CP: Lecture 13 Personality Disorders I

Question 1

personality stability

Answer 1

personality is relatively stable over time and situations

Question 2

personality =

Answer 2

Combination of our unique traits that are expressed in:
◦ Thoughts
◦ Behavior
◦ Feelings
◦ Interpersonal functioning

Question 3

the big 5

Answer 3

Neuroticism <–> Emotional stability
Extraversion <–> Introversion
Openness <–> ‘Traditionalism’
Agreeableness <–> Antagonism
Conscientiousness <–> ‘Heedlessness

Question 4

wanneer is iets een personality disorder

Answer 4

when personality traits are; extreme, inflexible/rigid, dysfunctional

Question 5

wat is verschillend aan personality disorders en bijvoorbeeld een phobia

Answer 5

PD: ego-syntonous (traits and problems are part of who you are)
phobia: ego-dystonous (problems are not part of who you are)

Question 6

differential diagnoses of pd

Answer 6

Other PD, autism, mental retardation,
chronic syndrome disorder,
circumstances, etc

Question 7

hoe heette het in dsm iv

Answer 7

◦ Axis I: Syndrome disorders
◦ Axis II: Personality

Question 8

dsm criteria personality disorders

Answer 8

An enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s culture”,
manifests on 2 or more of 4 domains:
◦ Cognition
◦ Affectivity
◦ Interpersonal functioning
◦ Impulse control

Question 9

dus welke domains

Answer 9

cognition
affectivity
interpersonal functioning
impulse control

Question 10

for a diagnosis, always check the 3 P’s:

Answer 10

pervasive
persistent
pathological

Question 11

pervasive =

Answer 11

inflexible, in many different situations

Question 12

persistent=

Answer 12

stable, long term, start early adulthood

Question 13

pathological =

Answer 13

distress or dysfunction

Question 14

borderline dsm 5

Answer 14

A pervasive pattern of instability of interpersonal relationships,
self-image, and affects, and marked impulsivity
beginning by early adulthood and present in a variety of contexts, as indicated by 5 (or more) of the following:

1. avoid real or imagined abandonment
2. unstable and intense relationships
3. identity disturbance
4. impulsivity
5. suicidal
6. affective instability
7. emptiness
8. anger
9. paranoid ideation or dissociative symptoms

Question 15

dsm: conceptualisation?

Answer 15

Most disorders seem more dimensional in nature (some more categorical)
◦ Syndromes and personality disorders

Thresholds are arbitrary
DSM 5 committee wanted change, but could not agree on new model

But:
◦ Thinking in multiple dimensions harder then categories?
◦ Research (evidence base) based on categories
◦ Lay people use categories: ‘real disorder’

Question 16

Cluster A: ‘odd, eccentric’

Answer 16

paranoid PD - distrusting
schizoid PD - distant
schizotypical PD - strange perceptions and behaviour

Question 17

Cluster B: ‘dramatic, emotional, erratic’

Answer 17

histronic PD - emotional, attention seeking
narcissistic PD - inflated ego
antisocial PD - violating rights of others
borderline PD - instability self images, relations, emotions

Question 18

Cluster C: ‘anxious, fearful’

Answer 18

avoidant PD - socially inferior
dependent PD - submissive, clinging
obsessive compulsive PD - perfectionistic, controlling

Question 19

welke soorten pd heb je ook nog

Answer 19

• Other specified PD, Unspecified PD
• Personality change due to another medical condition

Question 20

how to diagnose pd

Answer 20

◦ Semi-structured interviews: Always check ‘3 P’s’ : 1 example never enough!
◦ (Observations)
◦ (Hetero-anamnesis)
◦ (File research)

(Diagnosis often deferred / delayed)

Question 21

prevalence pd

Answer 21

• General population: 9-13%
• Outpatient care: 30-50%
• Inpatient clinics: 50-70%
• Prisons: 60-70%

Question 22

other characteristics of pd globaal gezien

Answer 22

 High disease burden
 High consumption of care
 Low quality of life
 Societal costs (NL): 3,6 - 7 billion

Question 23

comorbidity of pd

Answer 23

 Other PD:
◦ Cluster B (e.g. antisocial + borderline)
◦ Cluster C (e.g. dependent + avoidant)
◦ Between clusters (e.g. borderline + dependent)
 Other Syndromal disorders:
◦ E.g. avoidant+ alcohol abuse
◦ E.g. obsessive-compulsive PD + depression
◦ E.g. borderline + PTSD
◦ E.g. PD + anxiety/ depression / addiction

Question 24

kijken naar natural course personality

Answer 24

oke

Question 25

welke course verandert

Answer 25

social vitality omlaag, social dominance, conscientiousness,emotional stability and agreeableness omhoog

Question 26

course in life of pd

Answer 26

 Onset: adolescence:
◦ Many ‘symptoms’ then that don’t persist!
 Slowly more mild:
◦ Not more chronic than other syndromal psychopathology
◦ Participation & quality of life lagging

Question 27

pd treatable?

Answer 27

• Previously deemed untreatable
• Medication only dampens symptoms
• Roughly 5 x faster recovery with treatment then natural
  course