10: Personality disorders Flashcards
What does the following mean: personality disorders are axis 2 disorders Cluster A?
- thought to be stable LT conditions
- hence xp throughout much of an individual’s life
Personality disorders are characterised by individuals undergoing an enduring pattern of inner xp + behaviour that differs noticeably from the expectations of the individual’s culture in at least 2 of what?
- cognition
- mood
- interpersonal functioning
- impulsive control
What makes diagnosis of personality disorders difficult?
- high comorbidity with mood disorders
eg: Major depression, bipolar disorder
What are personality disorders?
clusters of traits that are stable over time
Why has the stability of personality disorders have come into question, challenging its definition (Loranger et al) esp when examining dependent + schizotypal personalities ?
- fair proportion of people who suffer from substance misuse have symptoms of personality disorders = occurring disorders
Why is there is shift in the assessment + diagnosis of personality disorders to dimensional models vs categorical?
- Allows personality to be assessed using various scales + psychometric test
= allows more comprehensive description of patient functioning - found to be better at predicting
- Dimensional scores more reliable across clinicians vs categorical diagnosis
- PD not so distinct from normal so better to think they are of an extreme of a distribution vs categorically different from norm population
Which behaviour did Ulrich, Borkenau + Marneros (2001) find personality tests were better able to predict?
offending behaviour than categorical diagnosis of antisocial personality disorder
What did Heuman + Morey (1990) found about the reliability between categorical diagnosis and dimensional scores?
Dimensional scores = more reliable across clinicians vs categorical diagnosis
Define the sub-clinical category Schizotypy
group of personality traits found to leave individual susceptible to delusion-like beliefs
- share a number of common characteristics with psychotic-based disorders = SZ
- SZ + schizoid PD found under category
What 2 beahviours can be observed between SZ + people with schizotypy?
- executive functioning deficits specifically associated with negative schizotypy
- score highly on psychometric measures of schizotypy
- Wisconson card sorting task - Abnormality in attention
Often schizotypy can be a prodromal phase to what to what (Yoon, Kang + Kwon, 2008)?
active phase of schizotypy personality disorder
How are schizotypes often characterised by an individual (Bentall, Claridge + Slade, 1989)?
- being quirky but awkward in social interactions
- showing sings of “odd” behaviour + lanuage
What support is there that schizotypy is a multi-factor construct (Claridge et al, 1996)?
various methods have been used to assess schizotypy
- using various approach + theory
1. 3 factor construct of Schizotypt
2. 4 factor construct of Schizotypy
Sz + Schizotypy personality disorder symptoms are clustered around what 3 factors?
- Positive
- Negative
- Disorganisation
What are the 4 factor construct of Schizotypy?
- Unusal xp (positive)
- Introversive anhedonia (negative)
- Cognitive disorganisation
- Impulsivity non-conformity
What is the difference between SZ vs Schizotypy?
SZ = episodic psychotic personality based disorder
Schizotypy PD = grounded in LT, fairly stable development of personality
To be diagnosed with SPD, 5 or more of what symptoms have to be present?
- ideas of reference (not delusions)
- odd beliefs/ magical thinking which influence behaviour that are not the nrom
- unusual perceptual xp, including bodily illisions
- odd thinking + speech
- being suspicious (of others)
- odd behaviour/ appearance
- lack of friends other than first degree relatives
- excessive social anxiety which doesn’t seem to subside even when familiar so more to do with paranoia
What is Schizoid PD?
- less intense form of SPD
Characterised by… - pattern of reduced attachment from social relationships
- accompanied by restricted range of emotions
To be diagnosed with Schizoid PD, at least 4 of what symptoms have to be present?
- no desire/ enjoyment of close relationships
- almost always choosing solitary activities
- little interest in sexual xp
- little pleasure in few activities
- lacks close friends/ confidants
- indifferent to praise/ criticism
What is the main difference between SPD vs Schizoid PD?
- reason for withdrawal from social interaction
SPD = fear of social interaction (paranoia/ suspicion)
Schizoid PD = lack of desire for social interaction
What are the 5 or more symptoms which need to be present + having a significant impact on their daily life for borderline PD to be diagnosed?
- erratic emotions accompanied by feelings of emptiness + anger
- Difficulty making + maintaining relationships
- unstable sense of identity - often driven by social influencers
- risk taking without considering potential consequences
- self-harming or thoughts of it
- fear of being rejected/ abandoned
- hallucinations/ delusions
Who are most likely to be diagnosed with borderline PD?
- 75% diagnosis = females :O
- prevalence = 1/2%
Why is there such a high rate of suicide (10%) among those diagnosed with borderline disorder?
- negative emotions xp = negative thoughts
What makes borderline PD hard to diagnose + treat?
high co-morbidity
- depression, anxiety, eating disorder, substance misuse
Who is Craig?
- went to doctor to sneakily ask for some codeine
- doctor found history of morphine addiction + impulsivity + irregular work
- didn’t give any drugs
- afterwards he returned for a legitimate reason and said he knows the doctor is not stupid and would believe him
How is the the term Antisocial PD described by clinicians?
- a pervasive pattern of disregard for, + violation of, the rights of others
- begins in childhood/ early adolescence
- continues into adulthood
What are the core characteristics of antisocial PD?
- impulsivity
- disregard for other people’s safety = reckless
- consistent irresponsibility
- lack of remorse for others
repeatedly. .. - performing illegal acts
- lying/ conning others for profit/ pleasure
What label are offenders given if they have mental illness, PD, learning difficulties or drug dependency?
mentally disordered offender
According to Lynam + Gudonis (2005), what are the five dimensions of personality would people with antisocial PD score low on?
Costa + McCrae (1995) 5-factor model of personality Low... - neuroticism - extroversion - openness - agreeableness - conscientiousness
A low score in the 5 factor model of personality (Costa + McCree) as suggested by Lynam + Gudonis for people with antisocial PD entails what type of behaviours?
- L neuroticism = emotional blandness - lacking appropriate concern for health/ social adjustment
- L extroversion = introversion - socially isolated, may xp flattened affect
- L openness = difficulty adapting to social/ personal change, little tolerance for opinions + high conformity
- L agreeableness = cynical + paranoia thinking, exploitative + manipulative
- L conscientiousness = underachiever, lack of self-discipline, aimless
Define the term ‘psychopathy’
- person demonstrates an apparent cluster of psychological, interpersonal + neurological features
Hare 1993, they are… - social predators who charm + manipulate
-ruthlessly plough through life - completely lacking consciousness + empathy
- selfishly take + do what they want
- violate social norm with no guilt
What are the 3 categories of psychopathy devised by Hare?
- Primary psychopath
- true psychopaths = actually have emotional, bio + cognitive differences - Secondary psychopaths
- behave as they do due to severe emotional problems/ inner conflict - Dyssocial psychopaths
- behaviour learnt from subcultures - gangs/ families
Why are secondary + dyssocial psychopaths portrayed as incorrently as psychopaths in the media?
- high recidivism rates
- those with psychopathic disorder = 7x more likely to commit serious crime on discharge vs those with mental illness (Bartol + Bartol, 2011)
What cluster does borderline PD belong to, A or B?
Cluster B
What is the PCL-R?
Psychopathic check list - revised (Hare)
- measures 20 items based on typical characteristics
- rated based on interviews + file information
EG, superficial charm, lack or remorse, impulsivity, juvenile delinquency
What is the prevalence of psychopathy in prison?
high
- around 13% in UK scored high
- 73% males in special unit
What is the difference between antisocial PD vs Psychopaths, which is often overlooked in the legal sector?
psychopaths = often associated with criminal/ antisocial behaviour + can be classified as having anti-social PD
- much more precise + in-depth
Anti-social PD = much more diverse
What are the guidelines + overall goals for treatment made by Roth + Fonagy (1998) for the treatment of borderline PD?
- Psychotherapy more effective for less severe cases
- Patients under age of 30 = greater risk of suicide = prevention rather than cure important target therapy
- those with good social support, chronic depression, psychologically minded + low impulsivity = most benefit from ‘talking therapy’
- commitment + enthusiasm of therapist important
What treatments are there for borderline PD?
- cognitive therapy
- identification + modification of cognitions + underlying schemata - Emotional awareness therapy
- work through a hierarchy of emotional awareness, starting with bodily sensations - Pharmacological treatment
What did Soloff et al find about the pharmacological treatment for borderline PD?
- inconsistent
- major tranquillisers (Haloperidol) reduce broad spectrum of symptoms
- some have heightened suicide threats/ agression
What treatment is there for antisocial PD?
Family + peer intervention (Borduin, 1999)
- give them skills to cope with family life
- reduce stress levels at home environment
- peer-intervention to encourage pro-social interaction
What are the treatments for psychopathy?
Therapeutic communities
- often used in forensic settings where there is a high percentage of offenders w/ PD
