Chapter 11 (Personality Disorders)
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Questions and Answers

What is a key characteristic of personality disorders compared to many Axis I disorders?

  • They are easier to diagnose.
  • They are more often treated.
  • They are typically less incapacitating. (correct)
  • They are always ego dystonic.

Which of the following traits is NOT part of the five factor model of personality?

  • Aggressiveness (correct)
  • Agreeableness
  • Extroversion
  • Neuroticism

How are traits distinguished from disorders in personality psychology?

  • Disorders are less stable over time.
  • Traits are exclusive to the clinical population.
  • Disorders are more prevalent in the general population.
  • Traits exist in the general population. (correct)

What does it mean that many personality disorders are described as 'ego syntonic'?

<p>The individual perceives their behaviors as consistent with their self-image. (B)</p> Signup and view all the answers

Which factor is often assumed to be continuous rather than categorical in understanding personality disorders?

<p>Disordered traits. (A)</p> Signup and view all the answers

What is primarily studied in the research on personality disorders?

<p>Prevalence rates among clinical populations. (A)</p> Signup and view all the answers

What is a notable feature of personality disorders regarding their treatment?

<p>They are less often treated than Axis I disorders. (C)</p> Signup and view all the answers

What does personality refer to in psychological terms?

<p>A consistent pattern of thinking, feeling, and behaving. (A)</p> Signup and view all the answers

What is an example of a trait that is advantageous in small doses?

<p>Conscientiousness (D)</p> Signup and view all the answers

Which of the following describes a consequence of having too much trust?

<p>Gullibility (A)</p> Signup and view all the answers

Which feature differentiates disordered personality from normal-range problematic behavior?

<p>Self-defeating behavior patterns (B)</p> Signup and view all the answers

According to the DSM-5-TR, which factor is NOT a characteristic of personality disorder?

<p>Temporary behavior changes (C)</p> Signup and view all the answers

What does functional inflexibility imply in the context of personality disorders?

<p>Rigid and consistent behavioral patterns (C)</p> Signup and view all the answers

What is a core feature that suggests instability in personality disorders?

<p>Marked instability in mood, thinking, and behavior (A)</p> Signup and view all the answers

Which aspect of personality disorders does the DSM-5-TR highlight as leading to distress or impairment?

<p>Inflexible behavior patterns (A)</p> Signup and view all the answers

What does a pattern of behavior that deviates markedly from cultural expectations imply in personality disorders?

<p>Behavior causes social rejection or conflict (C)</p> Signup and view all the answers

What is the primary difference between the dimensional and categorical approaches to personality disorders?

<p>Dimensional approaches consider personality characteristics as existing on a continuum. (C)</p> Signup and view all the answers

Which of the following does NOT describe a characteristic of the DSM's categorical system?

<p>Fosters flexibility (C)</p> Signup and view all the answers

What are the five domains in the alternative DSM-5 personality disorder system?

<p>Disinhibition, Negative affectivity, Detachment, Antagonism, Psychoticism (D)</p> Signup and view all the answers

Which of the following personality disorders was eliminated in the reduced list of six in the alternative DSM-5 PD system?

<p>Histrionic (A)</p> Signup and view all the answers

In young's schema therapy model, what is emphasized as influencing personality traits?

<p>Core beliefs about the self and others (C)</p> Signup and view all the answers

What is a primary critique of the categorical model of disorders in DSM?

<p>It can result in loss of individual information. (B)</p> Signup and view all the answers

How does Beck's cognitive model differ in its focus compared to a dimensional approach?

<p>It focuses on dysfunctional core beliefs affecting perceptions. (C)</p> Signup and view all the answers

The dimensional-categorical hybrid model in the DSM-5 aims to combine which two approaches?

<p>Dimensional and categorical (A)</p> Signup and view all the answers

Which Cluster B personality disorder is characterized by impulsivity and a fear of abandonment?

<p>Borderline Personality Disorder (A)</p> Signup and view all the answers

What is a common characteristic of Cluster C personality disorders?

<p>Anxious and fearful traits (A)</p> Signup and view all the answers

Which personality disorder includes symptoms such as magical thinking and social isolation?

<p>Schizotypal Personality Disorder (B)</p> Signup and view all the answers

Which of the following traits is NOT typically associated with Antisocial Personality Disorder?

<p>Empathy (D)</p> Signup and view all the answers

Which Cluster A personality disorder is often characterized by a pervasive mistrust and suspiciousness of others?

<p>Paranoid Personality Disorder (A)</p> Signup and view all the answers

What is a characteristic feature of Histrionic Personality Disorder?

<p>Heightened emotional expression (A)</p> Signup and view all the answers

Which disorder is associated with significant comorbidity with eating disorders such as bulimia nervosa?

<p>Borderline Personality Disorder (B)</p> Signup and view all the answers

What is NOT a symptom of Schizoid Personality Disorder?

<p>Enjoyment of close relationships (C)</p> Signup and view all the answers

What defines the clinical description of Avoidant Personality Disorder?

<p>Need for excessive reassurance (A)</p> Signup and view all the answers

Which personality disorder is characterized by an unreasonable sense of self-importance and a sensitivity to criticism?

<p>Narcissistic Personality Disorder (A)</p> Signup and view all the answers

Which of the following is NOT categorized as a Cluster A personality disorder?

<p>Antisocial Personality Disorder (A)</p> Signup and view all the answers

Which personality disorder is characterized by a focus on orderliness and perfectionism?

<p>Obsessive-Compulsive Personality Disorder (D)</p> Signup and view all the answers

What is a common misconception about personality disorders?

<p>They are static and do not change over time. (B)</p> Signup and view all the answers

What is the primary focus of schema therapy?

<p>Educating individuals about their schemas and modifying them (C)</p> Signup and view all the answers

What does Dialectical Behaviour Therapy (DBT) primarily address?

<p>Emotional regulation in borderline personality disorder (B)</p> Signup and view all the answers

Which therapy links cognitive psychology with object relations approach?

<p>Cognitive Analytic Therapy (A)</p> Signup and view all the answers

What is mentalisation in the context of mentalisation-based treatment?

<p>The capacity to think about one's mental states and those of others (C)</p> Signup and view all the answers

What possibly complicates treatment for cluster A personality disorders?

<p>Intimacy and trust issues (D)</p> Signup and view all the answers

What is the predominant interaction that leads to the development of antisocial personality disorder?

<p>Genetic vulnerability combined with adverse environmental conditions (C)</p> Signup and view all the answers

Which treatment has shown effectiveness in both individual and group settings for borderline personality disorder?

<p>Dialectical Behaviour Therapy (B)</p> Signup and view all the answers

What is a primary challenge when treating personality disorders?

<p>Intimacy and trust issues (B)</p> Signup and view all the answers

Which best describes reciprocal role procedures in Cognitive Analytic Therapy?

<p>Complimentary dynamics in relationships (A)</p> Signup and view all the answers

What is the main goal of therapy focused on early maladaptive schemas?

<p>Modifying underlying beliefs about oneself and the world (D)</p> Signup and view all the answers

What is typically considered the first-line treatment for borderline personality disorder?

<p>Psychological intervention (B)</p> Signup and view all the answers

Which psychosocial factor is strongly associated with the development of borderline personality disorder?

<p>Childhood trauma (B)</p> Signup and view all the answers

Individuals with narcissistic personality disorder are unlikely to seek treatment unless they are experiencing what?

<p>Distress related to other difficulties (A)</p> Signup and view all the answers

The treatment for histrionic personality disorder has been hampered by what issue?

<p>Lack of empirical findings (D)</p> Signup and view all the answers

What is a common early development experience associated with avoidant personality disorder?

<p>Early rejection experiences (C)</p> Signup and view all the answers

Which treatment method has shown promising results for individuals with dependent personality disorder?

<p>Schema therapy and DBT (B)</p> Signup and view all the answers

What is one of the biological influences likely contributing to borderline personality disorder?

<p>Genetic contributions (A)</p> Signup and view all the answers

Cognitive behavioral interventions are supported for which personality disorder treatment?

<p>Obsessive-compulsive personality disorder (B)</p> Signup and view all the answers

What type of interactions are emphasized in the models explaining the aetiology of histrionic personality disorder?

<p>Inconsistent and intense (D)</p> Signup and view all the answers

Impulsive and aggressive behaviors in certain disorders can be managed using which medications?

<p>Lithium and antipsychotic medication (C)</p> Signup and view all the answers

What type of therapy is often used in the treatment of avoidant personality disorder?

<p>Cognitive-behavioral therapy (A)</p> Signup and view all the answers

What is a likely genetic influence associated with obsessive-compulsive personality disorder?

<p>Moderate genetic contribution (A)</p> Signup and view all the answers

The aetiology of narcissistic personality disorder is most often linked to which childhood experience?

<p>Invalidating childhood experiences (C)</p> Signup and view all the answers

What type of childhood interaction is linked to the development of dependent personality disorder?

<p>Physical abuse (B)</p> Signup and view all the answers

Flashcards

Personality Disorders

Persistent patterns of thinking, feeling, and behaving that are consistent across situations and time, differing from those of the general population.

Personality Traits

Characteristics of thinking, feeling, and behavior that are common in the general population and less extreme than personality disorders.

Five Factor Model

A model of personality that identifies five main traits: Neuroticism, Extroversion, Openness to experience, Conscientiousness, and Agreeableness.

Axis II Disorders

A classification system in older versions of the DSM where Personality Disorders used to be listed.

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Ego-syntonic

Describes personality disorders where one's behavior is consistent with their sense of self and not troubling.

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Ego-dystonic

Describes personality disorders where one's behavior is considered problematic by the person and they desire change.

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Learning Objectives (Chapter 13)

Outline personality disorders, their diagnosis, prevalence, and treatment.

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Prevalence of Personality Disorders

The frequency or rate at which personality disorders occur in a population.

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What are the defining characteristics of personality disorders?

Personality disorders are characterized by inflexible and enduring patterns of thoughts, feelings, and behaviors that deviate from cultural norms and cause significant distress or impairment.

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What is functional inflexibility in personality disorders?

Functional inflexibility in personality disorders refers to the difficulty an individual has in adapting their behavior to different situations or demands. They tend to react in the same way, even when it's not helpful.

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How are self-defeating behavior patterns related to personality disorders?

Self-defeating behavior patterns in personality disorders involve behaviors that undermine the individual's goals and well-being. They often cause problems in relationships and work.

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What is the DSM-5 criterion for personality disorders?

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) defines personality disorders as enduring patterns of inner experience and behavior that deviate significantly from cultural expectations, are inflexible, have an onset in adolescence or early adulthood, are stable over time, and cause distress or impairment.

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Why are personality disorders considered 'enduring'?

Enduring in personality disorders refers to the fact that these patterns of behavior and thinking are persistent and have been present for a long time, typically since adolescence or early adulthood.

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What is the difference between normal-range problems and a personality disorder?

Normal-range problems are typically less severe and less pervasive than personality disorders. They can be addressed with strategies like coping mechanisms while personality disorders require more specialized intervention.

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What does 'deviates markedly from the expectations of the individual’s culture' mean in the context of personality disorders?

This means that the individual's behavior and patterns of thinking are significantly different from what is typically considered normal or acceptable in their cultural context.

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How does personality disorder diagnosis focus on the individual?

Personality disorder diagnosis is based on understanding how the individual's thoughts, feelings, and behaviors differ from societal expectations within their own cultural context.

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Categorical vs Dimensional

Two ways to view mental disorders: Categorical puts people into boxes based on specific criteria. Dimensional views disorders on a spectrum, with varying degrees of severity.

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DSM Reification

The DSM's categorical approach can lead to reification - treating mental disorders as real, distinct entities, even though they're complex and often overlapping.

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Dimensional Approach to Personality

This approach views personality traits as existing on a continuum from low to high, with personality disorders representing extreme ends of this spectrum.

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Five Domains of Personality Dysfunction

The alternative DSM-5 PD system uses five broad domains to describe personality disorders: Negative affectivity, Detachment, Antagonism, Disinhibition, and Psychoticism

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Specific Personality Traits

Within the five domains of personality dysfunction, there are 25 specific personality traits used to describe different personality disorders.

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Reduced Number of Personality Disorders

The alternative DSM-5 PD system simplifies the previous ten personality disorders into six: Antisocial, Avoidant, Borderline, Narcissistic, Obsessive-compulsive, and Schizotypal.

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Beck's Cognitive Model

This model suggests that dysfunctional core beliefs contribute to personality disorders. These beliefs shape how individuals perceive themselves, others, and the world.

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Young's Schema Therapy

This model focuses on maladaptive schemas, early life patterns of thinking and feeling that remain rigid and often lead to problems in adulthood.

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Cluster A Personality Disorders

These disorders involve odd or eccentric traits and behaviors.

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Cluster B Personality Disorders

These disorders involve dramatic, emotional, or erratic traits and behaviors.

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Cluster C Personality Disorders

These disorders involve anxious and fearful traits and behaviors.

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Paranoid Personality Disorder

A personality disorder marked by a pervasive and unjustified distrust of others, volatile emotions, and a constant sense of threat.

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Schizoid Personality Disorder

A personality disorder characterized by detachment from social relationships, limited range of emotions, and an inability or unwillingness to express affection.

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Schizotypal Personality Disorder

A personality disorder with peculiar thoughts, behaviors, and appearance. They may experience psychotic-like symptoms, such as magical thinking and ideas of reference.

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Antisocial Personality Disorder (ASPD)

A personality disorder characterized by disregard for social norms, violation of others' rights, impulsivity, deceitfulness, and a lack of remorse.

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Borderline Personality Disorder (BPD)

A personality disorder marked by instability in relationships, self-image, and emotions. Individuals with BPD often experience impulsivity, fear of abandonment, and self-destructive behaviors.

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Histrionic Personality Disorder

A personality disorder characterized by excessive emotionality, attention-seeking behavior, and dramatic expression of their feelings.

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Narcissistic Personality Disorder

A personality disorder defined by an inflated sense of self-importance, a need for admiration, and a lack of empathy for others.

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Avoidant Personality Disorder

A personality disorder characterized by extreme sensitivity to opinions, avoidance of relationships, and fear of rejection.

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Dependent Personality Disorder

A personality disorder marked by a pervasive need to be taken care of by others, leading to submissive behavior, fear of abandonment, and difficulty making independent decisions.

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Obsessive-Compulsive Personality Disorder (OCPD)

A personality disorder characterized by a preoccupation with orderliness, perfectionism, and control. Individuals with OCPD may have difficulty relaxing and are often rigid in their thinking.

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Interrater Reliability

The consistency of diagnosis between different mental health professionals.

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Comorbidity

The co-occurrence of two or more disorders in the same individual.

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Schema Therapy

Therapy focusing on modifying maladaptive schemas, which are deeply ingrained patterns of thinking, feeling, and behaving that often stem from childhood experiences.

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Early Maladaptive Schemas (EMS)

Negative and inflexible patterns of thinking, feeling, and behaving that develop early in life and can contribute to psychological problems.

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What is Dialectical Behavior Therapy (DBT)?

A therapy specifically developed for borderline personality disorder, focusing on improving emotional regulation skills and managing distress.

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What are 'invalidating' environments?

Circumstances that consistently dismiss or invalidate a person's feelings and experiences, contributing to emotional dysregulation.

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What are reciprocal role procedures in Cognitive Analytic Therapy (CAT)?

Complementary patterns of interaction between individuals in relationships, often influenced by past experiences.

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What is mentalization in Mentalization-based Treatment (MBT)?

The ability to understand one's own mental states (thoughts, feelings) and those of others.

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What are the aetiology and treatment of Cluster A disorders?

Aetiology: A combination of genetic predisposition and environmental factors, like trauma, contributes to these personality disorders. Treatment: Limited empirical evidence for treatment, often difficult due to issues with trust and intimacy.

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What is the aetiology of antisocial personality disorder?

A combination of genetically based vulnerability and exposure to adverse environmental factors.

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What is the focus of treatment for antisocial personality disorder?

Treatment often focuses on addressing comorbid disorders (those occurring alongside) like substance abuse or depression.

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How does therapy help with personality disorders?

Therapy aims to educate individuals about their schemas and uses cognitive and behavioural techniques to modify these patterns, ultimately leading to better self-awareness and improved emotional regulation.

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What is the role of genetics in BPD?

The influence of genetics in Borderline Personality Disorder (BPD) is unclear.

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Psychosocial factors in BPD

Psychosocial factors, such as childhood trauma, are strongly linked to the development of BPD.

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Biological influences in BPD

Biological factors, possibly related to brain structure or neurotransmitters, might contribute to BPD.

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First-line treatment for BPD

Psychological interventions are considered the primary treatment approach for BPD.

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Types of therapy for BPD

Various psychological therapies, including psychodynamic therapy, CBT, DBT, schema therapy, and cognitive analytic therapy have been studied for BPD.

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What is the main challenge in treating NPD?

Individuals with Narcissistic Personality Disorder (NPD) often don't seek treatment unless facing difficulties related to other issues.

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NPD treatment research

There's a limited research base on effective treatments for NPD.

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What is the role of parent-child interactions in HPD?

Models of Histrionic Personality Disorder (HPD) emphasize inconsistent, intense, and non-empathic parent-child interactions as a key factor.

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HPD treatment empirical findings

There's a lack of empirical evidence supporting specific treatment methods for HPD.

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Why might people with HPD seek help?

Individuals with HPD might be more likely to seek help due to dependency issues.

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Cognitive therapy for HPD

Cognitive therapy can be helpful in HPD to address identifying and challenging assumptions about dependency on others.

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Genetic contribution to AvPD

Research suggests a modest genetic contribution to Avoidant Personality Disorder (AvPD).

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Childhood experiences in AvPD

AvPD may develop early in life and be linked to childhood neglect and rejection experiences.

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Treatment focus for AvPD

Treatment for AvPD often focuses on comorbid disorders like depression and anxiety.

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Behavioral techniques for AvPD

Behavioral techniques that target and address social avoidance are effective in treating AvPD.

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Study Notes

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Chapter 13: Personality Disorders

Learning Objectives

  • Outline factors differentiating normal from dysfunctional personality functioning.
  • Describe two classification systems for diagnosing personality disorders, highlighting similarities and differences.
  • Summarize and critically evaluate research on the prevalence of personality disorders in general.
  • Describe prominent models regarding the etiology and treatment of personality disorders in general.
  • Describe prominent models regarding the etiology and treatment of specific personality disorders.

Personality Disorders

  • Previously coded on Axis II of the DSM.
  • Often more subtle and less incapacitating than "Axis I" disorders.
  • Less often treated.
  • "Disorders of reputation".
  • Often ego-syntonic (as opposed to ego-dystonic).
  • Assumed by many to occur on a continuum, but this is questionable.

The Definition of Personality

  • A persistent pattern of thinking, feeling, and behaving, pervasive across situations, enduring over time.
  • Five-factor model comprises five essential traits: Neuroticism, Extraversion, Openness to experience, Conscientiousness, and Agreeableness.

Traits vs. Disorders

  • Traits are present in the general (non-clinical) population.
  • Some traits in small doses (e.g., conscientiousness) are advantageous.
  • Some traits are maladaptive at either extreme (e.g., too little trust: paranoid; too much trust: gullibility).

Definition of Personality Disorder

  • DSM-5-TR Definition: "A Personality Disorder is an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual's culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time, and leads to distress or impairment" (American Psychiatric Association, 2022).
  • Millon (1981): Identified three core features differentiating disordered personality from normal-range problematic behaviours: functional inflexibility, self-defeating behaviour patterns, and tenuous stability under stress with marked instability in mood, thinking, and behaviour during difficult life events.

DSM-5-TR General Diagnostic Criteria for PDs

  • Enduring pattern of inner experience and behaviour that deviates markedly from cultural expectations.
  • Pattern manifested in two or more areas: cognition, affectivity, interpersonal functioning, impulse control.
  • Enduring pattern inflexible and pervasive across situations.
  • Pattern leads to clinically significant distress or impairment.
  • Pattern stable and of long duration, onset in adolescence or early adulthood.
  • Pattern is not better accounted for as a manifestation or consequence of another mental disorder.
  • Pattern not due to physiological effects of substances or general medical conditions.

Criteria for Borderline Personality Disorder

  • A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity.
  • Five (or more) of the following characteristics: frantic efforts to avoid abandonment, unstable relationships (idealization-devaluation), identity disturbance, impulsivity, recurrent suicidal behaviour or self-mutilation, affective instability, chronic feelings of emptiness, inappropriate or intense anger, transient, stress-related paranoid ideation or severe dissociative symptoms.

The Diagnosis of Personality Disorder

  • DSM-5-TR includes 10 distinct personality disorders categorized into three clusters: Cluster A (odd or eccentric), Cluster B (dramatic, emotional, erratic), and Cluster C (anxious and fearful).

Cluster A Personality Disorders

  • Paranoid PD: Mistrust and suspicion, pervasive, unjustified, few meaningful relationships, volatile, sensitive to criticism.
  • Schizoid PD: Appear to neither enjoy nor desire relationships, limited range of emotions, cold, detached, unaffected by praise/criticism, unable/unwilling to express emotions, no thought disorder.
  • Schizotypal PD: Psychotic-like symptoms (magical thinking, ideas of reference, illusions), odd behavior, unusual appearance, socially isolated, highly suspicious.

Cluster B Personality Disorders

  • Antisocial PD: Noncompliance with social norms (“social predators”), violate rights of others, irresponsible, impulsive, deceitful, lack a conscience, empathy, and remorse.
  • Borderline PD: Patterns of instability, labile/intense moods, turbulent relationships, impulsivity, fear of abandonment, very poor self-image, self-mutilation, suicidal gestures.
  • Histrionic PD: Overly dramatic, sensational, sexually provocative, impulsive, attention-seeking, appearance-focused, superficial speech, more common in women.
  • Narcissistic PD: Exaggerated and unreasonable sense of self-importance, require attention, lack sensitivity, sensitive to criticism, envious, arrogant.

Cluster C Personality Disorders

  • Avoidant PD: Extreme sensitivity to opinions, avoids most relationships, interpersonally anxious, fearful of rejection, similar in many ways to social anxiety disorder.
  • Dependent PD: Rely on others for major and minor decisions, unreasonable fear of abandonment, clingy, submissive, timid, passive, feelings of inadequacy, sensitivity to criticism, high need for reassurance.
  • Obsessive-Compulsive PD: Fixation on doing things the “right way”, rigid, perfectionistic, orderly, preoccupation with details, poor interpersonal relationships, obsessions and compulsions are rare.

Other Key Information

  • Role of Culture: Certain personality styles and disorders fit certain cultures or occupations. Culture can influence how often a disorder is diagnosed. Culture affects whether behaviours are considered aberrant.
  • DSM vs. ICD: Differences in diagnostic criteria between the DSM and ICD systems were noted.
  • Problems with Classification: Issues raised include interrater reliability, comorbidity, overlap among disorders, overlap with "Axis I" disorders, large numbers of unclassified cases, phenotypic heterogeneity, longitudinal instability, and diagnostic bias.
  • Diagnostic Bias: Gender bias in diagnoses was noted.
  • Categorical vs. Dimensional Views: A distinction was made between categorical ("kind") and dimensional ("degree") approaches to personality disorders.
  • Alternative DSM-5 PD System: Alternative, reorganized PD system presented, reorganized into five domains: Negative affectivity, Detachment, Antagonism, Disinhibition, and Psychoticism with specific trait facets.
  • General Models of Aetiology and Treatment: Factor approaches, Beck's cognitive model, Young's schema therapy model, and Mentalization-based treatment were discussed.
  • Early Maladaptive Schemas: These schemas are potentially formed in childhood and can contribute to the development of various personality disorders
  • Mentalisation-based treatment: This approach emphasizes the development of understanding one's mental state and others' states.

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