4. Personality Disorders Flashcards

1
Q

Outline the general elements of PDs

A

A) Enduring patterns of thinking / feeling / acting / relating
B) Culturally deviant
C) Pervasive and inflexible
D) Lead to distress or social impairment

Typical onset in adolescence and early adulthood

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2
Q

Outline the categorical model of PDs and its failures

A

PDs as distinct clinical entities –> this is problematic

Failures:
- does not account for extensive co-morbidity of PDs
- does not account for extreme heterogeneity (many ways you can display PDs)
- poor inter-rater reliability
- PD NOS was the most common category of PD diagnosis (does not fit into a certain PD)
- arbitrary cut-offs (you need diagnosis to get treatments, but what if you don’t meet these cutoffs?)

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3
Q

Outline the dimensional model proposal:

A

Personality disorder instead conceptualised as maladaptive variants of personality traits

but ‘too complex for clinical practice’

2 Criteria
- impaired personality functioning
- - pathological personality tratis

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4
Q

What were the changes from the DSM-IV to DSM-V regarding PDs

A

Removal of the axial system:
- Axis 1: clinical disorders (phobias, depression)
- Axis 2: Personality disorders and mental retardation (intellectual disability)
- Axis 3: physical health, etc

This gave the implicit message that personality disorders were ‘untreatable’ but evidence says that you can actually treat these disorders.

These axes were removed from DSM 5

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5
Q

What were the clusters?

A

Cluster A: “weird”, odd, eccentric
- paranoid
- schizoid
- schizotypal

Cluster B: “wild”, dramatic, emotional
- Antisocial
- Borderline
- Histrionic
- Narcissistic

Cluster C: “worried”, anxious, fearful
- Avoidant
- Dependent
- Obsessive Compulsive

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6
Q

Outline cluster A

A

Odd or eccentric

Paranoid: distrust, suspiciousness
- Misinterprets others’ actions and motives

Schizoid: social detachment, limited emotions
- Prefers isolation, lacks close friendships / relationships

Schizotypal: acute discomfort in close relations
- perceptual distortions
- eccentricities
- sometimes seen on the spectrum of schizophrenia

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7
Q

Outline Cluster B

A

Dramatic, emotional, errative

Antisocial: disregard and violation of rights of others beginning in childhood/adolescence
- more common in males
- highest prevalence in alcohol use disorder clinics, prisons, and other forensic settings

Borderline: instability of interpersonal relationships, self-image, emotions; behavioural dysregulatoin
- fear of abandonment, splitting, identity disturbances, emptiness, selfharm
- makes up to 1/5 of inpatients
- 75% of BPD patients are women

Histrionic: excessive emotionality and attention seeking
- self-dramatisation, craving for activity, overreacting to minor events, irrational, angry outburts or trantrums
- 1-2% population, F>M

Narcissistic : pervasive pattern of grandiosity, need for admiration, lack of empathy
- 6% population (75% men)

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8
Q

Alcohol and aggression

A

For individuals with APD, there’s a stark increase in aggressive responding when intoxicated - compared to non-clinical group

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9
Q

Criteria for Antisocial personality disorder

A

A. Pervasive pattern of disregard for and violation of the rights of others since 15 years, including 3 of the following:
- failure to conform to social norms (grounds for arrest)
- deceitfulness (lying)
- impulsivity
- irritability and aggressiveness (fights and assaults)
- reckless disregard for safety
- irresponsible
- lack of remorse

B: individual at least 18 years

C. evidence of conduct disorder (onset before 15)

D: not during the course of schizophrenia or bipolar epsiode

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10
Q

Criteria for Borderline Personality Disorder

A

A. instability of interpersonal relationships, self image, affects, marked impulsivity beginning by early adulthood (cross contexts) - indicated by 5+
- fear of abandonment
- unstable and intense relationships (splitting)
- identity disturbance
- impulsivity in 2 areas (self damaging)
- recurrent suicidal behaviour / self-mutilating
- affective instability
- emptiness
- inappropriate intense anger
- transient stress related paranoid ideation

BPD inpatients:
- 71% had history of childhood sexual abuse

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11
Q

Cluster B and childhood abuse

A

People with documented childhood abuse are 4x as likely than those who were not to be diagnosed with PDs

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12
Q

Outline cluster C

A

Anxious, fearful

Avoidant: social inhibition, feeling inadequate, hypersensitivity to negative evaluation
- avoid social situations for fear of embarrassment

Dependent: submissive and clinging; excessive need to be taken care of

Obsessive Compulsive: preoccupation with orderliness, perfectionism and control

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13
Q

Outline the dimensional model:

A

Usually based on 5 factor model:
- neuroticism (fearful, anxious –> other extreme, oblivious to signs of threat)
- extraversion (extreme –> intense attachments, other extreme: cold, distant)
- agreeableness (extreme: docile, meek, yielding –> other extreme: combative and aggressive)
- openness (extreme: unrealistic, lives in fantasy –> other extreme, concrete)
- conscientiousness (extreme: perfectionistic –> disincline, irresponsible)

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14
Q

Look at the alternative model for DSM-5 –> hybrid

A

PDs involve:
Criterion A - impaired personality functioning
Criterion B - pathological personality traits

Use functioning and traits to identify specific PD diagnoses for:
- antisocial, avoidant, borderline, narcissistic, obsessive compulsive, schizotypal

No paranoid, schizoid, dependent, histrionic

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15
Q

Outline Criterion A of the alternate model

A

Impairment in self and interpersonal functioning

Moderate or greater impairment in:
- identity
- self direction
- empathy
- intimacy

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16
Q

Outline Criterion B of the alternate model

A

Organised into 5 broad domains:
- Negative affectivity (neuroticism)
- Detachment (extraversion)
- Psychoticism (openness)
- Antagonism (agreeableness)
- Disinhibition / losing touch w reality (conscientiousness)

17
Q

Testing the alternative model:

A

Kreuger and Hobbs found
- meaningful clinical correlates (self-harm, treatment drop out)
- acceptable / improved inter-rater reliability
- reasonable psychometric properties

18
Q

Are there cultural differences in PD prevalence?

A
  • BPD and ASPD has increased in US over past 30 years (genuine increase, increase in pathology, definitional or diagnostic increase)
  • prevalence of ASPD in US = 3%, Taiwan = 0.2%
  • 15% US adults have at least one personality disorder
19
Q

Outline Winsper’s 2020 systematic review and meta-analysis

A

Global prevalence of PDs is 7.8%
PDs are more common in high income countries compared to low income countries.

Cluster B and C are less common in low income

Explanations for this is cultural protection factor (collectivism, community support system?)

20
Q

What is person-cultural value clash?

A

Avoidance, Dependent, Borderline personality disorders are not observed in Chinese classification of mental disorders –> in a confucian context, these traits may not be considered as disordered.

If your personality clashes with cultural values, it may cause distress (an underlying feature of personality disorders)

21
Q

Self-report of US and turkish participants - cultural clash

A

People in the US who rated themselves as more collectivistically oriented also rated themselves as higher in avoidant and dependant personality disorder features.

For Turkish participants who were more individualist oriented, they self-reported more narcissistic, antisocial and borderline features

22
Q

How can we make sense of normal personality disordered personality without culture?

A

A PD reflects difficulties in how a person behaves and is perceived to behave by others in this social field - bringing into play cultural values related to what is expected, valued and devalued in a person.