CP: Lecture 14 Personality Disorders II Flashcards by Megan H

elaborated diathesis stress model of psychopathology

heritable predisposition - early experiences
strength and vulnerability - support and stress
complaints and symptoms

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ethiology of personality disorders

◦ Abuse, Neglect
◦ Nurture
◦ Modelling
◦ Divorce
◦ Low SES
◦ Peer influences

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what does this ethiology influence

 Attachment
 Attributional style
 Cognitive biases
 Core assumptions / beliefs, (cogn. triad), schema’s
 Coping
 Neural circuits
 Neuro-endocrine (e.g. HPA-axis tuning)
 Personality traits

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heritability of personality disorders

35-65%

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which neurotransmitter systems are involved in pd

◦ Dopamine (cognitive problems, cluster-A)
◦ Serotonin (anger, impulse control)
◦ MAO (agression)

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which brain areas are involved in pd

◦ Lack of frontal cortical control: impulses and emotions (mid brain)
◦ Dysfunction amygdala: (hyper-emotionality vs. hypo-emotionality)

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wat was er met maoa en maltreatment

lage MAOA activiteit + maltreatment is meer kans op violence

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kijken naar model of psychopathology

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wat hoort bij heritable predispositions

genetics, temperament

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wat hoort bij early experiences

nurture, trauma, deprivation

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wat hoort bij strengths and vulnerabilities

Fenotype, schemas/cognitions/attributions, neuro-endocrine, personality etc

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support and stress

social, medication, psychotherapy, stress, trauma, life events etc

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schizotypal dsm 5

ssocial and interpersonal deficits, cognitive or perceptual distortions and eccentricities of behaviour, early adulthood, variety of contexts (!) and 5 or more:

ideas of reference
odd beliefs or magical thinking
unusual perceptual experiences
odd thinking and speech
paranoid ideation
inappropriate or constricted affect
eccentric behaviour
lack of close friends
social anxiety that does not diminish with familiarity, tend to be associated with paranoid fears rather than negative judgements about self

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which of the pds is the most heterogeneous group

paranoid pd?

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linehan model goed kennen

oke

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antisocial pd kenmerken

Conduct disorder before 15th
From 15th violation rights of others
Subgroup (15-25%) is also ‘psychopatic’

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2 factors of psychopathy

Factor 1: Affect / Interpersonal
- callous/unemotional, glib,
Factor 2: Behavior
- antisocial/impulsive

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borderline dsm 5 criteria

instability of relationships, self-image and affects, marked impulsivity, early adulthood and at least 5:

avoid real or imagined abandonment
unstable and intense personal relationships
identity disturbance
impulsivity, potentially self-damaging
suicidal behaviour
affective instability
chronic emptiness
anger
paranoid ideation or severe dissociative symptoms

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when basic needs are not met (safety, boundaries, autonomy), wat krijg je dan

early maladaptive schemas -> coping, kan leiden tot submission (the world is just like that)

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6 models for bpd

Learning / Behavioral
◦ Conditioning, modeling, contingencies
◦ Linehan: Emotion-regulation

Cognitive
◦ Beck: cognitive model
◦ Young: maladaptive schema’s

Psychodynamic
◦ Mentalisation
◦ Object-relations

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voorbeelden classical, operant and modelling

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Classical conditioning:
“if I attach to a person, I will be hurt”

Operant conditioning:
“if I force my way, I get what I want”

Modelling:
witnessing your parents resolve conflict with
clashes over and over again

linehans emotional dysregulation model of BPD

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biological diathesis -> emotional dysregulation in the child -> great demands on the family -> invalidation by parents through punishing or ignoring the demands -> emotional outbursts by child to which parents attend -> emotional dysregulation etc

kijken naar linehans model

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cognitive model of beck

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situation -> automatic thought -> schema -> alarm

kijken naar cognitive model

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schema theory of young

when basic needs are not met -> ealry maladaptive schemas -> coping with schemas -> modes

voorbeelden basic needs

safety autonomy boundaries etc

voorbeelden coping with schemas

submission avoidance overcompensation

submission =

the world is just like that

avoidance

geen sociaal contact bijv. omdat je bang bent om gereject te worden

overcompensation

juist het tegenovergestelde doen

modes voorbeeld

◦ Vulnerable child ◦ Angry child ◦ Detached protector ◦ Demanding parent ◦ Healthy adult

example of a schema van mistrust

The expectation that others will hurt, abuse, humiliate, cheat, lie, manipulate, or take advantage. Usually involves the perception that the harm is intentional or the result of unjustified and extreme negligence. May include the sense that one always ends up being cheated relative to others or "getting the short end of the stick.

object-relations

gaat om interpersonal relationship! Internalized representation of Self in relation to the object (another person, such as father, mother, men, etc.) In PD immature defence mechanisms such as ‘splitting’: All good, all bad

kijken naar model object-relations

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mentalization

understanding the behaviour of others in terms of his or her mental state (ik ben boos dus zij zijn ook allemaal boos)

hypothese bij mentalization

Mentalization is learned as primary caretakers mirror and name the child’s emotions -> ohhh heb je pijn??

what is needed to treat personality disorders

Safety /Safe environment ◦ Clear rationale / structure ◦ Attachment figure(s) Incentive / invitation to revise coping Possibility of new (positive) experience

Dialectical Behavioral Therapy

DBT; Linehan lots of structure, skills training (bv emotion regulation) -> gaat om acceptance and change

schema focused therapy

ST; Young Integrative: attachment theory, experiential therapy, cognitive therapy. Limited reparenting, imagery rescripting, chair dialogue.

limited reparenting=

Het verwijst naar een therapeutische techniek waarbij de therapeut de rol van een gezonde ouderfiguur aanneemt om de cliënt te helpen bij het helen van emotionele wonden uit het verleden.

mentalization based treatment

MBT; Bateman and Fonagy Foster mentalization: modelling, small steps

transference focused psychotherapy

TFP; Kernberg Object-relations: the relationship with the therapist as working material

what are similarities between all these treatment types

Theory ◦ Influence early childhood ◦ Internal working model of world ◦ Distorted experience of the other Treatment ◦ Building trusting relationship ◦ Novel experiences ◦ Use of transference?

welke therapy is goed voor crisis, destabilizing and automutilation

dialectical behaviour therapy

which therapy has the widest scope

schema therapy

which is the most simple

mentalisation based treatment

which is the most demanding

schema therapy

which works well for severe cases

mentalisation based treatment

which has the highest dropout

transference focused therapy

Genetically inherited vulnerabilities are combined with an internal working model of the world is too rigid and not adaptive

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CP: Lecture 14 Personality Disorders II Flashcards

(51 cards)