Task 8

Question 1

Personality disorders

Answer 1

extreme level of a personality trait
o Stable and enduring pattern of thought feelings and behaviour, and are pervasive and inflexible across many aspects of one’s life
o Leading to distress and impairment
o Must have negative consequences on well-being of yourself or others

Question 2

Origins of PDs

Answer 2

o	Generally the same as for Personality traits
o	Traumas (esp. borderline)

Question 3

PDs as a general genetically trait-based construct

Answer 3

o Genes might predispose for PDs (Personality traits are .50 heritable so it suggested that PDs are too)
o Early-life epigenetic variability as a result of early-childhood adversity might account for differential gene expression
o Elements of PD change over lifetime

Question 4

Stability and change

Answer 4

o Weak to moderate individual differences occur between 3 yrs till 18
 No real scientific validation (just assumed based on normal personality traits)
o Highest stability is reached with 30
o Odd or avoidant PDs tend to increase over time
o Features of personality disorder peak at about age 13-14 years and reduce monotonically from age 14 to 28
 Due to decrease in impulsivity, attention seeking and dependency

Question 5

´DSM-5 Model

Answer 5

Hybrid model

Question 6

Schizoid (DSM-5)

Answer 6

 Extreme degree of detachment from social relationships (isolation) and a very limited expression of emotions in interpersonal settings (emotional detachment)
 They prefer to be alone but even when they are they feel little joy or pleasure

Question 7

Schizotypal

Answer 7

 Also detachment form social relationships, but they experience extreme discomfort in such relationships
 They are considered as eccentric and have a tendency to perceive personal meanings in everyday events or objects
 Tend to be highly superstitious or fascinated with the paranormal
 Considered to be extremely odd, peculiar, or eccentric

Question 8

Paranoid

Answer 8

 Have an especially strong suspiciousness of others motives, and a sense of being persecuted
 They are quick to take offense or to feel insulted, even in response to innocent actions

Question 9

Antisocial

Answer 9

 A tendency to disregard, lying, and to violate the rights of others
 The don’t feel guilt for their actions
 Tend to be aggressive, irresponsible and impulsive and reckless
 Cognitive therapy is most successful

Question 10

Borderline

Answer 10

 Has intense and unstable love/hate relationships with others
 Paired with impulsive behaviours such as drug abuse, eating binges or sexual escapades, often self-harming behaviour
 Tends to be extremely moody and temperamental, has little sense of personal identity or of meaning in life

Question 11

Histrionic

Answer 11

 Exaggerated display of emotions and excessive attention seeking (need to be centre of attention)
 Use physical appearance to draw attention, and have seductive, sexually provocative style
 They tend to be suggestible or easily influenced by other, consider causal relationships as much closer as in reality

Question 12

Narcissistic

Answer 12

 Tendency to consider oneself as superior individual who deserves the admiration of others and a selfish lack of concern for others
 Tends to fantasise about having high status and to envy those who are highly successful

Question 13

Avoidant

Answer 13

 Defined by social inhibition and shyness, by feelings of inadequacy and by oversensitivity to possible negative evaluation
 Are unwilling to participate in socially unless certain of being liked
 Low self-esteem along with an extreme sensitivity to embarrassment, criticism and rejection
 The avoidant persons wants social contact but is afraid of rejection

Question 14

Dependent

Answer 14

 Characterized by an excessive need to be taken care of and by submissive, clinging behaviour and fears of separation.
 Need reinsurance for everyday life decisions and feel unable to take care of themselves when alone
 Try to gain support by doing unpleasant things voluntarily or by avoiding expression of disagreement

Question 15

Obsessive compulsive

Answer 15

 Involves preoccupation with orderliness, perfection and control
 Tends to put work ahead of social relationships and to be highly stubborn and inflexible
 Tendency to hoard money and objects unnecessarily
 No repeated behaviour such as handwashing (that is the difference to obsessive compulsive disorder so the PD version)

Question 16

Cluster A

Answer 16

odd and eccentric
schizoid, schizotypal and paranoid PD
• Least adaptive and treatable

Question 17

Cluster B

Answer 17

Dramatic and erratic
antisocial, borderline, histrionic and narcissistic PD
• Major social adaption difficulties and variable treatability

Question 18

Cluster C

Answer 18

anxious fearful

avoidant, dependent and obsessive-compulsive PD

Question 19

Problems with DSM-5

Answer 19

 Symptoms of a given disorder do not necessarily go together
• Some symptoms are just about unrelated to each other
• Two persons with the same disorder can have completely different symptoms
 Two disorders may have overlapping symptoms and tend to be diagnosed together
• Comorbidity: joint occurrence of two or more disorder at the same time
• Caused by the fact that some symptoms tend to co-occur despite being listed in different personality disorders
 Clusters of disorder do not match factor analysis results:
 A personality disorder should be seen as a continuum not as a category
• Should not be seen in all or nothing fashion, but as spectrum where you can score high or low on
 Doesn’t consider the development over lifetime

Question 20

Dimensional system in DSM-5

Answer 20

divided in those involving self and those that are involving interpersonal impairment

Question 21

Identity problems (A DSM-5)

Answer 21

o Does not have a sense of themselves as unique persons or identifies to much or to little (independence) with some other persons
o Highly unstable self-esteem, threated easily by negative experiences, distorted appraisal of own strengths and weaknesses
o Might be unable to regulate and/or recognizes one owns emotions

Question 22

Self-direction problems (A DSM-5)

Answer 22

o Might not be able to set realistic or meaningful goals in his or her life
o Lack of internal standards for behaving prosocially
o Might be unable to reflect constructively on his or her own experiences

Question 23

Empathy problems (A DSM-5)

Answer 23

o Might be unable to understand experiences or motivations of others
o Might be unable to understand or unwilling to see others perspective
o Might have little understanding how her/his actions affect others

Question 24

Intimacy problems

Answer 24

o Lacking in positive sustained relationships
o Unable to engage in close caring relationships
o Might be unable/unwilling to cooperate

Question 25

Diagnosing with alternative system of DSM-5

Answer 25

 Structured interview with the client and relatives, might observe behaviour  Than clinician rates every domain on an 4 point scale  Impairments have to be stable over time  Age/culture differences have to be respected  No effect of substances has to be insured

Question 26

ICD 11

Answer 26

No categories  Negative affective feature: describes the extent to how strong a person reacts negatively (e.g. anxiety) to a relatively minor stressor  Dissocial factors: • disregard for social obligations and the rights and feelings of others • manifested in an overly positive view of the self and a tendency to be manipulative and exploitative of others  Features of disinhibition: tendency to act impulsively, no long-term effect consideration, as well as irresponsibility and recklessness  Anankastic features: concerned with controlling behaviour of self and others to conform ones own ideal • Perfectionism, preservation, orderliness, stubbornness  Features of detachment: Emotional and interpersonal distance, marked in social withdraw • Coldness in relation to other people and reduced experience and expression of (mostly positive) emotions

Question 27

PD criterion in ICD 11

Answer 27

 A pervasive disturbance in how an individual experiences and thinks about the self, others, and the world, manifested in maladaptive patterns of cognition, emotional experience, emotional expression, and behaviour  The maladaptive patterns are relatively inflexible and are associated with significant problems in psychosocial functioning that are particularly evident in interpersonal relationships  The disturbance is manifest across a range of personal and social situations (ie, is not limited to specific relationships or situations)  The disturbance is relatively stable over time and is of long duration. Most commonly, personality disorder has its first manifestations in childhood and is clearly evident in adolescence

Question 28

Mild personality disorder ICD 11

Answer 28

 There are notable problems in many interpersonal relationships and the performance of expected occupational and social roles, but some relationships are maintained and/or some roles carried out  Mild personality disorder is typically not associated with substantial harm to self or others

Question 29

Moderate personality disorder ICD 11

Answer 29

 There are marked problems in most interpersonal relationships and in the performance of expected occupational and social roles across a wide range of situations that are sufficiently extensive that most are compromised to some degree  Moderate personality disorder often is associated with a past history and future expectation of harm to self or others, but not to a degree that causes long-term damage or has endangered life

Question 30

Severe personality disorder ICD 11

Answer 30

 There are severe problems in interpersonal functioning affecting all areas of life. The individual’s general social dysfunction is profound and the ability and/or willingness to perform expected occupational and social roles is absent or severely compromised  Severe personality disorder usually is associated with a past history and future expectation of severe harm to self or others that has caused long-term damage or has endangered life

Question 31

Problems in diagnosing PDs

Answer 31

o Often people do not recognize that they, and not others, are defective in their interpersonal relations o Has to be consistent over time and has to effect interaction with others o Threatened by stereotypes which lead to overdiagnoses

Question 32

Diagnosing PDs in young children

Answer 32

o Wasn’t accepted yet because they were afraid of stigmatisation o This is now overruled by personality difficulty category which represents sub-threshold PD, there is something but I won’t label it now (tries to counteract stigmatisation)

Question 33

PDs later in life (>65)

Answer 33

o Symptoms can be caused by other factors such as moving away from friends in a retirement home o PD related to neuroticism and negative affectivity diminish over time o Schizoid, paranoid and schizotypal presentation increase o Health problems might confound the symptoms of PDs

Question 34

Problems in treating PDs

Answer 34

o Generally hard because it is not based on external factors, but in internal ones that are relatively stable over time  Dysfunctional behaviour can be treated o Some disorders are based on personality characteristics that make people less willing to cooperate o Symptomatic improvement of a comorbid disorder during treatment is difficult to distinguish from true underlying personality change o Features of PD, substantial impairment of interpersonal function, identity problems and recognisable social dysfunction are all difficult to measure o Research concentrates on a few disorders, borderline and antisocial, as result any review is necessarily biased towards them

Question 35

Psychodynamic psychotherapy

Answer 35

o Clinician helps patient to express his/her emotions and to find reoccurring patterns of behaviour. o Overarching aim: encourage the patient to speak freely about what is on in her/his mind o Tries to improve the patients self-understanding and thereby improve his/her functioning o (Projective test)

Question 36

Cognitive behavioural therapy (CBT)

Answer 36

o Aims to understand the irrational beliefs that a patient holds and show the irrationality to them. o Less based on psychodynamic

Question 37

Dialect behaviour therapy (DBT)

Answer 37

o Developed for patients with borderline o Aimed to making the patient more aware of what he or she is currently thinking and feeling and to reflect on them o The gained mindfulness helps the person to handle feeling/thoughts that would cause distress based on CBT

Question 38

Pharamacotherapy

Answer 38

o Based on neurochemical abnormalities of the CNS o Should only be used in combination with psychosocial treatment and only to over come especially critical periods o Improvements might arise through comorbidity with depression which can be treated with drugs

Question 39

Pharamcotherapy for Cluster A

Answer 39

antipsychotics show improvement but risk to benefit rationis unclear. No robust evidence available

Question 40

Pharmacotherapy for Borderline

Answer 40

 Should generally be avoided because of high risk of misuse and addiction accept in a crisis  Can help to stabilize mood (SSRIs)  Only short term improvement  If no comorbid illness pharmacotherapy should be stopped

Question 41

Pharmacological treatment for Antisocial PD

Answer 41

should not be used despite comorbid PDs

Question 42

Pharamacological treatment of cluster C

Answer 42

might have an effect on phobias but no scientific evidence is available

Question 43

Psychosocial treatment

Answer 43

o Recommended as the primary treatment for borderline PD and other PDs o Ranges from behaviour therapy to psychoanalytical treatment Aim:reduce acute life-threating symptoms and improve distressing mental state symptoms

Question 44

Psychosocial treatment for Cluster A

Answer 44

no treatment trails of people with paranoid symptoms are being done

Question 45

Psychosocial treatment for Borderline

Answer 45

schema focused cognitive therapy  Treatment provider should have experience with borderline  Supportive (educational, encouraging)  Focus on managing life situation  Non-intense (i.e. once per week, with additional sessions as needed)  Interruptions are expected; consistent regular appointments are optional  Psychopharmacological interventions are integrated

Question 46

Psychosocial treatment for Cluster C

Answer 46

 Psychodynamic therapy improved social functioning and reduced distress  Cognitive behavioural is more effective than psychodynamic  Most success in treatment

Question 47

Treatment for Antisocial PD

Answer 47

o Often patients pretend to feel guilt and understand the fault they did o Increases confidence and competence in exploiting other for Psychopathic offenders o Approach for criminal persons with antisocial PD, is to make it in the persons own self-interest to avoid exploiting other people  Not used to change personality but at reducing the gap between that persons self-interest and the society expectations of acceptable behaviour

Question 48

Improvements caused by treatments

Answer 48

o Control over symptoms can be enhanced (e.g. for suicidal actions and impulsive behaviour)  Identity problems will probably remain

Question 49

Prevelance of PDs

Answer 49

o In North America and western Europe 4-15% o Cross cultural 6.1% (lowest in Europe and highest in south and north America) o Highest prevalence is noted in people in contact with the criminal justice system 2/3 (Cluster B)

Question 50

Intersection of mental state disorder and personality disorder

Answer 50

o PD can be diagnosed in up to half of patients with mental state disorder o PD might underlie treatment resistance in mental state disorder

Question 51

Dark Personality

Answer 51

middle ground between normal personality & clinical level pathology (= subclinical)

Question 52

Dark Triad

Answer 52

 Focus: pathologies characterised by motives to elevate the self & harm others  All are negatively correlated with A and related to Honesty-Humility  May be short-term evolutionary strategies for success

Question 53

Machiavellianism (dark triad)

Answer 53

Manipulative personality Take certain pleasure in successfully deceiving others but aren’t necessarily better in doing so High-machs: lack of empathy & affect, unconventional view of morality, self-focused Negatively correlated with C and Honesty-Humility, positively correlated with neuroticism, Destructive learders

Question 54

Narcissism (dark triad)

Answer 54

Grandiosity, entitlement, dominance, superiority Can’t maintain relationships, lack trust & care for others Tendency to engage in self-enhancement: appear charming in short-term but have difficulty to keep that up long-term Positively associated with openness, extraversion & neuroticism, Low Honesty-Humility bad negotiators

Question 55

Psychopathy (Dark Triad)

Answer 55

Impulsivity & thrill seeking combined with low empathy & anxiety Antagonistic + tendency toward self-promotion and superiority Lack of self-conscious emotions: guilt, anxiety, fear, embarrassment  fail to learn from punishment Negatively correlated with C & neuroticism, positively correlated with O, Honesty-Humility

Question 56

Normal range measures (dark triad)

Answer 56

based on overlap of five factor model with dark personality  Can be effective if you appropriately combine items  Advantage: doesn’t engender much suspicion from test takers  Disadvantage: not complete assessment

Question 57

Other reports (dark triad)

Answer 57

 Advantages: capable of reporting their destructiveness |  Disadvantages: no access to individuals’ inner thoughts but traits are largely attitudinal + often have hidden agendas

Question 58

Conditional reasoning test (dark triad)

Answer 58

 Justification mechanisms linked to implicit motives may be measured by asking individuals to solve inductive reasoning problems with multiple correct answers  Advantage: directly assesses biases used to justify motive-driven behaviour