L12 - Personality Disorders 1 Flashcards
1
Q
What is the 5-factor model of personality?
A
- Openness: artistic, curious, wide interests
- Conscientiousness: efficient, organised, responsible, planful
- Extraversion: Outgoing, energetic, talkative
- Agreeableness: Appreciative, kind, sympathetic and trusting
- Neuroticism: anxious, tense, worrying
2
Q
What is personality?
A
- How did you develop personality traits and how old you were when you noticed personality
- Meta-analysis conducted of 152 longitudinal studies on stability of personality traits by age and found stability increases with age, plateauing in 50s to 70s
- Personality is the set of unique traits and behaviours that characterise an individual
- Our personality influences how we engage with the world, how we develop and sustain relationship, and how we choose to spend our time
3
Q
What are clinical features of personality disorders?
A
- Problems with identity or sense of self
- Chronic interpersonal difficulties
- The person’s enduring pattern of experience and behaviour deviates markedly from the expectations of their cultures
- Must be inflexible, pervasive across broad range of personal and social situations
- Must be stable and of long duration, onset at adolescents/early adulthood
- Causes significant distress and impairment in functioning
- Manifests in 2+ areas: cognition, affect, interpersonal functioning or impulse control
4
Q
What is the cluster A clinical features of personality disorders?
A
- Paranoia: Suspiciousness and mistrust of others with little/no evidence: males = females
- Schizoid: Detachment from social relationships, restricted range of emotions: males > females
- Schizotypal: Cognitive =/perceptual distortions, eccentricities of behaviour/speech M>F
5
Q
What is the cluster B clinical features of personality disorders? (HNAB)
A
- Histrionic: excessive emotionality =, attention seeking, F>M
- Narcissistic: Grandiosity, need for admiration, lack of empathy M>F
- Antisocial: Persistent pattern of disregard for and violation of the rights of others M>F
- Borderline: Instability of interpersonal relationships, self-image, affect, and marked impulsiveness F =M
6
Q
What is the cluster C clinical features of personality disorders?
A
- Avoidant: Social inhibition, feelings of inadequacy, hypersensitivity to negative evaluation, F>M
- Dependant: Need to be taken care of, submissive and clinging behaviour, fear of separation, F>M
- Obsessive compulsive: Preoccupation with orderliness, perfectionism, mental and interpersonal control, M>F
7
Q
What is the relationship between age and diagnosis?
A
- PD diagnoses are typically made in adulthood
- Evidence of onset in adolescence/early adulthood is required
- Not all personality traits that appear in childhood will persist
8
Q
Relationship between culture and diagnosis?
A
- Core aspects of personality are influenced by culture
- Culture influences what behaviours, norms, personality traits are acceptable
- Personality disorders must be carefully considered in the context of culture
9
Q
What is the prevalence of personality disorders?
A
- Life prevalence rate is about 10%
- About 75% comorbidity
10
Q
What are Challenges in Diagnosing and researching personality disorders?
A
- Diagnostic criteria are not sharply defined
- Diagnosis relies on inferred traits or consistent patterns of behaviour
- Diagnostic categories not mutually exclusive
- Personality characteristics are dimensional in nature
11
Q
What is the Dimensional approach to Personality Disorders?
A
- Categorical systems assume mental health disorders are discrete with boundaries between normality and illness
- Dimensional systems can include: seeing symptoms as being a continuum rather than a category
- Identifying and measuring the traits that underlie PDs
- Mapping PD symptoms onto established models of personality
12
Q
What are the pros of categorical approach to PDs?
A
- Maps onto decision to offer treatment(diagnosis = yes)
- Directs the clinical approach and appropriate treatment
- Clearer communication about condition
13
Q
What are the cons of categorical approach to PDs?
A
- Dichotomous
- Limited support from evidence (e.g.,clusters)
- Diagnoses are heterogenous
- High amounts of comorbidity
- Poor diagnostic reliability and stability over time
14
Q
What are the pros of dimensional approach to PDs?
A
- More reliable (across raters and time)
- Help to understand heterogeneity within disorders and lack of clear boundaries
- Information about ‘subthreshold’ traits and symptoms
15
Q
What are the cons of dimensional approach to PDs?
A
- Hard to adopt into healthcare
- Seen as more cumbersome
- More difficult to communicate
16
Q
What is the assessment of PDs?
A
- History
- Interpersonal functioning
- Assessment over time
- Observation of emotional expression, non-verbal communication
- Informants
- Identify areas that are difficult for them, treatment goals and build therapeutic alliance
17
Q
Why are personality disorders a controversial diagnosis?
A
- Stigma of being seen as a difficult person
- See experiences as a natural reaction to adversity
- Challenges in making a diagnosis
BUT - Helpful to understand self and communicate to others
- Validation/relief
- Access to appropriate treatment
18
Q
What are the challenges in studying the causes of PD?
A
- Relatively new areas of study
- High levels of comorbidity among PDs
- Reliance on retrospective approaches: personality traits may be heritable
- Impact of childhood experiences
19
Q
What is BPD?
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:
- Frantic efforts to avoid real/imagined abandonment
- Pattern of unstable/intense interpersonal relationships characterised by alternating between extremes of idealisation and devaluation
- Identity disturbance: markedly and persistently unstable self-image
- Impulsivity in at least 2 areas that are damaging
- Recurrent suicidal behaviour, gestures, threats of self-mutilating behaviour
- Affect instability due to a marked reactivity of mood
- Chronic feelings of emptiness
- Inappropriate, intense anger or difficulty controlling anger
- Transient, stress-related paranoia ideation
20
Q
What are the genetic factors of BPD?
A
- Diagnosis of BPD is 4x higher in the biological relatives of patients with BPD compared to relatives of people without BPD
- Genes may account for 40% of variance in the disorder
21
Q
What are the environmental factors of BPD?
A
- People with BPD report a large number of negative, even traumatic events in childhood: include abuse and neglect, separation and loss
- Diathesis-Stress theory of BPD: Early vulnerability and Environmental risk
22
Q
What is Parental PD as a risk to Child Development?
A
- Through transmission of genetic vulnerability and env stress of living with a parent who had a PD
- Impact of parental behaviour and disorganised family life as stressor, is parent experiences a PD and is not receiving support
- Effects of rearing behaviour or brain chemistry and the formation of attachment
23
Q
What is the sensitivity to rejection?
A
- BPD may include a genetic predisposition to greater sensitivity and reactivity to interpersonal cues (e.g., rejection)
- Rejection sensitivity: personality dimension that involves disposition to expect and avoid anticipated or perceived threats of rejection
- Measured through self-report; experimentally(cyberball)
- Individuals with BPD (vs. controls)
- expect rejection more across several situations
- perceive receiving the ball less in cyberball studies (difference larger in inclusion conditions)
- experience great negative affect after rejection/exclusion
24
Q
Emotion Processing in BPD?
A
- Adverse experiences in childhood may help explain why people with BPD experience fear of abandonment, less trust of others
- Ability to correctly read cues about the emotions states of others is an important skill for interpersonal functioning and wellbeing
- If individuals with BPD experience higher rejection sensitivity = individuals with BPD will detect negative emotion states in others more quickly/accurately
25
Study looking at emotion processing in BPD?
- 44 women with BPD diagnosis, adverse childhood experience and no BPD diagnosis and 15 controls
- Methods: Emotion identification and recognition
- Individuals with BPD earlier prediction of anger: misidentification of anger
- Ability to detect happiness not significantly different from other groups
26
What are treatments and outcomes for PDs?
- PDs represent relatively enduring, pervasive and inflexible patterns of behaviour
- Different possible goals of therapy
- Client resistance to change because they don't see need to change
- Relationship formation challenges
- Antidepressant medications: SSRIs to Dialectical Behaviour Therapy: DBT
