W6) 14) Personality Disorders Flashcards
Why do we need to know about current statements?
What is a problem with the personality disorders?
What is the prevalence?
What is a Personality Disorder?
ICD-10 (WHO, 1992)
* Enduring and deeply ingrained ways of behaving, thinking, feeling and relating
* Deviate significantly from the norm
* Sufficient to cause significant personal and social distress and disruption
* Usually present since adolescence or childhood and persists throughout most of adult life.
What are the classifications?
Whar are the problems with classification?
- Most patients meet criteria for >1 PD - everyone is different.
- Extreme heterogeneity within PD diagnoses
- Arbitrary diagnostic thresholds
- Poor coverage (PD NOS the most common)
- Poor convergent validity
- Longitudinal course more like Axis 1 than previously realised
- Problems communicating about dimensions to other clinicians.
What is the DSM 5 classification?
PPDWG Proposal
* Hybrid categorical dimensional model
* Evaluation of impairments in personality functioning
* Six specific patterns of traits: borderline; obsessive-compulsive; avoidant; schizotypal; antisocial; narcissistic
* “PD – Trait specified” if fail to meet criteria for specific PD
Rejected at last minute by the APA Board of Trustees
* Placed in Section III, “Emerging Measures and Models”
* Retains DSM-IV diagnostic criteria
* Single axis system
What does ICD-11 show?
Focuses on global impairment of self and interpersonal personality functioning
General diagnostic requirements
Classified according to degree of severity
Personality difficulty; Mild/Moderate/Severe PD
Can specify with 1+ trait qualifiers
Negative affectivity
Detachment
Dissociality
Disinhibition
Anankastia
Can also code Subthreshold Personality Difficulty and a Borderline Pattern qualifier
Less emphasis on early onset and stability of d
How do you assess people?
Interview-based measures
International Personality Disorder Examination (IPDE)
Structured Clinical Interview for DSM-IV Axis II Personality Disorder (SCID-II)
Self-report measures
Millon Clinical Multiaxial Inventory (MCMI)
Minnesota Multiphasic Personality Inventory Personality Disorder Scales (MMPI-PD)
What did they find with the McLean study?
Enduring and persistent?
McLean Study of Adult Development Zanarini et al. (2006)
Prospective study of borderline PD
70% meet remission criteria at 8 years
~6% of remissions experience recurrence within 8 years
Different symptoms resolve at different rates
Impulsivity resolves most quickly, followed by interpersonal, cognitive and then affective symptoms.
What are the problems with PD?
- Mortality and accidents
- Mental illness
- Poor treatment outcome
- Increased service utilisation
- Antisocial behaviour
- Deliberate self-harm
- Suicide
What is the prevalence of PD and violence?
What are the specific PDs and violence?
Some are protective against violence.
How do you measure outcome?
Methodological problems
Lengthy evaluation period required
Treatment rejection
Multifaceted; comorbidity
Lack of consensus on outcome measures
Outcome measures
Symptoms; personality
Quality of life; social functioning
Behaviour; recidivism
Service use
What is the ‘what works’ literature?
Democratic Therapeutic Community = flatten heirachy, more responsibility for prisoners, small group therapy.
Drop outs do worse and low risk offenders do worse than high risks.
- You become more aware of difficulties. But you don’t get to the point of how you can address them.
- Mixing with others like you - negative associations.
- Try to match someone to the risks.
What are some models that helps to reduce the impact of PD?
What is MBT?
Mentalisation-Based Therapy
Definitions of mentalisation
The mental process by which an individual implicitly and explicitly interprets the actions of himself and others as meaningful on the basis of intentional mental states such as personal desires, needs feelings, belief, and reasons.
To see ourselves from the outside and others from the inside
Understanding misunderstanding
Having mind in mind
Introspection for subjective self-construction – know yourself as others know you but also know you subjective self (your experience)
What is SFT?
Schema-Focused Therapy
This is a very validating therapy. Non-judgemental and helpful
What is DBT?
Dialectical Behavioural Therapy
What are the common factors in these different models?
Gets worse?
- Not ready for treatment, not motivated, can get destabalised, covering work adds to trauma.
What is the risk-need-responsivity?
How do you deliver treatment?
What are the NICE guidelines?
What are the drug treatments?
What are the future directions?
