Chapter 14-15: Personality Disorders Flashcards
- Feeling recognition problems, fear of feeling, lesseened ability to endure/regulate emotion-states
- Stomp & Punch walls, Neurotransmitter & set-point changes
- Social fallout from addition behaviour.
Affect Intolorance | A Regressive Behaviour
________ of people with alcohol use disorder have a mental illness
________ of people who abuse drugs have a mental illness
37% | 53%
Cluster B: Dramatic, Erratic
Typical features are a failure to conform to lawful, ethical behaviour and an egocentric, callous lack of concern, accompanied by deceitful ness, irresponsibility, manipulativeness, and/or risk taking.
- Disorder is in the proposed alternative model (DSM-5 appendix)
_________
- pervasive pattern of disregard for / violation of rights of others
- 3% prevalence in males
- 1% prevalence in females
- Most comorbidity with narcissistic personality disorder
Psychopathy (extreme APD)
Psychopathy a specifier in proposed alternative model (DSM-5 appendix):
“marked by a lack of anxiety or fear and by a bold interpersonal style that may mask maladaptive behaviours (e.g., fraudulence). […] low levels of anxiousness and withdrawal and high levels of attention seeking.”
- 0.75 % prevalence in males
- 0.25 % prevalence in females
Yet psychopaths count 15-25% of imprisoned Canadian offenders
Key Characteristics
- Glibness/superficial charm
- Grandiose sense of self-worth
- Proneness to boredom/need for stimulation
- Pathological lying
- Conning/manipulative
- Lack of remorse
Antisocial Personality Disorder
Cluster C: Anxious, Fearful
A pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation
- This disorder is in the proposed alternative model (DSM-5 appendix):
- Typical features are avoidance of social situations and inhibition in interpersonal relationships related to feelings of ineptitude and inadequacy, anxious preoccupation with negative evaluation and rejection, and fears of ridicule or embarrassment.”
_____
- <1% prevalence
- Equally common in females and males
- Most comorbidity with schizoid personality disorder
Big Five Profile
- Low extraversion
- High neuroticism
Avoidant Personality Disorder
Big 5 Scores for PDs
Borderline = high EN low AC
Histrionic = high ENO low C
Avoidant - High N low E
Dependent = high NA
OCD = High NA low EO
Cluster B: Dramatic, Erratic
A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity
- This disorder is in the proposed alternative model (DSM-5 appendix)
_____
- 1-3% prevalence
- More common in females
- Most comorbidity with schizotypal personality disorder
Typical features are instability of self-image, personal goals, interpersonal relationships, and affects, accompanied by impulsivity, risk-taking, and/or hostility.
Big Five Profile
- High extraversion
- High neuroticism
- Low agreeableness
- Low conscientiousness
Borderline Personality Disorder
- gateway drug; frequent users have much greater lifetime probability than non-users to use ‘dangerous substances’; opioids or cocaine.
Cannabis
________% treated for other SADs report Cannabis use.
…with Cocaine addiction: 12%
…with Methamphetamine addiction: 6%
…with Heroin & other Opiates addiction: 2%
25%-80%
Percent of Cannibis Users with CO-OC Mental Disorder:
Major Depressive Disorder: ____%
Anxiety Disorder: ____%
Biolar 1 Disorder: ____%
Antisocial Personality Disorder: ____%
Obsessive-Compulsive Personality Disorder: ____%
Paranoid Personality Disorder: ____%
11% | 24% | 13% | 30% | 19% | 18%
Cannibis use with Mental Disorders… ( ABA MOP )
AD: ____
B: ____
AP: ____
MD: ____
OC: ____
P: ____
Major Depressive Disorder: 11%
Anxiety Disorder: 11%
Biolar 1 Disorder: 11%
Antisocial Personality Disorder: 11%
Obsessive-Compulsive Personality Disorder: 19%
Paranoid Personality Disorder: 18%
Percent of Cannibis Co-Occurring with another addiction:
Cocaine addiction: ____%
Methamphetamine addiction: ____%
Heroin & other Opiates addiction: ____%
12% / 6% / 2%
Cluster A
Odd, Eccentric:
Paranoid
Schizoid
Schizotypal
Cluster B
Dramatic, Erratic
Antisocial
Borderline
Histrionic
Narcissistic
Cluster C
Anxious, Fearful
Avoidant
Dependant
Obsessive-Compulsive
General Big Five profile
High neuroticism
And if we remove dependent personality disorder, considering just the alternative model (DSM-5 appendix)… then the remaining 2 (avoidant, obsessive-compulsive) both have low extraversion
Canadian (community samples)
- 37 % of those with AlcoholUD have a Mental Illness
- 53 % of those who abuse drugs have Mental Illness
North American (community samples)
- 28.6 % of those with AlcoholUD had at least one PD
- 47.7 % of those with DrugUD had at least one PD
Percentage of population with a PD also with addictive disorder
- 16.4% had a current alcohol use disorder
- 6.5% had a current SUD
Community Samples tell us:
- If you meet a random person with a PD, there is a fair (but not huge) chance they’ll also have an addiction or two.
- If you meet a random person with Addiction, there’s a good chance they’ll also have a PD or two.
CO-OC and Community Samples
(Canadian vs NA included)
Cocaine abusers
- 71 % had at least one PD
- 40 % had two or more
Most common
- Antisocial = 21 %
- Passive-aggressive = 21 %
- Borderline = 18 %
- Self-defeating = 18 %
CO-OC Clinical Cocaine Samples
Craig (1988) assessed 121 opiate addicts (in Chicago):
100% had at least one PD and 27% had more than one
- Antisocial = 22%
- Narcissistic = 18%
- Borderline = 16%
- Dependent = 16%
CO-OC Clinical Opiate Samples
Clinical samples (have more comorbidity):
- Of those with a current SUD:
- 57-73% had at least one PD
- 35-50% had at least two PDs
Co-Occuring and Clinical Samples
- Also referred to as Dual Diagnosis or Co-Occuring Disorders
- Important to consider addiction as primary before personality disorder. Too easy to diagnose personality disorder bassed on addiction behaviour.
Comorbidity
Things that occur together
Concomitant Factors
DSM-1: Inadequate Personality, Learning Disturbance, Sexual Deviation, Speech Disturbance, Enuresis (bed-wetting), Somnambulism (sleep-walking)
DSM-2: Explosive, Hysterical, Asthenic (weak) neurasthenia (lassitude, fatigue, headache, and irritability, associated chiefly with emotional disturbance).
DSM-3R: Masochistic, Self-Defeating
Personality PDs has been relatively unchanged since 1980s (DSM-3)
Dead Disorders
Cluster C: Anxious, Fearful
A pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency
_____
- This disorder is not in the proposed alternative model (DSM-5 appendix)
- Removal has been recommended due to little research on the disorder
_____
- 4% prevalence
- More common in males
- Most comorbidity with schizotypal personality disorder
Big Five Profile
- High neuroticism
- High agreeableness
Dependent Personality Disorder
Cluster B: Dramatic, Erratic
A pervasive pattern of excessive emotionality and attention seeking.
- This disorder is not in the proposed alternative model (DSM-5 appendix)
- Removal recommended. Little research on (successful treatment) of disorder
_____
- 2% prevalence
- Equally common in males and females
- Most comorbidity with narcissistic personality disorder
Big Five Profile
- High extraversion
- High neuroticism
- High openness
- Low conscientiousness
Histrionic Personality Disorder
- Cannot delay gratification, over-reactive, low frustration tolorance
- Craving, Withdrawal
Impulsivity | A Regressive Behaviour
Of adolescents who use Cannibis, ____% have _____ Disorders.
vs.
Of adolescents who use Cannibis, ____% have _____ Disorders.
Overall Internalizing Disorders 33%
Overall Externalizing Disorders 60%
The proportion of a population who, at some point in life has ever had the characteristic.
- Approximately ______ of Canadians (6 million) meet criteria for SUD during their lifetime.
Lifetime Prevalence
21.6%
Lifetime Prevalence: Most Common Additctions (by DSM-IV):
Alcohol: ______
Cannabis: ______
Other Drugs: ______
18.1 % / 6.8 % / 4.0 %
Approximately ______ of Canadians (6 million) meet criteria for SUD during their lifetime.
21.6%
The three most common types of addition comorbidity in order of prevalence are:
______________, ______________, and ______________
Affective (mood) disorders
Personality Disorders
Anxiety Disorder
Most common Personality Disorders
(lifetime prevalence by DSM-IV):
Obsessive-Compulsive Personality ____%
Avoidant (avoiding situations) ____%
Paranoid ____%
Borderline (females more than males) ____%
Schizotypal ____%
Antisocial roughly ____%
Personality Disorders
7.7% / 6.6% / 5.6% / 5.4% / 5.2% / 2-3%
Cluster B: Dramatic, Erratic
A pervasive pattern of grandiosity (in fantasy and behaviour), need for admiration, and lack of empathy.
- This disorder is in the proposed alternative model (DSM-5 appendix)
- Typical features are variable and vulnerable self-esteem, with attempts at regulation through attention and approval seeking, and either overt or covert grandiosity
_____
- <1% prevalence
- More common in males
- Most comorbidity with antisocial personality disorder
- SIN: Single Item Narcissism Question: How Narcissistic Are you?
Narcissistic Personality Disorder
Nicotine-dependent smokers (who experience withdrawal) are ______ - ______ times more likely to have these 6 disorders. Risk is _____ to _____.
(Hint) A_____,D _____, A_____, D_____, B_____, P_____.
2.7 - 8.1 times
alcohol | drug | anxiety | depressive | bipolar | personality
Risk is 22% - 32%
Cluster C: Anxious, Fearful
“A pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency.”
_____
This disorder is in the proposed alternative model (DSM-5 appendix):
“Typical features are difficulties in establishing and sustaining close relationships, associated with rigid perfectionism, inflexibility, and restricted emotional expression”
_____
- 4% prevalence
- More common in males
- Most comorbidity with schizotypal personality disorder
Big Five Profile
- High neuroticism
- Low extraversion
- Low openness
- High agreeableness
Obsessive-Compulsive Personality Disorder
Cluster A: Odd, Eccentric
A pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent
- Not in the proposed alternative model (DSM-5 appendix)
- Removal recommended due to little research on the disorder
________
- 0.5-2.5% prevalence (yearly)
- More common in males
- Most comorbidity with Schizotypal
- Suspects, without sufficient basis, that others are exploiting, harming, or deceiving him or her
- Is preoccupied with unjustified doubts about the loyalty or trustworthiness of friends and associates
- Is reluctant to confide in others because of unwarranted fear that the information will be used maliciously against him or her
- Reads hidden demeaning or threatening meanings into benign remarks or events
- Persistently bears grudges
- Perceives attacks on character/reputation that are not apparent to others and quick to react angrily or to counterattack
- Has recurrent suspicions, without justification, regarding fidelity of spouse or sexual partner
Paranoid Personality Disorder
- Being withdrawn, isolated, feeling helpless, mentally lazy.
- Adapted to high reward.
- Social uncertainty.
Passivity | A Regressive Behaviour
Percentage of population with a PD also with addictive disorder
______% had a current alcohol use disorder
______% had a current SUD
16.4% / 6.5%
North American (community samples)
______% of those with AlcoholUD had at least one PD
______% of those with DrugUD had at least one PD
28.6 % / 47.7 %
A persistent pattern of emotions (across situations), cognitions, and behaviour that results in enduring emotional distress for the individual or others. Assessed in terms of dysfunction (adaptive problems) and requires life long course (since at least adolescence).
- far less researched than other disorders
- most research is on APD
- relegtated (DSM-IV) to Axis II. Treated as “not quite real.”
- only some insurance providers cover them
- Axis II defered means “this client likely has but I don’t have time or need to get to bottom of it.”
- researchers dismissive (we’re all a little narcissistic”).
- If you see 3 clients for SUD expect one will have a PD.
Personality Disorder
- Personality Disorders affect between _____ and _____ of population (we think)
Personality Disorder Canadian Base Rates
6% / 15%
Percentage of population with addictive disorder who also have a PD:
- Of those with current Alcohol UD, _____ had at least one PD
- Of those with current Drug UD, _____ had at least one PD
Personality Disorder Comorbidity
28.6% / 47.7%
- Personality traits are dimensional
- Diagnoses are categorical (either have or don’t)
- Should PD be dimensional or categorical?
Personality Disorder Debate
- Paranoid
- Schizoid
- Histrionic
- Dependent
* the clients will not disappear, thier labels will change
Predicting Dead PDs
The proportion of a population that has the characteristic at any point during a given time period of interest, usually a year.
- Changes of having an SUD in a given year
- _____ for males
- _____ for females
Prevalence | Yearly Prevalence
6.4% / 2.5%
- Passivity (being withdrawn, isolated, feeling helpless, mentally lazy — Adapted to high reward, Social uncertainty.
- Impulsivity (cannot delay gratification, over-reactive, low frustration tolorance) — Craving, Withdrawal
- Self-Centredness (grandiosity, lacking empathy, no compromise, sees self as unique) — Changing priorities, Cocaine and other stimulants
- Affect Intolorance (feeling recognition problems, fear of feeling, lesseened ability to endure/regulate emotion-states) — Stomp & Punch walls, Neurotransmitter & set-point changes, Social fallout from addition behaviour
Regressive Behaviours
_____ to _____% of those treated for other SADs report using Cannibis.
25% - 80%
Schizotypal seen as “closer” to schizophrenia (e.g., genetically). It is listed also in the Schizophrenia Spectrum category of the DSM-5
- Schizoid seen as having less social interest and less affect (schizotypal may have more social fear)
- Schizotypal is better researched and supported diagnostic category of the two
Schizo vs. Schizotypal
Cluster A: Odd, Eccentric
A pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings
- Not in the proposed alternative model (DSM-5 appendix)
- Removal recommended due to little research on the disorder
______________
- <1% prevalence
- More common in males
- Most comorbidity with schizotypal
Schizoid Personality Disorder
80% of Canadians with __________ will experience a substance abuse problem in their lifetime. Roughly 4x the average risk.
Schizophrenia Comorbidity
Cluster A: Odd, Eccentric
A pervasive pattern of social and interpersonal deficits marked by acute discomfort with, and reduced capacity for close relationships, as well as by cognitive and perceptual distortions and eccentricities of behaviour.
- In the proposed alternative model (DSM-5 appendix)
__________
- Typical features: impairments for social/close relationships, eccentricities in cognition, perception, behaviour associated with distorted self-image, incoherent personal goals, accompanied by suspiciousness and restricted emotional expression
______________
- 3-5% prevalence;
- More common in males;
- Most comorbidity with paranoid personality disorder.
Schizotypal Personality Disorder
- Grandiosity, lacking empathy, no compromise, sees self as unique
- Changing priorities
- Cocaine and other stimulants
Self-Centredness | A Regressive Behaviour
- if you’ve had any other substance use disorder you have a roughly _______ chance of developing an alcohol use disorder in your lifetime
- Of those on methadone maintance treatment (recovering opiod users) _______ are smokers.
- Of those in inpatient treatment for alcoholoism, _______ are smokers.
Substances with Substances
50% / 90% / 90%
MC Cords
(uses for chems)
Medicinal
Competition
Ceremonial
Other: Belladone for complexion
Recreational
Dietary
Secular Social
What PDs are in DSM5
(absolutely never smell anyone’s BO)
Schizotypal
Antisocial
Borderline
Narcissistic
Avoidant
OCPD
