CP: Lecture 14 Personality Disorders II Flashcards
elaborated diathesis stress model of psychopathology
heritable predisposition - early experiences
strength and vulnerability - support and stress
complaints and symptoms
ethiology of personality disorders
◦ Abuse, Neglect
◦ Nurture
◦ Modelling
◦ Divorce
◦ Low SES
◦ Peer influences
what does this ethiology influence
Attachment
Attributional style
Cognitive biases
Core assumptions / beliefs, (cogn. triad), schema’s
Coping
Neural circuits
Neuro-endocrine (e.g. HPA-axis tuning)
Personality traits
heritability of personality disorders
35-65%
which neurotransmitter systems are involved in pd
◦ Dopamine (cognitive problems, cluster-A)
◦ Serotonin (anger, impulse control)
◦ MAO (agression)
which brain areas are involved in pd
◦ Lack of frontal cortical control: impulses and emotions (mid brain)
◦ Dysfunction amygdala: (hyper-emotionality vs. hypo-emotionality)
wat was er met maoa en maltreatment
lage MAOA activiteit + maltreatment is meer kans op violence
kijken naar model of psychopathology
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wat hoort bij heritable predispositions
genetics, temperament
wat hoort bij early experiences
nurture, trauma, deprivation
wat hoort bij strengths and vulnerabilities
Fenotype, schemas/cognitions/attributions, neuro-endocrine, personality etc
support and stress
social, medication, psychotherapy, stress, trauma, life events etc
schizotypal dsm 5
ssocial and interpersonal deficits, cognitive or perceptual distortions and eccentricities of behaviour, early adulthood, variety of contexts (!) and 5 or more:
ideas of reference
odd beliefs or magical thinking
unusual perceptual experiences
odd thinking and speech
paranoid ideation
inappropriate or constricted affect
eccentric behaviour
lack of close friends
social anxiety that does not diminish with familiarity, tend to be associated with paranoid fears rather than negative judgements about self
which of the pds is the most heterogeneous group
paranoid pd?
linehan model goed kennen
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antisocial pd kenmerken
- Conduct disorder before 15th
- From 15th violation rights of others
- Subgroup (15-25%) is also ‘psychopatic’
2 factors of psychopathy
Factor 1: Affect / Interpersonal
- callous/unemotional, glib,
Factor 2: Behavior
- antisocial/impulsive
borderline dsm 5 criteria
instability of relationships, self-image and affects, marked impulsivity, early adulthood and at least 5:
avoid real or imagined abandonment
unstable and intense personal relationships
identity disturbance
impulsivity, potentially self-damaging
suicidal behaviour
affective instability
chronic emptiness
anger
paranoid ideation or severe dissociative symptoms
when basic needs are not met (safety, boundaries, autonomy), wat krijg je dan
early maladaptive schemas -> coping, kan leiden tot submission (the world is just like that)
6 models for bpd
Learning / Behavioral
◦ Conditioning, modeling, contingencies
◦ Linehan: Emotion-regulation
Cognitive
◦ Beck: cognitive model
◦ Young: maladaptive schema’s
Psychodynamic
◦ Mentalisation
◦ Object-relations
voorbeelden classical, operant and modelling
Classical conditioning:
“if I attach to a person, I will be hurt”
Operant conditioning:
“if I force my way, I get what I want”
Modelling:
witnessing your parents resolve conflict with
clashes over and over again
linehans emotional dysregulation model of BPD
biological diathesis -> emotional dysregulation in the child -> great demands on the family -> invalidation by parents through punishing or ignoring the demands -> emotional outbursts by child to which parents attend -> emotional dysregulation etc
kijken naar linehans model
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cognitive model of beck
situation -> automatic thought -> schema -> alarm
kijken naar cognitive model
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schema theory of young
when basic needs are not met -> ealry maladaptive schemas -> coping with schemas -> modes
voorbeelden basic needs
safety
autonomy
boundaries etc
voorbeelden coping with schemas
submission
avoidance
overcompensation
submission =
the world is just like that
avoidance
geen sociaal contact bijv. omdat je bang bent om gereject te worden
overcompensation
juist het tegenovergestelde doen
modes voorbeeld
◦ Vulnerable child
◦ Angry child
◦ Detached protector
◦ Demanding parent
◦ Healthy adult
example of a schema van mistrust
The expectation that others will hurt, abuse, humiliate,
cheat, lie, manipulate, or take advantage. Usually
involves the perception that the harm is intentional or
the result of unjustified and extreme negligence. May
include the sense that one always ends up being
cheated relative to others or “getting the short end of
the stick.
object-relations
gaat om interpersonal relationship!
Internalized representation of Self in relation to the object (another
person, such as father, mother, men, etc.)
In PD immature defence mechanisms such as ‘splitting’: All good, all bad
kijken naar model object-relations
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mentalization
understanding the behaviour of others in terms of his or her mental state (ik ben boos dus zij zijn ook allemaal boos)
hypothese bij mentalization
Mentalization is learned as primary caretakers mirror and name the child’s emotions -> ohhh heb je pijn??
what is needed to treat personality disorders
Safety /Safe environment
◦ Clear rationale / structure
◦ Attachment figure(s)
Incentive / invitation to revise coping
Possibility of new (positive) experience
Dialectical Behavioral Therapy
DBT; Linehan
lots of structure, skills training (bv emotion regulation) -> gaat om acceptance and change
schema focused therapy
ST; Young
Integrative: attachment theory, experiential therapy, cognitive
therapy. Limited reparenting, imagery rescripting, chair
dialogue.
limited reparenting=
Het verwijst naar een therapeutische techniek waarbij de therapeut de rol van een gezonde ouderfiguur aanneemt om de cliënt te helpen bij het helen van emotionele wonden uit het verleden.
mentalization based treatment
MBT; Bateman and Fonagy
Foster mentalization: modelling, small steps
transference focused psychotherapy
TFP; Kernberg
Object-relations: the relationship with the therapist as working
material
what are similarities between all these treatment types
Theory
◦ Influence early childhood
◦ Internal working model of world
◦ Distorted experience of the other
Treatment
◦ Building trusting relationship
◦ Novel experiences
◦ Use of transference?
welke therapy is goed voor crisis, destabilizing and automutilation
dialectical behaviour therapy
which therapy has the widest scope
schema therapy
which is the most simple
mentalisation based treatment
which is the most demanding
schema therapy
which works well for severe cases
mentalisation based treatment
which has the highest dropout
transference focused therapy
Genetically inherited vulnerabilities are combined
with an internal working model of the world is too
rigid and not adaptive
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