TASK 8 - PERSONALITY DISORDERS Flashcards
1
Q
personality disorder
A
= extreme levels of some personality characteristics
- stable and enduring
- emerge in adolescence/early adulthood
- deviate from norms of one’s culture
- inflexible across many aspects of one’s life; maladaptive
- ego-syntonic: they not feel ‘unnormal’
- must involve negative consequence for functioning of individual or of others around him/her; lead to distress or impairment
2
Q
DSM-V
- cluster A
A
= odd, eccentric - prevalence of 5.7% SCHIZOID SHIZOTYPAL PARANOID
3
Q
DSM-V
- cluster A
SCHIZOID
A
= extreme detachment, lack of interest in social/personal relationships, very limited expression of emotions in interpersonal settings
- no affection for others, indifference to praise/criticism
- even in nonsocial preferred settings, little joy or pleasure
4
Q
DSM-V
- cluster A
SCHIZOTYPAL
A
= discomfort in close relationships, combined with eccentric behaviours
- unusual ‘ideas of reference’
- tend to be highly superstitious, fascinated by paranormal, may have bizarre perceptual experiences
- similarity with schizoid PD: detachment from social relationships
5
Q
DSM-V
- cluster A
PARANOID
A
= extreme distrust, suspiciousness of others’ motives, sense of being persecuted
- suspect others are trying to harm/deceive/exploit them, hold grudges against those perceived as causing harm
- quick to take offence/feel insulted
- response to stress: experience brief psychotic episodes
- may be an antecedent to schizophrenia
6
Q
DSM-V
- cluster B
A
= dramatic, emotional, impulsive, unstable, erratic - prevalence of 1.5% ANTISOCIAL BORDERLINE HISTRIONIC NARCISSISTIC
7
Q
DSM-V
- cluster B
ANTISOCIAL
A
= total disregard for and violation of rights of others
- deceitful, repeatedly lie to others for personal gain, feel no remorse for harm caused to others
- tend to be aggressive, irresponsible, impulsive, reckless
8
Q
DSM-V
- cluster B
BORERLINE
A
= extreme impulsivity, instability of relationships (love/hate and fear of abandonment), self-image, and emotions
- impulsive behaviour: drug/alcohol use, eating binges, spending sprees, sexual escapades, self-harming behaviours
- extremely moody, temperamental individuals
- little sense of personal identity/meaning in life
9
Q
DSM-V
- cluster B
HISTROINIC
A
= excessive attention seeking (physical appearance/provocative style)
- exaggerated expression of emotions (which are shallow and rapidly changing)
- intense need to be centre of attention, uncomfortable if not so
- easily influenced by others, tend over interpret new relations
10
Q
DSM-V
- cluster B
NARCISSISTIC
A
= grandiosity (thinking one is superior, deserves admiration); selfish lack of concern for others’ needs.
- arrogant style, often exploit others
- tend to fantasise about having high status, envies highly successful people
11
Q
DSM-V
- cluster C
A
= anxious, fearful - prevalence of 6% AVOIDANT DEPENDENT OBSESSIVE-COMPULSIVE
12
Q
DSM-V
- cluster C
AVOIDANT
A
= social inhibition, shyness, feelings of inadequacy (low self-esteem), oversensitivity to possible negative evaluation
- similarity with schizoid and schizotypal: avoid social contact –> avoidant person wants social contact but is afraid of rejection
13
Q
DSM-V
- cluster C
DEPENDENT
A
= excessive need to be taken care of, submissive/clinging behaviour, fear of separation
- need other people to take care of important things of their lives, feel unable to take care of themselves when alone
- when a close relationship ends: may desperately look for a new one
14
Q
DSM-V
- cluster C
OBSESSIVE-COMPULSIVE
A
= excessive preoccupation with orderliness, perfection, control (unnecessarily hoarding money and objects)
- may lead to failure to complete activities, tasks
- difference to obsessive-compulsive DISORDER: repeated behaviours such as hand washing or counting
15
Q
DSM-V
- NOS
A
= not other specified
- person has disorder but is not clearly specifiable into one type
- passive-agressive, depressive…
16
Q
critique/limitations to DSM-V
A
- symptoms of given disorders do not necessarily go together: two people diagnosed with same disorder, could have different symptoms
- comorbidity: two disorders may have overlapping symptoms –> tend to be diagnosed together
- makes the system inefficient - ‘clusters’ of disorders do not match factor analysis results
- dimensional models: should be seen as continuum
- NOT either have disorder, or not –> some people have slightly disorder, whereas others may have it severely - NOS: many people don’t seem to fit in the given categories
17
Q
prevalence of personality disroders
A
- reported point prevalence of 6.1%,
- lowest prevalence in Europe
- highest prevalence in North and South America
- as common in men than in women
- as common in people from ethnic minorities as in majority populations
- higher in people in contact with health-care services; in clinical settings, higher in women than in men
- highest prevalence of PD in people in contact with criminal justice system
18
Q
implications of personality disorders
A
- higher morbidity, mortality
- -> increased suicide and homicide
- -> cardiovascular and respiratory diseases
- -> life expectancy at birth is shorter (19 years W, 18 years M)
- difficulties in interpersonal relationships
- -> effect on relationships with health-care professionals (poorer quality care)
- high prevalence of smoking, alcohol, drug misuse
19
Q
assessment of personality disorder
A
- clinical practice: rarely diagnosed, accounts for less than 5% of all hospital admissions
- complex nature of diagnostic system: those diagnosed are usually assigned categories of borderline, antisocial or NOS
- -> few clinicians doing effort to assess personality status in all its components
- -> stereotyped thinking: self-harm = BPD; aggressive = antisocial
- difficulty in assessment : absence of quick, reliable instruments
- -> complexity of reviewing all (often inferential) criteria
- -> self-report questionnaires too long for general clinical settings
- -> simplest: Standardised Assessment of Personality Abbreviated Scale and Iowa Personality Disorder Screen (but over-diagnosis)
20
Q
alternatives to DSM-V
A
dimensional systems
1) disorder as extreme version of normal personality dimension
- five-factor model
√ eliminates comorbidity
x some people have extreme traits but no PD
2) disorder on dimension with other disorders (Axis I)
- e.g. schizophrenia spectrum
21
Q
ICD-11
A
- APA decided to keep its earlier system and include new one only as a topic of study
- people must have (A) impaired personality functioning + (B) pathological personality tratis
A. decide whether person has personality disorder, categorical
B. classify which personality disorder, dimensional - hybrid model: combo of categorical + dimensional model
22
Q
ICD-11
A. impaired personality functioning
A
- self problems
a) identity: not have sense of being unique person; unstable self-esteem, being easily threatened by negative experiences
b) self-direction: not be able to set realistic/meaningful goals; lack internal standards for behaviour; unable to reflect constructively on own experiences/motivations - interpersonal problems:
a) empathy: unable to understand experiences/motivations of others; unwilling to consider others’ perspective; little understanding of how own behaviour affects others.
b) intimacy: lack positive, sustained relationships; unable to engage in close/caring relationships with anyone; unable/unwilling to cooperate with others - self-regulation of emotions (impulsivity)
23
Q
ICD-11
B. pathological personality traits
A
- 25 personality traits (= ‘trait facets’) classified into five broad domains:
1. negative affectivity: intense, frequent experience of negative emotions - similar to Neuroticism in Big 5 and Emotionality, low Extraversion and low Agreeableness in HEXACO
2. detachment: withdrawal from social interactions - similar to low Extraversion in Big 5, HEXACO
3. antagonism: acting in ways that create difficulties for others - similar to low Agreeableness in Big 5 and HEXACO as well as low Honesty-Humility in HEXACO
4. disinhibition: impulsive behaviour - similar to low Conscientiousness in Big 5, HEXACO
5. psychoticism: unusual, bizarre thoughts and perceptions - limited similarities (eccentricity/oddness are a bit related to Openness to Experience and low Conscientiousness in HEXACO)
24
Q
ICD-11
C. temporal stability
A
= some degree of stability of disorder over time
25
ICD-11
| D. non-normatitivity
= not normative in culture (antisocial behaviour more normal in some cultures)
26
ICD-11
| E. medical exclusion
= traits must not be caused by medical interventions (phineas gage)
27
ICD-11
| - advantages/disadvantages
√ distinguish between patients having more or less severe cases--> severity of functional impairments & pathological traits
√ distinguish between many different varieties of PD --> considering which pathological traits are shown
28
origins of personality disorders
- roots in childhood/ adolescence
- gene-environment interactions
- similar as for personality traits
- neurobiological differences
- childhood adversities, rape incidents, trauma
- insecure attachments to parents, parental substance abuse --> maladaptive coping styles
29
life course of personality disorders
- evolve continuously over life span
- epigenetics
- similar to normal trait change
- moderately stable during childhood
- increases in stability from adolescence to adulthood
- disorder peak at 13-14 --> reduce monotonically until 28 years
- change more over time than people without PD, typically (not always) in the direction of improvement
- general psychological functioning poor but stable
- change in trait predicts change in disorder, not vice versa
30
difficulties in treatment
1. disorders are based on individual’s own personality characteristics --> tend to be stable across long periods of time, across different circumstances
2. some disorders entail characteristics that make individual less likely to be ‘good patient’ (emotional reactions in BPD or deceitfulness in Antisocial)
31
treatment of antisocial PD
- problematic --> might try to appear as though they have been cured
- psychopathic offenders show poor outcome in CBT, group therapy
√ best approach: show other ways to obtain what they want without harming others
- aims at reducing gap between person’s self-interest and society’s expectations of acceptable behaviour
√ cognitive behavioural therapy combined with training in social skills & problem solving gave most positive results (early intervention important)
32
treatment
| - cluster A
- hardest to treat (least adaptive + easily fake)
- psychosocial treatment: cognitive therapy can affect change in cognitive & social disabilities of schizotypal patients
- pharmacotherapy: some improvement in overall severity, risk benefit ratio unclear
33
treatment
| - cluster B
- psychosocial: improved outcomes on life-threatening behaviours & psychiatric symptoms
- -> generalist models: no extended training, no specialist in BPD
- -> evidence-based treatment: more intensive, BPD-specific treatment
- pharmacotherapy
- -> BPD: generally be avoided
- -> Antisocial PD: can be used for comorbid mental disorders; not routinely
34
treatment
| - cluster C
- psychosocial: improves social function & reduces distress
- pharmacotherapy: antidepressants work for people with social phobias --> might be effective in people with avoidant PD
35
psychosocial treatment
- idea: personality and its disorders arise from complex interaction between genes, developmental processes and adverse life events
- interpersonal difficulties
- mix of group and individual treatments, integrated with other services available --> optimum
36
pharmacotherapy/psychobiological treatments
- idea: behavioural traits associated with PD might be associated with neurochemical abnormalities of CNS/PD could be understood in terms of imbalances of chemical substances in brain --> certain kinds of drugs were said to counteract these imbalances and reduce symptoms
- model is still untested because clinical trials focus mostly on BPD
37
psychosocial treatment
| - psychodynamic psychotherapy
- aim: encourage patient to speak freely about everything, including dreams and fantasies, by improving patient’s self-understanding
- help patient express emotions (even troubling/distressing ones), help identifying recurring patterns in behaviour and examine important interpersonal experiences in patient’s life
38
psychosocial treatment
| - Cognitive-Behavioral Therapy (CBT)
- aim: understand irrational beliefs patient holds about oneself, surrounding world and future; show that views are inaccurate, harmful --> try to change those perceptions
39
psychosocial treatment
| - Dialectical Behavior Therapy (DBT)
- aim: make patient more aware of own thoughts/feelings, getting patient to reflect on, accept those thoughts and feelings openly and without judgement (to avoid conflict)
- specifically for people with BDP
40
subclinical
= middle ground between normal personality & clinical level pathology
41
dark triad
| - machiavellianism
- manipulative personality
- take certain pleasure in successfully deceiving others but aren’t necessarily better in doing so
- HIGH: lack of empathy & affect, unconventional view of morality, self-focused
- negatively correlated with C, positively correlated with neuroticism
- more willing & skilled to fake in employment interviews
- manipulation in negotiations
42
dark triad
| - narcissism
- 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
- motivated to be the best in their chosen area, put effort in development
- use appearance to charm others in negotiations
43
dark triad
| - psychopathy
- 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
- threats in negotiations
44
dark triad
| - workplace outcomes
- weakly related to poor job performance
- negative relationship to citizenship behaviour
- ineffective vs. destructive leadership
- -> psychopathic leaders = less cooperate social responsibility & diminished organisational support for employees
- -> toxic leaders = shitty feeling subordinates = less creativity
- -> leader failures (what gets you to the top doesn’t necessarily keep you there) --> unable to maintain relationships
- workplace deviance
- unethical decision making in organisations
- creativity
- less job satisfaction & high levels of interpersonal conflict (there is exceptions though)
- context-dependent whether positive or negative role
- big wins + losses; less stable year-to-year performance
- successful negotiators
45
dark triad
| - taxonomy
- potentially destructive intention, not necessarily result in negative outcome
- result in negative outcomes (= traits as channels for implicit motives)
- harm is a necessary consequence of label “dark”
