L12 - Personality Disorders Flashcards
aetiology of personality disorders?
Likely multi-factorial like almost all other psychiatric diagnoses.
Genetic and environmental factors such as chaotic home environment and abuse have been implicated in development of maladaptive behavioural patterns.
Heritability of PD
For comparison heritability of normal personality traits is approximately 0.5
Molecular genetics studies of PDs indicate that genes linked to neurotransmitter pathways, particularly the serotonergic and dopaminergic systems are involved.
genetic predisposition + abhorrent events/parenting… = PD? learning a maladptive pattern of responding.. can you medicate it? probably not due to it being a congenital disorder.. it’s who you are, not what you have.
Cultural influence on personality?
Studies have found that in Norway as compared to US, Germany and UK, avoidant personality is 3-4X more prevalent, dependent personality 2-3X more prevalent and schizoid is 2X more prevalent. Borderline is <1⁄2 as frequent and antisocial is 1⁄2 as prevalent.
Pattern exhibits increased internalization personality disorders are prevalent and externalization disorders are rarer.
what are the different clusters of personality disorders?
Cluster A: suspicious, odd
Paranoid, Schizoid, Schizotypal
Cluster B: dramatic
Antisocial, borderline, histrionic, narcissistic
Cluster C:anxious
Avoidant, dependent, obsessive-compulsive
Paranoid personality disorder?
A pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent.
Suspects others are exploiting or deceiving him
Preoccupied with unjustified doubts of loyalty
Is reluctant to confide in others because he believes they will use the information against him
Reads hidden demeaning meanings into benign remarks
Persistently bears a grudge
Perceives attacks on his character
Recurrent suspicions regarding fidelity of spouse or sexual partner
Schizoid personality disorder?
Pervasive pattern of detachment from social relationships and restricted expression of emotion with 4 or more the following:
Neither desires nor enjoys close relationships
Almost always chooses solitary activities
Little if any interest in sexual experiences with another person
Takes pleasure in few in any activities
Lacks close friends other than first-degree relatives
Appears indifferent to the praise or criticism of others
Shows emotional coldness or flattened affect
AKA NEGATIVE SYMPS
Schizotypal personality disorder?
A pervasive pattern of social and interpersonal deficits with reduced capacity for close relationships as well as cognitive or perceptual distortions and eccentricities of behaviour with 5 or more of the following:
Ideas of reference
Odd beliefs or magical thinking
Unusual perceptual experiences including bodily illusions
Odd thinking and speech
Suspiciousness or paranoid ideation
Inappropriate or constricted affect
Behaviour or appearance that is odd or eccentric
Lack of close friends other than first-degree relatives
Excessive social anxiety that does not diminish with familiarity
AKA POSITIVE SCZ SYMPS
Antisocial personality disorder?
CLUSTER B PD
A pervasive pattern of disregard for and violation of the rights of others occurring since the age of 15 years as indicated by 3 or more of the following:
Failure to conform to social norms with respect to lawful behaviours
Deceitfulness and conning others for personal profit or pleasure
Impulsivity or failure to plan ahead
Irritability or aggressiveness as indicated by repeated fights or assaults Reckless disregard for safety of self or others
Consistent irresponsibility
Lack of remorse
There is evidence of Conduct Disorder with onset before age 15
What has neuroimaging shown us about psychopathy
person with psychopathic tendencies showed DECREASED AMYGDALA and ORBITAL FRONTAL cortex responses to emotionally provocative stimuli which the author felt was suggestive of difficulties with basic forms of emotional learning and decision
making.
antisocial personality disorder and criminality?
Not all people with ASPD are criminals (or in jails)
Not all people in jail or considered criminal have ASPD
Not all people with ASPD are psychopaths
Course of antisocial disorder?
Course of all PDs is chronic, but overt antisocial behaviour seems to decrease after 40
Acquired sociopathy?
- most likely a consequence of impairment (lesions) in brain systems that respond to threat.
- amygdala and orbito PFC.
inability to FORM ASSOCIATIONS BETWEEN EMOTIONAL UCS (distress cutes) and CS (transgressions)
if the person is raised in a social environment where there are advantages for antisocial behaviour.. they will do so. and not experience aversion to victims’ distress
Which area of the brain do we think would be lesioned to cause acquired sociopathy
amygdala and orbito PFC
damaged system that responds to threats, and causes inability to form association between emotional distress cutes, and the transgressions…
in PET scans, what can we see in murderers?
reduced frontal lobe activity.
repeat offenders had 11% less frontal activity.
reduced PFC, pariental and corpus calloson activity
less aftivity in LHS than RHS
not aa good study though.. didnt control for a lot.
Borderline PD?
Pervasive pattern on instability of interpersonal relationships, self image and affects and marked impulsivity as indicated by 5 or more of the following:
Frantic efforts to avoid abandonment
Unstable and intense interpersonal relationships characterized by
alternating between extremes of idealization and devaluation
Identity disturbance
Impulsivity in at least two areas that are potentially self-damaging
Recurrent suicidal behaviours, gestures or threats or self-mutilating behaviours
Affective instability due to a marked reactivity of mood
Chronic feelings of emptiness
Inappropriate anger
Transient, stress-related paranoia
