Personality and Personality Disorders Flashcards

Fundamentals of Personality and Personality Disorders

• Definition of Personality: Characterized as a pattern of behaviors and inner experiences that are consistent across time and situations.
• Etiological Interaction: Personality is viewed as an interaction between an individual's inborn temperament and their psychosocial experiences throughout development.
• Definition of Personality Disorders (PDs): These are rigid, extreme, and maladaptive patterns of behavior and internal experience.
• Chronology and Stability:     * Onset: Typically occurs in adolescence or early adulthood.     * Longevity: Considered to be stable across the lifespan, though this stability is theoretically contested.

General Theoretical Perspectives on Personality Disorders

• Psychodynamic Perspective:     * Focuses on problematic relationships rooted in childhood.     * Emphasis on the development and use of maladaptive defense mechanisms.
• Cognitive-Behavioral Perspective (CBT):     * Views PDs as the result of individuals imposing rigid, preexisting beliefs or "schemas" across various situations.     * Involves selective attention, where the individual only notices or processes information that supports their existing schemas.

Categorization of Personality Disorders

• Cluster A (Odd or Eccentric Disorders):     * Paranoid Personality Disorder     * Schizoid Personality Disorder     * Schizotypal Personality Disorder
• Cluster B (Dramatic, Emotional, or Erratic Disorders):     * Antisocial Personality Disorder     * Borderline Personality Disorder     * Histrionic Personality Disorder     * Narcissistic Personality Disorder
• Cluster C (Anxious or Fearful Disorders):     * Avoidant Personality Disorder     * Dependent Personality Disorder     * Obsessive-Compulsive Personality Disorder

Cluster A: Profile, Criteria, and Explanations

• Paranoid Personality Disorder:     * Prevalence: Lifetime prevalence is estimated at $0.5\% - 2.5\%$ of the population.     * Diagnostic Criteria (requires four or more):         * Suspecting others are exploiting, harming, or deceiving without sufficient basis.         * Preoccupation with unjustified doubts regarding the loyalty/trustworthiness of associates/friends.         * Reluctance to confide in others due to unwarranted fear of malicious use of information.         * Reading threatening or demeaning meanings into benign events/remarks.         * Persistently bearing grudges (unforgiving of slights, insults, or injuries).         * Perceiving non-apparent attacks on character and reacting with quick anger or counterattacks.         * Recurrent, unjustified suspicions regarding the fidelity of a sexual partner or spouse.     * Explanations and Interventions:         * Psychodynamic: Results from repeated humiliation, criticism, and ridicule; involves the projection of hostility. Intervention aims for awareness of causes and conflict resolution.         * Cognitive-Behavioral: Based on paranoid schemas from early experience. Intervention encourages evaluating specific threats rather than attempting to change fundamental schemas.

• Schizoid Personality Disorder:     * Prevalence: Lifetime prevalence is estimated at $0.8\%$.     * Diagnostic Criteria (requires four or more):         * Neither desiring nor enjoying close relationships.         * Almost always choosing solitary activities.         * Little, if any, interest in sexual experiences.         * Taking pleasure in few, if any, activities.         * Lacking close friends/confidants other than first-degree relatives.         * Appearing indifferent to praise or criticism.         * Showing emotional coldness, detachment, or flattened affect.     * Explanations:         * Psychodynamic: Defensive withdrawal and intellectualization of emotions resulting from distressing early attachment.         * Cognitive-Behavioral: Belief that human involvement is too painful/complex; withdrawal is negatively reinforced by the comfort it provides.

• Schizotypal Personality Disorder:     * Prevalence: Lifetime prevalence is estimated up to $3\%$.     * Diagnostic Criteria (requires five or more):         * Ideas of reference.         * Odd beliefs/magical thinking inconsistent with subcultural norms (influences behavior).         * Unusual perceptual experiences (bodily illusions).         * Odd thinking and speech.         * Suspiciousness or paranoid ideation.         * Inappropriate or constricted affect.         * Odd, eccentric, or peculiar behavior/appearance.         * Lack of close friends other than first-degree relatives.         * Excessive social anxiety linked to paranoid fears rather than self-judgment (does not diminish with familiarity).     * Explanations:         * Psychodynamic: Viewed as a failure of the rational part of the psyche.         * Cognitive-Behavioral: Strange thought patterns/connections. Intervention focuses on social skills and managing anxiety.         * Biological: Strongly linked to Schizophrenia with similar neurobiological findings. Often treated with low doses of antipsychotic medication.

Cluster B: Profile, Criteria, and Explanations

• Antisocial Personality Disorder (ASPD):     * Prevalence: Lifetime prevalence is estimated at $2\%$.     * Diagnostic Criteria:         * Must be at least 18 years of age.         * Evidence of Conduct Disorder before age 15.         * Pervasive disregard for others' rights since age 15, indicated by three or more of the following: failure to conform to social/lawful norms (arrestable acts); deceitfulness (lying, aliases, conning); impulsivity/failure to plan; irritability and aggressiveness (physical fights); reckless disregard for safety; consistent irresponsibility (work/financial); lack of remorse (indifference to hurting others).     * Psychopathy vs. ASPD: Psychopathy predates ASPD and focuses on internal thoughts/feelings. Hare’s checklist assesses psychopathy via emotional detachment (lack of remorse/empathy) and antisocial behavior. Lack of remorse is common in ASPD but not an essential criterion for the DSM-5 diagnosis.     * Explanations:         * Psychodynamic: Roots in abuse-prone families leading to helplessness; defense mechanism involves identification with the aggressor. Disrupted child-parent relationships lead to abnormal superego development.         * Cognitive-Behavioral: Modeling of antisocial parents and reinforcement of antisocial behavior.         * Neurobiological: Modestly heritable (genetics involve criminality/psychopathy); involves anxiety deficiency and neuroanatomical differences, particularly in the frontal lobe.

• Narcissistic Personality Disorder:     * Prevalence: Lifetime prevalence is estimated at less than $1\%$.     * Diagnostic Criteria (requires five or more):         * Grandiose sense of self-importance.         * Preoccupation with fantasies of unlimited success, power, brilliance, or beauty.         * Belief in being "special"/unique (only understood by high-status people).         * Requirement for excessive admiration.         * Sense of entitlement.         * Interpersonally exploitative behavior.         * Lack of empathy.         * Envy of others or belief that others envy them.         * Arrogant, haughty behaviors/attitudes.     * Explanations:         * Psychodynamic: Underlying inadequacy due to emotional neglect or being used as a "prop" by parents. Intervention uses empathy and kind but consistent confrontation.         * Cognitive-Behavioral: Unrealistic schemas about self and expectations.

• Histrionic Personality Disorder:     * Prevalence: Lifetime prevalence is estimated at $2\% - 3\%$.     * Diagnostic Criteria (requires five or more):         * Uncomfortable when not the center of attention.         * Inappropriate sexually seductive/provocative interaction.         * Rapidly shifting, shallow expression of emotions.         * Consistency in using physical appearance to draw attention.         * Speech style that is impressionistic and lacking detail.         * Self-dramatization, theatricality, and exaggerated emotion.         * Suggestibility (easily influenced).         * Perceiving relationships as more intimate than they are.     * Explanations: Psychodynamic view suggests distant parenting and conditional love. Note: Group therapy is generally not a good idea due to constant attention-seeking behaviors.

• Borderline Personality Disorder (BPD):     * Prevalence: Lifetime prevalence is estimated at $2\%$.     * Diagnostic Criteria (requires five or more):         * Frantic efforts to avoid abandonment (real or imagined).         * Unstable/intense relationships (alternating between idealization and devaluation).         * Unstable self-image.         * Impulsivity in two potential self-damaging areas (e.g., sex, binge eating, substance abuse).         * Recurrent suicidal behavior, threats, or self-mutilation (e.g., cutting).         * Marked mood reactivity.         * Chronic feelings of emptiness/worthlessness.         * Inappropriate/uncontrolled anger.         * Transient stress-related paranoia or severe dissociation.     * Neurobiological and Biological Factors:         * Genetic component linked to impulsivity and emotional dysregulation.         * Decreased serotonin system functioning.         * Frontal lobe dysfunction and increased amygdala activation.         * Common use of antidepressants (though BPD is hard to separate from comorbid depression).     * Linehan’s Dialectical Behavioral Therapy (DBT):         * Multi-perspective approach viewing BPD as an interaction between biological diathesis (difficulty controlling emotions) and an invalidating family environment.         * Treatment is warm and accepting, focusing on emotional regulation, social strategies, and suppressing harmful impulses.     * Additional Etiology: Psychodynamic view includes unreliable caregivers and "splitting" (not split personality).

Cluster C: Profile, Criteria, and Explanations

• Avoidant Personality Disorder:     * Prevalence: Lifetime prevalence is estimated at $0.5\% - 1.0\%$.     * Diagnostic Criteria (requires four of the following):         * Avoids occupational contacts due to fear of criticism/rejection.         * Unwilling to involve self with others unless certain of being liked.         * Restraint in intimate relationships due to fear of shame/ridicule.         * Preoccupied with social criticism/rejection.         * Inhibited in new situations due to inadequacy.         * Self-view as socially inept or inferior.         * Reluctance to take personal risks for fear of embarrassment.     * Explanations:         * Psychodynamic: Rooted in childhood shame or rejection.         * Cognitive-Behavioral: Assumptions of rejection leads to selective attention to supportive details. Interventions involve group therapy and challenging the belief that rejection is unbearable.         * Biological: Linked to "slow-to-warm-up" infant temperament. Antidepressant/anti-anxiety drugs help patients benefit from psychotherapy.

• Dependent Personality Disorder:     * Prevalence: Lifetime prevalence is estimated at $2\%$.     * Diagnostic Criteria (requires five of the following):         * Difficulty making everyday decisions without excessive advice.         * Needs others to assume responsibility for major life areas.         * Fear of losing support prevents disagreeing with others.         * Difficulty initiating projects due to lack of self-confidence.         * Goes to extremes (even unpleasant tasks) for nurturance/support.         * Feelings of helplessness when alone due to fears of inability to self-care.         * Urgently seeks new relationships when one ends.         * Unrealistic preoccupation with fears of being left to care for self.     * Explanations:         * Psychodynamic: Insecure attachment; anxieties from early childhood.         * Cognitive-Behavioral: Parents who reinforced neediness and undermined independence. Intervention involves CBT, assertiveness training, and specific "homework assignments."

• Obsessive-Compulsive Personality Disorder (OCPD):     * Prevalence: Lifetime prevalence is estimated at $1\%$.     * Diagnostic Criteria (requires four of the following):         * Preoccupation with details, rules, and schedules to the point of losing the main point of activity.         * Perfectionism interfering with task completion.         * Excessive work devotion excluding leisure and friendships.         * Inflexible/overconscientious about morality/values (non-cultural/religious).         * Inability to discard worthless objects even without sentimental value.         * Reluctance to delegate unless others submit exactly to their methods.         * Miserly spending style (hoarding money for future catastrophes).         * Rigidity and stubbornness.     * Explanations:         * Psychodynamic: Overly-controlling or punitive parenting creates anxiety regarding "mess," leading to the opposite extreme of behavior.         * Cognitive-Behavioral: Excessive cognitive focus on details. Intervention involves "experiments" to prove relaxation does not destroy productivity.", "title": "Personality and Personality Disorders: Exhaustive Clinical Guide"}