Week 9 Lecture 9 - Personality Disorders - Jo Fielding (DN) Flashcards Preview

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Flashcards in Week 9 Lecture 9 - Personality Disorders - Jo Fielding (DN) Deck (82)
1

What is personality?

  • Qualities, traits  of character/behaviour
    • peculiar to a specific person
  • Enduring patterns of perceiving, relating to, & thinking about the environment & oneself that are exhibited in a wide range of social & personal contexts.

2

When is personality disordered?

Enduring pattern of behaviour & inner experience

deviates from expectations of a person’s culture in at least 2 of the following areas:

  • cognition
  • affectivity
  • interpersonal functioning
  • impulse control

3

How do personality disorders differ from many of the other disorders we have studied in this unit?

  • Chronic
  • tend to originate in childhood
  • persist throughout the lifespan
  • invade every aspect of persons life

 

4:00

4

How does DSM-5 classify Personality Disorders?

Cluster A: odd or eccentric behaviours

  • Paranoid
  • Schizoid
  • Schizotypal

 

Cluster B: emotional, erratic or dramatic behaviours

  • Borderline
  • Histrionic
  • Narcissistic
  • Antisocial

 

Cluster C: fear, anxiety

  • Avoidant
  • Dependent
  • Obsessive-Compulsive

5

What was one of the reasons for promotion of an alternative model in DSM-5?

Comorbidity of personality disorders

 

 

14:05

6

What is the DSM-5 criteria for Cluster A: Paranoid

Pervasive distrust & suspiciousness of others, motives interpreted as malevolent.

Indicated by 4 (or more) of the following:

  • 1. Suspiciousness of being exploited, harmed, deceived
  • 2. Doubts about loyalty /trustworthiness of others
  • 3. Reluctance to confide in others because - suspiciousness
  • 4. Reads hidden meanings into innocuous actions of others
  • 5. Bears grudges for perceived wrongs
  • 6. Angry reactions to perceived attacks on character/reputation
  • 7. Unwarranted suspiciousness of fidelity of partner

7

Which other Personality Disorders are comborbid with Paranoid Personality Disorder?

Schizotypal, borderline, avoidant all have similar diagnostic criteria

it is the underlying bit that distinguishes them

8

How does Cluster A: Paranoid Personality Disorder differ from Schizophrenia?

  • no hallucinations
  • only a general impairment in work & social 
  • dont have cognitive disorganised seen in Schizophrenia

12:30

9

What factors have been implicated in the aetiology of Cluster A: Paranoid Personality Disorder

we dont know a lot about cause
  • Genetic -
    • common if family member with schizophrenia
  • Psychological
    • difficult to get info out of them
    • childhood (faulty perceptions as they see the world as malevolent)
    • difficult to entangle fact from fiction
  • Cultural
    • misinterpreting others views/opinions of them

10

Why is treatment difficult for Cluster A: Paranoid Personality Disorder

  • Trust
    • hard to develop
    • unlikely to seek help unless crisis
    • may seek help for comorbid conditions (depression) not for the personality disorder itself
  • Therapists not optimistic about treatment
    • difficult to keep them around long enough to effect positive change

 

17:00

11

What is the DSM-5 criteria for Cluster A: Schizoid Personality Disorder

Pervasive pattern of detachment from social relationships, & a restricted range of expressions of emotion in interpersonal settings.

Indicated by 4 (or more) of following:

  • 1. Lack of desire/enjoyment close relationships
  • 2. Almost always chooses solitary activities
  • 3. Little interest in sex
  • 4. Few / no pleasurable activities
  • 5. Lack of friends
  • 6. Indifferent to praise / criticism from others
  • 7. Flat affect, emotional detachment

 

18:10

12

What factors have been considered in the Aetiology of Cluster A: Schizoid Personality Disorder?

  • childhood experiences
  • parents with autism may have child who develops Schizoid
    • possible biological basis 

 

more frequently diagnosed in males

 

21:00

13

Which personality types have similar diagnostic criteria to Schizoid Personality Disorder, so are often comorbid?

Schizotypal Personality Disorder

Avoidant Personality Disorder

Paranoid Personality Disorder

 

21:10

14

What are some likely precursors to Schizoid Personality Disorder?

Childhood shyness

Abuse

Parents of kids with Autism may develop Schizoid PD

 

21:30

15

What is likely to prompt someone with Schizoid PD to seek treatment?

What would treatment/therapy usually involve?

How effective is treatment?

Normally a crisis - or another individual distressed by them

  • e.g., job loss, extremem depression
  • Not likely to just go and seek help for the PD

Treatment approaches:

  • teaching them to empathise with others
  • social skills training
  • Role play: learning to identify & engage with social networks

Effectiveness

not alot of evidence as it is hard to get individuals to 

22:00

16

What is the DSM-5 criteria for Cluster A: Schizotypal Personality Disorder

Pervasive pattern of social & interpersonal deficits – acute discomfort with, & reduced capacity for close relationships as well as by cognitive, or perceptual distortions & eccentricities.

Indicated by 5 (or more) of the following:

  • 1. Ideas of reference
  • 2. Peculiar beliefs / magical thinking
  • 3. Unusual perceptions
  • 4. Peculiar patterns thought or speech
  • 5. Suspiciousness / paranoia
  • 6. Inappropriate / restricted affect
  • 7. Odd / eccentric behaviour / appearance
  • 8. Lack of close friends
  • 9. Anxiety about other people

17

How does Cluster A: Schizotypal Personality Disorder compare/differ to Schizophrenia?

  • Schizotypal exists on a continuum with schizophrenia

However Schizotypal

  • no hallucinations & delusions (more of a sense rather than actually seeing/hearing)
  • psychotic-like - but can test reality (have some insight)

 

25:45

18

What are ideas of reference?

belief that things relate to them

 

19

How do the unusual perceptions in Schizotypal PD differ from those in Schizophrenia?

 

Schizotypal - more like a sense that someone is there

Schizophrenia - will actually see or hear 

20

What factors have been implicated in the aetiology of Cluster A: Schizotypal Personality Disorder

Is there a gender difference in aetiology?

  • Genetic contribution possible
    • twin studies show increased prevalence in relatives with Schizophrenia
      • (as with other 2 Cluster A disorders (Paranoid & Schizoid)
    • may be a phenotype of the schizophrenia genotype
      • evidence its a precursor for schizophrenia
  • Neurobiological
    • brain changes
    • increased ventricles, decreased grey matter in temporal lobes
    • similar to schizophrenia
  • Environmental contributions
    • Childhood mistreatment
      • more typically in men
    • PTSD
      • more typically in women

27:00

21

Which other Personality Disorders are comborbid with Cluster A: Schizotypal Personality Disorder?

Which other non-PD disorder also commonly co-exists?

Most likely to be comorbid

  • Paranoid Personality Disorder (cluster A)
  • Avoidant Personality Disorder (cluster C)
  • (Symptoms overlap)

Depressive disorder also common in people with Schizotypal PD

26:30

22

What neurobiological similarity exists between Schizotypal PD & Schizophrenia?

  • similar brain changes
    • enlarged ventricles
    • reduced grey matter in temporal lobe

 

27:20

23

Why does Jo refer to the symptoms of Personality Disorders as 'Psychotic-like'

because there is no full blown psychosis in the personality disorders

 

28:50

24

Psychotic-like symptoms are characterised as either positive or negative

Which of the Cluster A Personality Disorders have positive symptoms &/or which have negative symptoms?

Cluster A:

  • Positive (e.g. Ideas of reference, magical thinking, perceptual disturbances)
    • Paranoid & Schizotypal
  • Negative (e.g. Social isolation, poor rapport, constricted affect)
    • Paranoid & Schizoid

25

Which of the Cluster A Personality Disorders was proposed to be dropped in DSM-5 (although did not eventuate)?

  • Paranoid & Schizoid (the first two) were proposed to be dropped (due to such overlapping symptoms)
  • just leaving Schizotypal (the third of the Cluster A PD's)
  • this may happen in future DSM revisions

 

26

What is one of the most common Personality Disorders found in clinical settings?

Borderline Personality Disorder

9.3% of clinical settings

 

33:15

27

What is the DSM-5 criteria for Cluster B: Borderline Personality Disorder

Pervasive pattern of instability of interpersonal relationships, self-image, & affects, & marked impulsivity.

Indicated by 5 (or more) of the following:

  • 1. Frantic efforts to avoid abandonment
  • 2. Unstable interpersonal relationships –others idealised / devalued
  • 3. Unstable sense of self
  • 4. Self-damaging, impulsive behaviours
  • 5. Recurrent suicidal behaviour, gestures, self-injury
  • 6. Affective instability
  • 7. Chronic feelings of emptiness
  • 8. Recurrent bouts of intense / poorly controlled anger
  • 9. During stress, experience transient paranoid thoughts / dissociative symptoms

28

What is the best predictor of suicide in individuals with Borderline Personality Disorder?

Emotional instability

 

33:15

29

Which other non-Personality Disorders are comborbid with Borderline Personality Disorder?

Which Cluster of Personality Disorders are likely to co-exist with Borderline PD?

Is there a gender difference in Borderline PD?

Non-PD Comorbidities

  • PTSD
  • Major depression
  • Bipolar disorder
  • Bulimia
  • Substance use disorderer

 

PD Comorbidity

  • Cluster A (Odd, eccentric)

 

Gender difference

  • more common in females (75%)

33:30

30

What factors have been considered in the Aetiology of Cluster B: Borderline Personality Disorder?

Genes

  • genes account for 60% variance in development of BPD
  • Twin studies - higher concordance in monozygotic twins

 

Serotonergic system dysfunction

  • linked to instability, suicide & impulsivity

 

Neuroimaging studies

  • look at limbic network involvement (involved in emotion regulation)
    • increased activity in amygdala
    • decreased activity in PFC
      • PFC normally downregulates an excitable amygdala

 

Environmental

  • early childhood trauma
    • sexual & physical abuse
      • significantly more likely to develop BPD, especially girls
    • not causative as there are people with BPD without abuse
      • thus complex relationship
      • though abuse seems to make one vulnerable (predisposed)
  • Temperament
  • Neurological impairment

 

42:00

31

What is 'splitting' in relation to Borderline Personality Disorder?

  • a defence mechanism that dichotomises everything into either good or bad
  • part of Object relations theory (Kernberg)
    • splitting leads to extreme views of others behaviour
    • then difficulty in regulating emotional response (as everything is at extremes)
    • others seen as supporting or not supporting

 

45:05

32

What two theories exist for Borderline Personality Disorder?

Object relations theory

  • Inconsistent childhood experiences
  • ‘splitting’ – good or bad
  • extreme views of others behaviour

Diathesis-stress theory

  • Biological vulnerability  > invalidating environment
    • e.g emotional dysregulation
      • > demands/outburst 
      • > punishment
      • > suppressed emotions
      • > emotional outburst = attention!
      • viscious cycle

45:50

33

What are the treatment outcomes for Borderline Personality Disorder?

What is the likely treatment time-course for Borderline Personality Disorder?

Treatment Outcomes

  • positive, successful outcomes if can get them into therapy

Time Course 

  • long & drawn out
  • 10 years

34:00

34

What are treatment options for Borderline Personality Disorder?


Pharmacological

  • Anticonvulsants/antipsychotics – core symptoms
  • Antidepressants – aggression/depression

 

Dialectical Behaviour Therapy

  • Empathy/acceptance, cognitive problem-solving, emotion regulation, social skills training
  • Stop black/white thinking
  • Prioritise treatment: Harm, Therapy, QOL
  • decreases suicide attempts, drop outs even after just 5 days of treatment
  • but treatment it is a long term prospect

 

Schema Focused Cognitive Therapy

  • Works to identify maladaptive assumptions
  • Increase use of healthy schemas

 

Pharmacological

 

  • Anticonvulsants/antipsychotics – core symptoms
  • Antidepressants – aggression/depression

 

48:15

35

What is the DSM-5 criteria for Cluster B: Histrionic Personality Disorder

Pervasive pattern of excessive emotionality & attention seeking.

Indicated by 5 (or more) of the following:

  • 1. Strong need to be centre of attention
  • 2. Inappropriate sexually seductive behaviour
  • 3. Rapidly shifting expression of emotions
  • 4. Use of physical appearance to draw attention to self
  • 5. Speech excessively impressionistic & lacking in detail
  • 6. Exaggerated, theatrical emotional expression
  • 7. Overly suggestible 8. Misreads relationships as more intimate

36

What are some classification issues with Histrionic Personality Disorder?

 

Cluster B: (emotional, erratic, or dramatic)

  • Bias association with women (even though it is actually equally common in men & women)
    • vanity etc thought to lead to this bias
  • Comorbidity: 2/3 of people have comorb Antisocial Personality Disorder (also Cluster B)
    • Antisocial PD more commonly diagnosed in males
    • some have wondered if Histrionic & Antisocial Disorders are sex-type alternatives of the same underlying condition
    • also comorbis with Borderline PD (also Cluster B)
  • Symptom overlap with
    • Borderline PD (Cluster B)
    • Narcissistic PD (Cluster B)
    • Dependent PD (Cluster C)

because of these classification issues, there was a strong push to remove Histrionic or put it in another category in DSM-5

note: the difference between 'symptom overlap' and 'comorbid'

102:40

37

What other PD and non-PD's are comorbid with Histrionic Personality Disorder?

Cluster B: (emotional, erratic, or dramatic)

Depression

Antisocial Personality Disorder (also Cluster B)

Borderline Personality Disorder (also Cluster B)

38

What are treatment options for Histrionic Personality Disorder?

Cluster B: (emotional, erratic, or dramatic)

  • Focus on problematic interpersonal relationships
    • Recognition of long-term costs
  • Taught more appropriate ways of negotiating wants & needs

39

What is the DSM-5 criteria for Cluster B: Narcissistic Personality Disorder

Pervasive pattern of grandiosity (in fantasy or behaviour), need for admiration & lack of empathy.

Indicated by 5 (or more) of the following:

  • 1. Grandiose view of importance
  • 2. Preoccupation with success, brilliance
  • 3. Belief one is special & understood only by other high-status people
  • 4. Extreme need for admiration
  • 5. Strong sense of entitlement
  • 6. Tendency to exploit others
  • 7. Lack of empathy 
  • 8. Envious of others
  • 9. Arrogant behaviour / attitudes

40

How does the lack of empathy in Narcissistic PD differ to that in Antisocial PD?

  • Lack of empathy not to same degree as in APD, comes from a different place
    • Narcissistic - because they are more focussed on self
    • Antisocial - from a disrespect for others

 

105:50

41

What is the defining feature of Narcissistic Personality Disorder?

 

Cluster B: (emotional, erratic, or dramatic)

unreasonable sense of self-importance

e.g., Sheldon lol

42

Why are people with Narcissistic Personality Disorder often depressed?

because people around them generally don't stand around admiring them as they expect they should

people do not live up to their expectations, e.g., they do not treat them as they expect the deserve to be treated

 

106:45

43

Are there gender differences in Narcissistic Personality Disorder?

What other Personality Disorder most commonly co-exists with Narcissistic PD?

  • Mostly male  (50 - 75%) 

 

  • Most commonly comorbid with Borderline PD (also Cluster B)

107:00

44

What factors have been considered in the Aetiology of  Narcissistic Personality Disorder?

 

  • Parental style
    • Failure by parents to model empathy
  • Self-psychology model (Kohut)
    • Characteristics mask a fragile self-esteem
      • bolster self worth by having others admire them
    • Parenting at extremes
      • Parental coldness
        • > diminishing sense of self
      • Over-emphasis on achievement
        • > over-elevated sense of self 
  • Social-cognitive model (Morf & Rhodewalt, 2001)
    • Interpersonal relationships = means to bolster self-esteem
    • Cognitive biases help maintain grandiose beliefs
      • focus is on self & being the best
      • not gaining or mainting closeness of others
  • Sociological view
    • Christopher Lash - book called 'The Culture of Narcissism'
    • "me generation"

 

107:40

45

What are treatment options for Narcissistic Personality Disorder?

Cluster B: (emotional, erratic, or dramatic)

  • Goal is to help them to focus on others
  • Options are limited because they are hypersensitive to evaluation
    • difficult for clinician to point out imperfections when they only want to be perfect
  • Cognitive therapy – replace fantasies
    • focus on day to day pleasurable experiences based in reality
  • Coping strategies
    • helping them accept criticism
    • relaxation training as they can be quite anxious

 

1:10:30

46

Which of the Personality Disorders are the most difficult to treat?

Antisocial Personality Disorder

47

What is the DSM-5 criteria for Cluster B: Antisocial Personality Disorder

Pervasive pattern of disregard for & violation of the rights of others occurring since age 15.

Indicated by 3 (or ore) of the following:

  • 1. Repeated law breaking
  • 2. Deceitfulness, lying
  • 3. Impulsivity
  • 4. Irritability & aggressiveness
  • 5. Reckless disregard for own safety & that of others
  • 6. Irresponsibility as seen in unreliable employment or financial history
  • 7. Lack of remorse

48

What are defining features of Antisocial PD?

disregard for others

violation of others rights

lack of remorse

 

1:13:15

49

What are some unique criteria that must be met for a diagnosis of Antisocial Personality Disorder?

  • 18 years old
  • had prior diagnosis of conduct disorder

 

1:13:20

50

What is prevalence, gender & comorbidity of  Antisocial Personality Disorder?

Cluster B: (emotional, erratic, or dramatic)

Aetiology

  • delinquency (conduct disorder precursor)

 

Prevalence

  • Associated with low SES and urban living

 

Gender

  • Much more common in males •
    • 3% in males and 1%in females

 

Comorbidity

  • 75% meet criteria for another disorder
  • Substance abuse common ~60%

51

What other names has Antisocial Personality Disorder been known by over the years?

Which of these is stilled used by health professionals today, even though it is not in DSM-5?

Moral Insanity, Egopathy, Sociopathy & Psychopathy

Psychopathy is still used

1:14:45

52

What broad factors have been considered in the Aetiology of  Antisocial Personality Disorder?

  • Delinquency (conduct disorder precursor)
    • Criminals > 3/4 have Antisocial Personality Disorder
  • Genetic influences
  • Social factors
  • Neurobiological factors

 

1:14:45

& 1:17:00 - 

53

What Neurobiological factors thought to be involved in the aetiology of Antisocial Personality Disorder?

Autonomic NS > less response to anxiety

  • decreased skin conductance to aversive stimuli
  • decreased startle to negative stimuli
  • don't see conditioned fear response so punishment is ineffective

 

Underarousal > low levels of cortisol = seek stimulation

 

Imbalance between inhibition & reward systems

  • Inhibition = septo-hippocampal system
    • noradrenergic/serotonergic systems
  • Reward = mesolimbic system •
    • dopaminergic system & limbic areas of brain
  • Fear/anxiety less apparent, positive feelings more prominent

 

54

What Social factors thought to be involved in the aetiology of Antisocial Personality Disorder?

  • Family environment predictive of antisocial behaviour:
  • High negativity, low warmth, inconsistency
  • Poverty, exposure to violence

55

What Genetic factors are thought to be involved in the aetiology of Antisocial Personality Disorder?

  • Twin, adoption studies – high heritability
  • APD, psychopathy, CD, substance abuse - related
  • Genetic, behavioural, family influences really hard to disentangle

56

How did the concept of Psychopathy come about? What was its basis?

  • Derived from the work of a psychiatrist called Hervey Cleckley
    • he identified a constellation of characteristics - personality traits
    • Key characteristic - poverty of emotions
    • Antisocial behaviour performed impulsively
  • Focussed on how the person thinks not on how they behave

57

What may be presumed when a person with Antisocial Personality Disorder displays positive feelings?

  • that it is an act
  • they are presumed to not experience the highs & lows of emotion
  • Key characteristic: poverty of emotions

 

1:15:50

58

Why doesn't the threat of incarceration diminish behaviour in Antisocial Personality Disorder?

  • they appear immune to anxiety or pangs of conscience
  • so unable to profit from punishment to curb impulses
  • dont see conditioned fear responses in these individuals

 

1:19:35

59

What is Antisocial Personality Disorder so difficult to treat?


Cluster B: (emotional, erratic, or dramatic)

  • Compliance issues
    • don't want treatment
      • extrememly manipulative
      • difficult to tell if they are responding to treatment or just playing the game
    • history of failing to comply with Social Norms
    • unacceptable actions with no remorse
  • Long term outcomes are poor
    • Clinicians are not optimistic
      • many think the only otpion is to incarcerate them

 

1:14:00 & 122:00

60

What is the focus of treatment for Antisocial Personality Disorder?

Focus on high-risk children 

  • Recognise problems early
    • conduct disorder in adolescence
    • antisocial behaviours in young children
    • treatment can be attempted before its too late

 

Most common treatment

  • Parent training
  • Using praise/privilege to reduce problem behaviour & encourage prosocial behaviour
  • this treatment is quite promising

Most clinicians will not engage with them once they are adults - unfortunately viewed as hopeless cases

 

122:30

61

What is the Psychopathy Checklist (PCL-R)?

What does it consist of?

Whose work was it based on?

  • standard tool for differentiating between someone with Antisocial Personality Disorder & someone who is a Psychopath
  • interviews, criminal records, social worker reports
  • based on the work of psychiatrist Hervey Cleckley

 

1:17:00

62

Conduct Disorder is a pre-requisite for a diagnosis of Antisocial Personality Disorder

What is the DSM-5 criteria for Conduct Disorder

Repetitive & persistent pattern of behaviour in which the basic rights of others or major age-appropriate societal norms or rules are violated.

3 (or more) criteria under following categories in the last 12 months with at least 1 present in the last 6 months:

  • 1. Aggression to people & (animals)
  • 2. Destruction of property
  • 3. Deceitfulness or theft
  • 4. Serious violation of rules Disturbance causes clinically significant impairment in social, academic, occupational functioning

 

124:10

63

What are the defining features of Conduct Disorder?

  • violation of major age-appropriate norms/rules
    • agression
    • destruction
    • deceitfulness
    • theft

64

What is the main difference between Conduct Disorder & Antisocial Personality Disorder?

lack of remorse/empathy in Antisocial Personality Disorder

 

126:40

65

What is the DSM-5 criteria for Cluster C: Avoidant Personality Disorder

DSM5 criteria: Pervasive pattern of social inhibition, feelings of inadequacy, & hypersensitivity to negative evaluation.

Indicated by 4 (or more) of the following:

  • 1. Avoidance of occupational activities - significant interpersonal contact
  • 2. Unwilling to get involved with people unless certain of being liked
  • 3. Restrained in intimate relationships -fear of being shamed or ridiculed
  • 4. Preoccupation with being criticised / rejected
  • 5. Inhibited in new interpersonal situations - fear of inadequacy
  • 6. Views self as socially inept / inferior
  • 7. Unusually reluctant to try new activities - may prove embarrassing

66

What factors have been considered in the Aetiology of Avoidant Personality Disorder?

  • Genetic
    • heritability 27-35%
  • Related to schizophrenia-related disorders
  • Integrated biological & psychosocial factors
    • Difficult temperament >  rejection by parents > perception of rejection > low self-esteem, social alienation
  • Modeling?

130:20

67

What are treatment options for Avoidant Personality Disorder?

Cluster C: (fear, anxiety)

  • Behavioural intervention techniques
    • Anxiety & social skills problems
  • Similar to treating social phobia
    • exposure, role play, modeling, cognitive therapy
  • Collaborative approach
    • Connection between therapist & client best predictor of success

68

How does the asocial behaviour differ between

Avoidant Personality (Cluster C fear anxiety)
and
Schizoid Personality Disorder (Cluster A: odd, eccentric)

  • Avoidant Personality Disorder
    • Asocial because of interpersonal anxiety or fear of rejection
  • Schizoid Personality Disorder
    • Asocial because apathetic & disinterested in relationships 

129:40

69

What is the DSM-5 criteria for Cluster C: Dependent Personality Disorder

Pervasive & excessive need to be taken care of that leads to submissive & clinging behaviour & fears of separation.

Indicated by 5 (or more) of the following:

  • 1. Difficulty making decisions without excessive advice & reassurance Need for others to take responsibility for most major areas of life
  • 2. Difficulty disagreeing with others - fear losing their support
  • 3. Difficulty doing things on own - lack of self-confidence
  • 4. Doing unpleasant things as a way to obtain the approval & support Feelings of helplessness when alone - lack of confidence in ability
  • 5. Urgently seeking new relationships when one ends
  • 6. Preoccupation with fears of taking care of self

70

How does Dependent Personality Disorder compare with Avoidant Personality Disorder?

 

(Both Cluster C: fear, anxiety)

  • same feelings of inadequacy,
    • sensitivity to criticism,
    • need for reassurance
  • ‘Cling to’ rather than avoid relationships

71

What defines Dependent Personality Disorder?

 

(Cluster C fear anxiety) 

Unreasonable fear of abandonment

 

134:30

72

Are there gender differences in Dependent Personality Disorder?

What other disorders are comorbid with Dependent Personality Disorder?

  • No gender differences
  • Comorbid
    • Borderline PD (Cluster B: emotional, errtic, or dramatic)
    • Schizoid PD (Cluster A: odd, eccentric)
    • Avoidant PD (Cluster C: fear,anxiety)
    • Mood & anxiety disorders

73

What non-PD and PD comorbidities exist with Avoidant Personality Disorder?

  • 80% experience depression
  • Borderline PD (Cluster B)
  • Schizotypal PD (Cluster A)

Social phobia – more chronic version?

 

130:00

74

What factors have been considered in the Aetiology of Dependent Personality Disorder?

  • Attachment theory
    • We are all born dependent
      • Disruption to early bonding (e.g., death of parent)
      • constant anxiety about ‘losing’ significant others
  • Over-protective & authoritarian parenting styles
    • prevent development of self-efficacy

 

134:55

75

What issues can negatively impact treatment of Dependent Personality Disorder?

What is the major goal of therapy?

Cluster C: (fear, anxiety)

  • Overdependence on therapist
    • can appear to be ideal patients (doing exactly as asked)
      • reinforces dependence
      • defeats major goal of therapy
  • Major goal
    • help client become more independent & personally responsible

 

136:00

76

What is the DSM-5 criteria for Cluster C: Obsessive-Compulsive Personality Disorder

Pervasive pattern of preoccupation with orderliness, perfectionism, & mental & interpersonal control, at the expense of flexibility, openness, & efficiency.

Indicated by 4 (or more) of the following:

  • 1. Preoccupation with rules, details, & organisation
  • 2. Extreme perfectionism interferes with task completion
  • 3. Excessive devotion to work - exclusion of leisure / friendship
  • 4. Inflexibility about morals & values
  • 5. Difficulty discarding worthless items 
  • 6. Reluctance to delegate unless others conform to one’s standards
  • 7. Miserliness
  • 8. Rigidity & stubbornness

77

What factors have been considered in the Aetiology of  Obsessive Compulsive Personality Disorder?

  • Weak genetic contribution
    • may be predisposition to favour structure in life
  • Parental reinforcement of conformity / neatness
  • Fear of loss of control so overcompensating

77

What are treatment options for Obsessive Compulsive Personality Disorder?

Cluster C: (fear, anxiety)

  • Directed at fear of inadequacy
  • CBT is similar to that used in OCD
    • Redirect compulsive thoughts
    • Relaxation / distraction / reality testing

78

Which Personality Disorder did Jo present as 'Masters of Control' in the lecture?

What kinds of people have been associated with this PD?

Obsessive Compulsive Personality Disorder

  • Serial killers 
  • Sex offenders – similar brain function  
  • Gifted children – debilitating perfectionism

137:45

79

Are there gender differences in Obsessive-Compulsive Personality Disorder?

Yes, its more common in males than females

80

What disorder is commonly comorbid with Obsessive-Compulsive Disorder?

Avoidant Personality Disorder (also Cluster C: fear, anxiety)

81

How does Obsessive-Compulsive Personality Disorder compare with OCD?

  • distantly related
  • don't get obsessions & compulsions