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YOUTH INTERVENTIONS > L7: PERSONALITY DISORDERS > Flashcards

L7: PERSONALITY DISORDERS Flashcards

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1
Q

Describe McAdams model of personality and list its domains

A
  • Disruptions in any of the three domains of personality might potentially lead to the development of PD

Domains:
* Dispositional Traits (actor)
* Characteristic Adaptations (agent)
* Narrative Identity (author)

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2
Q

What BFI traits are associated with PDs?

A
  • High neuroticism
  • Low agreeableness
  • Low conscientiousness
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3
Q

What characteristic adaptations are associated with PDs?

A

Maladaptive Coping Strategies
* Engagement (approach-oriented) - more adaptive
* Disengagement (avoidance-oriented) - more maladjustment

Mental Representations
* Include internal working models of the self and others, often rooted in early attachment relationships
* Hypermentalization common in PDs

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4
Q

EU IS MENTAL

Define hypermentalization

A

Excessive and often unrealistic thinking about the thoughts of others

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5
Q

Define the self as author

A

Internalized and evolving life story that integrates the past, present, and future into a coherent whole and creates a personal identity

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6
Q

Define the self as actor

A

General tendencies to behave, think, and feel in relatively consistent ways across situations and time

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7
Q

Define the self as agent

A

The person as a motivated agent with clear goals, values, mental representations, and coping strategies, contextualized within a specific time, place, and social role

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8
Q

What narrative identity is associated with PDs?

A
  • Problems with incorporating negative experiences into a positive & functional life story
  • Lack of construction of a coherent narrative
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9
Q

McAdams

Describe the personality domain of characteristic adaptations

A
  • The self as agent: the person as a motivated agent with clear goals, values, mental representations, and coping strategies, contextualized within a specific time, place, and social role
  • Develops in middle childhood
  • PDs → hypermentalization, maladaptive coping strategies
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10
Q

List arguments for diagnosing PDs in adolescence

A
  • Stability of PD symptoms/diagnosis in adolescence is similar to the stability in adulthood
  • Early detection and intervention
  • PD features are robust markers for future problems, severe psychopathology, future chronic psychosocial disabilities
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11
Q

McAdams

Describe the personality domain of dispositional traits

A
  • The self as actor: general tendencies to behave, think, and feel in relatively consistent ways across situations and time
  • Global & Internal
  • Shaped by G & E
  • PDs → High neuroticism, low agreeableness, low conscientiousness
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12
Q

McAdams

Describe the personality domain of narrative identity

A
  • The self as author: internalized and evolving life story that integrates the past, present, and future into a coherent whole and creates a personal identity
  • Develops in adolescence (and onward)
  • PDs → narrative identity disturbances
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13
Q

Describe the stability of PDs from adolescence through adulthood

A

Rank-order stability
* Moderate in both adolescents and adults

Mean-level change
* Average levels of PD symptoms peak in early adolescence & decline into adulthood

Stability of diagnosis
* Modest in both adolescents and adults
* Potentially due to:
-Categorical taxonomy of diagnosis
-High fluctuation of remission rates in PDs (acute behaviour fluctuate while personality traits remain stable)

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14
Q

6

List risks associated with adolescent PD

A
  • Antisocial behaviour (violence, law breaking)
  • Occupational dysfunction
  • Suicidal ideation/attempts
  • High-risk sexual behaviour
  • Self-harm
  • Relationship difficulties
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15
Q

List

Which domains are impaired in PD according to DSM-V Section II?

A
  • Cognition
  • Affectivity
  • Interpersonal Functioning
  • Impulse Control
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16
Q

What is the relationship between adolescent PD and impairment in adulthood?

A

The more persistent PDs are in adolescence, the greater the adaptive impairment in adulthood

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17
Q

Describe DSM-V Section II criteria for PD

A

Enduring and deviant patterns of inner experience and behaviour in minimum 2 of the following domains:
a) Cognition
* Disturbance in how you view the self, others, the world

b) Affectivity
* Emotional intensity, range, lability, appropriateness

c) Interpersonal Functioning
* Relationship difficulties manifested in dimensions of agency and/or communion

d) Impulse Control
* Excessive impulsivity
* Excessive inhibition

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18
Q

What domains are impaired in PD according to DSM-V Section III?

A
  • Self Functioning
  • Interpersonal Functioning
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19
Q

Describe the DSM-V Section III criteria for PD

A

All personality disorders are characterized by disturbances in the following two areas:
1) Self Functioning
* Unstable identity
* Variable self-worth
* Inaccurate self-image
* Problems with self direction (goals)

2) Interpersonal Functioning
* Develop/maintain mutually satisfying relationships

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20
Q

Describe comorbidity within PDs and its implications

A

Comorbidity with:
* Axis I Disorders (MDD, Anx, SUD, Conduct)
* PDs

  • High comorbidity of PDs challenges the categorical taxonomical model of the DSM-V, highlighting the need for a dimensional taxonomy
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21
Q

Describe maladaptive variants of BFI traits

A

Maladaptive variants of personality traits likely form the foundational basis of PDs
Extraversion
* Low - exhibitionism
* High - social avoidance

Agreeableness
* Low - antagonism
* High - compliance

Conscientiousness
* Low - impulsivity
* High - constraint

Neuroticism
* High - emotional instability, attachment problems, identity problems, worthlessness, poor stress tolerance

Peculiarity
* Odd beliefs, odd behaviour, perceptual aberrations

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22
Q

9

Describe DSM-V criteria for BPD

A

Instability of interpersonal relationships, self image, affects and marked impulsivity. Begins early adult, indicated by 5+:

1) Effort to avoid real/imagined abandonment
2) Pattern of unstable and intense interpersonal relationships. Alternating between extremes of idealization/devaluation
3) Identity disturbance
4) Impulsivity in at least two areas that are self damaging
5) Recurrent suicidal behavior, gestures, threats
6) Affective instability due to reactivity of mood
7) Chronic feelings of emptiness
8) Inappropriate, intense anger, lack of control over anger
9) Transient, stress related paranoid ideation/severe dissociative symp.

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23
Q

List the underlying mechanisms of PD

A
  • Emotional Dysregulation
  • Mentalizing Problems
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24
Q

overview

Explain the underlying mechanism of emotional dysregulation in PD

Study These Flashcards
A

According to the Biosocial Theory, (B)PD is a dysfunction of emotional dysregulation which is developed and maintained through a transaction between a biological predisposition for emotional dysregulation and an invalidating environment

25
# G: 2 (2, 3) // E: 2 (3, 1) List the Genetic and Environmental factors that contribute to emotional dysregulation in PD
*Genetic Factors:* * Temperament → emotional reactivity, low distress tolerance * Personality → impulsivity, obsessive-compulsive, perfectionism *Environmental Factors:* * System → attachment, lack of support, high control * Trauma
26
# 8 Explain the steps in the emotional dysregulation cycle of PDs
1) Stressful situation in environment 2) Activation of EMS 3) Emotional dysregulation (due to low distress tolerance) 4) Negative affect 5) Feedback loop between negative affect and EMS 6) Maladaptive behaviours (self-harm, interpersonal conflict, impulsivity) 7) Experiences of identity disturbance, feelings of inner emptiness 8) Feedback loop between experiences and maladaptive behaviours
27
Explain the underlying mechanism of mentalizating in PDs
* According to **Object Relations Theory**, PD develops due to **disturbed mental representations** of the self and others * This disturbed internal representation is caused by an **invalidating environment**, usually in the form of **insecure attachment** relationships * In infancy, all babies have two mental representations (all good vs all bad) * With age, a healthy **ambivalence** between good and bad mental representations develops * Due to disrupted attachment relationships, this ambivalence does not develop, leading to **splitting** in adulthood
28
Explain the dialectical dilemmas in BPD
**Emotional Vulnerability vs Self-invalidation** * Intense/uncontrollable suffering * Dismissal, judgement, and invalidation of suffering **Active Passivity vs Apparent Competence** * Passivity in solving one’s problems while actively engaging others to solve problems * Tendency of others to overestimate the capabilities of the person with BPD **Unrelenting Crisis vs Inhibited Grieving** * Tendency to experience life as a series of extreme problems * Ability to experience emotions associated with trauma/loss
29
# 5 List the primary treatment functions targeted by DBT
1) Enhancing behavioural capabilities 2) Improving motivation to change 3) Generalization of gains 4) Structuring the environment to reinforce functional behaviours 5) Enhancing therapist capabilities and motivation
30
Explain the dialectical philosophy underlying DBT
* There is no absolute truth * Opposing views can exist within one person at the same time * Reducing polarized thoughts/behaviours by recognizing and questioning oppositions/contradictions that exist within the therapeutic relationship * Non-judgemental observation of the self and others * Central dialect in treatment: tension between acceptance & change
31
What theories are included in the framework of DBT?
* Biosocial Theory * Dialectical Philosophy * Cognitive-behavioural Science
32
Explain the stages of DBT treatment
**Pretreatment** * Psychoeducation about treatment * Client commits to therapist-client relationship & work on goals **Stage 1** * Reducing maladaptive behaviours and increasing behavioural skills to help the client attain basic capabilities *Reduction in:* * Life-threatening behaviours * Therapy interfering behaviours * Quality-of-life interfering behaviours **Stage 2** * Experience, label, and cope with emotions **Stage 3** * Resolve problems in living by increasing self-respect and achieving goals * Helps client achieve ordinary happiness/unhappiness **Stage 4** * Attain capacity for freedom and sustained contentment
33
List the components of DBT
1) Individual Therapy 2) Group Skills Training 3) Telephone Crisis Coaching 4) Therapist Consultation Meetings
34
List the skills which are developed in DBT
* Attention Skills * Emotion Regulation Skills * Crisis Management Skills * Interpersonal Skills
35
Describe attention skills in DBT
* Mindfulness - finding synthesis between extremes by orienting to the truth in each position (emotional and rational mind)
36
# 5 Describe emotion regulation skills in DBT
* Methods for identifying and describing emotions * Determining whether an emotion is justified by current circumstances * Modulating emotion * Reducing vulnerability to unwanted negative emotions * Increasing experience of positive emotions
37
# 2 Describe crisis management skills in DBT
* Learning how to tolerate distress with impulsive control, distracting, and self-soothing strategies * Accepting situations that cannot be changed
38
# 3 Describe interpersonal skills in DBT
* Assertiveness skills to help clients reach their goals while maintaining a positive self-image and self respect * People with BPD have social skills but cannot positively engage in relationships due to interfering maladaptive cognitions and emotions * Skills are established through expressing feelings and thoughts, communicating boundaries
39
Describe DBT-A
DBT-A is a skill-based treatment for adolescents who experience trouble managing their emotions, thoughts, and behaviours. The ultimate goal of DBT is to remove obstacles that prevent the client from creating a life worth living.
40
Explain telephone coaching in DBT
* Clients or their family can call the therapist before a crisis behaviour occurs * Teaching them how to ask for help effectively * Supports application of newly developed skills in crisis settings
41
Explain therapist consultation meetings in DBT
* Discuss challenges encountered by the therapist
42
Who is MBT for?
MBT is a long-term treatment for adolescents who experience significant trouble with reflecting on their own thoughts, feelings, and behaviours, as well as those of others
43
Define mentalizing
The process by which we **make sense of each other and ourselves** (implicitly & explicitly) in terms of **subjective states** and **mental processes**
44
What is the fundamental pathology of BPD according to MBT?
* The fundamental pathology of BPD is a vulnerability to **frequent loss of mentalizing** and **slower recovery of mentalization** in the context of **interpersonal relationships** * When mentalization is lost, the person is vulnerable to rapidly changing **emotional states** and **impulsivity**, and there is **distorted understanding of intentions of others**
45
How does mentalization develop in infancy and how is this impaired in BPD?
* Develops in the context of an **attachment relationship** * Parent **gives meaning** to the infants internal states * Parent communicates this internal stae back to the infant via **contingent marked mirroring** If there is no contingency established between the emotional experiences of the infant and the mirroring of the caregiver: * The infant does not learn how to **represent affect**, **regulate emotions**, and establish **effortful attention control** * There is further stress in the infant when approaching the attachment figure. This will generalize to **hyperactivation of the attachment system** in other interpersonal contexts
46
List and explain the prementalistic modes of functioning in BPD
1) **Psychic Equivalent Mode** * Patient assumes that what is in their mind accurately reflects reality * Patient is unable to consider alternative explanations for behaviour 2) **Pretend Mode** * Mental world is detached from external reality * Internal reflection does not change according to new external information 3) **Teleological Mode** * Meaning is derived from observable and physical outcomes
47
Describe the pretend mode
* Mental world is detached from external reality * Internal reflection does not change according to new external information
48
Describe the teleological mode
* Meaning is derived from observable and physical outcomes
49
Describe the psychic equivalence mode
* Patient assumes that what is in their mind accurately reflects reality * Patient is unable to consider alternative explanations for behaviour
50
Describe differences between MBT and DBT
* *DBT*: focus on delivery of **skills** to **manage BPD symptoms** * *MBT*: focus on **maintaining mentalizing** with interpersonal contexts before it is lost, so that **BPD symptoms remain controlled** * *DBT*: therapeutic relationship is a **vehicle for skills coaching** * *MBT*: therapeutic relationship is a **resemblance of mentalizing** in the interpersonal domain
51
List core MBT techniques
* Validation of emotional experiences * Encouraging the exploration of mental states * Focusing on emotions and mental states * Exploring patient-therapist dynamics (thorugh transference) to re-establish mentalizing
52
What is the focus of treatment in MBT?
* Stabilizing the sense of self * Sustaining mentalizing in the interpersonal context of therapy * Maintaining an optimal level of arousal during interactions with others
53
Describe features of the therapeutic stance in MBT
* Humility * A sense of not knowing * Legitimizing and accepting different POVs * Activitely asking the patient about their experience when this is not clear * Modeling mentalizing through real time reflection from the therapist
54
Define transference
The act of the patient unknowingly transferring feelings about someone from their past on the therapist
55
Explain the aim of transference in MBT
Aim of transference in MBT is to: * Focus the patient's attention on another persons mind * Contrast the patients own perception of themselves with how they are perceived by others
56
Explain tranference processes/elements in MBT
* Transference feelings are **validated** by the therapist * **Triggers** which generate transference are **identified** and **discussed** * The therapist **accepts transference enactment** by the patient * The therapist and patient collaborate in coming up with **alternate explanations** by examining each other's thoughts and feelings * Alternative explanations are summarized by the therapist, with the therapist monitoring **patient reactions to summaries**
57
Describe overall findings on BPD intervention effectiveness
Therapies are **effective** for: **a)** Reducing BPD-specific symptomatology * Not maintained at follow-up * No sig diff between experimental and control groups **b)** Reducing frequency of NSSI * Not maintained at follow-up Therapies are **not effective** for: **a)** Reducing internalizing/externalizing symptoms **b)** Reducing frequency of suicide attempts *Implications:* * Lack of difference between experimental and control groups might be due to common therapeutic elements, like consistency, continuity, and the therapeutic alliance * Due to limited follow-up effects, realistic expectations about treatment must be communicated in clinical practice
58
Explain developmental considerations in BPD
* Adolescence is a period characterized by BPD traits and behaviours * In a subset of adolescents, these characteristics do not fade over time, and they are at increased risk for developing BPD * This risk is underlied by neurobiological characteristics and genetic dispositions
59
Describe study results comparing the effectiveness of MBT-A and DBT-A
DBT-A is especially effective for adolescents who engage in repeated NSSI

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