Personality Disorders Flashcards
(28 cards)
What is cluster A, and what disorders are in it?
-ODD, ECCENTRIC
Paranoid
Schizoid
Schizotypal
What is cluster B, and what disorders are in it?
-DRAMATIC, EMOTIONAL,ERRATIC Antisocial Borderline Histrionic Narcissistic
What is cluster C and what disorders are in it?
-ANXIOUS, FEARFUL
Avoidant
Dependent
Obsessive-Compulsive
Personality psychopathology fundamentally emanates from disturbances in thinking about _____ and _____
Self and Others
Self: identity integration, integrity of self-concept, self-directedness of life goals
Interpersonal: empathy, intimacy and cooperativeness, complexity and integration or representaiton of others
What is severe personality disorder?
Framework of the ICD 11 Takes a more ‘dimensional approach’ New thinking about personality disorders focuses on problematic traits such as the degree to which people are: Dissocial or antagonistic Detached from others or loners Disinhibited and impulsive Beset with negative emotions, bitter and depressed Obsessive, perfectionistic and rigid Psyhotic or Schizotypal
Personality disorders are trademarked with …
Inflexibility
DSM for borderline personality disorder
Borderline Personality Disorder
A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:
(1) frantic efforts to avoid real or imagined abandonment. Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.
(2) a pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation
(3) identity disturbance: markedly and persistently unstable self image or sense of self
(4) impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating). Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.
(5) recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior
(6) affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days)
(7) chronic feelings of emptiness
(8) inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights)
(9) transient, stress-related paranoid ideation or severe dissociative symptoms
What are the challenges of personality disorders and the health system?
Misdiagnosis (of bipolar disorder, PTSD, substance dependence, psycohsis ad repression)
Pharmacotherapy (not reccomended as primary treatment bu often over-medicated)
Relationship deficits (swing between interpersonla neediness, idealisation, devaluation, hypersensitivity, anger and avoidance)
Health service deficits (reactice, limiited, punitive, inconsistent, overwhelmed and under resourced)
Stigma/predjudice (amonst health professionals, not wanting to use the term personality disorder or provide compassionate service)
What do we want patients with personality disorders to do?
Come asking for help Tell us their problem clearly Accept our help Improve Do what we tell them Recognise their improvements Family acknowledge improvement Thank us for their work
What are different positive words to replace these negative ones…
Manipulative | Trying hard to get their needs met
Attention seeking|Attention needing
Drama queen/melodramatic| Trying hard to get their needs met
Overreacting/| Having a rough time
Non-compliant/uncooperative/|Choosing not to
Needy/dependent/attention | seeking Feeling vulnerable/insecure
Why do people cut/self harm?
Evidence to suggest that pain sensitivity and pain tolerance in BPD can be altered, and people do use cutting and pain to genuinely change the activity of the brain, and reduce emotional dysregulation
What do you need to ask before making a diagnosis?
Frequency: how frequent is the behaviour
Duration: how long has the behaviour been occurring
Severity: how severe or extreme is the behaviour
What are some early warning signs?
AIR: Affect, Identity, Relatinoship
Affect: highly emotional sensitivity, increased response to emotional stimuli, slow return to baseline
Identity: changing sense of self, aggression/impulsivity, withdrawal/avoidance
Relationship” social isolation, problematic peer realtionships, ineffective validation from parents/carers
Name 5 early warning signs of BPD
Fear of abandonment/attachment? Unstable realtionships Impulsive, self-destructive behaviours Self-harm Extreme emotional swings Chronis feelings of emptiness Explosive anger Distorted self imae
Outline the biopsychosocial model of personality disorder
Epigentic processes: genetic inheretence and environmental factors
Then Biological factors (infant temperament, neurobiological sensitivity and vulnerability) and psychosocial factors (attachemnt co-regulation, personality development, relationships and life events)
Then chore mechanisms (Affect: emotional regulation, Identity: sense of self, Relationships: social cognition)
Then symptoms and clinical presentation (Cognitive: hopelessness, dissociation, Emotional: shame, anger Behavioural: self-harm, impulsivity)
What are some risk factors that proceed personality disorders?
Mother spoking,
Post-natal depression
Parent wit mental health issues or attachment issues
Hypersensitivity to social information
What is epigentics
How cells learn to adapt to their environment
‘All mechansisms that regulate the genome through modifications that do not involve an alteration in the DNA sequence’
What are 8 key reccomendations for the treatment of BPD?
- BPD is legitimate diagnosis for healthcare services
- Structures psychological therapies should be provided
- Medicines should not be used as primary therapy
- Treatment should occur mostly in the community
- Adolescents should get structured psychological therapies
- Consumers should be offered
- Families and carers shuold be offered support
- Young people with emerging symptoms shoudl be assessed for possible BPD
Name 5 key recommendations for the treatment of BPD
- Psychotherapy (medication is not the first line of treatment)
- Dialectical behaviour therapy and psychodynamic approaches
- Medication based therapy
- Schema therapy
- Medication
- Transference-focused therapy (designed to help patients understand their emotions and interpersonal problems through the relationships between the patient and the therapist
The relational model works to improve which three relatinoships?
Relationships with:
Themself
The therapist/worker
The community (health services, families, children ect)
What are key principles for working with people with personality disorders
Be compassionate
Demonstrate empathy
Listen to the persons current experience
Validate the persons current emotional state
Take the persons experience seriously, noting verbal and non-verbal communications
Maintain a non-judgemental approach
Stay calm
Remain respectful
Remain caring
Engage in open communication
Be human nad be prepared to acknowledge both the serious and funny side of life where appropriate
Foster trust to allow strong emotions to be freely expressed
Be clear, consistent and reliable
Remember aspects of challenging behaviours have survival value given past experiences
Convey encouragementt and hope about their capacity for change whilst validating their current emotional experience
What do people with BPD want?
Improve self-identity (self-confidence, self-acceptance, sense of direction in life)
Improved relationships
Greater wellbeing
Symptomatic improvement
Explain DBT
Multimodal treatment
-Individual therapy (1hr/wk)
Skills training group (2hr/wk)
Phone coaching
Therapist consultation meetings (2hrs/week)
Duration of standard outpatient DBT for BPD is generally 12 months
DBT is essentially about finding the balance between change strategies and validation strategies. It’s the dialectic of ‘I have someone in front of me who is suffering greatly, how do I validate their suffering but also move them towards change, problem solving, and help them get out of the problem’
What is the DBT biopsychosocial theory?
BPD patients have high emotional vulnerability: low prefrontal control, high limbic system activity +
Emotional modulation deficits = the symptoms
