15 Personality Disorders 2 – treatment

Question 1

What’s the lifetime prevalence of personality disorders?

Answer 1

6.5%

Question 2

What’s the prevalence of PD in those with mental illness?

Answer 2

25-40%

Question 3

What’s the suicide rate in those with borderline PD?

Answer 3

10%

Question 4

What’s the major trait of antisocial PD?

Answer 4

Impulsivity.

Question 5

What 3 biological factors are associated with antisocial PD?

Answer 5

1) lower levels of serotonin
2) pre-frontal deficits –impairment of executive functioning
3) amygdala dysfunction –distress cues in others don’t register

Question 6

What developmental factors are associated with antisocial PD?

Answer 6

• early trauma

- reckless since birth –no thought of harm for self or others

Question 7

What treatment is usually recommended for antisocial PD?

Answer 7

• Social skills training and anger management

- Medication –lithium or anti-psychotics

Question 8

Why is success in treatment of antisocial PD hard to measure?

Answer 8

Unclear whether success is measured cognitively or behaviourally. Is it whether they have these urges, or whether they act them out?

Also, they lie, making self-report difficult.

Question 9

What biological factors are associated with borderline PD (compared to antisocials)?

Answer 9

Pre-frontal deficits - more impaired than anti-social, so more emotional dysregulation. But better than antisocials at recognising emotion.

Question 10

What 2 psychosocial factors are associated with borderline PD?

Answer 10

1) Most borderlines have history of childhood abuse

2) Associated with insecure attachment

Question 11

What treatment for borderline has the most empirical support?

Answer 11

Dialectical behavioural therapy

Question 12

What is dialectical behavioural therapy?

Answer 12

DBT combines standard cognitive-behavioral techniques for emotion regulation and reality-testing with concepts of distress tolerance, acceptance, and mindful awareness largely derived from Buddhist meditative practice.

Question 13

What treatments other than dialectical behavioural therapy have empirical support for treating borderline PD?

Answer 13

• Psychodynamic
• Schema
• CBT

Question 14

What evidence is there for CBT in reducing suicidality in borderlines?

Answer 14

CBT significantly reduced suicidal acts over two years –BUT… no difference in hospitalisation or number of emergency calls.

Question 15

What are the four key skills of dialectical behavioural therapy?

Answer 15

1. Mindfulness skills –acceptance of emotion
2. Distress tolerance skills – engaging in non-harmful emotion-regulation behaviour – e.g. painting nails
3. Interpersonal effectiveness – how to initiate and maintain good relationships; assertiveness sills
4. Emotion regulation skills – identification and verbalisation of feelings

Question 16

What’s the drop-out rate for Dialectical Behavioural Therapy?

Answer 16

27%. Drop-out rate for most conditions is 20-30%, so not too bad.

Question 17

What is the evidence of the effectiveness of DBT for borderline?

Answer 17

A 2010 meta analysis of 16 studies (Kliem et al.) showed a moderate effect size, globally and for reducing suicidal and self-injurious behaviours. BUT… according to 5 best RCTs, gains not maintained.

Question 18

What are the three maladaptive coping styles (ways of coping with schemas)?

Answer 18

1) Schema surrender
2) Schema avoidance
3) Overcompensation – feelings or behaviors that have developed to compensate for or gratify unmet core needs

Question 19

What are the 4 Innate Child Modes in schema therapy?

Answer 19

1. Vulnerable Child: feels isolated, sad, misunderstood, pessimistic
2. Angry Child : feels angry because the core emotional (or physical) needs of the vulnerable child are not being met
3. Impulsive/Undisciplined Child : acts on non-core desires or impulses in a selfish or uncontrolled manner to get his or her own way and often has difficulty delaying short-term gratification
4. Contented Child : feels loved, contented, connected, optimistic, spontaneous

Question 20

What are the 2 Maladaptive Parent Modes in schema therapy?

Answer 20

1. Punitive Parent : feels that oneself or others deserves punishment or blame and often acts on these feelings by being blaming, punishing, or abusive towards self (e.g., self-mutilation) or others.
2. Demanding or Critical Parent : feels that the “right” way to be is to be perfect or achieve at a very high level, to keep everything in order, to strive for high status, to be humble, to puts others needs before one’s own or to be efficient or avoid wasting time; or the person feels that it is wrong to express feelings or to act spontaneously.

Question 21

What is the Healthy Adult mode in schema therapy?

Answer 21

The healthy adult moderates maladaptive schemas.

AND here’s a long list of how it happens:

nurtures, validates and affirms the vulnerable child mode;

sets limits for the angry and impulsive child modes;

promotes and supports the healthy child mode;

combats and eventually replaces the maladaptive coping modes;

neutralizes or moderates the maladaptive parent modes.

This mode also performs appropriate adult functions such as working, parenting, taking responsibility, and committing; pursues pleasurable adult activities such as sex; intellectual, esthetic, and cultural interests; health maintenance; and athletic activities.

Question 22

What’s the evidence for schema therapy for Borderline PD against psychodynamic?

Answer 22

At 3-year follow-up significantly more schema therapy patients had recovered, symptoms improved, better QoL. Less drop-out for schema than for psychodynamic.

Question 23

What results did Bamelis et al. (2014) find for schema therapy in treating Cluster C personality disorders as well as paranoid, narcissistic and histrionic?

Answer 23

Schema therapy was superior to treatment as usual (psychodynamic) on recovery, other interview-based outcomes, and dropout at 3-year follow-up. Exercise-based schema therapy training was superior to lecture-based training.