4a - personality disorders Flashcards
Personality Disorders - all the Axis
Multiaxial DSM-IV
Axis I - clinical psychological disorders
Axis II - personality disorders
Axis III - medical conditions and physical disorders
Axis IV - psychosocial and environemntal factors
Axis V functional level
Axis II
enduring patterns of inner expereince and behaviour - deviate from cultural expectations, pervasive & inflexible, cause distress/impairement, not due to another disorder
cluster A
odd, eccentric:
paranoid PD
schizoid PD
schizotypal
cluster B
dramatic, emotional, or erratic’ disorders:
Antisocial
Borderline
Histrionic
Narcissistic
cluster c
‘anxious or fearful’ disorders
Avoidant
Dependent
Obsessive-compulsive
Borderline (Emotionally Unstable) PD:
Unstable personal relationships; frantic attempts to avoid real/imagined abandonment; lack of well-formed identity; feelings of emptiness/worthlessness; Instability of feelings.
Frequent suicidal, self-harming, self-mutilating behaviours; Impulsivity in self-damaging behaviours.
Continuity hypothesis
there is no discontinuity between normality and illness.
views of conceptual profiles:
wigner and Mcrae
Widiger et al. (1994): conceptual profile for Paranoid PD.
McCrae et al (2001): profiles may indicate risk (but not diagnosis) of PD. May be useful for ruling out a PD, or characterising a known PD
Testing the Big 5 Profile Approach
McCrae et al (2001)
patients from psychiatric hospitals
Calculated ‘profile agreement’ scores for each patient.
Significant correlations – but only “modest to moderate
Potential need to revise the current diagnostic classification system for personality disorders (DSM-IV).
A New Approach to PDs? - limitations DSM
Limitations of DSM-IV PD Classification include:
Extensive co-morbidity.
Low temporal/inter-assessor reliability.
Not based on empirical personality models…
Suggestions for DSM-5 - (4
dimensional rather than categorical approach
e.g. Widiger, Costa & McCrae (2002):
1) Assess personality facet profile (NEO-PI-R).
2) Assess personality-related social/occupational impairments and distress.
3) If dysfunction & distress clinically significant – diagnose PD.
4) (determine if the profile matches with PD category descriptor)
DSM-5 (2013)
Retention of all 10 PDs and Clusters in main DSM-5
But: additional ‘emerging measures and models’ section
DSM-5: Section III (Emerging Measures and Models)
criterion A and B
Criterion A: Severity
Significant impairments in functioning of
self (identity or self-direction)
Interpersonal (empathy or intimacy)
Criterion B: Style
One or more pathological personality trait domains or facets (measured with ‘Maladaptive Trait Model’: Krueger et al. 2012.)
Dissociative Identity Disorder (DID)
/ symptoms
DSM-5: A mental disorder defined by the presence of two or more distinct identities or personalities.
- Amnesia for prior or recent events.
- Cause distress and/or functional impairment.
- Not due to e.g. substance use, cultural practice or imaginative play.
Haslam (2007): Typically - DID
Primary ‘host’ personality plus one or more alters.
Alters take turns to control behaviour.
Distinctive patterns of thinking and behaving.
Different names, ages, genders etc.
Memory loss for experiences as other alters.
Features and Observations - DID
Reports of severe childhood sexual/physical abuse common.
Patients high in ‘trait suggestibility
Clustering of cases.
Geographically - most cases N AMerica
By therapist – small n of therapists diagnose
Increase in cases: Up to 1980: Fewer than 200 Current: 10s of thousands
Reports becoming more extreme
From 2/3 alters to >100 + More extreme abuse
Post-Traumatic Model of DID
Primitive response to trauma.
Dissociation of consciousness to escape initial trauma.
Dissociation becomes response mechanism for future stress.
→ Suggestibility pre-disposes to dissociation.
Socio-Cognitive Model of DID
Symptoms emerge as a product of therapy
Hypnosis and leading questions cause patient to reinterpret experiences.
Mood swings expressed as multiple personalities.
A culture-bound phenomenon (not ‘faking’).
→Suggestibility increases susceptibility .
→ Accounts for clustering of cases and rise in prevalence and severity.
Spanos (1994): and Paris (2012):
Spanos (1994): Experimental, hypnotic manipulations can ‘reveal’ apparent hidden self or past life identities in psychologically healthy individuals.
Paris (2012): Transcripts of ‘Sybil’’s therapy sessions show that the multiple personality narrative was imposed upon her.
