Week 7

Question 1

Name 7 arguments why we should diagnose and treat PD

Answer 1

1. Prevention and early intervention
2. PD features are highly informative markers for severe psychopathology
3. PD features are robust markers for future problems
4. Adolescence and young adulthood are sensitive periods for the development of chronis psychosocial disability; untreated PD symptoms can lead to lasting social and emotional impairments.
5. Regular PD treatment is often inaccessible or less effective for young individuals, so therefore we need treatment that is meant for adolescents
6. Misdiagnosis or poor treatment can worsen the adolescent’s condition, reinforcing the need for accurate diagnosis and tailored care.
7. Recognizing and addressing PD early may normalize care and reduce the stigma around mental illness.

Question 2

How is normal personality developed?

Answer 2

3 layers:
1. Dispositional traits (self as actor)
- Includes traits like the Big Five (e.g., neuroticism, extraversion).
- These traits reflect general tendencies that are relatively stable across time and situations.
- They are shaped by both genetics and environment.
- These traits give direction to how we feel, think, and act.
2. Characteristic adaptations (Self as agent)
- Encompasses personal goals, coping strategies, and values.
- Contextualized to time, place, and social roles.
- Begin to develop in middle childhood.
3. Narrative identity (self as author)
- Refers to the internalized life story that gives a sense of identity.
- Integrates past, present, and future.
- Develops more fully in adolescence.

Question 3

What are the consequences of disturbances in layer 1: dispositional traits?

Answer 3

Main Idea: Persistent personality trait extremes can signal disturbance.
- Adolescents with PD often show:
— High levels of neuroticism: emotional instability, anxiety, moodiness.
— Low levels of agreeableness and conscientiousness: difficulty cooperating or maintaining goals and responsibilities.

These traits are stable and global, and when extreme, may underlie persistent emotional and behavioral problems.

Question 4

What are the consequences of disturbances in layer 2: characteristic adaptations

Answer 4

Main Idea: Problems in how adolescents interpret and respond to the world.
- Adolescents with PD often:
— Hypermentalize: they over-interpret others’ thoughts, leading to mistrust or paranoia (linked to a negative attributional style).
— Use maladaptive coping strategies like:
——- Rumination
——- Aggression
——- Avoidance

These adaptations are personal and contextual, so chronic maladaptations can fuel personality pathology.

Question 5

What are the consequences of disturbances in layer 3: narrative identity

Answer 5

Main Idea: Personality disorders can stem from a disrupted sense of self.
- Adolescents with PD often show:
– Narrative identity disturbance:
—– Less coherent life stories
—– Weaker sense of agency or belonging
—– More negative interpretations of self-related events

This leads to a fragmented identity, affecting how adolescents understand themselves and relate to others.

Summary of all 3 layers:
These slides argue that personality disorders in adolescence often reflect problems across all three personality layers:
- Traits: biologically rooted, enduring dispositions
- Adaptations: learned and socially shaped coping styles
- Narratives: the evolving story that gives life meaning

Understanding and diagnosing PD requires attention to where and how development is disrupted—so treatment can be appropriately tailored.

Question 6

Describe the risk factors for BDP

Answer 6

➤ Individual Factors
1. Predisposition
- Genetics: BPD often runs in families, suggesting heritability.
- Brain stress-system alterations: Dysregulated biological stress responses increase vulnerability.
- Temperament: High negative emotionality and low distress tolerance are early risk signals.

📌 Connection to previous slides: These relate to Dispositional Traits (slide 2) — especially neuroticism and emotional instability.

2. Personality
   - Traits (e.g., neuroticism): Heightened emotional reactivity.
   - Maladaptive coping: Poor regulation strategies (e.g., avoidance, rumination).
   - Early maladaptive schemas: Deep-rooted, distorted beliefs about the self and others.

📌 These are linked to Characteristic Adaptations (slide 3), where problematic coping styles and cognitive patterns contribute to pathology.

3. Comorbidity
   - Presence of other mental disorders like depression, anxiety, PTSD, and substance use.
   - These can worsen or mask the symptoms of BPD.

📌 Comorbid conditions often emerge alongside disturbances across all three layers.

3. Self-functioning
   - Low self-worth
   - Identity disturbance

📌 These directly relate to Narrative Identity (slide 4), where adolescents struggle to form a coherent, positive life story or sense of self.

➤ Social Factors
1. System
- Insecure attachment, parental conflict, and parental psychopathology disrupt emotional development.

📌 These environmental influences can exacerbate issues in all personality layers, especially shaping maladaptive coping and self-concept.

2. Trauma
   - Abuse and neglect are critical risk factors, often leading to identity fragmentation, emotional dysregulation, and mistrust.
3. Loss and conflict
   - Significant interpersonal stressors can destabilize the developing personality.
4. Low social support, bullying
   - These contribute to isolation, poor self-esteem, and reinforce maladaptive narratives.

📌 These social factors intensify vulnerabilities in narrative identity and characteristic adaptations, leading to feelings of abandonment, mistrust, and emotional chaos.

🔗 Integrated Message Across Slides:

1. BPD risk is multi-layered, involving inherited traits, psychological coping patterns, and identity formation.
2. Personality develops through dynamic interactions of traits, adaptations, and narrative identity—disturbances at any layer can foster BPD.
3. Environmental context (e.g., trauma, family dynamics, peer support) deeply affects this trajectory.
4. Early recognition of these risk factors (slides 1–4) is critical for prevention and early intervention (first slide).

Question 7

Describe the DSM-5 criteria for (adolescent) PD

Answer 7

DSM-5 Section II – Core Symptoms (≥ 1 year)
- Cognition: Distorted perceptions of self, others, or events.
- Affect: Unstable or intense emotional responses.
- Interpersonal functioning: Difficulty maintaining stable relationships.
- Impulse control: Inability to regulate behavior.

DSM-5 Section III – Broader -Conceptualization (AMPD model)
- new alternative model to conceptualize/diagnose personality disorder
- AMPD = Alternative model of personality disorder
- Involves pathological personality traits.
- Requires moderate to extreme impairment in:
— Self-functioning (identity, self-direction)
— Interpersonal functioning (empathy, intimacy)

Thanks to the Alternative Model of Personality Disorders (AMPD):
- There’s growing research and clinical interest in adolescent PD.
- Emphasis on early intervention.
- Particular concern for Borderline PD due to:
— Its severity
— Association with suicidality and dysfunction
— High societal cost due to frequent healthcare use

✅ This echoes the rationale from the very first slide advocating for early diagnosis and treatment.

real-life consequences of untreated PD in adolescence:
- Suicidality
- School problems (dropout, academic struggles)
- Social difficulties (few friends)
- Behavioral issues
- Risk behaviors (e.g., substance abuse)

🚨 Key point: These impairments reinforce the need for early detection and targeted treatment, as emphasized in multiple earlier slides.

Question 8

Explain the DSM-5 criteria for BPD

Answer 8

core symptoms of BPD
1. Fear of abandonment – leads to frantic efforts to avoid it.
2. Unstable relationships – alternating between idealization and devaluation.
3. Identity disturbance – a fragmented and unstable self-image.
4. Impulsivity – in harmful areas like spending or substance use.
5. Suicidality or self-harm – recurrent and severe.

📌 These symptoms tie into all three personality layers:
- Traits (impulsivity, emotional reactivity)
- Adaptations (maladaptive coping)
- Narrative identity (unstable sense of self)

6. Emotional instability – rapid mood changes in response to stress.
7. Chronic emptiness – a persistent internal void.
8. Anger issues – frequent and intense expressions of anger.
9. Paranoia/dissociation – stress-induced perceptual disturbances.

📌 Again, these reflect:
- Dispositional traits (neuroticism, impulsivity)
- Adaptations (anger, paranoia, emotional dysregulation)

Question 9

Explain the big 5 traits:

Answer 9

1. Openness to Experience
   - High: Imaginative, curious, open to new experiences, creative.
   - Low: Conventional, routine-oriented, practical, resistant to change.
2. Conscientiousness
   - High: Organized, responsible, goal-directed, self-disciplined.
   - Low: Disorganized, careless, impulsive, unreliable.
3. Extraversion
   - High: Outgoing, energetic, sociable, assertive.
   - Low (Introversion): Reserved, quiet, solitary, low energy in social settings.
4. Agreeableness
   - High: Compassionate, cooperative, trusting, empathetic.
   - Low: Competitive, suspicious, critical, antagonistic.
5. Neuroticism
   - High: Anxious, moody, emotionally unstable, easily stressed.
   - Low (Emotional Stability): Calm, secure, emotionally resilient, relaxed.