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63 Cards in this Set
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Livesley and colleagues |
inability to come up with an adaptive solutions to life tasks DSM-5 reflects "adaptive failure" in terms of impaired self-idenitty and adaptive failure in establishing interpersonal relationships |
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Life tasks: personality disorders occur when there is a failure to manage these life tasks |
1. To form stable, integrated and coherent representations of self and others (to see your self and others as they really are) 2. To develop capacity for intimacy (to have positive inter-relationships) 3. To engage in prosocial and cooperative behaviours (to function adaptively in society) |
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Millon’s Perspective Criteria that distinguish ‘normal’ vs. ‘disordered’ personality: |
1. Rigid and inflexible
2. Self defeating, vicious cycle that perpetuate troubled ways of thinking and behaving 3. Structural instability, fragility, ‘cracking’ under stress |
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First > Millon |
disordered personality in indicated by ridged and inflexible behaviour
afflicted person has difficulty altering his/her behaviour according to changing situations |
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Second > Million |
the person engages in self defeating behaviour that fosters vicious cycles behaviour and cognitions exacerbate exiting conditions >self-defeating behaviour removes us further from our goals rather then closer |
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Third > Milion |
structural instability
fragility of the self that cracks under stress ex: student who functions well in the first part of the term and then cracks and loses inability to cope at the latter half when deadlines become closer |
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Personality Disorders (PD) |
heterogeneous group of disorders that are regarded as long-standing , pervasive and inflexible patterns of behaviour and inner experience that deviate from the expectations of a person's culture and that impair social and occupational functioning some cause emotional distress |
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General Personality Disorder |
new DSM category that reflects establishing whether a personality disorder first exists in general and then evaluating whether the criteria of a specific personality can also be applied |
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Personality Disorders DSM-5 |
Eliminated Axis II (DSM-IV-TR) Considered dimensional approach, which is described as an ‘alternative model’ in DSM-5 Section III |
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Dimensional perspective |
disordered personality reflects extreme levels of tendencies (traits) Not fully adopted in DSM-5, remains a proposal |
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DSM-5 criteria for General Personality Disorder A-C |
A. inner pattern and behaviour that deviates from expectations of ones culture
1. cognition 2. affectivity 3. interpersonal functioning 4. impluse control B. inflexible and pervasive across personal and social situations C. causes clinically sig digress |
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DSM-5 General Personality Disorder Criteria continued D-F |
D. stable, long duration, onset traced to adolescence or early adulthood E. not better explained by other mental disorderF. NOT attributed to physiological effects, substance or other medical condition |
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PersonalityDisorder ClustersDSM-5 |
Cluster A > Paranoid, Schizoid, and Schizotypal - Oddness and avoidance of social contact Cluster B > Anti-social, Borderline, Histrionic, and Narcissistic - Dramatic, emotional, or erratic - Extrapunitive and hostile Cluster C > Avoidant, Dependent, and Obsessive-Compulsive - fearful |
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Cluster A: Odd/Eccentric Cluster |
Paranoid Schizoid Schizotypal - Oddness and avoidance of social contact |
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Cluster A ParanoidPersonality Disorder Characteristics |
- Suspicious of others - Expect to be mistreated or exploited by others - Reluctant to confide in others - Tend to blame others - Can be extremely jealous most common in men |
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Cluster A Paranoid Personality Disorder Differential Diagnosis and Comorbidity |
- hallucinations and full-blown delusions are not present - less impairment in social and occupational functioning than paranoid schizophrenia Comorbid with schizotypal, avoidant, and paranoid personality disorders • |
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Cluster A SchizoidPersonality Disorder Characteristics |
- No desire for or enjoyment of social relationships - Appear dull, bland, and aloof - Rarely report strong emotions - Have no interest in sex - Experience few pleasurable activities - Indifferent to praise and criticism - Loners with solitary interests |
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Cluster A Schizoid Personality Disorder Prevalence and Comorbidity |
< 1% Slightly more common in men Comorbid with schizotypal, avoidant, and paranoid personality disorders |
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Cluster A Schizotypal Personality Disorder Characteristics |
Similar interpersonal difficulties (social detachment and restricted affect) of schizoid personality Key schizotypal features: - eccentric thinking (considered identical to prodromal and residual phases of schizophrenia) - Odd beliefs or magical thinking (e.g., belief they have telepathic powers) - Recurrent illusions (e.g., sense the presence of a force not actually there) - Odd speech (using words in unusual or unclear fashion) - Ideas of reference (misinterpret event as having particular personal meaning) - Suspiciousness, Paranoid ideation, Eccentric behaviour and appearance |
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Cluster A Schizotypal Personality Disorder Prevalence |
3% Slightly more frequent men Comorbidity is higher than any other personality disorder Comorbid with borderline, avoidant and paranoid personality disorders |
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EtiologyOdd/Eccentric Cluster |
Based upon family study research Possible genetic links to schizophrenia - Considered less severe variants of Could be linked to a history of PTSD and childhood maltreatment |
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Cluster B: Dramatic/ErraticCluster |
Anti-social Borderline Histrionic Narcissistic - Dramatic, emotional, or erratic - Extrapunitive and hostile |
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Cluster B BorderlinePersonality Disorder(BPD) |
Term: originally – ‘borderline’ between neurosis and schizophrenia but DSM no longer has this sense |
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Cluster B Borderline Personality Disorder (BPD) Characteristics |
- impulsivity and instability in relationships, mood, and self-image - Attitudes and feelings toward others vary dramatically - Emotions are erratic and can shift abruptly - Argumentative, irritable, sarcastic, quick to take offence, etc. |
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Cluster B Borderline Personality Disorder (BPD) Prevalence |
1 to 2% more common in women than in men Comorbid with mood disorder, substance abuse, PTSD, eating disorders, and Cluster A PDs |
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Etiology of BPD Object-relations theory |
inconsistent parental love causes insecure ego development |
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Etology of BPD Runs in families/Genetic |
heritablitity ranged from 37-69% 3-4X greater likelihood of being diagnosed |
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poor functioning of the frontal lobes |
may play a role in impulsive behaviours
over activation in the insula and posterior cingulate cortex under activation across a region that stretches from the amygdala to the dorsolateral prefrontal cortex |
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Linehan’s diathesis-stress theory cycle |
emotional dysregulation in the child
> great demands on the family > invalidation by parents through punishment or ignoring demands > emotional outbursts by child to which parent attends > cycle starts again |
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Cluster B HistrionicPersonality Disorder Characteristics |
- Overly dramatic and attention-seeking - Use physical appearance to draw attention - Display emotion extravagantly - Self-centred - Overly concerned with their attractiveness - Inappropriately sexually provocative and seductive - Speech may be impressionistic and lacking in detail |
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Cluster B Histrionic Personality Disorder Prevalence |
2 to 3% More common among women than among men Comorbid with depression and BPD |
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Etiology : Histrionic PD Psychoanalytic theory |
seductiveness encouraged by parental upbringing Family environment: talked about sex as ‘dirty’ but behaved as if exciting |
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Cluster B NarcissisticPersonality Disorder Characteristics |
- Grandiose view of own uniqueness and abilities - Preoccupied with fantasies of great success - Require almost constant attention and excessive admiration - Lack empathy - Envious of others - Arrogant, exploitive, entitled |
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Cluster B Narcissistic Personality Disorder Prevalence and Comorbidity |
< 1% Comorbid with BPD |
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Etiology Kohut view of emerging self: |
immature grandiosity and dependent over-idealization of others – failure to develop healthy self-esteem Product of our times and system of values? |
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Cluster B AntisocialPersonality Disorder (APD) two main components: comorbid with SU |
1. Conduct disorder present before age 15 (i.e., truancy, running away from home, theft, arson) 2. Pattern of anti-social behaviour continues into adulthood -Irresponsible and anti-social behaviour - Work only inconsistently - Break laws - Physically aggressive |
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Psychopathy is related to APD butemphasizes psychological (thoughts and feelings) not just behaviouralaspects: |
- lack of remorse (‘without conscience’), no sense of shame - superficially charming - manipulates others for own personal gain, exploits people - thrill seeking All psychopaths are diagnosed with APD but many with APD do not meet the criteria for psychopathy |
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Hare (1996) Pcyhopathy Checklist |
killers who were not simply persistently antisocial; they were remorseless predators, used charm, intimidation and cold-blooded violence to achieve their ends - 20% of people with APD score higher on the Hare Psychopathy Checklist - 75 to 80% of convicted felons meet criteria for APD but only 15 to 25% of convicted felons meet criteria for psychopathy |
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Etiologyof APD and Psychopathy PCL-Rdistinguishes psychopathic children and youth from those without psychopathy |
Psychopathic personality in adolescence predicts antisocial behaviour in adulthood Children with psychopathic traits show abnormal prefrontal cortex responsiveness |
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•Etiologyof APD and Psychopathy (cont.) Roleof the Family:
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- Lack of affection - Severe parental rejection - Physical abuse - Inconsistencies in disciplining - Failure to teach child responsibility toward others |
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Limitations to research findings on family role in ASP and psychopathy |
1. Harsh or inconsistent disciplinary practices could be reactions child’s anti-social behaviour 2. Many individuals who come from disturbed backgrounds do not become psychopaths |
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Etiologyof APD and Psychopathy (cont.) GeneticCorrelates of APD |
Criminality and APD have heritable components - higher concordance for MZ compared to DZ twin pairs |
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Environmental influences: |
Increased parental conflictand increased negativity decrease parental warmth predict antisocial behaviours Familieswithout antisocial tendencies may become harsh in their disciplining inreaction to the child with antisocial tendencies |
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Etiologyof APD and Psychopathy Emotionand Psychopathy |
Unresponsive to punishments / no conditioned fear responses - higher skin conductance in resting situations - higher skin conductance is less reactive when confronted or anticipate intense or aversive stimuli - normal heart rate under resting conditions but decreased heart rate when anticipating intense or aversive stimuli |
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Etiology of APD and Psychopathy Response Modulation, Impulsivity, and Psychopathy |
Slow brain waves and spikes in the temporal area Less activity in the amygdala/hippocampal formation Decreased prefrontal activity |
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Cluster C: Anxious/FearfulCluster |
Avoidant Dependent Obsessive-Compulsive - fearful |
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Cluster C AvoidantPersonality Disorder Characteristics |
- fearful in social situations - sensitive to possibility of criticism, rejection, or disapproval - reluctant to enter relationships unless sure will be liked |
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Cluster C Avoidant Personality Disorder Comorbidity |
Comorbid with dependent personality disorder, depression and generalized social phobia |
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Cluster C DependentPersonality Disorder Characteristics |
- Lack self-reliance - Overly dependent on others (sense of autonomy) - Intense need to be taken care of - Uncomfortable when alone - Subordinate own needs |
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Cluster C Dependent Personality Disorder Comorbidity |
Comorbid with bipolar disorder, depression, anxiety disorders, and bulimia Culture-laden? Connecting with others is more valued in collectivistic cultures (such as East Asia) compared with North American individualism |
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Cluster C Obsessive-CompulsivePD Characteristics |
- Perfectionistic approach to life - Preoccupied with details, rules, schedules, etc. - - Serious, rigid, formal, and inflexible - Unable to discard worn out and useless objects |
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Cluster C Obsessive-Compulsive PD Differential Diagnosis |
Obsessive Compulsive Personality Disorder (OCPD) does not have the obsessions and compulsions that define Obsessive Compulsive Disorder (OCD) |
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Cluster C Obsessive-Compulsive PD Comorbidity |
Comorbid with OCD (20%), panic disorder, depression, and avoidant personality disorder |
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Etiologyof Cluster C |
•Not much is known about causes for personality disorders in this cluster - Speculation focused on parent-child attachment relationships Psychoanalytic theories: OCPD traits due to fixation at anal stage of psychosexual development |
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Therapyfor personality disorders |
Schema therapy uses CBT approach to examine logical errors and dysfunctional attitudes |
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Therapies for borderline personality disorder (BPD) |
individuals with borderline personality disorder have troubles establishing trust alternatively idealize then vilify therapist, |
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These two approaches are used: 1. Object-relations therapy for BPD |
Strengthening client’s weak ego Reducing ‘splitting’ |
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2. Dialectical behaviour therapy for BPD |
Combines client-centred acceptance with a cognitive-behavioural focus Challenge dichotomous (‘black and white’) thinking teach assertiveness and emotion regulation |
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Therapyfor Psychopathy Psychopathyis virtually impossible to treat |
Psychopaths do not benefit from psychotherapy They are unable to form trusting, honest relationships with therapists Biological treatments are also mainly ineffective - large doses of anti-anxiety medication are used to reduce hostility |
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Linehan's Diathesis-stress theory of BPD |
BPD develops when a biological diathesis (genetic) for having difficulty controlling their emotions are raised in a family environment that is invalidating two main factors interact > dysregulation and invalidation |
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emotional dysregulation |
can interact with experiences that invalidate the child, leading to the development of a borderline personality |
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invalidating environment |
environment in which a person's wants and feelings are disregarded and efforts to communicate one's feelings are disregarded or even punished extreme> abuse sexual or non |
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Abuse and BPD |
more common among ppl with BPD then amongst those diagnosed with other disorders exception dissociative identity disorder > high rates of abuse as well |