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PERSONALITY > L7: Intro Personality Disorders > Flashcards

L7: Intro Personality Disorders Flashcards

1
Q

What are personality disorders?

A
  • when personality traits (like big 5) go to extreme
  • characterized by rigid, inflexible thoughts, feelings, actions and impulse regulation (more so than “normal” personality)
  • originates in early dev
  • present since late adolescence/early adulthood
  • dysfunctional (sometimes only experienced by others)
  • related to high helathcare costs & consumption, societal costs & lower quality of life
  • not more chronic compared to other chronic syndrome disorders (schizophrenia/bipolar)
  • here psychopathology connected to our personality
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2
Q

Are personality disorders egosyntoic or egodystonic?

A

Egosyntonic!
- consitent w self image, aligns w goals, values, self view…
- seen as normal, cannot imagine otherwise
ex: OCPD need for perfectionism seen as adaptive & necessary
vs egodystonic (like OCD): not consistent w self, causes conflict & distress

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3
Q

What is normal personality/normal personality traits?

A
  • habitual way of thinking, feeling, acting
  • big 5
  • consistent across situations (but large situational variance)
  • often thougth that personality is stable, shaped around 18y and remains unchanged
    -> but no proof of complete stability! relatively stable, but some changes (especially around 30)
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4
Q

What are the explanations for widely observed changes in personality w age?

A
  • biological maturation (ie decrease in impuslivity)
  • environmental influences (increased responsibility, corrective experiences like feedback from environment (conditioning))
    increase in conscientiousness, increase in emotional stability etc
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5
Q

How do you distinguish PD from other pathology?

A
  • Persistent: stable & long duration, since early adulthood
  • Pervasive: across most situations (and inflexible)
  • Problematic (causes distress and/or impairment)
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6
Q

What are the different PD clusters?

A
  • Cluster A: strange bizarre, variant psychosis
  • Cluster B: dramatic, emotional, impuslive, variant externalizing disorders
  • Cluster C: anxious, avoidant, variant internalizing disorders
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7
Q

What PDs are in cluster A?

A
  • paranoid PD (distrust)
  • schizotypal PD (ideas of reference, psychotic fear)
  • schizoid PD (isolation, no desires or flattened affectivity)
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8
Q

What PDs are in cluster B?

A
  • Histrionic PD (theatrical, attention seeking)
  • Narcissistic PD (superiority)
  • Borderline PD (instability)
  • Antisocial PD (no conformation norms, criminal)
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9
Q

What PDs are in cluster C?

A
  • Avoidant PD (avoiding)
  • Dependent PD (clinging to helper)
  • Obsessive Compulsive PD
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10
Q

Outside of the clusters, what other categories of PDs are there?

A
  • Personality Change Due to Another Medical Condition (a stroke, brain trauma etc)
  • Other Specified Personality Disorder (OSPD) (Diagnosis can be specified, Satisfies multiple criteria of various PDs, but does not satisfy criteria of 1 single PD, None-DSM PDs (such as sadistic PD), Category with highest prevalence)
  • Unspecified Personality Disorder
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11
Q

What are the 2 types of classification?

A
  • monothetic principle: all members must meet the same properties of criteria
  • polythetic: meeting a min number of symptom criteria from 1 criterion set (DSM, creates a lot of heterogeneity)
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12
Q

What is the prevalence of min 1 PD?

A
  • general pop: 9-13%
  • outpatient care: 30-50%
  • inpatient care: 50-70%
  • seen a lot in addiction & forensic settings
  • but still lack of good studies
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13
Q

How is life expectancy affected by PD?

A
  • on average 18y shorter (excluding suicides)
  • reasons: lifestyle, chronic stress, meds etc
  • risk intergenerational transmission
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14
Q

How can childhood trauma be an etiological factor for PD?

A
  • very related to PDs (mostly studied in BPD w sexual abuse)
  • emotional abuse important predictor (attachment issues, emotional regulation issues, coping issues, negative self views), especially w cluster c!!
  • but not everyone dev PDs
  • upbringing
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15
Q

What can mediate the relationship between parent PD & childhood problem behaviour -> future child PD?

A

type of problematic parental behaviour in the home while the child is young

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16
Q

How are PDs assessed?

A
  • SCID 5 Interview (structured so it avoids all the problems w diagnosing just based on clinical expertise)
17
Q

What are the problems w diagnosing PD based on clinical expertise (instead of using a structured instrument)?

A

low reliability cause of
- stereotypes
- premature closure
- confirmation bias
-> important to also assess syndrome disorders

18
Q

What are the treatment guidelines for PDs?

A
  1. Specialized Psychotherapy (e.g., DBT or ST)
    * Determine what should be treated first in case of comorbidity
    * Additional treatment can be effective (e.g., PTSD, phobias)
    * Integrated treatment for syndrome disorders
  2. Social psychiatric treatment (if first choice is not possible, lack of motivation)
  3. Pharmacotherapy is not useful for treatment personality disorders, only dampens symptoms
    * Possible for comorbid disorder or specific symptoms
    * For support psychotherapy, but should not interfere (too much sedation)
    * Prevent polypharmacy
19
Q

What is the commorbidity w OCPD like?

A

highly comorbid w:
- hoarding disorder
- MDD
- anxiety disorder
- body dysmporhpic disorder / EDs
- autism
- addiction
- other PDs
often confused w OCD but OCD is egodystonic & self aware

20
Q

What is a common clinical psychodynamic in OCPD?

A
  • outward deference & compliance w the therapist, who is a perceived authority figure
    while the treatment process is covertly undermined by unconscious resistance, covert aggression, and avoidance of emotion
  • therapist often feels flabbergasted, and has countertrasnference of numbness & frustration
21
Q

What is the treatment of choice for OCPD?

A
  • no empirically valid standard for OCPD treatment
  • but psychodynamic psychotherapy of CBT are treatment of choice
  • pharmacological treatment is considered additional
22
Q

What is the etiological model of OCPD?

A
  • additive genetic effect
  • unique environmental factors (low parental care, high parental overprotection, family system that emphasizes compliance & rules in exhange for acceptance and love-
23
Q

Where is OCPD in the DSM?

A
  • cluster C: fearful
  • defined as preoccupation w perfectionism, orderliness, and control beginning by young aduolthood: w 5 or more of 8 symptoms present
    including
  • preoccupation w details
  • perfectionism
  • excessive devotion to work
  • over conscientiousness
  • rigidity & stubborness
  • difficulty delegating
  • hoarding
  • stinginess
24
Q

What is the epidemiology of OCPD?

A
  • one of the most common PDs: 2-8% general pop
  • high risk factor for depressive relapse
  • causes less functional impariemtn as compared w other PDs
  • but still negatively impacts quality of life
25
Q

How can you spot OCPD in initial interview?

A

often present as
- meticulously groomed
- speak w careful detail
- highly intellectualized, frustrating the clinicians efforts to get details about their emotional life
extra info from close ones can be helpful
rule out other disorders like OC and related disorders, autism, EDs, other PDs, brain disorders & injuries

26
Q

How can you differentiate OCPD from OCD?

A

OCD:
- symptoms: obsessions & irrationally related compulsions
- experienced as distressing/ego dystonic
- symptoms are irrational in their pov
- often experience guilt & anxiety that lead to compulsions
- seek help cause symptoms are bothersome
OCPD
- symptoms: pervasive patterns of obsessional thoughts & behaviours
- experienced as not distressing & egosyntonic
- little insight, does not see problem/irrationality of their symptoms
- seeks helf cus of secondary symptoms or anothers insistence

27
Q

What is Avoidant PD symptoms?

A
  • shyness
  • social inhibition
  • feelings of inadequacy
  • hypersensitivity
  • feel inhibited & uncomfortable in relationships in fear of criticism
  • loneliness
  • low self esteem
  • rejection sensitivity
  • avoid other even though they crave human contact
  • triggering event(s) for symptoms: demands for close interpersonal interaction or public/social appearances
  • behavioural styles: chronic tenseness & self consciousness, controlled speech & behaviour, awkward or apprehensive appearnce, self critical
  • interpersonal styles: sensitivte to rejection, want acceptance but distance themselves
  • cognitive styles: hypervigilant, low self esteem
  • affective styles: shyness, apprehensivess, sadness, loneliness, emptiness, depersonalization
  • preoccupied & fearful attachment style
  • optimal diagnostic criterion: avoidance of work acitivites that involve significant interpersonal contact because of fear of rejection
28
Q

What is the difference between avoidant personality style & AVPD?

A

personality style is more flexible & causes less distress and impairment than AVPD

29
Q

how do you diagnose AVPD?

A

structured interview using the DSM 5 criteria

30
Q

What are the 5 common models for conceptualizing AVPD?

A
  • psychodynamic
  • biosocial
  • cognitive behavioural
  • interpersonal
  • integrative
31
Q

What are the 5 effective psychotherapy approaches for treating AVPD?

A
  • psychodynamic therapy
  • cognitive behavioural therapy
  • schema therapy
  • interpersonal psychotherapy
  • combined/integrated treatment
32
Q

What are the 4 clinically useful treatment modalities to treat AVPD?

A
  • group therapy
  • marital & family therapy
  • medication
  • combined/integrated treatment
33
Q

What is the prevalence of AVPD?

A
  • 2.4% of genearl pop
  • 5-55% of clinical pop
34
Q

How does the biosocial theory conceptualize & treat AVPD?

A
  • vigilance in this PD is explained by dominant sympathetic NS & lowered autonomic arousal treshold
  • shyness has genetic origin that requires environmental experiences (parental & peer group rejection) to progress into full avoidance
  • believes its combo of bio & environmental factors
35
Q

How do the cognitive behavioural theory & schema therapy conceptualize & treat AVPD?

A
  • those w AVPD: maintain core belief of rejection
  • social rejection so intolerable that they resort to avoidance
  • maladaptive schemas & dysfunctional beleifs about self and others underlie these avoidance patterns (see themselves as inept & see others as critical)
  • interventions: anxiety management, exposure methods
36
Q

How does the interpersonal theory conceptualize AVPD?

A
  • AVPD patients start dev w appropriate social bonding, thus they will keep desiring these bonds
  • but relenetless parental control toward creating a certain social image leads to them seeing flaws as subjects of humiliation & embarassement
  • so as adults they epect to perform flawlessly & avoid any criticsm (like rejection, which they often experienced in childhood)
  • this fear of rejection leads to avoidance
  • even tho this fear came from family, they see family as their main support and fear others instead
37
Q

How does the integrative case conceptualization see AVPD?

A
  • biologically: AVPD patient had hyperirritable & fearful infant temparements
  • psych: hold inadequate self views & critical views of others
  • socially: usually experienced parental ridicule & rejection
38
Q

How can you spot AVPD in an initial interview?

A

tend to be
- guarded
- respond w single word answers
- hypersensitive to criticism or rejection
-> use empathy & reassurance as response to this (not confronation)

39
Q

What are the genearl treatment guidelines for AVPD?

A
  • goal: expand their capacity to tolerate feedback & trust others
  • individual therapy can help them recognise patterns of avoidance & social withdrawal (CBT, schema therapy)
  • couples therapy & group therapy may help to assess interpersonal patterns

PERSONALITY (10 decks)

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