Personality Disorders:

1. Know the criteria for the General Personality Disorder

• Criterion A: Enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s culture

  • Seen in the following areas:

    • Cognition (i.e., ways of perceiving and interpreting self, other people, and events)

    • Affectivity (i.e., the range, intensity, lability, and appropriateness of emotional response)

    • Interpersonal functioning

    • Impulse control

• Criterion B: Inflexible and pervasive across a broad range of personal and social situations

• Criterion C: Clinically significant distress or impairment in social, occupational, or other important areas of functioning

• Criterion D: Stable and of long duration, and its onset can be traced back at least to adolescents or early childhood

2. Know the three clusters of personality disorder and their defining characteristics

• Cluster A: Odd-Eccentric

  • Behaviors similar to Schizophrenia

  • Flat affect, odd thought or speech patterns

  • Differ in their grasp on reality

  • Symptoms do not reach the severity seen in Schizophrenia

  • Comprises three disorders:p;.

    • Paranoid Personality Disorder

    • Schizotypal Personality Disorder (Symptoms of schizophrenia but not severe enough)

• Schizoid Personality Disorder 

• Cluster B: Dramatic-Emotional

  • Manipulative and potentially uncaring

  • Show little regard for others and potentially their own safety

  • Emotional Dysregulation

  • Can demonstrate highly erratic emotional responses

  • Histrionic Personality Disorder:

    • Exaggerated emotionality that lacks depth

    • Emotions are shallow and shift rapidly

    • Inappropriately sexual and seductive behavior

    • Extreme focus on appearance

  • Antisocial Personality Disorder:

    • Characterized by a disregard for and violation of the rights of others

    • Failure to conform to social norms with respect to lawful behavior

    • Deceitfulness

    • Impulsivity or failure to plan ahead

    • Irritability and aggressiveness

    • Reckless disregard for safety of others

    • Consistent irresponsibility

    • Lack of remorse for behaviors

• Cluster C: Anxious-Fearful

  • Extreme concern of criticism and abandonment that leads to impaired relationships

  • Avoidant Personality Disorder:

  • Feelings of extreme social inhibition, inadequacy, and sensitivity to negative criticism and rejection.

  • Avoidance of activities of daily living (e.g., work) involving people for fear of criticism or rejection

  • Low-self esteem and social isolation

  • Dependent Personality Disorder:

  • Feelings of helplessness, submissiveness, dependence, reassurance seeking

  • Difficulty making independent decisions

  • Avoidance of adult activities and tolerance of abuse and maltreatment

3. Know the defining features of Cluster A personality disorders and what differentiates

them from schizophrenia

• Features are similar to schizophrenia but do not meet the severity seen in schizophrenia

5. Know the material regarding self/other-concept of histrionic personality.

• Core Beliefs:

  • Self - If I can’t entertain people they will abandon me

  • Other - If other people don’t respond to me they are rotten

6. Know the information regarding learning deficits and novelty-seeking in ASPD.

• Learning History:

  • Selective interpersonal reinforcement by family and peer relationships leads to excessive attention-seeking behaviors

7. Understand the function of healthy narcissism and the behaviors associated with clinical

narcissism

• Healthy narcissism: Narcissism contributes to well-being by increasing an individual’s sense of personal agency

• Grandiose narcissism: 

  • Seething anger

  • Manipulativeness

  • Pursuit of interpersonal power and control

  • Lack of remorse

  • Exaggerated self-importance

  • Feelings of privilege

  • Externalize negative life events

  • Have little insight into their behavior

• Vulnerable narcissism:

  • An inability to consistently maintain a grandiose sense of self

  • Prone to narcissistic injury

  • Emotional states characterized by shame, anxiety, depression, and feelings of inadequacy

8. What are the two primary characteristics of Borderline Personality Disorder discussed in

class?

9. Be familiar with the early learning experiences that are associated with Borderline

Personality Disorder.

• A common theme across theoretical models of borderline personality disorder is an invalidating early attachment environment

10. What is meant by “good enough mothering”? How does this align with Linehan’s

understanding of Borderline Personality development?

• When caretakers are able to meet the child’s needs in this way, the child is able to develop a stable sense of self and an ability to regulate self-esteem

• In an unresponsive family environment, however, the child’s angry emotions disrupt the development of a positive sense of self

• Linehan (1993)

  • Child’s inner experiences are met with inappropriate or erratic responses from parent/caregiver

11. With respect to genetic factors, what do scientists believe is being inherited with respect

to Borderline Personality Disorder?

• Psychopathic deviate scale : Assesses family discord, authority conflict, social alienation, low social anxiety

  • Heritability = .61

• Mania scale: Amorality, social confidence and imperturbability, ego inflation (grandiosity)

  • Heritability = .55

What is the main limitation with twin studies on Borderline Personality Disorder?

• Twin Studies: 29% concordance for ASPD

• Individuals were more likely to behave like biological parents; not adoptive parents 

12. Know the defining characteristics and particular features of OCPD

• Obsessive-Compulsive Personality Disorder:

  • A pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency, beginning by early adulthood

    • Is over-conscientious, scrupulous, and inflexible about matters of morality, ethics, or values (not accounted for by cultural or religious identification)

    • Is unable to discard worn-out clothes or worthless objects even when they have no sentimental value

    • Is reluctant to delegate tasks or to work with others unless they submit to exactly his or her way of doing things

Sexual Paraphilias:

1. Be able to define what a sexual paraphilia is, as well as differentiate which disorders

belong to the victim/victimless categories.

• Sexual Paraphilia: Sexual arousal to non-normative or deviant stimuli and the associated sexual behaviors

  • Victimless:

    • Fetishism (Erotic attraction to non living objects)

    • Transvestic Fetishism

    • Sexual Masochism (Involves excitement in response to being humiliated or made to suffer)

    • Sexual Sadism (Involves excitement in response to the infliction of psychological and physical suffering)

  • Including Victim:

    • Exhibitionism (Recurrent urge for exposure of the genitals to strangers or unsuspecting persons)

    • Frotteurism (individual’s touching or rubbing his genitals against the leg, buttocks, or other body parts of an unsuspecting person)

    • Pedophilia

    • Sexual Masochism & Sadism

    • Voyeurism (Involves the observation of an unsuspecting person or persons who are nude, disrobing, or engaging in a sexual act)

• Examples of paraphilias:

  • Telephone Scatalogia (obscene telephone calling)

  • Necrophilia (corpses)

  • Zoophilia (animals)

  • Coprophilia (feces)

  • Urophilia (urine)

2. Know both the learning-based etiological models for sexual paraphilias, as well as the

dispositional factors that are often found in individuals with these disorders

• Learning Models:

  • Classical conditioning:

    • Pairing of a neutral stimulus with sexual arousal

    • Fetishes conditioned in normal volunteers (Rachman, 1966)

  • Imprinting:

    • Early sexual experiences influence the shaping of subsequent sexual desires and fantasies

  • Conditioning and fantasy rehearsal:

    • Self-directed conditioning paradigm

  • Early sexual trauma:

    • Control over painful memory through mastery

    • Identification with the aggressor

• Often found in individuals with these disorders:

  • Offenders are predominantly men

  • Impulsivity, anger, aggression, dominance, etc.

  • Heterosocial deficits

  • Early attachment problems

  • Comorbid pathology:

    • Mood disorder

    • Anxiety

    • Substance Abuse

• What does it mean that BPD has been referred to as a disorder of “stable instability”? In what ways are individuals with BPD “unstable”?

  • While a person’s emotional states, self-image, relationships, and behaviors can fluctuate rapidly and intensely, this pattern of instability is consistent over time

  • Instability in their mood (Intense anger/rapidly changing negative emotions)

  • Instability in self-image (Maintaining a sense of who they are)

  • Instability in interpersonal relationships (May like a person one day and not the next)

•   What are the clinical features of BPD as per Table 14.1?

  • 5 or more required for diagnosis:

    • Fears of abandonment

    • Intense and unstable interpersonal relationships

    • Disturbed self image

    • Impulsive behavior (substance abuse, reckless driving, binge eating, unsafe sexual behavior, excessive spending)

    • Suicide threats, gestures, or suicidal behavior

    • Highly reactive mood 

    • Persistent feeling of emptiness 

    • Intense/inappropriate anger that is difficult to control

    • Brief periods of paranoid ideation

• Where does the term borderline come from?  Be familiar with the types of patients that Stern (1938) and Knight (1953) were working with and how this informed their choice of the term

  • The term borderline was meant to reflect Stern’s view that the disorder did not fit well within the existing classification system 

  • Patients had severely impaired ego functions and primary process thinking (“pseudo-neurotic schizophrenia)

  • Knight considered the disorder to be on the border of both neurosis and psychosis 

• According to APA, approximately what percentage of patients with BPD are women?  What are some theories about why this might be (other than that a genuine difference exists across gender)?  What did Torgersen et al. (2001) and Lenzenweger et al. (2007) find? What do the authors of the chapter ultimately conclude with respect to gender differences in BPD?

  • 75% of cases are women (women are more likely to seek treatment) 

  • No gender differences in the prevalence of BPD in the United States

  • Authors believe there is no evidence to support the 3:1 ratio

• What do Linehan (1993) and Gunderson (1996) consider to be the core features of BPD?

  • Linehan (1993) - Affective instability

  • Gunderson (1996) - Fear and intolerance of aloneness 

• What are the main components of Linehan’s (1993) biosocial theory? What does she consider as the key environmental factor in the development of the disorder? 

  • Key environmental factor: An invalidating family environment

    • BPD results when biological or temperamental vulnerabilities interact with failures in a child’s social environment

    • If family environment does not provide the emotionally vulnerable child with the skill necessary to contain strong emotion

• What types of negative life events characterize the youth of those later diagnosed with BPD? What is the main problem with most of the studies that examine the early life experiences of BPD patients and why is this a problem?

  • Those who are later diagnosed with BPD often have high levels of trauma and adversity

    • Physical abuse, sexual abuse, neglect during childhood

  • Problem: Studies rely on retrospective reporting, data may be unreliable due to problems recalling events

• What is attachment theory and how has it been used to understand BPD?  What specific styles of insecure attachment appear linked to BPD in empirical studies? Be familiar with Bateman and Fonagay’s notions of what links attachment style and BPD?

  • Attachment Theory: Through the relationships and transactions between infants and caregivers, infants develop mental representations of themselves and others

  • Sets expectations about relationships 

  • If an infant is taken care of, they will view others as reliable

  • If an infant is abused or neglected, they will have expectations of unreliability

    • Bateman and Fonagay: An inability to “mentalize” (understand and interpret one’s own mental states as well as those of others”) is fundamental to BPD and linked to failures in early attachment relationships 

• Know the different forms of executive neurocognition and know the associated findings that link deficits in these areas to BPD.

  • Executive Neurocognition: Being able to delay or terminate a given response for the purpose of achieving another goal or reward that is less immediate

    • Interference Control: When we make a conscious and deliberate effort to control our attention or motor behavior

    • Cognitive Inhibition: The ability to suppress information from working memory 

    • Behavioral Inhibition: The ability to inhibit an expected motor behavior or cognitive response in order to follow a different direction

    • Motivational/Affective Inhibition: The purposeful interruption of a tendency or behavior that results from a particular motivational-emotional state

  • Those with BPD would show impairments on neurocognitive tasks requiring inhibition 

• In Cleckley’s The Mask of Sanity, what are the criteria for psychopathy (Table 15.1) and which six had the strongest influence on current conceptualizations of the disorder?

  • Superficial charm and good “intelligence.”

  • Absence of delusions and other signs of irrational thinking

  • Absence of “nervousness” or psychoneurotic manifestations

  • Unreliability

  • Untruthfulness and insincerity

  • Lack of remorse or shame

  • Inadequately motivated antisocial behavior

  • Poor judgment and failure to learn by experience

  • Pathological egocentricity and incapacity for love

  • General poverty in major affective reactions

  • Specific loss of insight

  • Unresponsiveness in general interpersonal relations

  • Fantastic and uninviting behavior with drink and sometimes without

  • Suicide rarelycarried out

  • Sex life impersonal,trivial,and poorly integrated

  • Failure to follow any lifeplan

• What is Gray’s BIS/BAS model?  What element of this model seems most related to psychopathy and what experimental and physiological evidence supports this notion?

  • BIS/BAS Model: 3 systems that served to regulate behavior

1. Fight/Flight System (FFS): Responds to unconditioned or innately aversive stimuli 

2. Behavioral Activation System (BAS): Sensitive to reward stimuli and likey to activate responses in the face if cues or conditioned stimuli signaling reward 

3. Behavioral Inhibition System (BIS): Sensitive to punishment stimuli and likely to inhibit ongoing response signaling punishment 

• Low BIS (Behavioral Inhibition System) is most related to psychopathy 

• What area of the brain figures most prominently in Blair’s conceptualization of learning deficits in psychopathy?  Does the research literature support that structural brain differences in psychopathy are limited to this area?

  • Amygdala

    • Psychopathic individuals show reduced amygdala activation during aversive conditioning tasks 

• What is the response modulation hypothesis? What is the main difference with low-fear and punishment-learning based models of psychopathy? What is the attention bottleneck? What findings from Newman & Baskin-Sommers (2011) support this hypothesis? How do findings using the fear-potentiated startle paradigm also support this conclusion?

  • Response Modulation Hypothesis: Psychopaths can process such cues, but only if they are part of their immediate goal or focus. If the cues are peripheral to their current goal, they are ignored

  • Attention Bottleneck: A narrow attentional filter in psychopaths

    • Once focused on a goal, they struggle to shift their attention to new or competing information, such as warning signs, punishment cues, or emotional signals

    • Newman and Baskin-Sommers (2011): Psychopaths perform poorly on tasks where punishment cues are peripheral to the goal but perform normally when those cues are central

  • Example: In go/no-go tasks or passive avoidance tasks, psychopaths ignore stop signals unless those are made primary

• What do findings suggest about the relative genetic and environmental contributions to psychopathy?  What is a potentially potent non-shared environmental factor in the development of psychopathy? What findings, in particular, highlight this factor?

  • There is a moderate contribution of each factor

  • A potentially non-shared environmental factor in the development of psychopathy is peer relationships

    • The level of psychopathic traits exhibited by an individual adolescent appears to be correlated with the levels of psychopathic traits exhibited by members of his or her peer friendship group 

• What does research suggest about the genetic influences on the development of callous-unemotional traits in psychopathy? 

  • Callous-Unemotional Traits: Personality traits characterized by a lack of empathy, guilt, and remorse, as well as a shallow or blunted affect, and a disregard for others' feelings and well-being

    • Research suggests that there is a strong genetic link between between the development of these traits