L6 - General introduction to personality disorders Flashcards
(24 cards)
temperament in the context of PDs
they are innate characteristics that contribute to personality development
- We are not introduced to the world as blank slates
temperaments and what they can reflect in extreme
* harm avoidance - anxiety & neuroticism
* novelty seeking - antisocial /dissocial
* reward dependence - social withdrawal / asocial
* persistence - conscientiousness / compulsivity
Learning objectives for this part of the course (4)
- recognize and identify the main characteristics of personality disorders
- evaluate influential personality theories concerning etiology in specific cases of personality pathology
- summarize core principles and empirical evidence of major treatments for personality disorders
- analyze how personality theory relates to clinical practice and specific treatment modalities
when does someone’s temperament become a PD?
We look at temperament in a continuous continuum
- Extreme harm avoidance over time give rise to anxiety disorders for example
- but there are no distinct boundaries (cut-off points) that clearly separate normal variations in behavior from their pathological counterparts
characteristics of PDs (6)
- Psychopathology connected to our personality
- Becomes a part of who we are
- Rigid, inflexible thoughts, feelings, actions and impulse regulation - when compared to ‘normal’ personality
- Originates in our early development
- Present since late adolescence/early adulthoods
- Caution against diagnosing before becoming a young adult -> lots of fluctuations in early years that is natural
- Recently, more often diagnosis in adolescence
- Has to be recognized as dysfunctional
- Sometimes only experienced by others
- Related to high healthcare costs, healthcare consumption, societal costs and lower quality of life
what is meant by psychopathology becoming part of your character in PDs?
In PD’s symptoms are often egosyntonic instead of egodystonic
Egosyntonic: symptoms seen as part of yourself, consistent with self-image, goals, values and self-view. Cannot imagine otherwise
- E.g., PD’s + some chronic syndromes
Sometimes symptoms also not seen as dysfunctional
- E.g., OCPD need for perfectionism is seen as adaptive and necessary
Egodystonic: not consistent wiht self-image or part of the self –> conflict and distress
- E.g., syndrome disorders, MDD, OCD
Note: through therapy schemas become egodystonic, they don’t necessarily change
normal personality and traits (3)
- They are a habitual way of thinking, feeling and acting (big five)
- Consistent across situations
- But large situational variance
- Often thought that personality is stable, shaped around 18 years and remains unchanged
- Almost no evidence for complete stability
- Personality is often more stable with increasing age, with largest changes around 30
traits are not stable across one’s lifestime, what are some proposed reasons? (2) + what are implications?
- biological maturation
e.g., decrease in impulsivity - environmental influences
increased responsibility
corrective experiences such as feedback from environment (conditioning)
implication: Them not being stable over time means that they can be treatable
what is to be noted about the available treatment methods?
! There isn’t a perfect treatment
- We get lectures on schema therapy and DBT because they are evidence-based
But there are many other treatments that can tackle different aspects of the disorder and work as well
distinguishin PD from other pathologies: the three P’s
- Persistent
- Stable and long duration, since early adulthood
- Pervasive
- Across most situations
- Problematic
- Has to cause distress or impairment
cluster A (not the focus)
- strange bizarre
- variant psychosis
A) Paranoid (distrust)
B) Schizotypal (ideas of reference, psychotic fear)
C) schizoid (isolation; no desires or flattened affectivity)
Cluster B
- Dramatic, emotional, impulsive
- Variant externalizing disorders
A) Histrionic (theatrical, attension-seeking)
B) Narcissistic (superiority)
C) Borderline (instability)
Antisocial (no conformation norms, criminal)
Cluster C
- Anxious, avoidant
- Variant internalizing disorders
A) Avoidant (avoiding)
B) Dependent (clinging to helper)
C) Obsessive compulsive
other categories
- Personality Change Due to Another Medical Condition
- a stroke, brain trauma
Category with highest prevalences:
* Other Specified Personality Disorder (OSPD)
- Diagnosis can be specified
- Satisfies multiple criteria of various PDs, but does not satisfy criteria of 1 single PD.
- Unspecified Personality Disorder
prevalence
- worldwide pooled prevalence of any PD: 7,8%
- general population: 9-13%
- outpatient care: 30-50%
- inpatient care: 50-70%
- addiction & forensic setting (2/3 of general population)
what is to be noted about the prevalences
- there are differences between studies
- Almost no international studies
- A gap in prevalence in high-income and low-
income countries - Different sampling methods
- Study instruments
- Poor diagnostic reliability
- Study setting
Life events correlated with PDs
- Life expectancy
- On average 18 years shorter (exc- suicides)
- Risk highest before 44 years (10x mortality rate)
- Cardiovascular diseases due to lifestyle, chronic stress, medication
- Risk of intergenerational transmission
Parents with PD’s have an increased chance to transfer it to their children
based on the observed life events, what may be the possible causes of PD? (4)
- Not one single factor
- Genetic vulnerabilities
- Learning experiences
- Early life experiences!
the role of childhood trauma
- In childhood, trauma (abuse and neglect) is common
- Between 11% (sexual abuse) and 26,7% (emotional abuse)
- Poorer mental health
- Range of syndrome disorders, incl.
- PTSD
- Personality disorders
childhood trauma (type) and PD type
graph from slides shows for example that
- Borderline associated strongly with sexual abuse and neglect
- Cluster C associated strongly with emotional abuse
–> Cluster C’s association explanation
The cluster is defined by low self esteem which could come from neglect in childhood
the role of emotional abuse as a predictor
Heavily influences the way you internalize yourself
emotional abuse influences through attachment
* attachment
- Insecure attachment and distrust of others
- Approach-avoidance: Something that makes this even more complicated
- Source of emotional abuse is often the figure you look for for comfort
other problems include:
* emotion refulation
* coping
* negative self-views
correlation between PD and parental problematic behavior
parental problematic behavior positively related to risk for developing PD
- this is the case for several PD’s
there was also a mediation effect found:
- Problematic arental behavior completely mediates the effect of the other 2 factors (offspring behavioral or emotional problem & lifetime parental psychiatric disorder)
–> their influence on the risk of PD’s always happens through the parental behavior
what is the implication of the mediation effect found?
- You can have problems + ur child can have problems
- But as long as you can respond to your child in a nonproblematic way, you take away that correlation
how is the mediator an important mechanism of change?
- Parent cannot change what has happened but can take an active role in treatment in this moment
- They can help influence the dialogue you have with yourself
conclusions (4)
- Important clinical group with a high disease burden and high healthcare
- PD criteria must meet the 3 p’s and are agosyntonic
- PD’s are changeable AND treatable - just like ‘regular’ personality
- Childhood trauma and environmental influences play an important role
- But not a 1 on 1 relationship
