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7153PSY > 9 & 10. Personality disorders > Flashcards

9 & 10. Personality disorders Flashcards

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1
Q

PDs

A

enduring pattern of inner experience and behaviour that deviates markedly from expectations of individual’s culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time and leads to distress or impairment

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2
Q

General PD

A

A. Enduring pattern of inner experience and behaviour that deviates markedly from the expectations of the individual’s culture. Pattern manifested in two or more of the following areas: cognition, affectivity, interpersonal functioning, impulse control
B. Enduring pattern is inflexible across a broad range of personal and social situations
C. Enduring pattern leads to clinically significant distress or impairment in social, occupational, or other important areas of functioning

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3
Q

Cluster A

A

MAD
Individuals often appear odd or eccentric
paranoid, schizoid, schizotypal PD

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4
Q

Cluster B

A

BAD
Individuals often appear dramatic, emotional or erratic
Antisocial, borderline, histrionic, narcissistic

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5
Q

Cluster C

A

SAD
Individuals appear anxious or fearful
Avoidant, dependent, obsessive compulsive PD

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6
Q

Comorbidites

A

frequent cooccurrence of disorders within and across clusters

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7
Q

differential diagnosis

A

Psychotic disorders- for the 3PDs that may be related to psychotic disorders (paranoid, schizoid, schizotypal), exclusion criteria that pattern of behaviour does not occur exclusively during the course of schizophrenia, a bipolar or depressive disorder with psychotic features, or other psychotic disorder
Anxiety and depressive disorders
PTSD
Substance use disorders
Personality change due to another medical condition

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8
Q

Paranoid PD

A

Pattern of pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent
assume others will exploit, harm or deceive them even if no evidence exists to support this expectation
More commonly diagnosed in males

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9
Q

Schizoid PD

A

Pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interersonal settings
reduced experience of pleasure from sensory, bodily or interpersonal experiences
may be oblivious to normal subtleties of social interaction and often not respond appropriately to social cues
difficulties expressing anger- often passive, dificulty responding appropriately to important life events
brief psychotic episodes in response to stress (minutes to hours)
sometimes premorbid antecedent to delusional disorder or schizophrenia
slightly more often in males

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10
Q

Schizotypal PD

A

pervasive pattern of social and interpersonal deficits marked by acute discomfort with and reduced capacity for close relationships, cognitive and perceptual distortions and eccentricities of behaviour
5 or more of:
ideas of reference (excluding delusions of reference)
odd beliefs or magical thinking that influences behaviour and is inconsistent with subcultural norms
unusual perceptual experiences including bodily illusions
odd thinking and speech
suspiciousness or paranoid ideation
inappropriate or constricted affect
behaviour or appearance odd, eccentric or peculiar
lack of close friends or confidants other than first degree relatives
excessive social anxiety that does not diminish with familiarity and tends to be associated with paranoid fears rather than negative judgements about self

slightly more common in males
may have brief psychotic features but most do not go on to develop a psychotic disorder
Cultural considerations: magical thinking and ‘odd’ beliefs may be culturally appropriate

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11
Q

Schizotypal PD aetiology

A

genetic risk particularly if first degree relative with schizophrenia or schizotypal
differences in brain structure (increased cortical folding)
greater exposure to stressful life events (trauma, early separation from caregivers, low SES)
Adolescence: bullying and teasing, severe anxiety, mood and suicidal ideation

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12
Q

Schizotypal PD differentials

A

other psychotic disorders (but PD features must be present in absence of psychosis), NDD, SUD, medical disorders, other PDs

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13
Q

Schizotypal PD comorbidities

A

mood (depression)
psychotic disorders
Other PDs (cluster A, ASPD, BPD)
SAD
OCD

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14
Q

Antisocial PD

A

Pervasive pattern of disregards for and violation of the rights of others
deceit and manipulation, collateral information key
more common in males
some remittance can be observed over life course (debatable whether for criminal activities vs personality traits)

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15
Q

BPD

A

pervasive patterns of instability of interpersonal relationships, self image, affect, marked impulsivity

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16
Q

histrionic PD

A

pervasive and excessive emotionality and attention seeking behaviour
uncomfortable when not centre of attention
interaction with others often characterised by sexually seductive/provocative behaviour
rapidly shifting and shallow emotional expression
physical appearance to draw attention to self
excessively impressionistic style of speech, lacking in details
self dramatisation, theatricality, exaggerated emotion expression
considers relationships to be more intimate than actual

approximately equal gender distributions
culture considerations regarding appropriate behaviour and dress

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17
Q

histrionic PD comorbidities

A

BPD
narcissistic
antisocial
dependent
somatic symptoms disorder
conversion disorders

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18
Q

histrionic PD differentials

A

other PDs
SUD

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19
Q

Histrionic PD aetiology

A

genetic and biological factors
parenting styles that lack boundaries or are overindulgent
parental modelling of erratic, dramatic, volatile, sexually inappropriate behaviours
childhood trauma

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20
Q

narcissistic PD

A

pervasive pattern of grandiosity in fantasy or behaviour, need for admiration, lack of empathy that begins in early adulthood and is present in various contexts
more common in males

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21
Q

OCPD

A

preoccupation with orderliness, perfectionism and mental and interpersonal control at the expense of flexibility, openness and efficiency
more common among males

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22
Q

OCD v OCPD

A

ego dystonic v ego syntonic

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23
Q

Avoidant PD

A

pervasive pattern of social inhibition, feelings of inadequacy and hypersensitivity to negative evaluation
equal gender distribution
shyness in childhood that does not abate in adolescence
cultural consideration- consider if effects of acculturation

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24
Q

avoidant PD comorbidities

A

MDD
bipolar
anxiety disorders, especially SAD
Dependent PD
BPD
Cluster A PDs

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25
Avoidant PD differentials
anxiety disorders, especially SAD and agoraphobia other PDs SUD
26
Dependent PD
pervasive and excessive need to be taken care of that leads to submissive and clinging behaviour and fears of separation, beginning by early adulthood and present in various contexts as indicated by 5 or more of: difficulty making everyday decisions without excessive advice or reassurance needs others to assume responsibility for most areas of life difficulty expressing disagreements because of fear of support or approval loss (unrealistic level) difficulty initiating projects or doing things on their own (because of lack of self confidence in judgement or abilities rather than lack of motivation or energy) goes to excessive lengths to obtain nurturance and support from others to the point of volunteering to do things that are unpleasant feels uncomfortable or helpless when alone because of exaggerated fears of being unable to care for self urgently seeks relationships when one ends unrealistically preoccupied with fears of being left to take care of self gender difference debated submissiveness deemed appropriate in some cultures
27
Dependent PD aetiology
early onset but consider age-appropriate dependence in youth early anxiety experiences and modelling are important predisposing factors
28
dependent PD differentials
dependency arising from other mental and medical conditions BPD- DPD reacts to abandonment with increasing submissiveness and appeasement Histrionic- DPD less overt/extraverted in attempts to seek attention Avoidant- DPD don't tend to withdraw re fear of rejection
28
DPD comorbidities
anxiety depression adjustment disorders other PDs (BPDS, avoidant, histrionic)
28
Assessment
interview collateral self reports - PAI, MMPI-3, MCMI-IV
29
PAI
344 items, 50-60 mins 22 scales: 4 validity malingering scales, 11 clinical scales across 3 broad classes (neurotic spectrum, psychotic spectrum, behav disorder/impulse control), 5 treatment scales (potential issues in treatment, potential for harm to self or others, motivation), 2 interpersonal scales (warm affiliative v cold rejecting, dominating/controlling v meek/submissive)
29
MMPI-3
567 items 1-2 hours 10 clinical scales which can also be coded into restricted scales to measure core constructs, 9 validity scales, (faking good/bad, defensiveness), content scales (anger, family problems, work interference etc)
30
MCMI-IV
195 items, 25-30 mins 25 scales: 15 clinical personality patterns scales, 7 clinical syndrome scales, 3 modifying indices (e.g. inconsistency, validity) Grossman facet scales- primary expression of the personality, e.g. cognitive, interpersonal, expressive behaviours etc.
31
conceptualisations
attachment theory CBT and variants (schema) psychodynamic theory and variants (mentalisation based therapy) third wave approaches (DBT)
32
Treatment
not well developed most focus on BPD or ASPD Cluster A- tx guidelines indicative only, no established trials Cluster B: BPD- sig effects for both specialised and generalised approaches ASPD- some evidence for CBT with problem solving focus Cluster C: cognitive and psychodynamic, but unsure which specific PDs benefited most overall, should be structured and recommend manualised but responsive approach, well supervised, focus on managing life situations,
33
histrionic PD
generally viewed as lifelong and treatment and medication resistant focus on reducing interpersonal conflict and stabilising psychosocial functioning
34
BPD treatment NHMRC guidelines
CBT DBT DBT skill training ERT IP MACT MBT MOTR SFP STEPPS TFP medicine not used unless necessary, disorder specific and specialised therapy, early intervention
35
biopsychosocial theory of BPD
emotional vulnerability (biological disposition) interaction/transaction over time invalidating environment transactional process between emotional vulnerability and invalidating environment predisposes and leads to features of BPD according to Linehan Neither alone creates the problems
36
BPD predisposing factors of emotionality
high sensitivity to emotional stimuli, low threshold for emotional reactions high reactivity, high arousal dysregulates cognitive processing slow return to baseline functioning, longer lasting reactions
37
BPD predisposing- an invalidating environment
invalidates behaviour independent of actual validity of behaviour (punish, ignore, correct) indiscriminately rejects communication of private experiences and self-generated behaviours punishes emotional displays and intermittently reinforces emotional escalation oversimplifies ease of problem solving and meeting goals constant, not occassional, invalidation abuse, emotionally neglectful, highly critical goodness of fit tells the individual they are wrong in description and analysis of own experience, attributes experience to socially unacceptable characteristics or personality traits teaches individual to self-invalidate and search social environment for cues on how to respond, oscillate between emotional inhibition and extreme emotional styles, form unrealistic goals and expectations of own abilities
38
individuals with BPD often reach adulthood with skills deficits in areas of
emotion regulation interpersonal effectiveness distress tolerance
39
BPD- perpetuating factors of emotionality
emotional dysregulation interpersonal dysregulation self dysregulation behavioural dysregulation cognitive dysregulation
40
DBT conceptualisation and skill
emotion dysregulation - emotion regulation skills (model of emotions, vulnerability factors) behavioural dysregulation - distress tolerance skills (crisis survival) interpersonal dysregulation - interpersonal effectiveness skills (balance self respect, relationship and wants/needs) self dysregulation - mindfulness cognitive dysregulation - mindfulness each DBT conceptualisation refers to DSM5 criteria component of BPD
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3 main DBT components
CBT behavioural science zen practice dialectical philosophy
42
DBT for BPD treatment considerations
therapeutic relationship long term/intensive therapist consistent, excellent boudnaries staff splitting supervision
43
DBT focus
specificity clarity compassion flexible, based on principles
44
assumptions about client in DBT
doing their best lives of suicidal borderline indiividuals are unbearable want to improve must learn new behaviours in all relevant contexts cannot fail may not have caused all their own problems but do have to solve them anyway need to do better, try harder and be more motivated to change than others
45
assumptions about therapy in DBT
therapist can help client initiate change to bring them closer to goals real relationship between equals principles of behaviour are universal, affecting therapists no less than clients treating therapists need support therapists can fail DBT can fail even when therapists do not
46
DBT consultation team agreement
dialectical agreement consultation to the patient agreement consistency agreement observing limits agreement phenomenological empathy agreement fallibility agreement
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5 treatment functions in DBT
improve motivation enhance capabilities ensure generalisation enhance environment maintain skills and motivation on therapists
48
DBT treatment modes
individual treatment addresses motivation and strengthening skills skills training (group at least 12 mo, core mindfulness skills, distress tolerance, emotion regulation, interpersonal effectiveness skills) phone coaching (application of coping skills, not for immediate safety, no further calls for 24H) DBT therapist consultation - enhance motivation and skills for therapists
49
CBT core strategies
change strategies (chain analysis, solution analysis, self monitoring, exposure, cognitive modification, psychoed, commitment strategies) validation/acceptance strategies dialectical strategies (assumptions and stance, balancing) change, stylistic, acceptance acceptance and change of emotions, conflicts and situations, and balancing efforts to change with efforts to acceptance (change can't occur without acceptance)
50
dialectic analysis
identification of the paradox, conflict and emotional strain
51
goals of distress tolerance
survive crisis situations without making situation worse accept reality become free (responding not reacting, control)
52
DBT radical acceptance
acknowledgement of present situation without judging the events or engaging in blame present situation exists because of a long chain of events that began far in the past
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DBT reality acceptance skills
willing hands, half smile, accepting reality with your body
54
DBT STOP skill
notice if in crisis situation and how to proceed with intention Stop Take a step back Proceed mindfully
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DBT distraction
temporarily stop thinking about emotional pain and gives time to find appropriate coping response
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Example DBT distress tolerance skills
self soothing with your senses IMPROVE the situation (imagery, meaning, prayer, relaxation, one thing in moment, vacation, encouragement) safe place visualisationM
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Example DBT mindfulness skilss
focus on present recognising and focusing on thoughts, emotions, physical sensations moment to moment stream of awareness separate thought-emotion-physical sensation radical acceptance non judgemental wise mind (reasonable v emotional mind)
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psychoeducation on emotion awareness
primary v secondary emotions ambivalence adaptive nature of emotions conditioned responses
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emotion regulation skills
recognising and naming emotions overcoming the barriers to healthy emotions- myths reducing vulnerability by treating (PLEASE factors) check the facts increasing positive emotions (ST and LT) built mastery cope ahead (imagery) being mindful of emotions without judgement emotion exposure doing the opposite of emotional urges problem solving
60
PLEASE factors
physical illness balancing eating avoid mood altering drugs balanced sleep get exercise
61
goals of interpersonal effectiveness
be skilful at getting what you want and need from others build relationships and end destructive ones walk the middle path
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interpersonal effectiveness priorities
objective effectiveness relationship effectiveness self respect effectiveness
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objective effectiveness
DEARMAN- be effective in asserting your rights and wishes Describe Express Assert Reinforce stay Mindful Appear Confident Negotiate
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relationship effectiveness
GIVE- act in a way to maintain positive relationship and that others feel good about themselves and you be Gentle act Interested Validated use an Easy manner
65
self respect effectiveness
FAST- when your self respect is the priority be Fair no Apologies Stick to your values be Truthful
66
DBT- First stage targets
decreasing suicidal behaviours decreasing therapy interfering behaviours decreasing quality of life interfering behaviours increasing behavioural skills
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DBT- second stage targets
decreasing post traumatic stress
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DBT- third stage targets
increasing respect for self achieving individual goals
69
balancing irreverent and reciprocal communication styles
therapist is warm and supportive when the client is working hard irreverent/confrontational/unorthodox/playing devil's advocate when the client is not. An irreverent response is almost never the response the client expects
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dialectical process with the therapist
to be used in a balanced way radical acceptance v problem solving for change unwavering centeredness v compassionate flexibility warm, nurturing encouraging v benevolent demanding
71
DBT therapist characteristics
oriented to change benevolent demanding compassionate flexibility oriented to acceptance nurturing unwavering centeredness

7153PSY (11 decks)

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