Lecture 1&2 Flashcards
DSM-5 criteria Personality Disorders
Cluster A
- paranoid pd
- schizoid pd
- schizotypical pd
individuals appear odd or eccentric (5.7%)
cluster B
- antisocial pd
- borderline pd
- histrionic pd
- narcissistic pd
individuals appear dramatic, emotional or erratic (1.5%)
cluster C
- avoidant pd
- dependent pd
- obsessive-compulsive pd
individuals appear anxious or fearful (6.0%)
prevalence for any pd
9.1%
general pd
is het soort overkoepelende –> hierna komen ze allemaal specifiek
criteria A t/m F
A. pattern of inner experience and behavior that deviates markedly from the expectations of the individuals culture. this pattern is manifested in 2 (or more) of following areas:
- cognition (how you perceive self, others, world)
- affectivity (range, intensitity, lability and appropriateness of emotional repsonse)
- interpersonal functioning
- impulse control
B. pattern is inflexible and pervasive across broad range of personal and social sittuations
C. pattern leads to clinically sign distress or impairment in social, occupational, or other important areas of functioning.
D. pattern is stable and of long duration –> onset can be traced back at least to adolscence or early adulthood
E. pattern is not better explained by other mental disorder
F. pattern is not due to effects of substance or other medical condition.
Diagnostic features general PD
Personality traits
Enduring patterns of:
- perceiving
- relating to
- thinking about
the environment and oneself that are exhibited in a wide range of social and personal contexts
Development and course general PD
Begin features: adolescence/early adulthood
Enduring pattern of thinking, feeling and behaving that is relative stable over time
A PD can be diagnosed in indi’s under 18 years –> features must be present for at least 1 year.
Except antisocial PD –> cannot be diagnosed in indi younger than 18.
Gender in PD
More frequent in males:
- antisocial pd
More freq in females:
- borderline
- histrionic
- dependent PD
PD
differential diagnosis
Psychotic disorders: pattern of behaviour must not have occured during course of schizophernia, bipolar or depressive disorder with psychotic features.
depressive or anixiety disorder, cautious during these episodes to diagnose a PD
Personality change after a lot of stress, consider PTSD
with substance use disorder, careful that behaviour is not associated with substance consequences
personality changes due to medical condition (brain tumor)
Cluster A
Paranoid personality disorder
A. Pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent, beginning by early adulthood, with 4 or more of following:
1. suspects, without sufficient basis, that others are exploiting, harming or deceiving him/her
2. preoccupied with doubts about loyalty or trustworthiness of friends or associates
3. reluctant to confide in others because of fear that information will be used maliciously against them
4. reads hidding demeaning or threatening meanings into benign remarks or events
5. percieves attacks on his/her character/reputation that are not apparent to others and is quick to react angrily or to counterattack
6. has recurrent suspicions, without justification, regarding fidelity of spouse or sexual partner.
B. Does not occur exclusively during the course of schizophrenia, bipolar disorder or depressive disorder with psychotic features, or another psychotic diosrder and is not attributable to the phsyiological effects of another medical condition.
Diagnostic features paranoid PD
Pervasive pattern of distrust and suspiciousness of others.
Begins in early adulthood
Associating features supporting diagnosis paranoid PD
- having problems with close relationships
- act: guarded, secretive, devious, cold
- excessive need to be self-sufficient and strong autonomy
- high degree of control over those around them, being: rigid, critical of others, unable to collaborate
- blame others for their shortcomings
- may be litigious and become involved in legal disputes
- they may exhibit unrealistic grandiose fantasies, are often attuned to issues of power and rank, and tend to develop negative stereotypes of others
development and course paranoid PD
childhood/adolescence: solitariness, poor peer relationships, social anxiety, underachievement in school, hypersensitivity, peculiar thoughts and language and idiosyncratic fantasies.
more common in males
risk and prognostic factors paranoid pd
genetic and physiological: relatives with schizophrenia, and familial with delusional disorder, persecutory type.
culture: minority groups, immigrants, political and economic refugees.
Cluster A
Schizoid pd
A. Pervasive pattern of detachment from social relationships and restricted range of expression of emotions in interpersonal settings, beginning by early adulthood, 4 or more of following:
1. no desire no joy in close relationships, including family
2. always chooses solitary activities
3. little/no interest in sexual experiences with other person
4. takes pleasure in few - no activities
5. no close friends/confidants
6. indifferent to praise or criticism from others
7. emotional coldness, detachment or flattened affectivity
B. Does not occur exclusively during the course of schizophrenia, bipolar, depressive with psychotic features, other psychotic disorder, autism spectrum, or medical condition
Schizoid PD
associated features
- difficulty expressing anger –> impression that they lack emotion
- their lives seem directionless, they “drift” in goals
- react passively
- few friends, date infrequently and often not marry
- do well in work under conditions of social isolation
- may experience brief psychotic episodes
development and course schizoid pd
childhood/adolescence: solitariness, poor peer relationships, underachievement in school, subject to teasing
risk and prognosis schizoid pd
genetic/physiological: relatives with schizophrenia or schizotypical pd
more in males
cluster A
Schizotypical pd
A. Pervasive pattern of social and interpersonal deficits marked by acute discomfort with, and reduced capacity for, close relationships as well as by cognitive or perceptual distortions and eccentricities of behavior, beginning by ealry adulthood, 5 or more of following:
1. Ideas of reference (excluding delusions of reference)
2. Odd beliefs/magical thinking that is inconsitient with subcultural norms
3. unusual perceptual experiences, including bodily illusions
4. odd thinking and speech
5. suspiciousness or paranoid ideation
6. inappropriate or constricted affect
7. behavior is odd, eccentric or peculiar
8. lack of close friends/confidants
9. excessive social anxiety –> paranoid fears
B. does not occur exclusively during course of schizophrenia, bipolar disorder, depressive with psychotic features, other psychotic disorder, autism spectrum disorder
Ideas of reference
incorrect interpretations of casual indcidents and external events as having a particular and unusual meaning specifically for the person
Delusions of reference
aforementional beliefs are held with delusional conviction.
associated features schizotypical pd
- they often seek treatment for depressive and anxiety symptoms than for pd features
- in response to stress –> transient psychotic episodes
development and course schizotypical pd
- stable course –> not much develop schizophrenia of other psychotic disorder
- childhood/adolescence: solitariness, poor peer relationships, social anxiety, underachievement in school, hypersensitivity, peculiar thoughts and language, bizarre fantasies.
- children may appear odd or eccentric and attract teasing
risk and prognostic factors schizotypical pd
genetic/physiological: first-degree relatives with schizophrenia
cultural: religious beliefs and rituals, can appear to be schizotypical to the uninformed outsider (voodoo, speaking tongues etc.)
more common in males
Cluster B
antisocial PD
criteria A
A. Pervasive pattern of disregard for and violation of the rights of others, occurring since age 15, 3 or more of following:
1. Failure to conform to social norms with respect to lawful behvaiors; performing acts that are grounds for arrest
2. Deceitfulness: repeated lying, use of aliases, conning others for personal profit or pleasure.
3. Impulsivity or failure to plan ahead
4. Irritability and aggressiveness
5. Reckless disregard for safety of self or others
6. Consistnt irresponsibility: failure in work behavior or honor financial obligations
7. Lack of remorse
Cluster B
Overige criteria antisocial PD
B,C,D
B. At least 18 years old
C. Evidence of conduct disorder with onset before age 15
D. Antisocial behavior is not exclusively during course of schizophrenia or bipolar disorder
associated features supporting diagnosis ASPD
- Lack of empathy
- Inflated an arrogant self-appraisal
- Superficial charm
- Psychopathy
- Irresponsible and exploitative in sexual relationships
- History of many sexual partners, no monogamous relationships
- Irrisponsible as parents
- Dishonerable discharge from army, fail to be self-supporting, become impoverished or homeless or many years in penal institutions
- Likely die prematurely from violence
- Dysphoria
- Comorbid disorders
- Other PD disorder
- Child abuse or neglectt, unstable or erratic parenting, inconsistent parental discipline may increase conduct disorder –> ASPD
Development and course ASPD
Chronic course, may become less evident or remit as individual grows older, particularly by 4th decade of life.
Risk and prognosis ASPD
Genetic/ physiological: first-degree relatives with ASPD –> biological risk higher in females.
Cultural: low SES and urban setting (can be misdiagnosed in people who use protective survival strategy)
ASPD much more in males
Cluster B
Borderline pd
A. Pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity, beginning by early adulthood, 5 or more of following:
1. Frantic efforts to avoid real or imaged abandonment
2. Pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation
3. Identity disturbance: unstable self-image or sense of self
4. Impulsivity in at least 2 areas that are potentially self-damaging
5. Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior
6. Affective instability due to a marked reactivity of mood (intense episodic dysphoria, irritability, anxiety usually lasting a few hours)
7. Chronic feelings of emptiness
8. Inappropriate, intense anger or difficulty controlling anger
9. Transient, stress-related paranoid ideation or severe dissociative symptoms
Associated features supporting diagnosis BPD
- Undermining themselves the moment a goal is about to be realized (dropping out of school just before graduation)
- Some develop psychotic symptoms during times of stress
- May feel more secure with transitional objects (pet or inanimate possession) than in interpersonal relationships.
- Premature death from suicide may occur
- Physical handicaps as results from self-inflicted abuse or failed suicide attempts
- Recurrend job losses, interrupted education, seperation or divorce
- Physical and sexual abuse, neglect, hostile conflict, early parental loss are more common in childhood history
- Common comorbid disorders: depression, bipolar, substance use, eating (bulimia), ptsd, adhd
Development and course BPD
- Variability in course
- Most common pattern: chronic instability in early adulthood, with episodes of serious affective and impulsive discontrol and high levels of use and mental health resources
- During 30s and 40s, majority attains greater stability in relationships and vocational functioning.
Risk and prognostic factors BPD
Genetic/physiological: BPD 5x more common among first-relatives
Mostly diagnosed in females
Cluster B
Histrionic pd
Criterion A (without symptoms)
A. Pervasive pattern of excessive emotionality and attention seeking, beginning in early adulthood.
HPD
How many symptoms are needed for diagnosis?
5 or more of 7
HPD
What are the 7 symptoms?
- Uncomfortable in situations in which he/she is not centre of attention
- Inappropriate sexually seductive or provocative behavior
- Rapidly shifting and shallow expression of emotions
- Uses physical appearance to draw attention to self
- Style of speech that is excessively impressionistic and lacking in detail
- Self-dramatization, theatrically, and exaggerated expression of emotion
- Is suggestible: easily influences by others/circumstances
- Considers relationships to be more intimate than they actually are
Associated features supporting diagnosis HPD
May (have):
- Difficulty achieving emotional intimacy in romantic or sexual relationships
- Without being aware, they often act out a role (princess, victim)
- Control partner through emotional manipulation or seductiveness, while displaying a marked dependency on them at another level
- Often impaired relationships with same-sex friends because their sexually provocative interpersonal style may seem a threat to their friends’ relationships
- Alienate friends with demands for constant attention
- Become depressed and upset when not center of attention
- Crave novelty, stimulation and excitement and tend to become bored with usual routine
- Intolerant of, or frustrated by, situations that involve delayed gratification, and their actions are often directed at obtaining immediate satisfaction
- Interest may lag quickly in a job or project which was initiated with great enthousiasm
- Increased risk for suicidal gestures and threats to get attention and coerce better caregiving
HPD
What are comorbidities?
- Higher rates of somatic symptom disorder, conversion disorder, MDD
- Comorbid: BPD, NPD, ASPD, DPD
HPD
What gender is more common?
Females
Cluster B
Narcissistic pd
Criterion A (without symptoms)
A. Pervasive pattern of grandiosity, need for admiration, and lack of empathy, beginning in early adulthood.
NPD
How many symptoms needed?
5 or more of 9
NPD
What are symptoms?
- Grandiose sense of self-importance
- Preoccupied with fantasies of unlimited succes, power, brilliance, beauty, or ideal love
- Believes that he/she is special and unique and can only be understood by or associated with other sepcial or hihj-status people
- Requires excessive admiration
- Has sense of entitlement
- Interpersonally exploitative (takes advantage of others to achieve own ends)
- Lacks empathy
- Often envious of others, or believes that others are envious of them
- Shows arrogance, haughty behaviors or attitudes
Associated features NPD
- Can’t handle criticism
- Interpersonal relationships typically impaired
- Ambition and confidence may leed to high achievement, performance may be disrupted due to intolerance of criticism
- Vocational functioning can be very low, don’t want to take risks when defeat is possible
- Shame and humiliation due to critique –> can lead to depressed mood, social withdrawal, dysthemia, MDD
- Periods of grandiosity may be associated with hypomanic mood
NPD
What are associated disorders?
- Associated with anorexia and substance use disorder (cocaine)
- Associated with: histrionic, antisocial, paranoid pd
Development and course NPD
- May have special difficulties adjusting to onset of physical and occupational limitations that are inherent in aging process
50-75% diagnosed are male
Cluster C
Avoidant pd
Criterion A (without symptoms)
A. Pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation, beginning by early adulthood.
APD
How many symptoms are needed?
4 or more of 7
APD
What are symptoms?
- Avoids acitivities with interpersonal contact because of fear of criticism, disaproval, or rejection
- Unwilling to get involved with people unless certain of being liked.
- Restraint with intimate relationships because of fear of being shamed or ridiculed
- Preoccupied with being critized or rejected in social situations
- Inhibited in new social situations because of feelings of inadequacy
- Views self as socially inept, personally unappealing, or inferior to others
- Usually reluctant to take personal risks or ingage in new activities –> fear of embarrasment
Associated features APD
- Vigilance (waakzaamheid) of others
- Fearful and tense demeanor may elicit ridicule and derision from others, which confirms their self-doubt (ze lokken het dus uit)
- Very anxious that they will react with blushing or crying to criticism
- Major problems in social and occupational functioning
- Low self-esteem and hypersensitivity to rejection –> restricted interpersonal contacts
- Become isolated
- Desire affection and acceptance and may fantasize about idealized relationships
APD Associated features
How are they described by others?
Are described as “shy”, “timid”, “lonely” and “isolated”
APD
What are comorbidities
Comorbid: social anxiety, depression, bipolar, anxiety
APD
What is it often diagnosed with?
Other PDs
- PD: often diagnosed with dependent pd, because they can become very attached to few friends they have
- PD: tends to be diagnosed with BPD and cluster A PDs
Development and course APD
- Avoidant behavior starts in childhood with: shyness, isolation, fear of strangers and new situations.
- Increasingly shy during adolescence and early adulthood
- Some evidence that it becomes less evident or to remit with age
APD
Gender
Equally frequent in males and females
Cluster C
Dependent pd
Criterion A (without symptoms)
A. Pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation, beginning by early adulthood
DPD
How many symptoms?
5 or more of 8
DPD
What are symptoms?
- Difficulty to make everyday decisions without advise and reassurance from others
- Needs others to assume responsibility for most major areas of their life
- Difficulty expressing disagreement with others, because fear of loss of support or approval
- Difficulty initiating projects or doing things on their own (due to lack self-confidence)
- Goes excessive lengths to obtaint nurturance and support from others, to the point of volunteering to do things that are unpleasant
- Feels uncomfortable or helpless when alone, due to exaggerated fear of being unable to care for themselves
- Urgently seeks other relationship when close relationships end
- Unrealisticly preoccupied with fears of being left to take care of themselves
Associated features DPD
- Pessimisms and self-doubt, belittle their abilities, refer to themselves as “stupid”
- Take criticism as proof of their worthlessness
- Seek overprotection and dominance from others
- Occupational functioning impaired if independence is required
- Avoid positions of responsibility, become anxious when faced with decisions
- Social relationships limited to those few on whom individual is dependent
DPD
They have increased risk on … mentalhealth disorders
- Depression
- Anxiety
- Adjustment disorder
DPD
What during childhood/adolescence may predispose individual to development of this disorder?
Chronic physical illness or separation anxiety disorder
DPD
What are co-occuring PDs?
- BPD
- APD
- HPD
DPD
Gender
Female
Cluster C
Obsessive-compulsive pd
Criterion A (without symptoms)
A. Pervasive pattern of preoccupation with ordeliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency, beginning by early adulthood,
OCPD
How many symptoms
4 or more of 8
OCPD
What are symptoms?
- Preoccupied with details, rules, lists, order, organization or schedules to the extend that point of activity is lost
- Perfectionism that interferes with task completion (unable to complete because own strict standards are not met)
- Excessively devoted to work and productivity to the exclusion of leisure activities and friendships
- Over-conscientious, scrupulous, and inflexible about matters of morality, ethics or values
- Unable to discard worn-out or worthless objects even when they have no sentimenttal value.
- Is reluctant to delegate tasks or to work with others unless they submit to exactly his or her way of doing things.
- Adopts a miserly spending style towards both self and others, money is viewed as something to be hoarded for future catastrophes
- Shows rigidity and stubbornness
Associated features OCPD
- Decision making= time-consuming, often painful proces
- Become upset or angry when no control
- Express affection very controlled –> uncomfortable with others who are emotionally expressive
- Everyday relationships have formal and serious qualilty, stiff
- Carefully hold themselves back until they are sure that whatever they say will be perfect
- Preoccupied with logic and intellect, intolerant of affective behavior in others
- Difficulty expressing tender feelings, rarely paying compliments
- Occupational difficulties, when confronted with new situations that demand flexibility and compromise
Associated features OCPD
Many features overlap with what type of PDs?
Type A
OCPD
What disorders is it associated with?
Association:
- depression,
- BD,
- eating disorders
OCPD
Do people with OCD meet for these criteria?
NO
Majority of individuals with OCD do not have pattern of behavior that meets criteria for this pd
OCPD
Gender
Twice as often diagnosed in males
