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PSYC3018 Abnormal Psychology > Personality Disorders > Flashcards

Flashcards in Personality Disorders Deck (51)
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1

What is personality?

Comes from Greek word for mask - "Persona"
Key pattern of inner experience. Manner of thinking/feeling etc
What is portrayed in interaction with others.

Consists of aspects of Nature (Innate temperament: Genetic, constitutional) and Nurture (Character: Acquired values and attitudes) --> particular traits --> Personality (as expressed in psychosocial context)

2

What is a Personality Disorder, according to DSM-V?

Enduring pattern of inner experience/behaviour that:
- Deviates markedly from societal norms
- Pervasive, inflexible and stable over time
- Leads to distress or impairment

Pattern manifested in 2 or more areas:
- Cognition
- Affect
- Interpersonal functioning
- Impulse control
(not all areas of personality need to be affected in PDs)
Onset: very early (childhood) or adolescence for adults

3

What are the core features of PDs? (4)

1. Functional Inflexibility: Failure to adapt to situations
- Applying same rigid response to many diff situations, even when inappropriate
2. Self-defeating: Respond/cope in ways that worsen the situation or is highly damaging
3. Unstable in response to stress: Unstable mood, thoughts and behaviours during stressful life events

- Often accompanied by lack of insight: Failure to recognise dysfunctional aspect of personality. They just think it's part of who they are

4

History of PD development in the DSM

Just know that it's variable and volatile.

5

Classification systems: What are the differences between how DSM-V and ICD-10 have classified PDs?

DSM-V: 10 PDs categorised in 3 clusters
ICD-10: 9 PDs. Not clustered, and have slightly different labels
e.g. Antisocial = Dissocial, Obsessive-compulsive = Anankastic

6

List all the PDs in their clusters as in DSM-V.

Cluster A (Odd/eccentric)
Paranoid
Schizotypal
Schizoid
Cluster B (Dramatic/emotional/erratic)
Borderline
Antisocial
Histrionic
Narcissistic
Cluster C (Anxious/fearful)
Avoidant
Dependent
OCPD

7

What are the characteristics of the way the DSM-V PDs have been classified?

- PDs rarely appear in textbook form
- Highly comorbid - Lots of overlap, both within and between clusters (esp within clusters)
- Survey of clinicians: 60% of patients did not fit in these 10 categories

Categorical (Axis-I) vs Dimensional Approach (Axis-II)
DSM-V uses categorical approach
- Assumes that PDs represent distinct clinical syndromes
Adv: Clarity and ease of communicating info
Disadv: Hard to distinguish threshold from "normal" personality traits to meeting PD criteria
- Gradual move towards dimensional/spectrum approach for PD classification

8

Differences between DSM-IV Axis I vs Axis II?

Axis I: Major clinical disorders with acute symptoms that need treatment
Axis 2: PDs (and intellectual disabilities)
- Early age of onset
- Enduring traits that are clinically significantly distressing/dysfunctional
- Involves self and identity - related to presumed poorer self-awareness (lack of insight)
- Generally poorer response to treatment - often prolonged
But: high degree of co-occurrence of symptoms (comorbid)
- heterogeneity within diagnoses
- diagnostically unreliable
- lack of robust scientific evidence

9

A1. Paranoid PD: Symptom Description

Consistent/pervasive pattern of distrust, suspiciousness, and prolonged grudges held.
- Believes others intentionally exploit, harm or deceive them
- Severely sensitive to criticism & threat - hypervigilant for signs of others to harm them
- Misinterprets comments to indicate concealed, hidden or malevolent intent/motivation
- Hostile, aggressive and angry response to perceived insults
- Jealousy (distrust and misinterpretation)
2/3rds of them meet criteria for other PDs (Schizotypal, Narcissistic, Borderline, Avoidant)

10

A1. Paranoid PD: Underlying Assumptions and Thought processes

Assumptions: (very negative in nature)
People are malicious and out to get you --> Expectancy of hostility, Lack of trust, Guardedness --> Suspiciousness and guarded against closness, resentful, failure to trust others --> Tendency to elicit hostility & distrust from others

They will take advantage of you if they can --> Guardedness

You will be ok as long as you do not let your guard down --> Vigilance
(refer to diagram)

11

A2: Schizoid PD: Symptom Description

Like talking through a glass wall. Cold, hard to connect
Detachment and disinterest in social relationships
- Withdrawal into internal world to avoid affect and maintain distance from others
See others as intrusive and controlling
Flatness of affect: coldness, aloofness, self-absorption, social ineptitude or conceit
Unresponsive to socially criticism:
- Sexually apathetic, reflecting incapacity to form interpersonal bonds
- Anhedonia
Comorbid with Schizotypal and avoidant PDs

12

A3: Schizotypal PD: Symptom Description

Marked interpersonal deficits, behavioural eccentricities and distortions in perception and thinking (that do not meed criteria for schizophrenia)
(e.g. magical thinking, extreme superstition, etc)
- Odd thoughts and speech patterns: vague, abstract, but coherent
- Often seek treatment for anxiety, depression and affective dysphoria
Comorbid with borderline, avoidant, paranoid and schizoid PDs
- Tend to be at the fringe of eccentric groups - even more eccentric than them (e.g. vegans)

13

B1: Antisocial PD: Symptom Description

Repeated reckless disregard for others/social norms
- Victimising/blaming others for inadequacies
- Shallow and manipulative interpersonal relationships
- Self-centered focus (related to histrionic/narcissistic) and failure to adhere to regulations
- Impulsive, aggressive, charismatic, deceitful
- Lack empathy, although they experience guilt and depression
- Antisocial behaviour: may/may not have crim history
Comorbid: Borderline, narcissistic, histrionic and schizotypal PDs

14

B2: Borderline PD: Main Symptoms

1. Emotional instability/affective dysreg in reaction to envr/interpersonal problems
- wide range of extreme emotions (anxiety, anger, dissociation)
2. Low impulse control: Self-harm, promiscuity, suicidal behaviour (10% suicide), spending, binge eating, poor limit setting
- Suicide: stems from feelings of emptiness - makes them feel more real
- Can be attn seeking
3. Identity/insecure attachments
- Unstable self-concept, avoidance of real/imagined relationships
- Inability to integrate positive and negative aspects of self --> sense of emptiness

15

B2: Borderline: Prevalence, Comorbidity

Prevalence: most prev PD in clinical settings (due to self-harm)
- 10% of outpatients
- 15-20% of inpatients
Highly comorbid with mood disorders, substance-use disorders & anxiety disorders (PTSD)
(% of people with these disorders also have borderline)
15% MDD
10% Dysthymia
15% Bipolar I
20% Bulimia/Anorexia
10% Substance abuse
- Shared impulsivity/disinhibition and affective instability personality traits
Arguably causing greatest disability of all PDs

16

B3: Histrionic PD: Symptoms

Attention-seeking behaviour - very dramatic
(Used to be called "Hysterical PD" in DSM-II, 1968)
- Excessive emotionality, attention seeking, egocentric, flirtatious, seductiveness (vain)
- Gregarious, manipulative
- Shallow and fickle displays of emotion - affects interpersonal relationships
Comorbid: Narcissistic, borderline, antisocial, psychoactive substance abuse

17

B4: Narcissistic PD: Symptoms

Huge sense of self-entitlement
Pervasive pattern of grandiosity, sense of entitlement, exaggerated sense of self-importance, arrogant attitudes/behav
Have fragile self-esteem, envy, self=consciousness and vulnerability
- Compensate with self-righteousness, pride, contempt, vanity and superiority
Cold, disinterested, snobbish, patronising
Comorbid: Antisocial, Histrionic, borderline + Substance abuse

18

C1: Avoidant PD: Symptoms

Social inhibition, discomfort in social situations, feelings of inadequacy, low self esteem, hypersensitivity to criticism/rejection/ridicule
Avoidance of social activities
Socially inept/incompetent, personally unappealing, inferior to others
Low self-esteem
Comorbid: Dependent and Mood, anxiety, eating disorders

19

C2: Dependent PD: Symptoms

Exaggerated sense of not being able to take care of themselves - reliance on others
Lack in self-confidence, feel incompetent, constantly needing reassurance

20

C2: Dependent PD: Key characteristics

Self view: Needy, weak, helpless and incompetent
View of others: Strong caretaker. Function well when idealised figure is accessible
Threats: Rejection/abandonment
Strategy: Cultivate a dependent relationship by subordinating
Affect: Heightened anxiety. Depression if strong figure is removed, euphoria/gratification when dependent wishes are granted

21

C3: OCPD: Symptoms

Extreme and pervasive pattern of perfectionism and orderliness (really high standards) - seen as "workaholics"
- very rigid lives run by rules and schedules
Rigidity, inflexibility and stubbornness
Preoccupation with rules, minor details and structure - attn to detail interferes with ability to complete tasks
Unrealistic standards of morality, ethics or values
Excessive need for control - interferes with ability to maintain interpersonal relationships or employment
- Reluctance to delegate tasks
(No sig r/ship between OCD and OCPD)

22

C3: OCPD: Key characteristics

Self view: Responsible for themselves vs others. Driven by "shoulds".
View of others: Too casual, irresponsible, self indulgent and incompetent
Threats: Any flaws, errors, disorganisation. Catastrophic thinking: Things will be out of control
Strategy: System of rules, standards and "shoulds". Overly directing, punishing and disapproving.
Affect: Regrets, disappointment, and anger towards self/others because of perfectionistic standards

Some characteristics are quite useful /positive - but can get really dysfunctional

23

EPIDEMIOLOGY:
What is the prevalence of PDs, in Australia and abroad?

Aus: 6.5% adults have 1+ lifetime prevalence
- Younger unmarried males: higher presence of anxiety, affective, or substance use disorder, and greater disability than those without PD
- Females: more prevalent in borderline/histrionic
International: 6-13%, average 9.7%

24

What is the epidemiology of Antisocial PD?

0.2-3.3% general population
Gender diff: 3% males vs 1% females
3-30% of psychiatric outpatients
47% of male prisoners and 21% of female prisoners

25

What is the epidemiology of Borderline PD?

Aus: 1-5%, USA: 1-2%, Norway: 0.7%
Diagnosis:
- 4-6% in primary care (GPs)
- 25-40% in clinical population with mental illness
- Females 3x higher than in males (diagnosed as antisocial)
- Suicide rate of 10%

26

What are some problems in the diagnosis of Borderline PD?

High prevalence, yet underrecognised and underdiagnosed
- Symptoms co-occur with other mental disorders
- Concerned that diagnosis is stigmatising and may interfere with clinician's ability to be empathetic

27

What is an assumption of Antisocial PD? And what are some behaviours in PDs that break this assumption?

People act in a rational manner guided by logic, rules and social convention

- Behaviours carried out with little regard for consequences
- Inability to delay gratification
- Self-defeating behaviours (cause aversive outcomes to themselves/others)
- Irrational behaviours - aversive outcomes outweigh reward

28

Antisocial PD Etiology: How are constitutional factors implicated in the etiology of Antisocial PD?

Constitutional factors = neurobio correlates: Envr/familial influences on predisposition of expression of antisocial variant
- External vulnerabilities: Heritable broad trait-dispositional factor reflect disinhibitory personality and risk taking found in childhood CDs, adult antisocial behaviour and substance-use disorders

29

What are the associated biological factors in the etiology of Antisocial PD?

- Reduced levels of serotonin (impulsive behaviour)
- Low resting heart rate --> physiological hypo-arousal --> sensation seeking
- Neuropsych deficits on frontal lobe exec functioning
--- Weak behavioural inhib and emotional reactivity - less responsive to threat and punishment
--- Evolutionary advantage?

30

What are the associated psychosocial factors in the etiology of Antisocial PD?

- Personality and temperament, shaped by envr and learned coping skills to deal with stress
- Social factors: childhood dysfunctional role modelling and interactions with family
- Peer group interactions: Deviant sub-cultures - cause or effect?