Lecture 5- Personality Disorders Flashcards
(34 cards)
define personality
a stable psychological and behavioural set of characteristic
these are usually predictable and consistent, how the person relates to the world, what distinguishes us to on another
also is flexible
some personality are favoured/ unfavoured by society
how many different types of personality disorders are there
10 different PD diagnoses- this is the general criteria
- also general PD not otherwise specified- meet general criteria but not an individual one
- often apparent in adolesence/ early adulthood often goes on for decades
describe the DSM for personality disorders ( the general one)
ALL PD diagnoses start with ‘General Personality Disorder’ diagnostic criteria: Apply to all 10 PDs
- A. Enduring pattern of inner experience and behaviour that deviates markedly from the expectations of the 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”. This pattern is manifested in two or more of the following areas:
o Cognition (ways of perceiving and interpreting self, other people, and events
o Affectivity (range, intensity, lability, and appropriateness of emotional response)
o Interpersonal functioning
o Impulse control
- B. Enduring pattern is inflexible and pervasive 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
- D. The pattern is stable and of long duration, and its onset can be traced back to at least adolescence or early childhood
- E. The disturbance is not better explained by another mental disorder
- F. The disturbance is not due to the direct physiological effects of substance abuse or a general medical condition
what is it called when you have a PD that doesnt fit with the crtieria
PD not otherwise specified
what are the 3 main clusters for PD
A : ODD/ ECCENTRIC
B: DRAMATIC/ ERRATIC
C: Anxious / fearful
name some personality types in cluster a
A : ODD/ ECCENTRIC
Paranoid
o Schizoid
o Schizotypa
name some personality types in cluster b
Cluster B: Dramatic/erratic
o Antisocial
o Borderline
o Histrionic
o Narcissistic
name some personality types in clusterc
Cluster C: Anxious/fearful
o Avoidant
o Dependent
o Obsessive-compul
name some criticisms of the clusters for PD
- current categorical method of diagnosing PDs is widely seen as inadequate (e.g. Skodol & Bender, 2009; Widiger & Trull, 2007) BECAUSE :
o High level of co-morbidity amongst PDs, within and between clusters
o Heterogeneity (variability) amongst patients with the same diagnosis
- E.g. borderline PD requires a minimum of 5 of 9 symptoms
- So, there are 126 possible combinations!
o Arbitrary cut-off point for diagnosis. E.g.:
- If someone meets 5 of the 9 criteria, they are given diagnosis of BPD
- If the meet 4 of the 9, they are not diagnosed
- But they may still have significant levels of suffering
o Over use of the ‘personality disorder not otherwise specified’ diagnosis (Verheul & Widiger, 2004)
o Broad genetic and environmental risk factors for PDs that cut across clusters (as well as more specific risk factors)
name some alternate ways of diagnosing PD
- measuring the severity on a continuum
- have no boundary betwen normal and abnormal
- people who have PDs only those who show extremes
It was thought that DSM-V would be organized using a hybrid dimensional/ categorical system - In fact, all that changed was amalgamating Axis I & Axis II
- Instead ‘Section III’ of DSM-V has an ‘alternative model’ of PD classification/diagnosis: just a proposal, subject to investigation
- Most clinicians & researchers in the field acknowledge the dimensional properties of PD; but we still use DSM-V diagnostic system
- See APA PD Fact Sheet
- BIG 5
An alternate way of measuring personality by costa and mcrae
Costa + mcrae 2995= Big 5 personality theory
- populations vary on a continuum across 5 domains
Neurotic-ism
extroversion
openness to experience
agreeableness
conscientiousness
these domains have 30 sub domanis
people described as high/ low
People are described in term high-low on each dimension
- Someone who might diagnosed with avoidant PD might show high neuroticism, medium agreeableness and conscientiousness, and very low extroversion and openness to experience
Explain widieger and trull (2007) arguement for the BIG 5 for personality
- Evidence supporting Big 5 dimensions/domains is much better than that supporting DSM PD categories
o A dimensional PD diagnostic system based on Big 5 would address at least some of the limitations of the DSM categorical system
o Using Big 5 might help de-stigmatise a diagnosis of PD
o Will Section III of DSM-5 better address dimensional diagnosis of PD than this approach?
Personality disorderds general features
Long term
- Pervasive
- Can be associated with risky behaviours
- High levels of co-morbidity with ‘Axis I’ disorders
- Predictive of poor treatment outcomes
- Common
o Prevalence: 4 - 15% in adult community samples
- And yet, relatively little research and treatment development
Prevelance of PD
General PD prevalence:
o 4 - 9% UK adult community samples (Coid et al., 2006; Samuel et al., 2002)
o 15% US community sample (Grant et al., 2004)
o 36% - 67% psychiatric inpatient (NIMHE, 2003)
o Similar high prevalence within the prison population
- PD is thought to be under-diagnosed in both community and in-patient settings (Lamont & Brunero, 2009)
- See Lamont & Brunero (2009) for an overview of PD prevalence and treatments
Age and Gender relations for PD
- more common in young adults
- PD shouldnt be diagnosed in kids or adolescents as personalitys arent fully developed
- Males = Females across all diagnoses, but this varies from PD to PD
o E.g. BPD: F>M
o ASPD: M>F
Give a reason for genetic cayses of PD
- Twin studies have shown risk factors for PD
- o One broad factor: “negative emotionality/emotion dysregulation,” contributing to 6 PDs across all 3 clusters
o Two additional, more specific factors contributing to
o (i) Borderline and antisocial PDs: “Impulsive aggression”
o (ii) Schizoid and avoidant PDs: “Inhibition/introversion”
- These genetic risk factors do not reflect the 3 PD clusters
- The authors described the heritabilities for PDs in their sample as “modest”
- Ranging from 20% (schizotypal) to 41% (antisocial)
- Implying that environmental factors play an important role
explain some heritability factors and statistics linking to PD
PARANOID= 23.4 schizoid= 25.8 schizotypal = 20.5
avoidant = highest - 37.3
and
antisocial= 40.9
General causes : enviornmental
Longitudinal studies e.g. Johnson et al., (1999; 2006) have identified several environmental risk factors for PDs:
o One broad factor: “childhood parental neglect,” contributing to 7 PDs across all 3 clusters
o Other, more specific factors contributing to specific diagnoses or clusters. E.g. “Childhood physical abuse” significantly contributing to antisocial PD
- The environmental risk factors that Kendler et al., (2008) identified, were a reasonable fit to the 3 PD clusters
- So, its possible that environmental experiences could be implicated in tendency of cluster A, B, and C PDs to co-occur
name some causes of cluster a ( odd / eccentric) personality types
Paranoid
o Often emotionally detached
o Suspicious of other people and their motives
o May hold longstanding grudges against people
o Believe others are not trustworthy, other people are deceiving, threatening, making plans against them
- Schizoid
o Difficulties in expressing emotions, particularly around warmth or tenderness
o Often feel shy in company, but may come across as aloof or remote
o Have difficulty in developing or maintaining social relationships
- Schizotypal
o Has problems around developing interpersonal relationships.
o The condition is characterised by thought disorders and paranoia.
o To other people they may appear odd or eccentric; they may dress or behave inappropriately, e.g. talking to themselves in public
name some causes of cluster b ( odd / eccentric) personality types
Antisocial
o Characterised by a lack of regard for the rights and feelings of other people,
o A lack of remorse for actions that may hurt others.
o Often ignore social norms about acceptable behaviour, often may disregard rules and break the law.
- Borderline
o Characterised by unstable personal relationships
o Impulsive behaviour in areas such as personal safety and substance misuse.
o They may self-harm, feel suicidal and act on these feelings,
o experience instability of mood, or have episodes of psychosis.
o They may have feelings of chronic emptiness and fears of abandonment by friends or partners.
- Histrionic
o Characterised by extreme or over-dramatic behaviour.
o May form relationships quickly, but be demanding and attention-seeking.
o They may appear to others as being self-centred, having shallow emotions, craving attention, or being inappropriately sexually provocative.
- Narcissistic
o Exaggerated sense of their own importance.
o They are frequently self-centred and intolerant of other people.
o The condition is typified by grandiose plans, ideas and cravings for attention and admiration
name some causes of cluster c personality types
Avoidant
o fears being judged negatively by other people, leading to feelings of discomfort in group or social settings
o May come across as socially withdrawn and have low self-esteem
o Though they may crave affection, fears of rejection can be overwhelming.
o Avoidant personality disorder is associated with anxiety disorders (especially social phobia)
- Dependent
o Typified by someone who assumes a position of passivity, allowing others to assume responsibility for most areas of their daily life.
o They usually lack self-confidence
o May feel unable to function independently of another person
o Feel their own needs are of secondary importance
- Obsessive-compulsive
o Difficulties in expressing warm or tender emotions to others.
o Frequently perfectionists, things must be done in their own way.
o Often lack clarity in seeing other perspectives or ways of doing things.
o Rigid attention to detail may prevent them from completing tasks
where does borderline PD result form on the cluster system
cluster B- odd/ eccentric
- it is the most researchrf snf has more emperical knowledge / treatments based upon it
Name some features of BPD
People with BPD diagnoses:
o Often experience crisis after crisis – due to impulsivity, difficulty maintaining relationships etc.
o Can feel chaotic inside – due to extreme and frequently changing emotions and lack of stable sense of self
o Can be a risk to themselves (but very rarely to other people)
o Often have other co-morbid diagnoses: depression, anxiety disorders, eating disorders, substance misuse, other PDs etc.
EXPLAIN some of the elements in the dsm for BPD
A. Pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity, beginning … variety of contexts, as indicated by 5 or more of:
o Frantic efforts to avoid real or imagined abandonment
o Unstable/intense interpersonal relationships (alternating between extremes of idealisation and devaluation)
o Markedly and persistently unstable self-image
o Impulsivity in at least two (potentially self-damaging) areas (e.g. overspending, sex, substance abuse, reckless driving…)
o Recurrent suicidal behaviour/threats or self-mutilating behaviour
o Rapidly changing mood (often swings lasting just a few hours)
o Chronic feelings of emptiness
o Inappropriate, intense anger or difficulty controlling anger
o Transient, paranoid ideation or severe dissociation
