personality disorders

What are personality disorders?

A chronis, longstanding, stable, central and pervasive pattern of behaviour in individuals older than 18.

What are the requirements for a behaviour or set of behaviours to be classified as a personality disorder?

It must be chronic, have an early onset, be stable and longstanding, pervasive across all areas of life, central to identity, inflexible, deviates from cultural expectations, and results in clinical distress or impaired functioning.

What are the three clusters of personality disorders?

Cluster A, B, and C.

What disorders are part of cluster A?

Paranoid, schizoid, and schizotypal.

What are the common characteristics of cluster A personality disorders?

Odd, eccentric, and avoidance of social contact.

What is paranoid personality disorder?

A disorder characterized by suspiciousness, distrustfulness, and expectations of attacks or that people are out to harm them.

What is Schizoid personality disorder?

Also known as the lighthouse disorder, it is characterized by an inability to form attachment with others and no interest in doing so.

What is schizotypal personality disorder?

Characterized by strange, often magical, thinking and the individuals perception and speech often interferes with normal communication.

What disorders make up cluster B personality disorders?

Antisocial, histrionic, borderline, and narcissistic.

What are the common characteristics of individuals with cluster B personality disorders?

Dramatic, erratic, punitive, and hostile.

What is histrionic personality disorder?

Characterized by dramatic, attention-seeking behaviour and a strong emphasis on attractiveness or sexual desire.

What is narcissistic personality disorder?

Characterized by grandiosity, attention-seeking, lack of empathy, ans self-promoting behaviour.

What is antisocial personality disorder?

Characterized by Inadequate conscious development, irresponsible and impulsive behaviours, and the ability to impress and exploit others.

What is borderline personality disorder?

Characterized by impulsiveness, extreme emotional reactivity, drastic mood shifts, and self-injury/suicide attempts. It can be defined as affective instability and impulsivity.

What disorders make up cluster C personality disorders?

Avoidant, dependent, and obsessive-compulsive.

What are the primary characteristics of Cluster C personality disorders?

Anxious and fearful.

What is avoidant personality disorder?

Characterized by shyness, hypersensitivity to rejection, extreme social insecurity, self-consciousness, and self-critical behaviour.

What is dependent personality disorder?

Characterized by extreme discomfort with being alone, suppression of one’s own need to maintain relationships, indecision, and the inability to function independently.

What is obsessive-compulsive disorder?

Characterized by excessive concern with order, rules, and trivial details, as well as perfectionism and lack of warmth.

What is the prevalence for each cluster of personality disorder?

Cluster A: 4%, Cluster B: 4%, Cluster C: 7%

How many people with a personality disorder meet the criteria for more than just one?

Roughly 10-12%.

Why is it difficult to study personality disorders?

Because of diagnostic issues and their etiology.

What about the diagnostic criteria for personality disorders make them difficult to study?

The diagnostic criteria is not sharply defined, the categories are not mutually exclusive, personality traits are dimensional but are not represented this way, and there is a lack of agreement on assessment measures.

Are personality disorders stable over time?

No!!

Are the measures used to assess personality disorders reliable?

While their inter-rater reliability is good, their test-retest reliability has a large range with the values going as low as .11, showing that personality disorder are not stable over time!

What is the five-factor model?

A model stipulating that there are 5 primary dimensions of personality: Openness, conscientiousness, extraversion, agreeableness, and neuroticism.

What is openness?

Openness to new experiences.

What is conscientiousness?

Oder, duty, achievement, and self-discipline.

What is extraversion?

Warmth, excitement seeking, and positive emotions.

What is agreeableness?

Trust, compliance, and altruism.

What is neuroticism?

Anxiety, anger-hostility, depression, and self-consciousness.

How is the OCEAN model related to personality disorders?

Personality disorder represent extreme levels of typical traits.

Where would someone with antisocial personality disorder rank of each of the 5-factors of personality?

High neuroticism, low openness to experience, low extraversion, low agreeableness, low consciousness.

How would someone with obsessive-compulsive personality disorder rank on each of the 5-factors of personality?

High neuroticism, low extraversion, low openness, low agreeableness, and high consciousness.

Why are personality disorders difficult to treat?

Because clients have different goals than their practitioner, clients response to treatment can pose a threat to the therapist, developing a relationship with the client is difficult, and clinician motivation/patience also impedes treatment.

How many people drop out of treatment early for personality disorders?

Roughly 37%

When would antipsychotics be used to treat personality disorders?

When treating schizotypal personality disorder.

When are antidepressants used to treat personality disorders?

When treating schizotypal or avoidant personality disorder.

What is the most common treatment for personality disorders in general?

CBT, but the majority of treatment is greatly adapted based on the individual needs of the client.

What is the difference between borderline personality disorder and bipolar personality disorder?

With borderline, the baseline mood for people is dysthymia, emptiness, anger, and anxiety. Whereas with bipolar the baseline mood is normal. Furthermore, people with borderline are highly responsive to environmental changes and their behaviour can last minutes to hours while people with bipolar are more responsive in certain phases of their cycle and their behaviour can last weeks to months.

Why was borderline personality disorder named what it is?

Because it is on the “border” between neurosis and psychosis.

What are the four domains for symptoms for people with borderline personality disorder?

Emotional, interpersonal, behavioural, and self.

What are examples of emotional symptoms of borderline personality disorder?

High emotional reactivity and an unstable mood.

What are example of interpersonal symptoms of borderline personality disorder?

Fears of abandonment, unstable/intense relationships, rejection sensitivity.

What are example and behavioural symptoms of borderline personality disorder?

Extreme impulsivity and NSSI or suicidal behaviour.

What are samples of self-symptoms of borderline personality disorder?

Feelings of emptiness, unstable sense of self, and stress-related paranoia/dissociation.

What percent of people with BPD meet diagnostic criteria 10 years later?

Less than 50%, even without treatment.

What changes occur from young adulthood to older adulthood when it comes to borderline personality disorder presentation?

In young adulthood we see the greatest impairment and suicide risk whereas in middle adulthood we see greater stability.

What is the prevalence of BPD?

1-2% of the population.

What percent of people in inpatient psychiatric facilities have BPD?

20%

What percent of people with BPD have a mood disorder?

85%

What percent of people with BPD have an anxiety disorder?

83%

What percent of people with BPD suffer from substance abuse?

78%

What disorder are highly comorbid with BPD?

Mood disorders, anxiety disorders, substance abuse, eating disorders, PTSD, and other cluster B personality disorders.

What are two genetic traits that affect emotional responsiveness?

Neuroticism and impulsivity.

Is BPD genetic?

Yes, it is 5x more common among first degree relatives and common among relative with other impulse spectrum disorders.

What do twin studies show about the relationship between impulsivity, affective instability, and BPD.

They show that impulsivity and affective instability make an individual more likely to develop BPD.

How is the orbitofrontal cortex related to BPD?

Lower orbitofrontal volume is present in many people with BPD, which influences impulsivity, aggression, and mood instability.

How is the hippocampus related to BPD?

Lower hippocampal volume is present in many people with BPD which influences stress overactivity and causes a heightened fear response.

How is the amygdala related to BPD?

Many people with BDP have amygdala hyperactivity, which may affect liability resulting in hypervigilance, emotional dysregulation, and heightened threat perception.

What is the relationship between 5-HT and BPD?

People with BPD have lower 5-HT which influences impulsive behaviour and disinhibition.

What are the biological risk factors for borderline personality disorder?

Neuroticism, high impulsivity, a 1st degree relative with BPD, relative with impulse spectrum disorders, lower orbitofrontal volume, lower hippocampal volume, amygdala hyperactivity, lower 5-HT.

What psychological risk factors contribute to the development of BPD?

Perceived rejection leading to intense rage, misperception of anger (seeing it when its not there), dichotomous thinking, and catastrophizing.

What social risk factors contribute to the development of BPD?

Fears of abandonment and rejection, an invalidating environment, early adverse events (abuse or neglect), early separation or loss, abnormal parenting, the biosocial theory (emotional reactivity + invalidating environment = BPD)

How is the development of BPD related to early adverse events?

90% of people with BPD experienced childhood physical or sexual assault and/or neglect. Childhood physical abuse, sexual abuse, and/or neglect also put someone at an 8x higher risk for cluster B personality disorders.

What is the biosocial theory (BPD)?

The biosocial theory says that a biological diathesis for emotional reactivity + an invalidating environment will lead to BPD. An invaliding environment occurs when a child experiences emotional dysregulation leading to greater demands on the family which results in parents ignoring the child or pushing them emotionally. This negatively reinforces the bad behaviour and leads to more emotional outbursts from the child to get the parents attention.

What is the biological presentation of BPD?

Lower orbitofrontal volume, lower hippocampal volume, amygdala hyperactivity, lower 5-HT.

What is the psychological presentation of BPD?

Perceived rejection leading to intense rage, misinterpretation of anger, dichotomous thinking, catastrophizing, fear of abandonment and rejection, high emotional reactivity, and an unstable mood.

What are the social presentations of BPD?

Fears of abandonment, unstable/intense relationship, rejection sensitivity.

What are the biological treatments used to treat BPD?

SSRIs and mood stabilizers are often used to treat the comorbid mood disorders. Antipsychotics can be used to treat any psychotic/dissociative symptoms.

What psychological therapies are used to treat BPD?

DBT, Mentalization focusing on building a client-therapist relationship and perspective taking, Transference-based psychodynamic psychotherapy focusing on the client-therapist relationship.

What are the cons to transference-based psychodynamic psychotherapy?

Its very expensive and it takes a very long time (7 ish years)

What social treatments can be used to treat BPD?

Increase social support and being in a validating environment.

What are the most common symptoms of antisocial personality disorder?

Disregard for and violation of the rights of others, deceitfulness, impulsivity, aggressiveness, reckless disregard for the safety of self or others, consistent irresponsibility, and lack of remorse.

Is antisocial personality disorder comorbid with other disorders?

Yes, it is usually comorbid with substance abuse and other cluster B personality disorders.

What disorders in childhood make someone have an increased risk for developing ASPD?

If a kid has ODD by the age of 6 and conduct disorder by the age of 9 or if they have ADHD and conduct disorder in childhood.

What is the prevalence of antisocial personality disorder?

ASPD occurs in roughly 3% of men and 1% of women.

What is the prevalence of antisocial personality disorder in prisons?

ASPD occurs in roughly 47% of male inmates and 21% of female inmates.

What biological factors increase the risk of developing ASPD?

PFC dysfunction leading to poor executive control, low MAOA gene, being male, conduct disorder in childhood, and inherited traits.

What psychological factors increase the risk of developing ASPD?

Aggressiveness, impulsivity, low anxiety.

Why is it estimated that more men than women have ASPD?

Because of a low MAOA gene which is found on the X chromosome.

How does MAOA affect the development of ASPD?

The MAOA gene is an enzyme that breaks down 5-HT, NE, and DA and results in structural and functional changes in the brain. If you have low MAOA is makes you much more likely to develop ASPD when severe abuse occurs.

What social risk factors contribute to the development of ASPD?

Low SES, low parental supervision, parent psychopathology, delinquent siblings/peers, neglect, abuse, harsh discipline, and childhood maltreatment.

What is psychopathy?

Psychopathy is considered a more specific category of ASPD that focuses specifically on personality structure.

What are the two types of psychopaths?

Successful psychopaths are the individuals who end up running companies while unsuccessful psychopaths often end up incarcerated.

What are the two main dimensions of psychopathy?

Core and behaviour. The core dimension includes interpersonal behaviours such a superficial charm and pathological lying as well as affective behaviours such as lack of remorse, guilt, and empathy. The behavioural dimension includes lifestyle needs for stimulation and impulsivity as well as antisocial behaviour and poor behavioural control, resulting in higher criminality.

What is the prevalence of psychopathy?

The true prevalence of psychopathy is unknown because it is a very difficult group of people to study.

What biological risk factors contribute to the development of psychopathy?

Genetics (50% of variance is from genes), inherited callous-unemotional traits, lower amygdala volume, PFC dysfunction.

What psychological risk factors contribute to the development of psychopathy?

Callous-unemotional traits, low levels of fear conditioning, high reward sensitivity, attentional directedness (tunnel vision), development risk factors.

What developmental factors increase an individuals risk for psychopathy?

Fearlessness, low anxiety, poor conscience development, premeditated aggression.

What social risk factors contribute to the development of psychopathy?

Early parental loss, parental loss or rejection, callous/unemotional traits evoking negative parenting responses including ager, frustration, and harsh discipline.

What is the psychological presentation of psychopathy?

Callous/unemotional traits, low levels of fear, high reward sensitivity, attentional directedness.

What psychological treatment are used for psychopathy?

Redirecting skills towards prosocial behaviour, working to reduce hostile attributions, working to increase kind response to self and soften primary emotions to predictable limits.

Why is treatment for psychopathy so difficult?

Treatment is so difficult because punishment is usually ineffective and if treatment were to focus on social skills it would just improve their ability to manipulate. Group therapy also doesn’t work because many psychopaths don’t feel empathy.

What social therapies are used for psychopathy?

Work to increase closeness in relationships, compassion in caregivers, and kind responses to others.

What are the differences in developmental risk factors between ASPD and psychopathy?

For ASDP, children often have difficulty learning to regulate emotions and high emotional reactivity in response to stress. Children with psychopathy are often fearless, exhibit low anxiety, have poor conscience development, and show premeditated aggression.

What is DBT?

A form of therapy based on three principles: acceptance, change, and dialectics (balancing both). Acceptance is similar to acceptance-commitment therapy and focuses on validation while change is similar to CBT and focuses on problem-solving.

How are acceptance and change balanced in DBT?

With acceptance, it's important to assume that individuals are doing the best they can and want to improve. At the same time though, the change part focuses on the fact that they need to do better, try harder, and be more motivated to change. While they might not have caused all of their problems, they still need to solve them. Their lives are often unbearable as they are currently living, therefore they must learn new behaviours in many contexts. 

How is DBT usually formated?

It is usually done individually and the client and therapist focus on different skills groups including mindfulness, emotion regulation, distress tolerance, interpersonal effectiveness, and dialectics.

What is radical acceptance?

Radical acceptance is an example of a form of acceptance taught in DBT. It has 4 primary steps: acknowledging the situation, enduring it, not giving up, and working to change it when it's effective.