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Flashcards in Task 8 Deck (58)
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Personality disorders

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


Origins of PDs

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


PDs as a general genetically trait-based construct

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


Stability and change

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


´DSM-5 Model

Hybrid model


Schizoid (DSM-5)

 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



 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



 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



 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



 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



 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



 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



 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



 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


Obsessive compulsive

 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)


Cluster A

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


Cluster B

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


Cluster C

anxious fearful
avoidant, dependent and obsessive-compulsive PD


Problems with DSM-5

 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


Dimensional system in DSM-5

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


Identity problems (A DSM-5)

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


Self-direction problems (A DSM-5)

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


Empathy problems (A DSM-5)

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


Intimacy problems

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


Diagnosing with alternative system of DSM-5

 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


ICD 11

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


PD criterion in ICD 11

 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


Mild personality disorder ICD 11

 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


Moderate personality disorder ICD 11

 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


Severe personality disorder ICD 11

 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