10: Personality disorders

Question 1

What does the following mean: personality disorders are axis 2 disorders Cluster A?

Answer 1

• thought to be stable LT conditions

- hence xp throughout much of an individual’s life

Question 2

Personality disorders are characterised by individuals undergoing an enduring pattern of inner xp + behaviour that differs noticeably from the expectations of the individual’s culture in at least 2 of what?

Answer 2

• cognition
• mood
• interpersonal functioning
• impulsive control

Question 3

What makes diagnosis of personality disorders difficult?

Answer 3

• high comorbidity with mood disorders

eg: Major depression, bipolar disorder

Question 4

What are personality disorders?

Answer 4

clusters of traits that are stable over time

Question 5

Why has the stability of personality disorders have come into question, challenging its definition (Loranger et al) esp when examining dependent + schizotypal personalities ?

Answer 5

• fair proportion of people who suffer from substance misuse have symptoms of personality disorders = occurring disorders

Question 6

Why is there is shift in the assessment + diagnosis of personality disorders to dimensional models vs categorical?

Answer 6

• Allows personality to be assessed using various scales + psychometric test
  = allows more comprehensive description of patient functioning
• found to be better at predicting
• Dimensional scores more reliable across clinicians vs categorical diagnosis
• PD not so distinct from normal so better to think they are of an extreme of a distribution vs categorically different from norm population

Question 7

Which behaviour did Ulrich, Borkenau + Marneros (2001) find personality tests were better able to predict?

Answer 7

offending behaviour than categorical diagnosis of antisocial personality disorder

Question 8

What did Heuman + Morey (1990) found about the reliability between categorical diagnosis and dimensional scores?

Answer 8

Dimensional scores = more reliable across clinicians vs categorical diagnosis

Question 9

Define the sub-clinical category Schizotypy

Answer 9

group of personality traits found to leave individual susceptible to delusion-like beliefs

• share a number of common characteristics with psychotic-based disorders = SZ
• SZ + schizoid PD found under category

Question 10

What 2 beahviours can be observed between SZ + people with schizotypy?

Answer 10

1. executive functioning deficits specifically associated with negative schizotypy
   - score highly on psychometric measures of schizotypy
   - Wisconson card sorting task
2. Abnormality in attention

Question 11

Often schizotypy can be a prodromal phase to what to what (Yoon, Kang + Kwon, 2008)?

Answer 11

active phase of schizotypy personality disorder

Question 12

How are schizotypes often characterised by an individual (Bentall, Claridge + Slade, 1989)?

Answer 12

• being quirky but awkward in social interactions

- showing sings of “odd” behaviour + lanuage

Question 13

What support is there that schizotypy is a multi-factor construct (Claridge et al, 1996)?

Answer 13

various methods have been used to assess schizotypy

• using various approach + theory
  1. 3 factor construct of Schizotypt
  2. 4 factor construct of Schizotypy

Question 14

Sz + Schizotypy personality disorder symptoms are clustered around what 3 factors?

Answer 14

1. Positive
2. Negative
3. Disorganisation

Question 15

What are the 4 factor construct of Schizotypy?

Answer 15

1. Unusal xp (positive)
2. Introversive anhedonia (negative)
3. Cognitive disorganisation
4. Impulsivity non-conformity

Question 16

What is the difference between SZ vs Schizotypy?

Answer 16

SZ = episodic psychotic personality based disorder

Schizotypy PD = grounded in LT, fairly stable development of personality

Question 17

To be diagnosed with SPD, 5 or more of what symptoms have to be present?

Answer 17

1. ideas of reference (not delusions)
2. odd beliefs/ magical thinking which influence behaviour that are not the nrom
3. unusual perceptual xp, including bodily illisions
4. odd thinking + speech
5. being suspicious (of others)
6. odd behaviour/ appearance
7. lack of friends other than first degree relatives
8. excessive social anxiety which doesn’t seem to subside even when familiar so more to do with paranoia

Question 18

What is Schizoid PD?

Answer 18

• less intense form of SPD
  Characterised by…
• pattern of reduced attachment from social relationships
• accompanied by restricted range of emotions

Question 19

To be diagnosed with Schizoid PD, at least 4 of what symptoms have to be present?

Answer 19

1. no desire/ enjoyment of close relationships
2. almost always choosing solitary activities
3. little interest in sexual xp
4. little pleasure in few activities
5. lacks close friends/ confidants
6. indifferent to praise/ criticism

Question 20

What is the main difference between SPD vs Schizoid PD?

Answer 20

• reason for withdrawal from social interaction
  SPD = fear of social interaction (paranoia/ suspicion)
  Schizoid PD = lack of desire for social interaction

Question 21

What are the 5 or more symptoms which need to be present + having a significant impact on their daily life for borderline PD to be diagnosed?

Answer 21

1. erratic emotions accompanied by feelings of emptiness + anger
2. Difficulty making + maintaining relationships
3. unstable sense of identity - often driven by social influencers
4. risk taking without considering potential consequences
5. self-harming or thoughts of it
6. fear of being rejected/ abandoned
7. hallucinations/ delusions

Question 22

Who are most likely to be diagnosed with borderline PD?

Answer 22

• 75% diagnosis = females :O

- prevalence = 1/2%

Question 23

Why is there such a high rate of suicide (10%) among those diagnosed with borderline disorder?

Answer 23

• negative emotions xp = negative thoughts

Question 24

What makes borderline PD hard to diagnose + treat?

Answer 24

high co-morbidity

- depression, anxiety, eating disorder, substance misuse

Question 25

Who is Craig?

Answer 25

- went to doctor to sneakily ask for some codeine - doctor found history of morphine addiction + impulsivity + irregular work - didn't give any drugs - afterwards he returned for a legitimate reason and said he knows the doctor is not stupid and would believe him

Question 26

How is the the term Antisocial PD described by clinicians?

Answer 26

- a pervasive pattern of disregard for, + violation of, the rights of others - begins in childhood/ early adolescence - continues into adulthood

Question 27

What are the core characteristics of antisocial PD?

Answer 27

- impulsivity - disregard for other people's safety = reckless - consistent irresponsibility - lack of remorse for others repeatedly. .. - performing illegal acts - lying/ conning others for profit/ pleasure

Question 28

What label are offenders given if they have mental illness, PD, learning difficulties or drug dependency?

Answer 28

mentally disordered offender

Question 29

According to Lynam + Gudonis (2005), what are the five dimensions of personality would people with antisocial PD score low on?

Answer 29

``` Costa + McCrae (1995) 5-factor model of personality Low... - neuroticism - extroversion - openness - agreeableness - conscientiousness ```

Question 30

A low score in the 5 factor model of personality (Costa + McCree) as suggested by Lynam + Gudonis for people with antisocial PD entails what type of behaviours?

Answer 30

1. L neuroticism = emotional blandness - lacking appropriate concern for health/ social adjustment 2. L extroversion = introversion - socially isolated, may xp flattened affect 3. L openness = difficulty adapting to social/ personal change, little tolerance for opinions + high conformity 4. L agreeableness = cynical + paranoia thinking, exploitative + manipulative 5. L conscientiousness = underachiever, lack of self-discipline, aimless

Question 31

Define the term 'psychopathy'

Answer 31

- person demonstrates an apparent cluster of psychological, interpersonal + neurological features Hare 1993, they are... - social predators who charm + manipulate -ruthlessly plough through life - completely lacking consciousness + empathy - selfishly take + do what they want - violate social norm with no guilt

Question 32

What are the 3 categories of psychopathy devised by Hare?

Answer 32

1. Primary psychopath - true psychopaths = actually have emotional, bio + cognitive differences 2. Secondary psychopaths - behave as they do due to severe emotional problems/ inner conflict 3. Dyssocial psychopaths - behaviour learnt from subcultures - gangs/ families

Question 33

Why are secondary + dyssocial psychopaths portrayed as incorrently as psychopaths in the media?

Answer 33

- high recidivism rates - those with psychopathic disorder = 7x more likely to commit serious crime on discharge vs those with mental illness (Bartol + Bartol, 2011)

Question 34

What cluster does borderline PD belong to, A or B?

Answer 34

Cluster B

Question 35

What is the PCL-R?

Answer 35

Psychopathic check list - revised (Hare) - measures 20 items based on typical characteristics - rated based on interviews + file information EG, superficial charm, lack or remorse, impulsivity, juvenile delinquency

Question 36

What is the prevalence of psychopathy in prison?

Answer 36

high - around 13% in UK scored high - 73% males in special unit

Question 37

What is the difference between antisocial PD vs Psychopaths, which is often overlooked in the legal sector?

Answer 37

psychopaths = often associated with criminal/ antisocial behaviour + can be classified as having anti-social PD - much more precise + in-depth Anti-social PD = much more diverse

Question 38

What are the guidelines + overall goals for treatment made by Roth + Fonagy (1998) for the treatment of borderline PD?

Answer 38

1. Psychotherapy more effective for less severe cases 2. Patients under age of 30 = greater risk of suicide = prevention rather than cure important target therapy 3. those with good social support, chronic depression, psychologically minded + low impulsivity = most benefit from 'talking therapy' 4. commitment + enthusiasm of therapist important

Question 39

What treatments are there for borderline PD?

Answer 39

1. cognitive therapy - identification + modification of cognitions + underlying schemata 2. Emotional awareness therapy - work through a hierarchy of emotional awareness, starting with bodily sensations 3. Pharmacological treatment

Question 40

What did Soloff et al find about the pharmacological treatment for borderline PD?

Answer 40

- inconsistent - major tranquillisers (Haloperidol) reduce broad spectrum of symptoms - some have heightened suicide threats/ agression

Question 41

What treatment is there for antisocial PD?

Answer 41

Family + peer intervention (Borduin, 1999) - give them skills to cope with family life - reduce stress levels at home environment - peer-intervention to encourage pro-social interaction

Question 42

What are the treatments for psychopathy?

Answer 42

Therapeutic communities | - often used in forensic settings where there is a high percentage of offenders w/ PD