WEEK 8

Question 1

What is personality?

Answer 1

Personality refers to enduring and persistent patterns of
thinking and behaviour that define a person that distinguishes them from others. It is a unique pattern of
traits that characterise an individual.

patters of
–expressing emotion
–feeling
–behaving
–thinking about ourselves and other people – i.e. our
representations
–relating to others

Question 2

Challenges of personality

Answer 2

Personality usually facilitates interactions with others–but some patterns of behaviour, emotion, thought etc (our tendencies) - can bring us into conflict with others.

EG: When does assertiveness benefit and advantage us – when is it an asset? – Can it also create challenges when we try to relate to others?

Question 3

What is abnormal personality

Answer 3

• Dysfunctional personality marked by rigidity/inflexibility, narrow range of responses
• Impacting on identity and self direction and interpersonal relationships (empathy and intimacy)

–May bring a person into conflict with others; exacerbate conflict
–Impede connectedness
–Undermine problem resolution

Question 4

Did personality disorders change much from the DSM 4 to the DSM 5?

Answer 4

Considerable debate in the lead up to DSM 5 – BUT
largely unchanged from DSM-IV to DSM-5

DSM-5 kept the same categorical system as DSM-IV (little change).

Many experts believe personality disorders aren’t separate categories, but exist on a continuum.

DSM-5 considered a dimensional model, but experts couldn’t agree on how to do it, so it stayed categorical

Question 5

Why are PD difficult to dignose?

Answer 5

PD’s have high risk for misdiagnosis/relatively low interrater reliability.

Lots of overlap between personality disorders (PDs) and with other disorders (e.g. anxiety, mood).

PDs don’t fit neatly into major personality models — many more patterns exist than the 10 DSM types.

Big differences within each category (people with the same PD can look very different).

DSM categories describe symptoms, but don’t explain causes — causes of PDs are still unclear.

Gender bias exists in diagnosis.

PDs are often ego-syntonic (feel normal to the person, so they may not see a problem).

Question 6

General criteria for a Personality Disorder

Answer 6

• An enduring pattern of inner experience and behaviour that deviates markedly from the expectations of the individual’s culture
• Manifests in two (or more) of the following areas:
  1. Cognition (i.e., ways of perceiving & interpreting self, other people, & events).

2. Affectivity (i.e., the range, intensity, lability, & appropriateness of emotional responses).
3. Interpersonal functioning.
4. Impulse control.

PLUS
* Inflexible and pervasive across personal and social situations
* Causes clinically significant distress or impairment
* The pattern is stable and of long duration -onset in adolescence or early adulthood.

Question 7

PDs can be understood as maladaptive variations in the following aspects:

(PD is a variation to the usual in one of these three aspects)

Answer 7

• Social motivation
• Cognitive perspectives regarding self and others
• Temperament and personality traits

Question 8

How many categories of PD are there in the DSM?

Answer 8

10

Question 9

How are personality disorders clustered/distinguished in the DSM?

Answer 9

Separated into 3 clusters characterised by descriptive
similarities

–Cluster A – social detachment, eccentric/odd
–Cluster B – emotional, erratic, dramatic
–Cluster C – anxious, fearful

Question 10

What diagnosis’s are in cluster A

Answer 10

–Schizotypal personality disorder
–Schizoid personality disorder
–Paranoid personality disorder

Question 11

What diagnosis’s are in cluster B

Answer 11

–Borderline personality disorder
–Histrionic personality disorder
–Narcissistic personality disorder
–Antisocial personality disorder

Question 12

What diagnosis’s are in cluster C

Answer 12

–Avoidant personality disorder
–Obsessive compulsive personality disorder
–Dependent personality disorder

Question 13

What is Schizotypal personality disorder

Answer 13

Main traits: Social discomfort, odd thoughts/behaviours, and eccentric appearance.

Starts early, seen in many situations.

Key features (need 5+):
Odd beliefs or magical thinking (e.g. telepathy, sixth sense).
Unusual perceptions or body illusions.
Strange speech or thinking (vague, metaphorical).
Suspicious/paranoid ideas.
Inappropriate or flat affect.
Eccentric behaviour or appearance.
Few close friends.
Strong social anxiety tied to paranoia, not low self-esteem.

Not due to schizophrenia, bipolar/psychotic disorders, or autism.

Question 14

What is Schizoid personality disorder

Answer 14

Main traits: Detached, prefers being alone, limited emotions.

Starts early and seen in many settings.

Key features (need 4+):
No desire for close relationships or family.
Chooses solitary activities.
Little interest in sex or pleasure.
Few friends, indifferent to praise/criticism.
Emotionally flat or distant.
Not due to schizophrenia, mood/psychotic disorders, or autism.

Question 15

What is Paranoid personality disorder (diagnostic criteria)

Answer 15

-Main feature: Constant distrust and suspicion of others — believes people have bad motives.

Starts early and occurs across many situations.

Common signs (need 4+):
- Thinks others are out to harm or deceive them.
- Doubts friends’ loyalty or trustworthiness.
- Won’t confide in others – fears info will be used against them.
- Reads threats or insults into innocent comments.
- Holds grudges, can’t forgive.
- Feels attacked easily and reacts with anger.
- Jealous/suspicious of partner’s fidelity.

Not due to schizophrenia, bipolar, depression with psychosis, or a medical condition

Question 16

What is Antisocial Personality disorder (diagnostic criteria)

Answer 16

Main traits: Disregard for others’ rights, rules, and laws.

Since age 15, person shows 3+ of:
Breaks laws/repeated arrests.
Lies or cons for gain.
Impulsive, poor planning.
Aggressive/fights often.
Reckless about safety.
Irresponsible with work or money.
Lacks remorse or guilt.
Must be 18+ years old.
Must have Conduct Disorder before 15.

Not due to schizophrenia or mania.

Question 17

What’s the difference between Psychopathy & antisocial behaviour

Answer 17

psychopathy has two key components:

Emotional/Interpersonal traits – e.g. charm, manipulation, lack of empathy or guilt.

Social deviance traits – e.g. impulsivity, irresponsibility, rule-breaking.

Psychopathy = both emotional/interpersonal + social deviance features.

ASPD (Antisocial Personality Disorder) = mainly reflects the social deviance factor (behavioural problems, not emotional ones).

Question 18

What is BPD (diagnostic criteria)

Answer 18

Key feature:
– Ongoing instability in relationships, self-image, and emotions, with impulsivity.
– Begins by early adulthood.

Main signs (5+):
Fear of abandonment (real or imagined).
Unstable, intense relationships – swings between idealising & devaluing others.
Unstable self-image or sense of identity.
Impulsivity (spending, sex, drugs, driving, eating).
Suicidal or self-harming behaviour.
Rapid mood changes (anger, anxiety, depression).
Chronic emptiness.
Intense, inappropriate anger.
Brief paranoia or dissociation under stress.

Question 19

What is histrionic personality disorder (criteria)

Answer 19

Core pattern:
– Excessive emotionality and attention-seeking, starting by early adulthood.

Main traits (5+):
Uncomfortable when not the centre of attention.
Sexually provocative or flirtatious behaviour.
Rapidly shifting, shallow emotions.
Uses appearance to gain attention.
Vague, dramatic speech lacking detail.
Theatrical, exaggerated emotions.
Easily influenced by others.
Overestimates closeness of relationships.

Question 20

What is narcissistic personality disorder (criteria)

Answer 20

Core pattern:
– Grandiosity, need for admiration, and lack of empathy, starting by early adulthood.

Main traits (5+):
Inflated self-importance and exaggeration of achievements.
Fantasies of unlimited success, power, beauty, or ideal love.
Believes they’re special/unique and deserve elite treatment.
Craves admiration and attention.
Entitled and expects special treatment.
Exploits others for personal gain.
Lacks empathy for others’ feelings or needs.
Envious or believes others envy them.
Arrogant, haughty behaviour or attitude.

Question 21

What is Avoidant personality disorder (criteria)

Answer 21

Core pattern:
– Social inhibition, feelings of inadequacy, and fear of rejection, starting by early adulthood.

Key traits (need 4+):
Avoids social or work activities due to fear of criticism/rejection.
Won’t get close unless sure of being liked.
Holds back in relationships out of fear of shame or ridicule.
Preoccupied with criticism or rejection.
Feels inadequate or socially inept.
Low self-esteem and sees self as inferior.
Avoids risks/new activities in case of embarrassment

Question 22

Difference between Social Anxiety [Social phobia] and Avoidant Personality disorder AvPD

Answer 22

SAD: avoids specific situations (e.g., public speaking, performance).

Can have friends and feel comfortable with familiar people.

AvPD: shows broader avoidance — avoids intimacy and close relationships in general.

More pervasive fear of rejection and social contact

SAD = situational avoidance.
AvPD = global, relationship avoidance.

Question 23

What is dependant personality disorder (criteria)

Answer 23

Core pattern:
– Excessive need to be cared for, leading to clingy, submissive behaviour and fear of separation.

Key traits (need 5+):
Needs reassurance to make decisions.
Lets others take responsibility for their life.
Avoids disagreement to keep approval.
Can’t start tasks alone (low confidence).
Goes to extremes to gain support.
Feels helpless or anxious when alone.
Seeks new relationships quickly after one ends.
Fears abandonment or being left to cope alone

Question 24

What is Obsessive Compulsion personality disorder (criteria)

Answer 24

Core pattern:
– Preoccupation with order, perfection, and control at the cost of flexibility and efficiency.

Key traits (need 4+):
Overfocused on rules, lists, and order — loses sight of the goal.
Perfectionism interferes with completing tasks.
Overworks, neglecting leisure or relationships.
Rigid morals and inflexible values.
Can’t discard useless items.
Won’t delegate unless others do things their way.
Stingy with money; hoards for “future crises.”
Rigid and stubborn.

Question 25

How is Obsessive Compulsion personality disorder different to OCD

Answer 25

* Rigidity/rule bound behaviours are prescribed to because of the belief that they are the best person to control things * Often do not describe subjective feelings of anxiety * Having control does not relieve distress/anxiety as in OCD * OCPD is typically ego-syntonic, whereas OCD is usually ego-dystonic OCPD is Ego-syntonic = feels right or natural to the person. → The thoughts and behaviours fit with their self-image and values. OCD is Ego-dystonic = feels wrong or distressing to the person. → The person sees their thoughts/behaviours as unwanted or irrational.

Question 26

Prevalence of Personality Disorders

Answer 26

* Difficult to estimate, but worldwide lifetime prevalence of PD ~ 10%, slightly lower in Aus * Harder to identify prevalence of specific PDs due to reliability issues & comorbidity. Best prevalence data is for antisocial PD – overall lifetime prevalence (men & women combined) = 3% * OCPD & AvPD each estimated to affect 3-4% of the population (lifetime prevalence) * Lifetime prevalence for other PDs tends to be lower (about 1-2%), except for NPD which affects >1%

Question 27

Heterogeneity & Comorbidity

Answer 27

High heterogeneity (PD's look different on eveyone) Many ways to meet criteria (e.g. BPD = 256 possible symptom combinations). Symptom overlap: Traits often appear across multiple PDs. High comorbidity: ~50% with one PD meet criteria for another PD. ~75% also have other mental disorders (e.g. depression, anxiety). Vague/overlapping criteria make it hard to tell what’s normal vs. disordered. Poor coverage: Many cases diagnosed as “Other/Unspecified PD” due to unclear fit.

Question 28

Critique of PD in the DSM

Answer 28

The categorical system (separate PD types/clusters) is flawed. Too much overlap and redundancy between categories. Too many PDs → impractical for clinicians and research. Weak and inconsistent predictive power — diagnoses don’t reliably predict outcomes or behaviour

Question 29

Sex differences in PD

Answer 29

Overall PD rates: roughly equal in men and women. Antisocial PD: much more common in men (≈5% men, 2% women). BPD & DPD: may be slightly more common in women, but evidence is weak. Paranoid & OCPD: possibly more common in men. Note: Ongoing controversy about gender bias in PD diagnosis.

Question 30

gender-based critique of PD

Answer 30

Some PD definitions reflect sex-role stereotypes → can be sexist. e.g. Dependent PD = traits seen as “feminine” (unassertive, self-sacrificing). Raises question: are these traits truly disordered or culturally biased? Clinician bias: women are more often diagnosed with BPD than men, even with similar symptoms.

Question 31

Cause of PD's

Answer 31

Few clear models – causes are multifactorial (no single pathway). Early life experiences can contribute but don’t determine outcome. Genetic factors influence some PDs more than others. ASPD example: develops from a mix of social factors (e.g., parenting, peers, incarceration).

Question 32

What is Equifinality and Multifinality

Answer 32

Equifinality: different experiences → same outcome (e.g., abuse, neglect → depression). Multifinality: same experience → different outcomes (e.g., two abused children → different paths).

Question 33

What increases the risk for the development of any of the personality disorders

Answer 33

* Childhood maltreatment increases the risk for the development of any of the personality disorders (and many other forms of psychopathology). * This link is particularly strong for Cluster B

Question 34

A relational perspective on what causes PD

Answer 34

Disordered personality = early adaptation to relational environment. Childhood relationships shape how we relate throughout life. Humans are highly sensitive to connection and disconnection (link to attachment theory). We learn behaviours to maintain relationships. These early adaptations are later applied broadly — if they were extreme, they can become maladaptive in adulthood

Question 35

Adolescent girls with BPD report

Answer 35

–a lack of supervision –frequent witnessing of domestic violence –being subjected to inappropriate behavior by their parents and other adults –verbal, physical, and sexual abuse

Question 36

What causes BPD? (From developmental perspective)

Answer 36

Linked to relational/complex childhood trauma, which can: Disrupt attachment → loss of basic trust and safety. Affect self-development and independence. Impair emotion regulation (poor co-regulation in childhood). Reduce mentalisation (understanding self and others).

Question 37

What is Linehan’s Diathesis-Stress Theory and how can it be applied to BPD

Answer 37

–Individuals with BPD have difficulty regulating their emotions (Possible biological diathesis) –Family invalidates or discounts emotional experiences and expression –Leads to further difficulty organising and regulating affect –Corresponds to the symptoms of BPD

Question 38

Treatment of BPD

Answer 38

*Main treatment: Long-term psychotherapy. *Dialectical Behaviour Therapy (DBT): - Builds tolerance for intense emotions. - Develops skills to self-soothe and regulate affect. - Therapist’s stable, accepting presence helps support change. Other effective therapies: *Schema Therapy *Interpersonal Therapy (IPT) *Psychodynamic Therapy *Mentalisation-Based Therapy (MBT)

Question 39

Cause of Schizotypal PD

Answer 39

* First degree relatives of patients diagnosed with Schizophrenia are more likely to meet criteria for Schizotypal PD * Has led to the postulate that Schizotypal PD is genetically related to Schizophrenia

Question 40

Treatment of Schizotypal PD

Answer 40

Limited treatment seeking and high rates of premature termination *Low dose antipsychotic medications have been shown to be effective in some instances *Limited evidence for psychotherapy *Treatment often focuses on other comorbid issues –e.g. depression or substance abuse/dependence

Question 41

What is Kohut’s Self-Psychology Model (narcissism Cause)

Answer 41

* Characteristics mask low self-esteem, feelings of worthlessness * The presentational self * In childhood, narcissism valued to increase parent’s own self-esteem * Child is not valued for his or her own competency and self worth, but for the mirroring the child provides to the parent * Child becomes an extension of the parent and fails to develop a genuine internalised self image * People with high levels of narcissism often report cold parents who overemphasized child’s achievement/performance * May have been dismissing or mocking/devaluing of vulnerability, emotion and distress * Social cognitive model * “Narcissist” has low self esteem * Sense of self depends on achieving * Interpersonal relationships are a way to bolster self esteem rather than increase closeness to others * Cognitive biases that maintain narcissism *people with Narcissism have low self esteem and develop a mask to hide this low self esteem.

Question 42

Treatment of narcissistic PD

Answer 42

* Low rates of treatment seeking due to difficulty acknowledging weakness/vulnerability * Treatment complicated by difficulty with interpersonal relationships * Often short term –present during a depressive episode/crisis, cease treatment following crisis * May be cyclical engagement * Psychodynamic psychotherapies focus on increasing willingness to acknowledge vulnerability and understanding the impact of defenses on relationships

Question 43

Cause of antisocial PD

Answer 43

Most studied PD — strong evidence base. Findings show multiple risk factors, not one single cause ASPD arises from genetic vulnerability + harsh or chaotic environments, with low fear and impulsivity increasing risk.

Question 44

Cause of antisocial PD (genetic cause)

Answer 44

Moderate heritability. Twin studies: 55% concordance (MZ) vs. 13% (DZ). Adoption studies: children of criminals still at higher risk. Genetic links may also explain comorbidity (e.g. substance use). Genes interact with environment → not purely biological.

Question 45

Cause of antisocial PD (Environmental & developmental cause)

Answer 45

Family environment: lack of warmth, inconsistent discipline, poor monitoring. Other risks: poverty, violence exposure, parental conflict, substance use, criminal role models

Question 46

Underarousal hypothesis (cause of avoidant PD)

Answer 46

Low anxiety & fear → reduced response to punishment. Lower physiological arousal (low heart rate, skin conductance). High impulsivity and poor conditioning to fear or punishment

Question 47

Treatment of Avoidant PD

Answer 47

*Rarely seek treatment * May be referred via the legal system * Treatment tends to be time limited and focused on reducing recidivism OR targeting substance abuse/dependence * Some evidence that targeted interventions are effective in changing specific behaviours, but general character/personality remains unchanged

Question 48

How many people with PD's will also meet the criteria for another mental disorder

Answer 48

75%