Comps - Psychopathology (Subdomain 1) Flashcards
What is a personality disorder? (APA, 2013)
An enduring pattern or inner experience and behavior that deviates markedly from the expectations of an individual’s culture. They are inflexible and pervasive across time and situation
What areas do personality disorders have an effect on?
-Affect
-Cognition
-Interpersonal Functioning
-Impulse Control
What are the key features of personality disorders? (Kendall, 2002)
-Early onset
-Stable and persistent
-Interpersonally focused
-Impairment
What are the problems with defining personality disorders as different from other disorders? (Kendall, 2002; Widiger, 2011)
- It leads to stigma around viewing personality disorder as untreatable/hard to treat
- Personality disorders are seen as different because they are lifelong, but so are many disorders (e.g., schizophrenia or BPI)
- Personality disorders have genetic overlap with other types of disorders (e.g., schizophrenia and schizotypal PD have some symptom overlap)
- Personality disorders are conceptually similar to other disorders (e.g., social anxiety and avoidant PD are conceptually similar)
- Personality and psychopathology have a bidirectional relationship (psychopathology can vary in appearance based on a person’s personality traits; appearance of personality can be affected by the presence of comorbid psychopathology)
- They can also fail to be distinct entities (all PDs could be maladaptive variants of general personality traits; some PDs could be early onset, chronic, and pervasive variants of other mental disorders – e.g., schizotypal PD is considered to be a variant of schizophrenia)
What are the difficulties of studying personality disorders? (Kendall, 2002; Watson & Clark, 2023)
- Self-report measures are challenging because people with personality disorders often experience features of their disorder as being ego-syntonic. Also, not all people with PDs experience symptoms of their disorder as being distressing
- PDs are not organized into a simple structure due to the comorbidity between PDs within and across clusters
- Uncertainty about whether the extremes on both sides of a dimension are pathological
- PDs are conceptually heterogenous (the way they are different from each other makes it hard to research them)
- We have limited information about each disorder
- Research is largely from an unrepresentative clinical population (we need more research with better representation and need more community-based samples)
- There is trouble with aligning PD models with existing personality models
Ego-syntonic
Views are consistent with their own self-image
What are the problems with the current DSM model of PDs? (Skodol, 2012; Kotov et al., 2017; Tyrer et al., 2019; Crocq, 2013)
- Excessive PD comorbidity (people who meet criteria for one PD likely meet criteria for multiple other PDs)
- Ignores the complexity and heterogeneity of personalities and of PDs
- Many patients fall short of criteria, however, experience significant distress or impairment, signaling the need for care
- “…categorical nomenclature on naturally dimensional phenomena leads to a substantial loss of information and diagnostic instability”
- Many of the PDs are not being used for diagnosis
- The categories were not scientifically derived
What are the advantages of the current DSM model for PDs? (Crocq, 2013; Tyrer et al., 2019)
-The current model matches the model of traditional, Western medicine (aka diagnostic categories)
-It is potentially more convenient for providers
-Relative simplicity of categorical classifications
What are the reasons to switch to a dimensional model of PD? (Tyrer et al., 2019; Crocq, 2013; Skodol, 2012)
- A severity model of PD is useful as a predictive tool
- Dimensions allow for more sensitivity to change when researching PDs
- Dimensions make up for the current lack of complexity
- Dimensions can show both pathological and nonpathological personality traits in the same model
What are the criticisms of the dimensional model? (Skodol, 2012; Tryer et al., 2019)
- It is unfamiliar to clinicians
- There is little research on the practical implications of this model
- There are no established cut points yet
- There is not enough support for removing the current categorical model
- Changing the model hurts the treatment utility of the current model
- Some are worried about losing the BPD diagnosis
What might affect how we conceptualize PDs in the future? (Kendall, 2002)
-If we begin to develop treatments for PDs that are effective, it may lead to us viewing PDs more like illnesses
-Potentially, if we change how we treat PDs, we may have less of a problem viewing them as similar to other mental disorders
Alternative Model for Personality Disorders (AMPD; Waugh et al., 2022)
-A hybrid categorical-dimensional model
-Categorical diagnoses are defined by 2 conjoint dimensions (Criterion A and Criterion B)
-An individual’s placement on Criterion A determines if 1 of the 6 hybrid dimensional PDs apply
-PD-trait specified (PD-TS) is used to characterized the specific pattern of impaired functioning and maladaptive traits
Criterion A (Waugh et al., 2022)
Level of impairment in personality functioning:
-Antisocial
-Avoidant
-Borderline
-Narcissistic
-Obsessive-Compulsive
-Schizotypal
Criterion B (Waugh et al., 2022)
Profile of maladaptive personality traits; evaluates degrees of expression of a suite of maladaptive personality traits:
-Negative Affectivity
-Detachment
-Psychoticism
-Antagonism
-Disinhibition
AMPD Advantages (Waugh et al., 2022)
-Accommodates multiple theoretical viewpoints
-May be evaluated with various assessment methods
-Supports case formulation and treatment planning
-High degree of clinical utility
-Replaced PD-NOS with PD-TS to characterize the specific pattern of impaired functioning and maladaptive traits if the presentation does not match the 6 predefined PDs
