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'?

The individual perceives their behaviors as consistent with their self-image. Signup and view all the answers

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

Disordered traits. Signup and view all the answers

What is primarily studied in the research on personality disorders?

Prevalence rates among clinical populations. Signup and view all the answers

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

They are less often treated than Axis I disorders. Signup and view all the answers

What does personality refer to in psychological terms?

A consistent pattern of thinking, feeling, and behaving. Signup and view all the answers

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

Conscientiousness Signup and view all the answers

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

Gullibility Signup and view all the answers

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

Self-defeating behavior patterns Signup and view all the answers

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

Temporary behavior changes Signup and view all the answers

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

Rigid and consistent behavioral patterns Signup and view all the answers

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

Marked instability in mood, thinking, and behavior Signup and view all the answers

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

Inflexible behavior patterns Signup and view all the answers

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

Behavior causes social rejection or conflict Signup and view all the answers

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

Dimensional approaches consider personality characteristics as existing on a continuum. Signup and view all the answers

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

Fosters flexibility Signup and view all the answers

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

Disinhibition, Negative affectivity, Detachment, Antagonism, Psychoticism 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?

Histrionic Signup and view all the answers

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

Core beliefs about the self and others Signup and view all the answers

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

It can result in loss of individual information. Signup and view all the answers

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

It focuses on dysfunctional core beliefs affecting perceptions. Signup and view all the answers

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

Dimensional and categorical Signup and view all the answers

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

Borderline Personality Disorder Signup and view all the answers

What is a common characteristic of Cluster C personality disorders?

Anxious and fearful traits Signup and view all the answers

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

Schizotypal Personality Disorder Signup and view all the answers

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

Empathy Signup and view all the answers

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

Paranoid Personality Disorder Signup and view all the answers

What is a characteristic feature of Histrionic Personality Disorder?

Heightened emotional expression Signup and view all the answers

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

Borderline Personality Disorder Signup and view all the answers

What is NOT a symptom of Schizoid Personality Disorder?

Enjoyment of close relationships Signup and view all the answers

What defines the clinical description of Avoidant Personality Disorder?

Need for excessive reassurance Signup and view all the answers

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

Narcissistic Personality Disorder Signup and view all the answers

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

Antisocial Personality Disorder Signup and view all the answers

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

Obsessive-Compulsive Personality Disorder Signup and view all the answers

What is a common misconception about personality disorders?

They are static and do not change over time. Signup and view all the answers

What is the primary focus of schema therapy?

Educating individuals about their schemas and modifying them Signup and view all the answers

What does Dialectical Behaviour Therapy (DBT) primarily address?

Emotional regulation in borderline personality disorder Signup and view all the answers

Which therapy links cognitive psychology with object relations approach?

Cognitive Analytic Therapy Signup and view all the answers

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

The capacity to think about one's mental states and those of others Signup and view all the answers

What possibly complicates treatment for cluster A personality disorders?

Intimacy and trust issues Signup and view all the answers

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

Genetic vulnerability combined with adverse environmental conditions Signup and view all the answers

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

Dialectical Behaviour Therapy Signup and view all the answers

What is a primary challenge when treating personality disorders?

Intimacy and trust issues Signup and view all the answers

Which best describes reciprocal role procedures in Cognitive Analytic Therapy?

Complimentary dynamics in relationships Signup and view all the answers

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

Modifying underlying beliefs about oneself and the world Signup and view all the answers

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

Psychological intervention Signup and view all the answers

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

Childhood trauma Signup and view all the answers

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

Distress related to other difficulties Signup and view all the answers

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

Lack of empirical findings Signup and view all the answers

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

Early rejection experiences Signup and view all the answers

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

Schema therapy and DBT Signup and view all the answers

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

Genetic contributions Signup and view all the answers

Cognitive behavioral interventions are supported for which personality disorder treatment?

Obsessive-compulsive personality disorder Signup and view all the answers

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

Inconsistent and intense Signup and view all the answers

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

Lithium and antipsychotic medication Signup and view all the answers

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

Cognitive-behavioral therapy Signup and view all the answers

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

Moderate genetic contribution Signup and view all the answers

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

Invalidating childhood experiences Signup and view all the answers

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

Physical abuse Signup and view all the answers

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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