Lecture 6 Flashcards
What are the three personality disorder categories and their associated PDs?
- Cluster A (eccentric, odd) : Paranoid, Schizoid, Schizotypal
- Cluster B (erratic, emotional) : Antisocial, Borderline, Histrionic, Narcissistic
Cluster C (fearful, anxious) - Avoidant, Dependent, Obsessive-Compulsive
Outline Paranoid PD
Pervasive distrust and suspicion of others . 4+ of following (7):
- Suspects others are harming, deceiving or plotting (no basis)
- Doubts about trustworthiness of friends
- Reluctance to confide in others
- Reads hidden demeaning/threatening meanings into remarks
- Bears grudges
- Perceives attack and reacts quickly and angrily
- Suspicions about fidelity in relationships
Schizoid PD
Pervasive detachment from social relationships. Restricted emotional expression. 4+ of following (7):
- Neither enjoys or seeks close relationships
- Chooses solitary activities
- Little interest in sexual relationships
- Takes pleasure in v few activities
- Lacks close confidants
- Indifferent to praise/criticism of others
- Emotional coldness, detachment, flattened affect
Schizotypal PD
Acute pervasive discomfort with social relationships. Cognitive and perceptual distortions. Eccentric behaviour. 5+ of following (9):
- Ideas of reference
- Odd beliefs outside norms
-perceptual illusions - odd thinking and speech
- suspicious/paranoid
- peculiar behaviour
- inappropriate/constraint effect
- Lack of confidants
- social anxiety which doesn’t diminish with familiarity
Antisocial PD
Perceived disregard of the rights of others since 15 years old. 3+ of following (7)
- Lack of conformity to social norms
- lying, aliases, conning for profit or pleasure
- impulsivity, failure to plan
- irritability, aggressiveness, frequent fights
- disregard for own and safety of others
- irresponsibility
- lack of remorse for actions
18+ for diagnosis - CD prior to 15 years old
Borderline PD
Pervasive instability of interpersonal relationships, self-image, affect. Marked impulsivity. 5+ of following (8):
- Frantic efforts to avoid abandonment
- extremes of idealisation and devaluation in relationships
- identity disturbance
- impulsivity
- recurrent suicidal gestures, threats, self-harm
- chronic feelings of emptiness
- inappropriate anger
- transient, stress-related paranoia/ severe dissociative symptoms
Histrionic PD
Pervasive excessive emotionality and attention seeking expression. 5+ following (8):
- Uncomfortable if not centre of attention
- interactions often inappropriately sexual or provocative
- rapidly shifting and shallow emotional expression
- gains attention via physical appearance
- speech is impressionistic and lacking in detail
- self-dramatisation
- suggestable
- considers relationships to be more intimate than they are
Narcissistic PD
Pervasive grandiosity, need for admiration, lack of empathy 5+ of following (9):
- grandiosity without commensurate achievements
- fantasies of unlimited success/power
- so special, few people could understand them
- requires excessive admiration
- sense of entitlement
- interpersonally exploitive
- lack of empathy
- envious of others/believe others envy them
- arrogant/haughty behaviours and attitudes
Avoidant PD
Pervasive social inhibition, inadequacy, hypersensitivity to negative evaluation. 4+ of following (6):
- avoids jobs with interpersonal contact due to fear or disapproval or rejection
- only get involved with people if certain to be liked
- restraint in relationships in case of being ridiculed
- preoccupied with being rejected in social situations
- views self as socially inept, inferior
- reluctant to take risks or try something new in case of embarrassment or failure
Dependent PD
Pervasive need to be taken care of. Submissive and clingy behaviour. 5+ of following (8):
- difficulty making everyday decisions without advice from others
- needs others to assume responsibility
- difficulty expressing disagreement due to fear of loss or support
- difficulty initiating projects on own
- goes to lengths to gain nurturance and support
- uncomfortable when alone
- urgently seeks another relationship when one ends
- unrealistically preoccupied with fears of being left to care for self
Obsessive-Compulsive PD
Pervasive pre-occupation with orderliness, perfection and control at expensive of flexibility 4+ (8)
- preoccupied with details, rules, lists. Big picture lost
- perfectionism interferes with completion
- excessively devoted to work to exclusion of leisure and friends
- over-conscientiousness and inflexibility
- unable to discard items even if have no value
- reluctant to delegate
- miserly form of spending to self and others
- rigidity and stubbornness
What are some of the challenges with categorical approach
- no evidence supporting presence of 10 discrete PD categories
- diagnostic comorbidty between 10 PD categories
- within-disorder heterogeneity
- few validated interventions for 10 distinct PD categories
- categorical approach lacks evidence base when compared to trait approach
Dimensional Approach to PDs
5 broad traits proposed:
- Extraversion - Introversion
- Antagonism - Complaince
- Constraint - Impulsivity
- Negative affect - Emotional Stability
- Unconventionality - Closed to Experience
What is DSM-5 dimensional approach
Five traits: Detachment (previously introversion), Disinhibition (previously impulsivity), Antagonism, Negative Affect, Psychotism
Advantages of DSM-5 alternative personality trait model
- Empirical model that extends knowledge of FFM into maladaptive personality traits
- predicts clinical outcomes above and beyond categorical classification
- more in accordance with complexity of syndromes observed in clinical practice
- finer analyses can be made of the patient characteristics
