Personality and Mood Disorders

Question 1

Adolescence

Answer 1

• transitional phase between childhood and adulthood
• biological and cognitive changes (physical and cognitive maturation)
• psychological changes (identity development, psychological autonomy)
  -social changes (increase in societal expectations, romantic relationships)
• these changes may increase potential for conflict -> internal (mood disruptions or disorder), external (risk behaviour, personality disorder, interpersonal conflict)

Question 2

Normative or disorder

Answer 2

• DSM-5/ICD-11: are the diagnostic criteria met? (this has been criticised)
• psychological disorders are disruptions in normal development (so we need to know what is normal development)
• how changes relate to symptom manifestation and disorder

Question 3

Major Depressive Disorder (MDD)

Answer 3

• depressed mood for most of the day (nearly every day)
• weight loss or gain
• increase or decrease in appetite
• loss of energy
• diminished interest or pleasure in (almost) all activities)
• feelings of worthlessness and guilt
• recurrent thoughts of death and suicidal ideation (with or wirthout plan)
• at least 5 during the same 2-week period

Question 4

Suicide and self harm

Answer 4

• if an adolescent seems/is depressed, always check for and talk about
• suicidal thoughts or plans, and self harming behaviours (i.e. cutting), which increase the risk of suicidal thoughts, plans and attempts
• the more specific the plan, the more specific the intervention plan should be
• look at the functions of self harm and talk about alternatives

Question 5

Functions of self harm

Answer 5

• alleviate negative thoughts and feelings
• alleviate feelings of guilt
• regain a sense of control

Question 6

Prevalence of MDD

Answer 6

• 20% in adolescents (prevalence has increased since COVID-19)
• four trajectories:
  1. consistently low trajectory (63%)
  2. chronically medium trajectory (13%)
  3. increasing trajectory (3%)
  4. decreasing trajectory

Question 7

Persistent depressive disorder (PDD)

Answer 7

• depressed mood for most of the day for at least a year
• during this year has not been without symptoms for more than 2 months at a time
• at least 2 of the symptoms of depression
• symptoms are less severe but longer lasting and result in long-term impairment in psychosocial functioning

Question 8

Bipolar disorder

Answer 8

• going through cycles of different moods: normal mood, depression, mania or hypomania
• BD1: manic episodes, may be followed or preceded by hypomanic or depressive episodes or normal mood
• BD2: milder cycles of normal mood, hypomania, and depression (no mania)

Question 9

(Hypo)mania

Answer 9

• abnormally and persistently elevated, expansive or irritable mood
• increased goal directed activity or energy
• last at least 1 days or 1 week
• at least 3 symptoms: inflated self esteem/grandiosity, decreased need for sleep, being more talkative than usual, racing thoughts, distractibility, risky activities, etc.
• full mania can show psychotic features and can even lead to harm to self and others and in hypomanic episodes this is not the case

Question 10

BPD

Answer 10

• frantic efforts to avoid real or imagined abandonment
• emotional instability
• identity disturbances
• chronic feelings of emptiness
• inappropriate intense anger or difficulty controlling anger
• stress related paranoid ideation or severe dissociative symptoms
• 5 symptoms during 1 year

Question 11

Alternative Model for Personality Disorders

Answer 11

• lots of overlap in personality disorders so..
• PDs are all characterised by disturbances in 2 areas:
• self functioning: unstable identity, low/high self worth, inaccurate self view, problems with self-direction
• interpersonal functioning: inability to develop and maintain mutually satisfying relationships,
  inability to understand others’ perspectives
• these are central developmental tasks of adolescents, personality disorder features may become apparent during this life phase

Question 12

Retained PD types

Answer 12

• BD, Obsessive compulsive, antisocial, avoidant, schizotypal, narcissistic

Question 13

Prevalence of BPD

Answer 13

• 3% of general population
• 11% outpatient
• 76% inpatient with suicidal behaviour
• trajectories:
• low (37.6%)
• moderate (41.5%)
• high

Question 14

Proximal Risk Factors

Answer 14

• Individual factors
• self functioning: low self worth, identity disturbance
• stressful events: COVID, school stress, financial stress and poverty
• comorbidity: symptom disorders (MDD), physical illness, substance use
• Social factors:
• loss and conflict
• low social support and bullying
• Social factors

Question 15

Distal

Answer 15

Predisposition:
- Genetics
- alterations in brain stress systems
- temperament (negative affect, LOW DISTRESS TOLERANCE)
- Personality:
- traits (neuroticism, IMPULSIVITY)
- maladaptive coping strategies
- early maladaptive schemas
Social factors:
- system: insecure attachment, parental psychopathology
- trauma: maltreatment: abuse and neglect

Question 16

Low distress tolerance in BPD

Answer 16

• stressful situation i.e. cancelling plans
• activation of EMS: i feel rejected, abandoned, worthless -> negative emotions
• low distress tolerance -> emotional dysregulation (anger)
• self harm, interpersonal conflict, impulsivity
• identity disturbance and feelings of inner emptiness ( this feeds into self harm, interpersonal conflict and impulsivity

Question 17

MDD as a risk factor for BPD

Answer 17

• emotional problems at age 5 predict BPD features at 12
• depression and suicidality are predictive of BPD features in adolescence
• internalizing disorders in adolescence precede BPD features in adulthood (but not the other way around)
• childhood or adolescent depression seems to be a stepping stone for borderline personality disorder
• they share underlying vulnerabilities and MDD can disrupt key developmental processes in adolescence

Question 18

Identity disturbance as a risk factor

Answer 18

• 4 trajectories in adolescence
• Consolidated: they have a good idea of their identity and their interests
• Disturbed identity: identity is changing and not stable over time, identity based on others, identity changes from day to day
• Lack of identity: feeling fragmented, feeling broken, feeling empty inside, lack of sense of self
• measured these dimensions of identity over time
• then narrowed it down to 4 groups
• adaptive (high consolidation, low lack and disturbed): 70%
• diffused (low levels of healthy identity, stable high levels of lack of identity and identity disturbance)
• rewatch
• also looked at depression and BPD levels
• diffused struggled with consistent high levels of BPD and depressive symptoms
• identity disturbances may underlie different trajectories of depressive symptoms

Question 19

Maintaining mechanisms

Answer 19

• early maladaptive schemas
• maladaptive coping strategies
• negative attributional style
• EMS: inadequate information processing

Question 20

Coping: negative attributional style

Answer 20

• negative life events: internal, stable and global attributions
• positive life events: external, unstable and specific attributions

Question 21

EMS

Answer 21

• stressful situations evoke the activation of maladaptive schemas or core beliefs -> automatic, spontaneous and seemingly uncontrollable negative thoughts about the self, others and the world and the future

Question 22

(Long term) outcomes of mood and personality disorders

Answer 22

• risky behaviours: suicidal behaviour, self harm, unsafe sexual practices
• academic difficulties: lower educational attainment, higher odds of unemployment, lower income
• lower social support, loneliness, social challenges
• poorer physical health (increased risk of obesity and type 2 diabetes)
• comorbidity: anxiety, substance abuse, conduct disorder, eating disorders
• more severe MDD and BPD in adulthood (longer episodes)