Lecture 11 (Personality disorders) Flashcards
(10 cards)
Personality and personality disorder definition
-> patterns of thinking and behaviour that define a person and distinguish them from other people
-> personality pathology is the extreme end of the normal personality, when traits have become rigid, inflexible, and maladaptive
-> every person has positive and negative traits
Personality disorder: chronic, enduring, pervasive patterns that persist over time and across a range of situations
Deviates from expectations of the individuals culture in areas of cognition, affect, interpersonal and impulse control
Causes emotional distress impacting important life areas -> significant others also suffer
Most other conditions are ego-dystonic -> those living with the disorder are distressed by their symptoms
Personality disorders -> ego-syntonic -> ideas or impulses are acceptable to the person
Epidemiology
Lifetime prevalence is 10%
most is obsessive compulsive PD, BPD, Narcissistic PD
BPD most researched because people are likely to self harm
High comorbid with anxiety disorders, and mood disorders
Comorbid screening is important -> may have an effect on exacerbating symptoms, helps with prioritising treatment
Males more often for substance use or antisocial PD
Females more for BPD and present with more self harm and suicidal
DSM and diagnoses
can use the SCID-5-PD (picks out parts that are most relevant for diagnosis)
It is common for those with a PD for lack of awareness of their condition
Person might get diagnoses for their co-morbid but never get the correct PD diagnosis
Stigma around PDs has reduced significantly -> stigma can impact on communication of diagnosis to patient or family by clinicians
Belief that personality cant be changed
Treatment is usually very long term -> but family might have expectation that it will be treated immediately
Cluster A
People who often appear odd or eccentric
Paranoid
-> distrust and suspiciousness of others such that their motives are interpreted as evil or mischievous >4 more
suspects people exploiting them, preoccupied with unjustified doubts about loyalty, persistently bears grudges, perceives attacks on their character that are not apparent to others and is quick to react angrily
Schizoid
-> Pattern of detachment from social relationships and restricted range of expression of emotions in interpersonal settings >4 or more
Does not desire relationships, absorbed in own thoughts, introverted to the extreme, indifferent to the praise or criticism of others
Schizotypal
->social and interpersonal deficits marked by acute discomfort and reduced capacity for close relationships as well as cognitive or perceptual distortions and eccentricities of behaviour >5 more
ideas of reference (excluding delusions) -> isnt as long and chronic in schizo
Schizotypal can be made aware of their reference, e.g. feel like someone is sitting next to them in a room.
Odd or magical thinking, speak in abstract manners
Odd or suspicious ideation and innapropriate affect
Cluster B
People who appear dramatic, emotional, or erratic
Antisocial personality disorder
->pervasive pattern of disregard for and violation of the rights of others occuring since age 15
-> failure to conform to social norms with respect to the law, driven by doing stuff for own pleasure, lack of empathy and remorse (defining characteristics), impulsivity or failure to plan ahead
-> at least 18, but conduct disorder has onset before age of 15
Borderline personality disorder
instability of interpersonal relationships, self-image and affects, marked impulsivity >5 more
-> frantic efforts to avoid abandonment, unstable interpersonal relationships, impulsivity in at least two areas that are self-damaging (e.g. spending, sex, substance, driving, eating), suicidal behaviour
Histrionic personality disorder
pattern of attention seeking >5 more
uncomfortable in situations where they are not centre of expression
Inappropriately sexually seductive or provocative
uses physical attention to draw attention
easily influenced, consider relationships to be more intimate than they actually are
Narcissistic personality disorder
pattern of grandiosity, need for admiration, lack of empathy >5 more
grandiose self importance (exaggerates achievements and talents), expects to be recognised as superior
preoccupied with unlimited success
believes that they are special or unique
lack of empathy for others and is arrogant
Expect people to serve their desires and worship them
Cluster C
Often appear anxious of fearful
Avoidant personality disorder
social inhibition, feelings of inadequacy and hypersensitivity to negative evaluation
Avoids occupational activites because of fears of criticism
restraint within intimate relationships and fear of shame and being ridiculed
views self as inferior to others
Dependent personality disorder
Need to be taken care of and leads to submissive behaviours and clinging behaviour
difficulty making decisions without excessive amount of advice
difficulty initiating doing things on her own
wont disagree with others because of fear or loss of support
Obsessive compulsive personality disorder
preoccupation with orderliness, perfectionism, and interpersonal conflict at the expense of flexibility openness and efficiency
Extreme end of rigidity causing inefficieny
different to OCD because compulsions are more about orderliness and perfectionism
Aetiology
Antisocial -> may be due to problems with temperament in children
BPD -> interaction of highly sensitive temperament in an invalidating environment
BPD 35% MZ
Transactional model: invalidating responses from people causing pervasive history of heightened emotional arousal -> inaccurate expression -> invalidating responses -> history of invalidating responses -> emotional vulnerability (sensitivity, reactivity), this then. this then goes back to emotional vulnerability and cycle continues
Treatment (excl Schema focused therapy)
use anti psychotics meds
Dialectical behaviour therapy -> most efficacy studies
-> acceptance (building awareness and kindness to self)
-> change (emotional regulation, and changing emotions)
-> distress tolerance (being able to manage what comes)
-> interpersonal effectiveness (allowing them to function and get needs met in adaptive ways)
Effective for people who have difficulty controlling their emotions and behaviours
targets life threatening (level 1)
therapy interfering (level 2)
Quality of life behaviours (level 3)
youth DBT models involves helping family understand and build communications
adult DBT -> skills groups, individual therapy, phone coaching (a lot of work)
Treatment (schema focused therapy)
Identifying early maladaptive schemas in response to trauma and working with schemas for adaptive functioning
Early maladaptive schemas (EMS) -> targets extremely stable and enduring themes comprised of memories, bodily sensations, emotions and cognitions that are dysfunctional to a significant degree
-> EMS develop through an interaction of child temperament and child experiences, in which core childhood needs are not met
Schemas fall in 5 domains -> disconnection and rejection, impaired autonomy, impaired limits, other directedness, over vigilance and inhibition
Elements of CBT, object relations, and gestalt therapies -> support the SFT reduces cluster B and C symptomology espescially for BPD and avoidant
Imagery rescripting:
-> imagines a schema related memory, imagine seeing the child and intervenes as an adult to get their core needs met -> client experiences the adults intervention from child perspective and ask for other / extra interventions
Gestalt chair work:
-> talk therapy exercise where you express your thoughts and feelings as if you were talking to a specific person even though the person is not present
Treatment of other PDs
Antisocial PD: seldom seek treatment and use social skills training and CBT procedures
Schizotypal: schema therapy, social skills training, strategies for managing solitary life style
Avoidant: CBT and schema therapy, exposure based therapy to challenge fears
