CP: Lecture 13 Personality Disorders I Flashcards
personality stability
personality is relatively stable over time and situations
personality =
Combination of our unique traits that are expressed in:
◦ Thoughts
◦ Behavior
◦ Feelings
◦ Interpersonal functioning
the big 5
Neuroticism <–> Emotional stability
Extraversion <–> Introversion
Openness <–> ‘Traditionalism’
Agreeableness <–> Antagonism
Conscientiousness <–> ‘Heedlessness
wanneer is iets een personality disorder
when personality traits are; extreme, inflexible/rigid, dysfunctional
wat is verschillend aan personality disorders en bijvoorbeeld een phobia
PD: ego-syntonous (traits and problems are part of who you are)
phobia: ego-dystonous (problems are not part of who you are)
differential diagnoses of pd
Other PD, autism, mental retardation,
chronic syndrome disorder,
circumstances, etc
hoe heette het in dsm iv
◦ Axis I: Syndrome disorders
◦ Axis II: Personality
dsm criteria personality disorders
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
dus welke domains
cognition
affectivity
interpersonal functioning
impulse control
for a diagnosis, always check the 3 P’s:
pervasive
persistent
pathological
pervasive =
inflexible, in many different situations
persistent=
stable, long term, start early adulthood
pathological =
distress or dysfunction
borderline dsm 5
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:
- avoid real or imagined abandonment
- unstable and intense relationships
- identity disturbance
- impulsivity
- suicidal
- affective instability
- emptiness
- anger
- paranoid ideation or dissociative symptoms
dsm: conceptualisation?
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’
Cluster A: ‘odd, eccentric’
paranoid PD - distrusting
schizoid PD - distant
schizotypical PD - strange perceptions and behaviour
Cluster B: ‘dramatic, emotional, erratic’
histronic PD - emotional, attention seeking
narcissistic PD - inflated ego
antisocial PD - violating rights of others
borderline PD - instability self images, relations, emotions
Cluster C: ‘anxious, fearful’
avoidant PD - socially inferior
dependent PD - submissive, clinging
obsessive compulsive PD - perfectionistic, controlling
welke soorten pd heb je ook nog
- Other specified PD, Unspecified PD
- Personality change due to another medical condition
how to diagnose pd
◦ Semi-structured interviews: Always check ‘3 P’s’ : 1 example never enough!
◦ (Observations)
◦ (Hetero-anamnesis)
◦ (File research)
(Diagnosis often deferred / delayed)
prevalence pd
- General population: 9-13%
- Outpatient care: 30-50%
- Inpatient clinics: 50-70%
- Prisons: 60-70%
other characteristics of pd globaal gezien
High disease burden
High consumption of care
Low quality of life
Societal costs (NL): 3,6 - 7 billion
comorbidity of pd
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
kijken naar natural course personality
oke
welke course verandert
social vitality omlaag, social dominance, conscientiousness,emotional stability and agreeableness omhoog
course in life of pd
Onset: adolescence:
◦ Many ‘symptoms’ then that don’t persist!
Slowly more mild:
◦ Not more chronic than other syndromal psychopathology
◦ Participation & quality of life lagging
pd treatable?
- Previously deemed untreatable
- Medication only dampens symptoms
- Roughly 5 x faster recovery with treatment then natural
course
