Lecture 14

Question 1

In order to diagnose a personality disorder, the person’s enduring pattern of behavior must be?

Answer 1

• Pervasive and inflexible
• Stable and of long duration
• The cause of clinically significant distress or impairment of functioning and be manifested in two of the following: cognition, affectivity, interpersonal functioning, or impulse control.

Question 2

why is there a problem to diagnosing personality disorders and what would be done to help in diagnosing them?

Answer 2

• There are difficulties dx personality disorders due to an overlap of criteria. When this happens, the clinician may put Personality Disorder, NOS, and the cluster (A B C) the individual shows criteria from

Question 3

What is Cluster A of personality disorders?

Answer 3

Odd or eccentric, with unusual behavior ranging from significant distrust of others without sufficient reason to social detachment.

• Paranoid personality
• disorder Schizoid personality
• disorder Schizotypal personality disorder

Question 4

What is Cluster B of personality disorders?

Answer 4

Dramatic, emotional and erratic.

• Antisocial personality disorder
• Histrionic personality disorder
• Narcissistic personality disorder
• Borderline personality disorder

Question 5

What is Cluster C of personality disorders?

Answer 5

Anxiety is the significant component.

• Dependent personality disorder
• Obsessive-compulsive personality disorder (This is NOT the same as obsessive compulsive disorder.)
• Avoidant personality disorder:

Question 6

What is antisocial personality disorder?

Answer 6

Antisocial personality disorder (ASPD) is a deeply ingrained and rigid dysfunctional thought process that focuses on social irresponsibility with exploitive, delinquent, and criminal behavior with no remorse

Question 7

What are some Pathological personality traits that can become apparent?

Answer 7

• Antagonism
• Disinhibition

Question 8

What are some significant impairments in personality functioning that can manifest?

Answer 8

• Identity: Ego-centrism; self-esteem derived from personal gain, power, or pleasure.
• Self-direction: Goal-setting based on personal gratification
• failure to conform to lawful or culturally normative ethical behavior.

Question 9

What are some impairments in interpersonal functioning?

Answer 9

• Empathy: Lack of concern for feelings, needs, or suffering of others
• Lack of remorse after hurting or mistreating another
• Intimacy: Incapacity for mutually intimate relationships, as exploitation is a primary means of relating to others, including by deceit and coercion; use of dominance or intimidation to control others.

Question 10

What is the age of onset for Antisocial personality disorder?

Answer 10

Though typically antisocial personality disorder isn’t diagnosed before age 18, some signs and symptoms may occur in childhood or
the early teen years. Usually there is evidence of conduct disorder symptoms before age 15

Question 11

What is the ASP Antagonism Dimension of Manipulation?

Answer 11

Frequent use of subterfuge to influence or control others; use of seduction, charm, glibness, or ingratiation to achieve one’s ends.

Question 12

What is the ASP Antagonism Dimension of Deceit?

Answer 12

Dishonesty and fraudulence; misrepresentation of self; embellishment or fabrication when relating events.

Question 13

What is the ASP Antagonism Dimension of Callous?

Answer 13

Lack of concern for feelings or problems of others; lack of guilt or remorse about the negative or harmful effects of one’s actions on others; aggression; sadism.

Question 14

What is the ASP Antagonism Dimension of Hostility?

Answer 14

Persistent or frequent angry feelings; anger or irritability in response to minor slights and insults; mean, nasty, or vengeful behavior.

Question 15

What is the ASP Disinhibition Dimension of Irresponsibility

Answer 15

Disregard for and failure to honor financial and other obligations or commitments; lack of respect for and lack of follow through on agreements and promises.

Question 16

What is the ASP Disinhibition Dimension of Impulsivity

Answer 16

Acting on the spur of the moment in response to immediate stimuli; acting on a momentary basis without a plan or consideration of outcomes; difficulty establishing and following plans.

Question 17

What is the ASP Disinhibition Dimension of Risk Taking

Answer 17

Engagement in dangerous, risky, and potentially self-damaging activities, unnecessarily and without regard for consequences; boredom proneness and thoughtless initiation of activities.

Question 18

What is the Interpersonal Factor of Psychopathy?

Answer 18

includes superficial charm, grandiosity, pathological lying and manipulation

Question 19

What is the Affective Factor of Psychopathy?

Answer 19

includes callousness, lack of remorse, shallowness and failure to accept responsibility

Question 20

What is the Impulsive Lifestyle Factor of Psychopathy?

Answer 20

that comprises impulsivity, sensation seeking and irresponsibility.

Question 21

What is the Antisocial Factor of Psychopathy?

Answer 21

involves general rule breaking

Question 22

What is Antisocial Personality Disorder like in Prison?

Answer 22

Antisocial personality disorder is common in prison settings. Surveys of prisoners worldwide indicate a prevalence of antisocial personality disorder of 47% for men and 21% for women.

Question 23

What are inhibitory control deficits

Answer 23

• Aggression is correlated with
  impulsivity.
• Behaving without thinking
• Quick decision making
• Failure to plan

Question 24

What is the treatment for those with inhibitory control deficits?

Answer 24

• Medication can help
  facilitate therapy.
• Less effective with APD patients.

Question 25

What is Borderline Personality Disorder?

Answer 25

- Borderline personality disorder (BPD) is a severe psychiatric disorder affecting about 3% of the adult population - Core features of BPD are affective dysregulation, identity disturbances and problems in social interaction, with an intense fear of loss, abandonment, or rejection by social partners

Question 26

What are some significant impairments in functioning that may manifest in those with BPD?

Answer 26

- Identity: Markedly impoverished, poorly developed, or unstable self-image, often associated with excessive self- criticism; chronic feelings of emptiness; dissociative states under stress. - Self-direction: Instability in goals, aspirations, values, or career plans.

Question 27

What are the pathological personality traits in BPD?

Answer 27

- Emotional lability: - Anxiousness - Separation insecurity - Hostility

Question 28

What are the Disinhibition traits in BPD?

Answer 28

- Impulsivity - Risk taking

Question 29

What was the BPD "Cyberball" Study?

Answer 29

Participants engage in an online ball-tossing game with partners who they believe to be co- participants, but in fact are pre- programmed virtual players

Question 30

What were the results of the Cyberball Study?

Answer 30

- In the ‘inclusion’ condition, all players receive the same number of ball tosses, whereas in the ‘exclusion’ condition the co-players stop tossing the ball to the subject, thereby excluding him from the game. - BPD patients felt more rejected than did healthy controls independent of the experimental conditions, i.e. they felt more rejected even when they were being equally included.

Question 31

Why is it difficult to treat BPD?

Answer 31

- Prone to feel slighted or insulted. - Research suggests even in situations they are treated fairly, they experience feelings of being treated unfairly. (Perception) - Intense, unstable, and conflicted close relationships, marked by mistrust, neediness, and anxious preoccupation with real or imagined abandonment, boundary breaching. - Test therapist’s frustration with a sense of entitlement. - Close relationships often viewed in extremes of idealizing the person and devaluing them with alternating between over involvement and withdrawal.

Question 32

What is the Transactional Model of Emotion Dysregulation Development

Answer 32

- Invalidating developmental environment. - Some individuals have a sensitive temperament that predisposes them to react with intense emotions or it’s a consequence of something that happened. - Caregivers don’t understand or allow these reactions or help with emotion management. - Doesn’t learn emotional regulation, how to label emotions and talk about them, how to cope with them etc. - Child becomes further dysregulated; caregiver becomes more frustrated, and it becomes a cycle of dysfunction into adult life. - Doesn’t advance goals. - Isn’t typically true. - Regret later when emotional arousal is attenuated. - Damage to relationships.

Question 33

What is Emotion Dysregulation?

Answer 33

Exaggerated or misattributed emotions lead to the maladaptive behaviors used to try to regulate emotions.

Question 34

What is the Treatment Focus of Stabilization & Skill Building?

Answer 34

- Assess & Reduce Life Threatening Behaviors - Reduce Therapy Interfering Behaviors - Reduce Quality of Life Interfering Behaviors - Increase Skills that Replace Ineffective Coping

Question 35

What are some Life Threatening Behaviors?

Answer 35

- Suicidal Ideation/Attempts - Superficial Attempts / Risky Behavior

Question 36

What are some Therapy Interfering behaviors?

Answer 36

- Missing sessions - not completing homework - behaviors that interfere with therapist’s motivation to treat client

Question 37

What are some Quality of Life inhibiting behaviors?

Answer 37

- Substance use - eating disordered behaviors - inability to sustain job, school etc.

Question 38

What is the Strategy of Problem solving?

Answer 38

- change-based - Analyzing behavior - committing to change - taking steps to change

Question 39

What is the Strategy of Validation?

Answer 39

- acceptance-based - Engaging client in understanding actions, emotions, and thoughts

Question 40

What are the 3 steps of the Validation Strategy?

Answer 40

1. Communicating to the patient that their responses make sense and are understandable within current life context. 2. Finding the kernel of truth in the patient’s perspective or situation. 3. Acknowledging causes of emotions, thoughts, and behaviors.

Question 41

True or false, Validation Decreases Negative Emotionality?

Answer 41

True: - Validation helps acclimation to stressful situations. - Invalidation leads to high negative emotionality.

Question 42

What is Distress Tolerance?

Answer 42

The ability to manage an emotional incident without feeling overwhelmed is called distress tolerance (Linehan, 2014).

Question 43

When are Distress Tolerance: Crisis Survival Skills used?

Answer 43

- When patient in a situation that is * Highly stressful * Short-term * Creating intense pressure to resolve the crisis now - AND * Acting on emotions and urges will make things worse * cannot make things better right away * must temporarily tolerate painful events and emotions

Question 44

When are Distress Tolerance: Crisis Survival Skills not to be used?

Answer 44

- Everyday use - Solving all of life’s problems - Making life worth living

Question 45

What is Dialectical Behavioral Therapy (DBT)?

Answer 45

Post Dialectical behavioral therapy (DBT) - attenuated amygdala hyperactivity which correlated with changes in a measure of emotion regulation and increased use of emotion regulation strategies.

Question 46

What is the effectiveness of DBT?

Answer 46

- Multiple randomized controlled studies have shown effectiveness of this therapy for emotion regulation difficulties. - Also effective for PTSD. - Comprehensive DBT shows robust results with BPD. - Medication is typically a part of the beginning of TX.