Abnormal Psychology by Kring, Davison, Neale & Johnson (12th edition) - a summary
- 7388 reads
Clinical psychology
Chapter 15
Personality disorders
The personality disorders are a heterogeneous group of disorders defined by problems in forming a stably positive sense of self and with sustaining close and constructive relationships.
People with personality disorders experience difficulties with their identity and their relationship in multiple domains of life, and these problems are sustained for years.
Their personality problems are evident in cognition, emotion, relationships, and impulsive control. The symptoms of personality disorders are pervasive and persistent.
The DSM-5 approach to classification
In the DSM-5, the 10 different personality disorders are classified in three clusters, reflecting the idea that these disorders are characterized by:
Many people with psychological disorder will also experience a personality disorder.
Comorbid personality disorder are associated with more severe symptoms, poorer social functioning, and worse treatment outcomes for may conditions.
Diagnostic reliability
Using structured interviews and multiple informants can improve reliability.
Comorbidity
Personality disorders tend to be comorbid with each other.
Alternative DSM-5 model for personality disorders
Reducing the number of personality disorders, incorporating personality trait dimensions, and diagnosing personality disorders on the basis of extreme scores on personality trait dimensions.
Two types of dimensional scores
Key strengths:
Alternative DSM-5 criteria for Personality disorder
Odd/eccentric cluster includes:
Paranoid personality disorder
DSM-5 criteria for Paranoid personality disorder
People with paranoid personality disorder are suspicious of others.
Suspicion influences relationships.
They expect to be mistreated or exploited and thus are secretive and continually on the lookout for signs of trickery and abuse. They are often hostile and react angrily to perceived insults.
Other symptoms of schizophrenia are not present and there is less impairment in social and occupational functioning.
Full-blown delusions are not present.
Co-occurs most often with schizotypical, bordeline, and avoidant personality disorders.
Schizoid personality disorder
DSM-5 criteria for Schizoid personality disorder
People with schizoid personality disorder do not desire or enjoy social relationships and usually have no close friends.
They rarely experience strong emotions.
Comorbidity is highest for schizotypical, avoidant, and paranoid disorders.
Schizotypal personality disorder
DSM-5 criteria for Schizotypal personality disorder
Schizotypal personality disorder is defined by unusual and eccentric thoughts and behavior, interpersonal detachment, and suspiciousness.
Some people diagnosed with schizotypal personality disorder develop more severe psychotic symptoms over time, and a small portion do develop schizophrenia over time.
Etiology of the personality disorders in the Odd/eccentric cluster
Highly heritable.
The genetic vulnerability of schizotypal personality disorder appears to overlap with the genetic vulnerability for schizophrenia.
They also have deficits in cognitive and neuropsychological functioning that are similar but milder than those seen in schizophrenia.
They also have enlarged ventricles and less temporal lobe gray matter.
Among people with schizotypal personality disorder who do not have a family history of schizophrenia, early trauma and adversity are commonly reported.
The disorders in the dramatic/erratic cluster are:
They are characterized by symptoms that range from highly inconsistent behavior to inflated self-esteem, exaggerated emotional displays, and rule-breaking behavior.
Antisocial personality disorder and psychopathy
Antisocial personality disorder: Clinical description
Antisocial personality disorder (APD) involves a pervasive pattern of disregard for the rights of others.
The person with APD is distinguished by aggressive, impulsive, and callous traits.
People with APD show irresponsible behavior. They show little regard for truth and little remorse for their misdeeds.
APD is observed much more frequently among men than women.
Higher among younger than among older adults.
DSM-5 criteria for Antisocial personality disorder
Psychopathy: Clinical description
One of the key characteristics is poverty of emotions.
Etiology of antisocial personality disorder and psychopathy
Genetic factors
Genetic risk for APD, psychopathy, conduct disorder, and substance use appear to be related.
A person might inherit a general vulnerability for these types of symptoms, and then environmental factors might shape which of the symptoms evolve.
Social factors: Family environment and poverty
High negativity, low warmth, and parental inconsistency predict antisocial behavior.
The family environment might be particularly important when a child has an inherent tendency toward antisocial behavior.
Social factors, including poverty and exposure to violence, predict antisocial behavior in children, even when the children are not genetically at risk for APD.
Fearlessness
An inability of people with psychopathy to profit from experience or even from punishment. People with psychopathy fail to learn from punishment because they are fearless.
People with psychopathy fail to show classical conditioning to aversive stimuli at a very basic level.
Impulsivity
People with psychopathy may be unresponsive to threats when they are pursuing rewards. Part of this deficit might be overcome by slowing the person down so that he or she attend to the signals of treat.
People with psychopathy have less gray matter in the prefrontal cortex.
Deficits in empathy driving unresponsiveness to other’s victimization
Some features of psychopathy arise from a lack of empathy.
Borderline personality disorder
BPD is very common in clinical settings, is very hard to treat, and associated with suicidality.
Clinical descriptions of borderline personality disorder
DSM-5 criteria for Borderline personality disorder
The core features of borderline personality disorder are impulsivity and instability in relationships and mood.
Suicidal behavior is a particular concern in BPD. People with BPD are also particularly likely to engage in non-suicidal self-injury.
Over a 10 to 15 year period, about three-quarters of people with BPD stabilize and so no longer meet diagnostic criteria.
People with BPD are highly likely to have comorbid posttraumatic stress disorder or mood disorders.
They are also at risk for comorbid substance-related disorders and eating disorders, as well as schizotypal personality disorder.
Etiology of borderline personality disorder
Neurobiological factors
Biological factors seem to be quite important in the development of BPD.
Genetic factors .
Lower serotonin function.
Other vulnerabilities may contribute to the components of emotion dysregulaton or impulsivity, rather than to the disorder as a whole.
Increased activation of the amygdala.
Low levels of activity and structural changes in the prefrontal cortex and the anterior cingulate cortex. Connectivity between the prefrontal cortex and the amygdala seems to be disrupted.
Social factors: childhood abuse
People with BPD are much more likely to report a history of parental separation, verbal abuse, and emotional abuse during childhood than are people diagnosed with other personality disorders.
Dissociation is caused by extreme stress of childhood abuse.
Linehan’s diathesis-stress theory
BPD might develop when people who have difficulty controlling their emotions because of a biological diathesis are raised in a family environment that is invalidating.
In a invalidation environment, the person’s feelings are discounted and disrespected. An extreme form of invalidation is child abuse.
Emotion dysregulation and invalidation interact with each other in a dynamic fashion.
Histrionic personality disorder
DSM-5 criteria for Histrionic personality disorder
The key feature of histrionic personality disorder is overly dramatic and attention-seeking behavior.
Self-centered, overly concerned with their physical attractiveness, and uncomfortable when not the center of attention.
They can be inappropriately sexual provocative and seductive and are easily influenced by others.
They speech is often impressionistic and lacking in detail.
Highly comorbid with depression, borderline personality disorder, and medical problems.
Etiology of Histrionic personality disorder
The emotional display and seductiveness are encouraged by parental seductiveness.
Narcissistic personality disorder
DSM-5 criteria for Narcissistic personality disorder
People with narcissistic personality disorder have a grandiose view of their abilities and are preoccupied with fantasies of great success.
They require almost constant attention and excessive admiration.
Interpersonal relationships are disturbed by their lack of empathy, arrogance to other coupled with feelings of envy, their habit of taking advantage of others and feelings of entitlement.
Etiology of narcissistic personality disorder
Self-psychology model
The characteristics of narcissistic personality disorder may mask a very fragile self-esteem.
Two parenting dimensions would increase the risk of narcissism: emotional coldness and an overemphasis of the child’s achievements.
Social-cognitive model
Built around two basic ideas
Includes:
People with these disorders are prone to worry and distress
Avoidant personality disorder
DSM-5 criteria for Avoidant personality disorder
People with avoidant personality disorder are so fearful of criticism, rejection, and disapproval that they will avoid jobs or relationships to protect themselves from negative feedback.
Avoidant personality disorder often co-occurs with social anxiety disorder, and major depression. Also borderline personality disorder, schizotypal personality disorder, and alcohol abuse.
Heritable (a bit)
The genetic vulnerability to social anxiety disorder overlap with vulnerability to avoidant personality disorder.
And early childhood experiences.
Dependent personality disorder
DSM-5 criteria for Dependent personality disorder
The core features of dependent personality disorder are an overreliance on others and a lack of self-confidence.
Dependent personality disorder often co-occurs with borderline, schizoid, histrionic, schizotypal, and avoidant personality disorders, as well as mood disorders, anxiety disorders, and bulimia.
Dependent personality disorder may result from an overprotective and authoritarian parenting style that prevents the development of feelings of self-efficacy.
Obsessive-compulsive personality disorder
DSM-5 criteria for Obsessive-compulsive personality disorder
The person with obsessive-compulsive personality disorder is a perfectionist, preoccupied with details, rules, and schedules. They often pay so much attention to detail that they fail to finish projects.
They are more oriented toward work than pleasure.
Often co-occurs with obsessive-compulsive disorder and avoidant personality disorder.
Many people with personality disorders enter treatment for a condition other than their personality disorder.
Personality disorders predict slower improvement in psychotherapy.
General approaches to the treatment of personality disorders
Psychodynamic therapist aim to alter the patient’s present-day views of the childhood problems assumed to underlie the personality disorder.
In cognitive therapy of personality disorders, they apply the same kind of analysis used in the treatment of depression. Each disorder is analyzed in terms of negative cognitive beliefs that could help explain the pattern of symptoms.
Treatment of schizotypal personality disorder, avoidant personality disorder, and psychopathy
Treatments for schizotypal personality disorder draw on the connections of this disorder with schizophrenia.
Antipsychotic drugs have shown effectiveness with schizotypal personality disorder.
Avoidant personality disorder appears to respond to the same treatments that are effective for those with social anxiety disorder.
Antidepressant medication as well as cognitive behavioral treatment can be helpful.
Group versions of cognitive behavioral treatment have been found to be helpful and may offer chances to practice constructive social interactions in a safe environment.
Psychoanalytic psychotherapy with psychopathy was found to be helpful in domains such as improving interpersonal relationships, increasing the capacity for feeling remorse and empathy, reducing the amount of lying, being released from probation, and holding down a job.
Similar for cognitive behavioral therapy.
To be at all effective, treatment had to be quite intensive.
Treatment of borderline personality disorder
Dialectical behavior therapy of borderline personality disorder
Dialectical behavior therapy (DBT), combines client-centered empathy and acceptance with cognitive behavioral problems solving, emotion-regulation techniques, and social skills training.
The cognitive behavioral aspect of DBT involves four stages
Mentalization-based therapy of borderline personality disorder
Mentalization-based therapy is a form of psychodynamic treatment developed for BPD.
Foster a more active, thoughtful approach to relationships and feelings.
Schema-focused cognitive therapy of borderline personality disorder
Enriches traditional cognitive therapy with a broader focus on how early childhood antecedents and parenting shape current cognitive patterns.
The therapists and the patient work to identify the maladaptive assumptions that a client holds about relationships from his or her early experiences.
Join with a free account for more service, or become a member for full access to exclusives and extra support of WorldSupporter >>
This is a summary of Abnormal Psychology by Kring, Davison, Neale & Johnson. This summary focuses on clincal psychology and mental health. Discussed are etliolgies of disorders and treatments.
There are several ways to navigate the large amount of summaries, study notes en practice exams on JoHo WorldSupporter.
Do you want to share your summaries with JoHo WorldSupporter and its visitors?
Main summaries home pages:
Main study fields:
Business organization and economics, Communication & Marketing, Education & Pedagogic Sciences, International Relations and Politics, IT and Technology, Law & Administration, Medicine & Health Care, Nature & Environmental Sciences, Psychology and behavioral sciences, Science and academic Research, Society & Culture, Tourisme & Sports
Main study fields NL:
JoHo can really use your help! Check out the various student jobs here that match your studies, improve your competencies, strengthen your CV and contribute to a more tolerant world
3776 |
Add new contribution