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Personality and Personality Disorders > L7: Personality disorders: general introduction + OCPD and AVPD > Flashcards

L7: Personality disorders: general introduction + OCPD and AVPD Flashcards

1
Q

what are personality disorders?

A
  • rigid, inflexible thoughts/feelings/actions/impulse regulations
  • originates in early development
  • present since late adolescence/early adulthood (nu steeds meer diagnosen in adolescenten)
  • dysfunctional
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2
Q

PDs are associated with

A
  • high healthcare costs (want vaak gerelateerd aan andere disorders), healthcare consumption, societal costs, lower quality of life
  • but PDs are not more chronic than other chronic symptom disorders (schizphrenia, bipolar disorder)
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3
Q

egosyntone=

A

Consistent with self-image, aligns with goals, values and self-view. Seen as ”normal”, cannot imagine otherwise.
→ Personality disorders

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4
Q

egodystone=

A

Not consistent with self-image or part of the self. Causes conflict and distress
→ Syndrome disorders (depression)

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5
Q

normal personality traits are consistent across variables, but there is large situational variance

A

oke

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6
Q

Often thought that personality is stable, shaped around 18 years and remains unchanged. But…

A
  • Personality is often more stable with increasing age, with largest changes around 30 (Roberts et al., 2008; Bleidorn et al., 2022)
  • Almost no studies find evidence for complete stability
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7
Q

dus wat gebeurt er met persoonlijkheid gedurende je leven

A
  • personality becomes more stable
  • most personality changes around 30
  • traits become softer: decrease (OCEA)
  • wel meer emotional stability
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8
Q

uitleg voor deze veranderingen in persoonlijkheid

A
  • biological maturation (decrease in impulsivity bv)
  • evironmental influences: increased responsibility, corrective experiences such as feedback from the environment (conditioning)
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9
Q

three P’s

A
  • persistent (stale and long duration, since early adulthood)
  • pervasive (across most situations, inflexible)
  • problematic (causes distress and/or impairment)
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10
Q

beschrijvingen van de 3 clusters

A

Cluster A = strange, bizarre, variant psychosis
Cluster B = dramatic, emotional, impulsive, variant externalising disorders
Cluster C = anxious, avoidant, variant internalizing disorders

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11
Q

cluster A=

A
  1. Paranoid PD (Distrust)
  2. Schizotypal PD (Ideas of reference, psychotic fear)
  3. Schizoid PD (isolation; no desires or flattened affectivity)
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12
Q

cluster B=

A
  1. Histrionic PD (Theatrical, attention-seeking)
  2. Narcissistic PD (superiority)
  3. Borderline PD (instability)
  4. Antisocial PD (No conformation norms, criminal)
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13
Q

cluster C=

A
  1. Avoidant PD (Avoiding)
  2. Dependent PD (Clinging helper)
  3. Obsessive-compulsive PD (rigid rules and perfectionism)
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14
Q

other PD categories

A
  1. Personality Change Due to Another Medical Condition
    * a stroke, brain trauma
  2. Other Specified Personality Disorder (OSPD)
    * Diagnosis can be specified
    * Satisfies multiple criteria of various PDs, but does not satisfy criteria 1 single PD.
    * None-DSM PDs, such as sadistic PD
    * Category with highest prevalence
  3. Unspecified Personality Disorder
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15
Q

classification=

A
  • Monothetic:
    Members must meet the same properties of criteria (dus dan zou iedereen alle criteria moeten hebben)
  • Polythetic:
    Meeting a minimal number of symptom criteria from 1 criterion set, developed by Wittgenstein for biological classifications/family resemblance
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16
Q

prevalence of minimal 1 PD

A

general population: +- 10%
outpatient care: 30-50%
inpatient care: 50-70%

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17
Q

waarom verschillen tussen prevalence studies

A
  • Almost no international studies
  • Different sampling methods
  • Study instruments
  • Poor diagnostic reliability
  • Study setting
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18
Q

life expectancy of PDs

A
  • On average, 18 years shorter (excluding suicides)
  • Risk highest before 44 years (10x mortality rate)
  • Cardiovascular diseases
  • Reasons: Lifestyle, chronic stress, medication
  • Risk intergenerational transmission
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19
Q

childhood trauma

A
  • In childhood, trauma (abuse and neglect) is common
  • Between 11% (sexual abuse) and 26.7% (emotional abuse) -> Poorer mental health, range of syndrome disorders, including PTSD and personality disorders
  • General and unique correlations with childhood trauma types
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20
Q

difference AVPD and schizoid PD

A

AVPD people feel very lonely, ppl with schizoid PD do not have this urge to be with people.

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21
Q

maar er is dus veel overlap tussen de PDs, altijd goed nadenken over de reden achter iemands gedrag, dus de motivaties.

A

oke

22
Q

the risk of intergenerational risk is very high with PDs

A

oke

23
Q

emotional abuse vs. emotional neglect

A

abuse = active, calling the child names, shouting.

neglect = passive, absent, distant

24
Q

sexual abuse is associated with which PDs

A
  • paranoid
  • borderline
25
Q

physical abuse is associated with which PDs

A
  • antisocial
26
Q

emotional abuse is assoicated with which PDs

A
  • borderline
  • avoidant
  • dependent
  • obsessive-compulsive
27
Q

emotional neglect is associated with which PDs

A
  • borderline
28
Q

dus waar is borderline mee geassocieerd

A
  • sexual abuse
  • emotional abuse
  • emotional neglect
29
Q

emotional abuse highly associated with which cluster?

A

cluster C

30
Q

emotional abuse as an important predictor

A
  • Attachment (insecure attachment and distrust of others, approach-avoidance)
  • Emotion regulation (they mainly experience negative emotions, and cannot recognize their own emotions)
  • Coping
  • Negative self-views
31
Q

questions about emotional abuse as a predictor

A
  • Not everyone develops psychopathology/PD
  • Upbringing/behaviour caregivers might have an effect on vulnerability
  • Difference between PDs or general negative effects?
32
Q

wat is nog meer een risicofactor voor PDs

A

problematic parental behaviour during child rearing.

(hoe meer soorten problematic parental behaviours, hoe meer kans op PDs in kids)

33
Q

Diagnosis based on clinical expertise has low
reliability, due to

A
  • Stereotypes
  • Premature closure
  • Confirmation bias (Interviews force disconfirmation)
34
Q

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
35
Q

conclusions

A
  • Important clinical group with a high disease burden and high health care utilization/consumption
  • PD criteria must be dysfunctional (sometimes only experienced by the environment), are egosyntonic ,and
    must meet the 3 p’s
  • PDs are changeable – just like ‘regular’ personality
  • Childhood trauma and environmental influences play an important role
  • Specialized psychotherapy is the treatment of choice
36
Q

Obsessive-compulsive personality disorder (OCPD) is characterized by

A

preoccupation with perfectionism, orderliness, and control beginning by young adulthood with other symptoms including:

(5 of 8)
- preoccupation with details;
- excessive devotion to work;
- over-conscientiousness;
- fastidiousness;
- inflexibility/rigidity;
- stubbornness;
- difficulty delegating;
- hoarding;
- stinginess.

37
Q

OCPD is one of the most common personality disorders. While it can negatively impact the quality of life, it is thought to cause less impairment when compared with other personality disorders

A

oke

38
Q

OCPD is also commonly associated with ….

A

hoarding disorder, major depressive disorder, anxiety disorder, body dysmorphic disorder/eating disorders, autism spectrum disorders, alcohol abuse/ dependence, and other personality disorders

39
Q

A common clinical psychodynamic in OCPD:

A

outward deference (respect) and compliance with the therapist, who is a perceived authority figure, while the treatment process is covertly undermined by unconscious resistance, covert aggression, and avoidance of emotion. The therapist often feels flummoxed, vacillating between countertransference states of numbness and frustration.

40
Q

treatment OCPD

A

While there is no empirically validated standard for the treatment of OCPD, psychodynamic psychotherapy or CBT are the treatment of choice. Pharmacological treatment is considered adjunctive. Schema therapy also good

41
Q

willem reich zei

A

people with severe obsessive characters are like living machines, who use thought and action to avoid emotions

42
Q

obsession with order and control is at the expense of flexibility and efficiency, which often results in the loss of the meaning or point of the activity altogether

A

oke

43
Q

prevalence OCPD

A

2-8% in general population

44
Q

consequences of ocpd

A

decrease QoL, and employment. but also higher status and wealth

45
Q

wat zei freud over ocpd

A

origins in anal stage (toilet training years), due to control issues in parent and child

46
Q

OCPD more common in relatives of OCD

A

oke

47
Q

OCPD as a brain disease

A
  • enhanced visual acuity
  • smaller pineal gland volume
  • 40% voorkomend in parkinsons
48
Q

parental influence on OCPD

A
  • high parental overprotection
  • low parental care
  • family system that emphasizes compliance and rules in exchange for acceptance
  • firstborn children
  • marry histrionic individuals
  • anhedonic temperaments
49
Q

overt kenmerken OCPD

A
  • groomed
  • speak with details
  • highly intellectualized
  • no talking about emotions
50
Q

clinical distinctions OCD and OCPD

A

OCD:
- focal obsessions and irrationally related compulsions.
- symptoms are distressing, egodystonic
- insight that symptoms are irrational
- seeks help because the symptoms are bothersome
- symptoms fluctuate over time (stress)
- no good capacity to delay

OCPD:
- pervasive patterns of obsessional thoughts and behaviours
- symptoms are not distressing, egosyntonic
- little insight
- seeks help because of secondary symptoms or via another person
- patterns, always the same
- greater capacity to delay

51
Q

people with OCPD wish to be the perfect patient, but often undermine the treatment unconsciously by avoiding their emotions

A

oke

Personality and Personality Disorders (18 decks)

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