns with the DSM-IV-TR prompted change in the DSM-5?
1. half of people who met criteria for one PD met criteria for another;
2. some current PD's are very rare in the community;
3. many people with seemingly serious perosnality problems don't fit any current PD diagnosis;
4. great deal of variability in the nature and severity among people with the same diagnosis;
5. the definition of PD suggests stability over time which is not the case
What are the three steps proposed for personality assessment in the DSM-5?
levels of personality functioning, personality disorder types, and personality trait domains and facets
How many trait domains and facet ratings are proposed for the third step of assessment of personality in DSM-5?
5 trait domains and 25 facet ratings
What are the two broad types of impairment assessment are in the first step of the personality assessment process in the DSM-5?
disturbance's in one's self or identity, and interpersonal disturbances
What two areas of self are assessed in the level of personality functioning in the DSM-5?
Identity and self-direction
What two areas of interpersonal functioning are assessed in the level of personality functioning in the DSM-5?
Empathy and intimacy
How many points of the likert scale for assessing the overall degree of impairment in the level of personality functioning in the DSM-5?
What degree of impairment in the levels of personaity functioning in the DSM-5 is required to move to stage two personality disorder type?
moderate level
What is assessed in stage two of the DSM-5 proposed personality assessment?
an evaluation of whether the porplems with impairment fit with one of the six DSM-5 PD types
What alternate diagnosis can be given in the DSM-5 when the impairment problems do not fit with on of the six DSM-5 PD types?
PD trait specifed
What three issues must the clinician consider before assigning a PD type?
1. is it unusual in the cultural context;
2. characteristics must be stable;
3. is the behaviour pervasive across aspects of the persons life
What are the five personality trait domains in the DSM-5?
negative affectivity, detachment, antagonism, disinhibition, and psychoticism
What are the 5 personality trait facets in the negative affectivity domain?
anxiousness, emotional labilitiy, hostility, perserveration, restricted activity, submissiveness
What are the 5 personality trait facets in the detachment domain?
anhedonia, depressivity, intimacy avoidance, suspiciousness, and withdrawal
What are the 5 personality trait facets in the antagonism domain?
attention seeking, callousness, deceitfulness, grandiosity, and manipulativeness
What are the 5 personality trait facets in the disinhibition domain?
distractibility, impulsivity, irresponsibility, and rigid perfectionism
What are the 5 personality trait facets in the psychoticism domain?
eccentricity, perceptual dyregulation, unusual belifs/experiences
What are the 4 criteria for a PD in DSM-5?
1. significant impairments in self and interpersonal functioning;
2. at least one pathological personality trait domain or facet;
3. personality impairments are persistent and pervasive;
4. personality impairments are not explained by developmental stage. sociocultural environment, substance abuse, another psychological condition, or a medical condition
What are the 8, of which 4 must be present, for the diagnosis of Obessive-compulsive PD in the DSM-IV-TR?
1. preoccupation with rules, details, and organisation to the extent that the point of the acitvity is lost;
2. extremem perfectionism interferes with task completion;
3. excessive devotion to work to the exclusion of leisure and friendships;
4. inflexibility about moral and values;
5. difficulty disregarding worthless items;
6. reluctance to delegate unless others conform to one's standards;
7. miserliness;
8. rigidity and stubborness
An intense need for order and control describes which PD?
Obsessive-compulsive PD
What traits and facets must be present to meet the DSM-5 criteria for obsessive-compulsive PD?
1. Disinhibition - characterised by rigid perfectionism;
2. Negative Affectivity - characterised by perserveration
What are the 9, of which 5 must be present, for the diagnosis of Narcissistic PD in the DSM-IV-TR?
1. grandiose view of one's importance;
2. preoccupation with one's success, brilliance, or beauty;
3. belief that one is speical and can be understood only by other high-status people; 4. extreme need for admiration;
5. strong sense of entitlement;
6. tendency to exploit others;
7. lack of empathy;
8. envious of others;
9. arrogant behaviour or attitudes
Grandiose view of their abilties and are preoccupied with fantasies of great success characterises which PD?
Narcissistic PD
What traits and facets must be present to meet the DSM-5 criteria for narcissistic PD?
Anatagonism - characterised by grandiosity and attention seeking
What are the 9, of which 5 must be present, for the diagnosis of Schizotypal PD in the DSM-IV-TR?
1. ideas of reference;
2. peculiar beliefs or magical thinking;
3. unusual perceptions;
4. peculiar patterns of thought and speech;
5. suspiciousness or paranoia;
6. innapropriate or restricted affect;
7. odd or eccentric behaviour or appearance; 8. lack of close friends;
9. anxiety around other people, which does not diminish with familiarity
Unusual and eccentric thoughts and behaviour, interpersonal detachment and suspisciousness describe which PD?
schizotypal PD
What traits and facets must be present to meet the DSM-5 criteria for schizotypal PD?
1. psychoticism - characterised by eccentricity, cognitive and perceptual dysregulation, and unusual beliefs and experiences;
2. detachment - characterised by restricted affectivity and withdrawal;
3. negative affectivity - characterised by suspiciousness
What are the 7, of which 4 must be present, for the diagnosis of Avoidant PD in the DSM-IV-TR?
1. avoidance of occupational activities that involve significant interpersonal contact, because of fears of criticism or disapproval;
2. unwilling to get involved with people unless certain of being liked;
3. restrained in intimate relationships because of fear of being shamed or ridiculed;
4. preoccupation with being criticised or rejected;
5. inhibited in new interpersonal situations because of feelings of inadequacy;
6. views self as socially inept or inferior;
7. unusually reluctant to try new activites because they may prove embarrassing
Being so fearful of criticism, rejection, and disapproval that they will avoid jobs or relationships to protect themselves from negative feedback describes which PD?
Avoidant PD
What traits and facets must be present to meet the DSM-5 criteria for avoidant PD?
1. Detachment - characterised by withdrawal, intimacy avoidance, and anhedonia;

2. Negative affectivity - characterised by anxiousness
Along with 2 other criteria what are the 7, of which 3 must be present, for the diagnosis of Antisocial PD in the DSM-IV-TR?
1. Repeated lawbreaking;
2. Deceitfulness, lying;
3. Impulsivity;
4. Irritability and agressiveness;
5. Reckless disregard for own safety and that of others;
6. Irresponsibility as seen in unreliable employment or financial history;
7. Lack of remorse
Which PD involves a pervasive pattern of disregard for the rights of others?
Antisocial PD
Which other term is often used interchangeably with antisocial PD?
What is the key characteristic of psychopathy?
poverty of both negative and positive emotions
What are the three criteria for antisocial PD in the DSM-IV-TR?
1. Age 18 or over;
2. Evidence of conduct disorder before age 18;
3. Pervasive pattern of disregard for the rights of other since age 15 as shown by at least 3 of the 7 listed criteria.
What traits and facets must be present to meet the DSM-5 criteria for Antisocial PD?
1. Antagonism - characterised by manipulativeness, deceitfulness, callousness, and hostility;

2. Disinhibition - characterised by irresponsibility, impulsivity, and risk taking
What are the 8, of which 5 must be present, for the diagnosis of Borderline PD in the DSM-IV-TR?
1. frantic efforts to avoid abandonment;
2. unstable interpersonal relationships in which otehrs are either idealised or devalued;
3. unstable sense of self;
4. self-damaging, impulsive behaviours in at least two areas, such as spending, sex, substance abuse, reckless driving, being eating;
5. recurrent suicidal behaviour, gestures, or self injurious behaviour;
6. recurrent bouts of intense or poorly controlled abger;
7. during stress, a tendancy to experience transient paranoid thoughts and dissociative symptoms.
Impulsivity and instability in relationships and mood describes which PD?
Borderline PD
What traits and facets must be present to meet the DSM-5 criteria for borderline PD?
1. Negative affectivity - characterised by emotional lability, anxiousness, seperation insecurity, and depressivity;

2. Disinhibition - characterised by impulsivity and risk taking; 3. Antagonism - characterised by hostility
Prevalence of Obessive-compulsive PD in clinical and general population
8.7% in clinical and 1.9% in general
Is Obsessive-Compulsive PD more common in men or woman?
Obsessive-Compulsive PD is most commonly comorbid with which other PD?
Avoidant PD
Rigidity and controlling behaviours are features of which PD?
Obsessive-compulsive PD
What are three features in the aetiology of Obsessive-compulsive PD?
1. Genetic predisposition;
2. Parental reinforcement of conformity/neatness;
3. Fear of loss of control
What are three methods for treating Obsessive-compulsive PD?
1. Directed at fear of inadequacy;
2. Redirect compulsive thoughts;
3. Relaxation. Distraction.reality testing
Prevalence of Narcissistic PD in clinical and general population
2.3% in clincial and >1% in general
Is Narcissistic PD more common in men or woman?
Narcissistic PD is most commonly comorbid with which other PD?
Borderline PD
What is the primary goal of people with narcissistic disorder to interact with others?
to bolster their own self esteem
What do people with narcissistic PD show that helps maintain their grandiose beliefs?
cognitive bias
Failure of parents to model what is implicated in the aetiology of narcissistic PD?
The self-psychology model suggests that narcisstic PD masks what?
a fragile self-esteem
What two parenting dimensions increase the risk of narcissistic PD in the self-psychology model?
emotional coldness and an overemphasis on the child's achievements
The social cognitive model of narcissistic PD is built around what two basic ideas?
1. people with this disorder have a fragile self esteem and;
2. interpersonal interactions are important to them for bolstering self-esteem, rather than for gaining closeness or warmth
For a person with Narcissistic PD it is more important for them to be admired or to achieve competitive succes than it is to be what?
close to others
Why is treatment of narcissistic PD difficult?
because they are hypersensitive to evaluation
What is the goal for treatment of narcissistic PD?
focus on others
What is used to help a person with narcissistic PD accept criticism?
development of coping strategies
Prevalence of Schizotypal PD in clinical and general population
0.6% in clinical and 0.6% in general
Is Schizotypal PD more common in men or woman?
Why is it common for people diagnosed with schizotypal PD likely to be comorbid with Avoidant PD?
because both involve interpersonal attachment
What is the heritability of schizotypal PD?
A small proportion of people with schizotypal PD develop what other disorder?
What don't Schizotypal PD people have that people with schizophrenia have?
hallucinations and delusions, psychosis as they can reality test, and they feel others rather than see them
What percentage of people with schizotypal PD have comorbid MDD?
30 to 50%
What neurobiological features are found in people with schizotypal PD are also found in people with schizophrenia?
enlarged ventricles and reduced temporal lobe grey matter
A combination of what three methods are used for treating schizotypal PD?
a combination of antipsychotic medication, community treatment, and social skills training
Prevalence of Avoidant PD in clinical and general population
14.7% in clinical and 1.2% in general
Is Avoidant PD more common in men or woman?
Avoidant PD is commonly comorbid with which other PD's and at what rate?
80% have comorbid borderline or schizotypal PD
Avoidant PD commonly co-occurs with which other Axis 1 disorder?
social anxiety disorder
The heritability of Avoidant PD is?
Compared to schizoid PD, why are people with avoidant PD asocial?
because of interpersonal anxiety not because they are apathetic or disinterested in relationships
What are 5 treatment options for Avoidant PD?
1. Behavioural interventions aimed at building social skills and reducing anxiety;
2. Exposure therapy;
3. Role Paly;
4. Modeling;
5. Cogntive therapy
What is the prevalence of Antisocial PD in males vs females?
3% in males and 1% in females
What two factors or highly correlated with the prevalence of antisocial PD?
low SES and urban living
What percentage of people with antisocial PD have a comorbid disorder?
What is the most common comorbid disorder for people with antisocial PD?
substance abuse
What is the PCL-R?
Psychopathy Check List - Revised
Who was the author of the Mask of Sanity and what is it about?
Harvey Cleckley - psychopathy
Superficial charm is asscoaited with what type of Personality trait?
What three forms of evidence are collected to complete the PCL-R?
interviews, criminal records and social work reports
Does the diagnosis of psychopathy require the onset of symptoms before age 15?
What three facets of the family environment predict anti social behaviour?
high negativity, low warmth, and prenatal inconsistency
People with psychopathy have deficits in what repsonse?
fear response
Why might there be deficits in fthe fear response in people with psychopathy?
because they have low autonomic arousal demonstrated by lower skin conductance and cortisol levels
People with psychopathy may be unresponsive to threats when they are pursuing what?
What technique seems to increase the liklihood of people with pychopathy to reflect on negative feedback and behave less impulsively?
pausing before responding to stimuli
A lack of response to threats is known as what?
What are the two issues involved with treating people with antisocial PD?
rarely identify with needing treatment and can be manipulative with therapist
What is the most common treatment strategy for children at high risk of antisocial PD?
parenting training using antisocial and prosocial behaviours
What are the three risks for ceasing treatment for antisocial PD?
high degree of family dysfunction/stress, low SES, and parental history of AD, CD as a child
What percent of people with borderline PD commit suicide?
What proportion of people with borderline PD self harm?
When does borderline PD tend to improve?
30' s and 40's
Prevalence of Borderline PD in clinical and general population
9.3% in clinical and 2.7% gernal
What percentage of people with borderline PD are female?
What five disorders is BPD mostly comorbid with?
PTSD, MDD, bipolar, bulimia, and substance use
Which other disorder is BPD most comorbid with?
substance abuse
Heritability of BPD?
People with BPD show increased activation of which brain structure?
Which system is implicated in BPD?
serotonergic system
People with BPD show decreased activation and structural changes in which brain structure?
prefrontal cortex, specifically anterior cingulate cortex
The connectivity between which two brain structures seems disrupted in people with BPD?
the prefrontal cortex and the amygdala
People with BPD are much likely to report what events in the childhood?
parental separation, verbal abuse, and emotional abuse
Who developed the diathesis-stress theory for BPD?
The object relations theory of BPD aetiology asserts that inconsistent childhood experiences causes what?
splitting - extreme dichotmous views
What are the two main factors of the diathesis-stress theory for BPD?
emotional dysregulation and invalidation
Explain the cycle that occurs in the diathesis-stress theory of BPD development?
the child has emotion dysregulation and demands from other, this elicits and invalidating repsonse from parents such as punishment causing the child to supress the emotions which leads to an emotional outburst due to inability to regulate emotions
What is the main challenge of treating people with BPD?
the therapist finds it challenging to develop and maintain the therapeutic relationship
Antidepressents are used to treat what symptoms in people with BPD?
aggressiveness and depression
What are the three main psychological treatments for BPD?
dialectical behavior therapy, mentalisation-based therapy, and schema-focused cognitive therapy
What is aim of DBT for BPD?
to stop the black and white thinking
DBT stands for what?
Dialectical Behaviour Therapy
How does DBT work?
by combining client-centred empathy and acceptance with cogntive behavioral problem solving, emotion regulation techniques, and social skills training
What are the four stages of DBT?
Stage 1 - promote greater control of impulsive behaviours;
Stage 2 - learn to modulate extremem emotionality;
Stage 3 - improving relationships and self-esteem;
Stage 4 - promote connectedness and ahppiness
What is mentalisation?
thinking about their own and other's feelings
Why might people with BPD fail to engage in mentalisation?
because early insecurity in relationships, coupled with intense trauma, leads the person to defensively avoid thinking about feelings and relationships
What is the goal of the therapist in Menatlisation-based therapy for BPD?
to foster a more active, thoughtful apporach to relationships and feelings
What is the main aim of schema-focused therapy for people with BPD?
work with the person identify maladaptive schemas and increase the use of healthy schemas
A pervasive distrust and suspiciousness of others describes which PD?
Paranoid PD
A pervasive pattern of detachment form social relationship and a restricted range of expressions of emotions in interpersonal settting describes which PD?
A pervasive pattern of excessive emotionality and attention seeking describes which PD?
Histrionic PD
A pervasive and excessive need to be taken care of that leads to a submissive and clinging behaviour and fears of separation described which PD?
Dependent PD
When are personality disorders thought to begin?
in childhood
When did personality disorders begin to receive attention in the research?
What is the particular problem with diagnosis of personality disorders?
What are the three most prevalent PD's
avoidant, obsessive-compulsive and antisocial
What are the least prevalent PD's?
schizotypal, narcissistic, and borderline
The overal prevalence of PD's in the clincial and general populations
0.5 to 2.5% in general pop and 10% to 30% in clinical pop