Personality Disorders – Integrative Approach (Chapter 12)

A comprehensive set of question-and-answer flashcards covering definitions, causes, features, and treatments of all major personality disorders, as outlined in Barlow & Durand’s Integrative Approach (9th ed.).

What are the two core characteristics of personality disorders (PDs)?

They are enduring and inflexible predispositions that are maladaptive, causing distress and/or impairment.

PD symptoms must cause distress or impairment in at least two of which four areas?

Cognitions, affectivity, interpersonal functioning, and impulse control.

Why do patients with personality disorders often resist treatment?

They typically do not feel their behavior is problematic or that treatment is necessary.

What is countertransference in the context of treating PDs?

Strong emotional reactions that therapists may have toward a client, which can complicate treatment.

How does the categorical model of PDs differ from the dimensional model introduced in DSM-5?

The categorical model treats PDs as all-or-nothing diagnoses, whereas the dimensional model rates individuals on the degree to which they exhibit various personality traits.

List the five broad traits of the Five-Factor Model (Big Five).

Openness to experience, conscientiousness, extraversion, agreeableness, and neuroticism.

What is the estimated prevalence of personality disorders in the general population?

Approximately 6–10%.

When do personality disorders typically begin and what is their usual course if untreated?

They generally begin in childhood and tend to run a chronic course if untreated.

What pattern of comorbidity is common in PDs?

Having two or more personality disorders and/or additional mood or anxiety disorders is the rule rather than the exception.

How do gender patterns influence PD diagnosis?

Men more often show aggression and detachment (e.g., antisocial PD), whereas women more often display submission and insecurity; diagnostic bias can also influence rates.

Which personality disorders are included in Cluster A (Odd/Eccentric)?

Paranoid PD, Schizoid PD, and Schizotypal PD.

What is the central feature of Paranoid Personality Disorder?

Pervasive and unjustified mistrust and suspicion of others.

What developmental factor is thought to contribute to Paranoid PD?

Early learning experiences that the world and people are dangerous.

Which treatment goal is primary for Paranoid PD?

Developing trust and challenging maladaptive, negativistic thinking through cognitive therapy.

How does Schizoid Personality Disorder primarily manifest?

Through detachment from social relationships and a very limited range of emotions in interpersonal situations.

Schizoid PD shares etiologic overlap with which neurodevelopmental condition?

Autism spectrum disorder.

What is emphasized in treating Schizoid PD?

Building the value of interpersonal relationships, empathy, and social skills.

Name three hallmark features of Schizotypal Personality Disorder.

Odd beliefs or magical thinking, social isolation with suspiciousness, and perceptual illusions or ideas of reference.

Which major mental disorder is Schizotypal PD sometimes considered a milder form of?

Schizophrenia.

What combined approach is recommended for treating Schizotypal PD?

Medication, cognitive-behavioral therapy, and social-skills training, while addressing comorbid depression.

Which personality disorders comprise Cluster B (Dramatic/Erratic)?

Antisocial PD, Borderline PD, Histrionic PD, and Narcissistic PD.

List three defining traits of Antisocial Personality Disorder (APD).

Failure to comply with social norms, violation of others’ rights, and a lack of empathy or remorse.

What proportion of APD risk is attributed to genetics?

Approximately 56%.

Which childhood disorder is a common precursor to APD, especially its 'callous-unemotional' type?

Conduct disorder.

Summarize the underarousal and fearlessness hypotheses for APD.

Underarousal: cortical arousal is too low; Fearlessness: individuals fail to respond to normal danger cues.

According to Gray's model, why do people with APD persist in risky behavior?

Reward signals outweigh inhibitory (punishment) signals in their behavioral activation/inhibition systems.

Why is treatment prognosis poor for APD and what strategy is often required?

Few seek treatment voluntarily; incarceration or legally mandated rehabilitation is often necessary, focusing on practical consequences.

What are the core symptoms of Borderline Personality Disorder (BPD)?

Unstable moods and relationships, impulsivity, fear of abandonment, and self-harm/suicidal gestures.

Describe Linehan’s 'triple vulnerability' model for BPD etiology.

1) General biological vulnerability (high emotional reactivity), 2) generalized psychological vulnerability, and 3) specific psychological vulnerability (early invalidating environment).

What therapy has the strongest empirical support for BPD?

Dialectical Behavior Therapy (DBT).

Name three primary DBT targets for BPD treatment.

Acceptance plus change, interpersonal effectiveness, and distress tolerance/reduction of self-harm.

Identify four typical features of Histrionic Personality Disorder.

Overly dramatic behavior, need to be the center of attention, possible sexual provocation, and shallow emotional expression.

Which PD frequently co-occurs with Histrionic PD, suggesting a possible sex-typed variant?

Antisocial Personality Disorder.

What is the main treatment focus for Histrionic PD?

Reducing attention-seeking behavior and addressing long-term interpersonal consequences.

What defines Narcissistic Personality Disorder (NPD)?

An exaggerated sense of self-importance, need for admiration, lack of empathy, and hypersensitivity to criticism.

According to Kohut, what developmental failure contributes to NPD?

A failure to develop empathy because parents used the child to boost their own self-esteem.

Which therapeutic themes are emphasized in NPD treatment?

Reducing grandiosity, enhancing empathy, promoting realistic goals, and improving coping with criticism.

Which disorders make up Cluster C (Anxious/Fearful)?

Avoidant PD, Dependent PD, and Obsessive-Compulsive PD.

What is the central interpersonal fear in Avoidant Personality Disorder?

Fear of rejection leading to extreme social avoidance and low self-esteem.

Which childhood experiences are commonly linked to Avoidant PD?

Early neglect, isolation, rejection, and conflict with others.

Avoidant PD treatment resembles the therapy for which anxiety disorder?

Social anxiety (social phobia), emphasizing exposure and social-skills training.

How does Dependent Personality Disorder manifest in relationships?

Reliance on others for decisions, submissiveness, and an unreasonable fear of abandonment.

What is a key therapeutic challenge in Dependent PD treatment?

Progress must be gradual because the client may quickly become dependent on the therapist.

List three core traits of Obsessive-Compulsive Personality Disorder (OCPD).

Rigid perfectionism, preoccupation with orderliness, and reluctance to delegate tasks.

How does OCPD differ from OCD regarding obsessions and compulsions?

True obsessions and compulsions are rare in OCPD; the focus is on personality style rather than intrusive thoughts or rituals.

What treatment targets are common in OCPD therapy?

Cognitive reappraisal of rigid thoughts, reducing rumination and procrastination, and addressing feelings of inadequacy.