Disordered Personalities Flashcards
1
Q
18-20th century influences
A
- Idea that there are distinct personality types has existed for centuries e.g. ancient Greek philosophy
- Longstanding idea that there are pathological or maladaptive personalities, in the absence of other psychiatric symptoms.
- Pathological does not refer to being ill or mentally ill but some4thing that is deviant from normal personality
- Philippe Pinel’s “Manie sans delire”, impulsive violence without any other psychiatric symptoms.
- Pinel use the term to describe patients who did not have typical psychiatric symptoms but did have problems with regulating emotions e.g. impulsivity
- Kraepelin’s seven types of psychopathic personalities resulting from an ‘inborn defect.
- Psychopathic here means abnormal or pathological or deviant
- Freud’s work connected childhood experiences to personality traits and types.
- For Freud, maladaptive personalities stemmed from early childhood experiences
- All of these emphasised behavioural difficulty that was abnormal compared to society and persists across different cultures
2
Q
21st century understanding
A
- Personality Disorders refer to a pattern of experiences and behaviour that affects cognitions, emotions, relationships, and behaviour.
- Differs from what is expected within the dominant culture
- Typically emerges by late adolescence or early adulthood and is stable and long-standing
- Causes significant personal distress or problems in functioning and is considered maladaptive
- Cause impairments in peoples life e.g. cannot develop career, low self esteem, struggle socially
- Covers a wide range of experiences and behaviours relating to someone’s personality
3
Q
DSM classification
A
- A. An enduring pattern of inner experience and behaviour that deviates markedly from the expectations of the individual’s culture. This pattern is manifested in 2 (or more) of the following areas: cognition, affectivity, interpersonal functioning, or impulse control.
- Behaviour should be very different and to what is expected of people
- B. Inflexible and pervasive across a broad range of personal and social situations
- C. Leads to clinically significant distress or impairment in social, occupational or other important areas of functioning
- someone should experience mental distress in order to be diagnosed or experience significant deficits in areas of life e. for example brain injury can cause a change in personality
- D. Stable and of long duration, and its onset can be traced back at least to adolescence or early adulthood
- E. Not better explained as a manifestation or consequence of another mental disorder.
F. Not attributable to the physiological effects of a substance (e.g. - a drug of abuse, a medication) or another medical condition
4
Q
cluster A- odd/eccentric
A
- Paranoid
- Suspicious of the motives of others
- Schizotypal
- Bodily sensations that do not coincide with experiences but not strong enough to be psychosis
- Strange thinking
- Schizoid
- Restricted range of emotions
Detached socially or emotionally
- Restricted range of emotions
5
Q
Cluster B- Dramatic/Erratic (impulsive behaviour, not much restraint, extreme and intense emotions. All the disorders here are characterised by a lack of empathy)
A
- Antisocial
- Risk taking, manipulating, deceitful
- Narcissistic
- Feeling superior to others
- Histrionic
- Exaggerate emotions, attention seeking often relating to seductive behaviour
- Borderline
- Pattern where someone has unstable emotions and relationships e.g. going from idolising their partner to devaluing them in a short period of time
- Intense fear of abandonment
Also associated with disassociation- disengage with themselves or reality
6
Q
cluster c- anxious, fearful
A
- Avoidant
- Relates to a fear of criticism and being negatively evaluated so avoid situations where this would happen
- Dependent
- Fear about making decisions independently, relying heavily on people
- Obsessive-compulsive
Perfectionism, following rigid rules
7
Q
prevalence
A
- Around 1 in 16 persons worldwide are given a PD diagnosis at some point (Huang et al., 2009 – 21.162 participants).
- Around 1 in 20 to 25 adults are diagnosed with a personality disorder in the UK (Coid et al., 2006; Singleton et al., 2001).
- Prevalence varies across socio-demographic factors (> in those who are separated or unemployed and live in urban areas; e.g. Coid et al., 2006)
- Far higher in healthcare and forensic settings compared to the general community (e.g., Singleton et al., 1998).
- UK prisons- 60-70% have at least 1 personality disorder- exposed to criminal disorder and stressors which cause personality disorders
Varies cross-culturally, tends to be lowest in Western Europe (Huang et al., 2009).
8
Q
stability across raters
A
- Inter-rater reliability (IRR) assesses whether different clinicians give the same diagnosis to a given individual.
- Perfect reliability (κ = 1) means that different clinicians always arrive at the same diagnosis for a given individual.
- Can be tested in field trials.
- IRR for DSM PD diagnoses vary
- Between clinicians (e.g., Zanarini et al., 2000)
- Clusters (e.g., Tyrer et al., 2007)
Measurement instruments (e.g., Perry, 1992)
9
Q
stability over time
A
- Test-retest reliability measures whether the same individual would be given the same diagnoses at two different points in time.
- Baca-Garcia et al (2007) studied PD diagnoses of > 10,000 patients in a Spanish hospital over time:
- Ppts were assessed based on a diagnostic classification manual (ICD-10).
- 34.1% who received a PD diagnosis in the first evaluation retained the same diagnosis in their last evaluation.
- 26.3% who received a PD diagnosis in the last evaluation received the same diagnosis in their first evaluation.
- The idea that PDs are long-standing and stable patterns of experiences is fundamental to the diagnosis.
- Symptoms for some PDs decrease over time (), symptoms for other PDs increase (e.g., D’Huart et al., 2003; Johnson et al., 2000; Seivewright et al., 2002).
- Morey & Hopwood (2013) reviewed four longitudinal studies:
- Moderate differential stability, i.e. some stability in terms of persons retaining the same ‘rank’ in symptom scores.
- Less absolute stability, i.e. symptom scores tend to decline within the individual.
Stability depends on measures and samples used
10
Q
comorbidity
A
- High comorbidity with other PDs:
- Coid et al (2006): study in UK adults (N = 626).
- Many ppts with a cluster A PD were also diagnosed with a cluster C (48%) or B (32%) PD
- 27% of ppts with a cluster C also had a cluster B diagnosis
- High comorbidity with non-PD diagnoses:
- Those with a PD diagnosis are more likely to have three or more ‘Axis I’ diagnoses (Huang et al., 2009).
- Conceptual overlap between diagnostic criteria of PDs and other disorders in the DSM.
11
Q
dimensional perspectives
A
- Personality consists of personality traits that range on a dimension and vary in degree, not in kind.
- Thus, PD’s might be extreme variants of normal personality traits that lead to mental distress.
- Widiger & Simonsen (2005) found that DSM diagnostic criteria overlap well with high or low traits on common personality dimensions.
- FFM proposals for Personality Disorder (Widiger & Mullins-Sweat, 2009; Trull & Widiger, 2013).
- Could help account for diagnostic comorbidity and temporal stability.
- (Trull & Widiger, 2022)
- What traits can be high or low and overlap with [personality disorders
- Use extreme traits to map onto different personality disorders
- Can help explain why there is so much comorbidity, potentially improves stability, personality traits are more stable
Good for treatment planning
12
Q
DSM 5- TR alternative model, section III
A
- A. Significant impairments in i) self-identity and ii) interpersonal (empathy or intimacy) functioning.
- Scored from 0 – 4 (no impairment – extreme impairment)
- Diagnosis requires a moderate impairment
- B. One or more pathological personality trait domains or trait facets, each consisting of sub-traits:
- Negative affectivity; Detachment; Antagonism; Disinhibition; and Psychoticism
13
Q
trauma
A
- Increasing interest in the role of early childhood trauma (e.g. physical, emotional, or sexual abuse and neglect) in mental distress.
- Kessler et al (2010): WHO mental health survey on 50,000 ppts in 21 countries
- Childhood adversities, such as childhood abuse, neglect, and parental mental health problems, were the strongest predictors of DSM-IV disorders
- Accounted for 29.8% of all forms of mental distress
- Cumulative effect, i.e. the more trauma someone is exposed to, the larger the impact on mental health (e.g. McKay et al., 2021).
- Meta-analysis of 24 studies on trauma experienced in childhood and adolescence, and mental health outcomes in adulthood.
- All forms of trauma were associated with a higher likelihood to be diagnosed with a mental health issue.
Strongest increase in likelihood for those who had been exposed to multiple forms of trauma, and those who had been both a victim and perpetrator of specific forms of trauma (i.e. bullying).
14
Q
trauma and PD
A
- Experiences associated with the term ‘personality disorders’ are very closely associated with childhood abuse.
- Childhood trauma increases the likelihood to be diagnosed with a PD in later life (e.g., Battle et al., 2004; Bozzatello et al., 2021; Johnson et al., 2000; Hailes et al., 2019).
- Children in the Community Study (Cohen, 2005; Johnson et al., 2000):
- Interviewed 639 adolescents and mothers in New York at different timepoints.
- Ppts who experienced childhood abuse or neglect were four times more likely to be diagnosed with a DSM-IV PD in later life.
Different types of childhood abuse related to different PDs
15
Q
maladaptive personality traits
A
- Back et al (2021) reviewed evidence for the relationship between childhood trauma, personality functioning, and maladaptive traits (N = 7):
- Detachment and psychoticism associated with childhood trauma, particularly emotional abuse and neglect
- Negative affectivity and antagonism associated with having experienced childhood trauma
- Responses similar to trauma-associated avoidance and trauma-reactive dissociation (disconnection from thoughts, feelings, memories, identity, behaviour).
PDs might be interpreted as a coping response to trauma, similar to PTSD.
