Lecture 10: Everyday life

Question 1

Describe the history of personality disorder

Answer 1

In 1885, Ribot published a book about personality. The modern Western idea of individual personalities only dates back from the 18th century.
Personality disorders were in the DSM I and it drew on psychoanalytic conceptual framework. This was drawn from the US military medical manual, however, that manual believed they were reactions to events and weren’t related to individual personality.
In the 50s/60s, there were two main empirical approaches; Cattell/Eysenk etc. believed in measuring personality traits whereas the other approach believed that personality was a series of states that aren’t consistent over time. However, some theorists like Freud and Adler still believed personality was based on early experience, which is what the DSM I was informed upon.

Question 2

Discuss culture in relation to personality disorders

Answer 2

Individual personality is linked to Western notions but this trait of personality is now universal.
Leising 2009 tried to specify the personality disorder criteria in the DSM IV as some disorders like ASPD were only concerned with what they did (like deviance, committing crimes) instead of their personality. People say it’s less to do with mental health and personality and is more to do with transgressions from moral codes.

Question 3

Describe the prevalence of personality disorders

Answer 3

In 2000 it was reported from a survey that 1 in 25 adults have some sort of personality disorder. UK prevalence was higher among men and the most prevalent type was obsessive.

Question 4

What are personality disorders?

How are they diagnosed?

Answer 4

They are inflexible, maladaptive traits that impair social or occupational functioning. It develops in adolescence.
You must have patterns present in at least two of the following areas: cognition, emotions, relationships and impulse control. Comorbidity is linked to more severe symptoms and a poorer outcome. More than half the people that have been diagnosed with a personality disorder have another one and more than two thirds meet lifetime criteria for another disorder.

Question 5

Discuss the dimensional approach for personality disorder

Answer 5

This involves the 5 factor model which believes that your personality is grouped into: neuroticism, extra/introversion, openness to experience, agreeableness/antagonism and conscientiousness. These are all heritable. These traits are continuous but people with personality disorders are at the extremes. To find out, you rate each of the five factors but this involves categorical labels that might not fit to your personality. Most personality disorders entail high neuroticism and antagonism. High extraversion=histrionic and narcissistic PDs. Low extraversion=social isolation like schizoid PD, schizotypal and avoidant PD.

Question 6

What personality disorders are in cluster A?

Answer 6

Paranoid PD
Schizoid PD
Schizotypal PD

Question 7

Describe paranoid PD

Answer 7

These people shun close relationships, they don’t trust anyone, they have excessive trust in their own abilities and they expect to be hurt or deceived and as a result, expect the worst in others. It’s an extension of antisocial, narcissistic or OCD personality disorders and it usually emerges under extreme stress. To treat it, a therapeutic alliance is formed and the therapist agrees that the world is threatening at times. It aims to help people be more competent at discriminating real threats from perceived ones. However, many patients threaten to sue the therapist.

Question 8

Describe schizoid PD

Answer 8

Someone who doesn’t yearn for close ties, they avoid social contact and prefer to be alone. They have had a lifelong indifference to other people and don’t have interest in sex or marriage. It’s biologically influence via dopamine and early childhood trauma, abuse or neglect can cause it. Also, a fragmented pattern of family communication, a rigid home environment and reinforced social isolation can also cause it. To treat it, therapists establish an empathetic relationship and acknowledge the resistance of self disclosure (revealing secrets).

Question 9

Describe schizotypal PD

Answer 9

It’s milder than schizophrenia. It involves the belief that people are watching or talking about you. They often have magical thinking, have peculiar perceptions, talk to themselves, are slovenly, speak in a vague, rambling manner and have blunted or inappropriate emotions. It’s an extension of avoidance and schizoid PD. It has been linked to dopamine, parental abuse, neglect and psychological malnourishment. The milder variations respond better to treatment.

Question 10

What personality disorders are in cluster B?

Answer 10

Histrionic PD
Borderline PD
Narcissistic PD
Antisocial PD

Question 11

Describe histrionic PD

Answer 11

They have dramatic emotionality and live in constant pursuit for attention. They are emotionally elaborate over small events. They try and be centre stage by being charming, attractive and seductive. They are controlling in relationships, need constant praise and reassurance and look for authority figures to solve their problems. They have an inept self image, they self sacrifice and they have behavioural incompetence. They may have deficient physical stature or health. Not very competent perhaps because of overprotection. They feel unattractive and unintelligent. To treat it you encourage them to express their feelings, opinions and preferences without fear of rejection. It’s caused by a halted psychological growth and progression at a level of adolescence.

Question 12

Describe borderline PD

Answer 12

It’s one of the most frequently diagnosed. It involves instability (most recognised characteristic), uncertainty of themselves, their image, their sexual orientation, their life goals and their life values. They often feel empty or bored. They’re prone to depression, anxiety, anger, impulsive behaviour, unstable moods. They have dysfunctional relationships and it can be an extension of histrionic, dependent or passive-aggressive PDs. It’s linked to family dysfunction, parental neglect, parental inconsistency, physical or emotional trauma and contradictory parental communications. To treat it, predictable boundaries are established and the therapist has an active, supportive role to get them to recognise self destructive, maladaptive behaviours and their underlying needs.

Question 13

Discuss Linehan’s diathesis stress theory about borderline PD

Answer 13

Individuals with BPD have difficulty controlling their emotions, perhaps a biological cause. Their family invalidates their emotional expression or experience. The interaction between these two causes BPD. It’s a circular theory.

Question 14

Discuss BPD in relation to self harm

Answer 14

Castillo 2003 found that 87% of female with BPD had reported early emotional abuse, 70% sexual abuse, 51% violent abuse. Miller found that BPD patients used coping strategies, like dissociation or self harm, which corresponded with their symptoms. Slef harm is a symptom of BPD but it could be a coping mechanism for their childhood abuse that they had no control over.

Question 15

Describe narcissistic PD

Answer 15

This was based on the greek myth about narcissus dying because he pined at his reflection for too long. They have pervasive fantasies of success, beauty or talent with extreme self focus. They only look at others to further their goals. However, they actually feel worthless, envious and are wounded by criticisms. Most people have some symptoms of this, for example 70% glance at themselves occasionally when out and about. They can get narcissistic injury which involves being temporarily overwhelmed by personal failure or rejection, this lessens quickly though. It’s caused by excessive, unconditional parental valuation of the child with overindulgence and no limits. It’s treated via long term therapy and social skills training.

Question 16

Describe antisocial personality disorder

Answer 16

This can involve psychopathy or sociopathy. They have a life long history of misconduct, they don’t have a steady job, they’re indifferent to others, they’re self focused, they’re aggressive and impulsive. They’re good liars. Men are 5 times more likely than average to have a biological relative with ASPD and women are 10 times more likely. Psychopaths react less to threatening stimuli than non-psychopaths. They have a neuronal hypersensitivity in their amygdala which lowers their threshold for impulsive, aggressive and ego-centric behaviour. It’s caused by parental hostility, deficient parenting, severe socio-economic hardship and overcompensation of parental abuse or neglect. In the 19th century it was called moral insanity. Emotions: Lack of fear, anxiety, low levels of skin conductance at age 3 (this can predict ASPD). Many children view violence from an early age.

Question 17

Give an example of someone who had ASPD

Answer 17

Dahmer, he murdered 17 boys, dismembered them, raped their corpses and kept body parts as trophies.

Question 18

What personality disorders are in cluster c?

Answer 18

Obsessive compulsive personality disorder
Avoidant PD
Dependent PD

Question 19

Describe obsessive compulsive PD

Answer 19

When people must do everything right, which can impair productivity and relationships. They are perfectionists and have really high standards, so much so that tasks are rarely finished as they can’t be good enough. They demand perfectionism from others and plan their leisure time. Mostly men have it and people with it are considered emotionally cold and moralistic. It’s different from OC anxiety disorder because they embrace their symptoms and rarely wish to change, unlike people with OCAD. At least one parent is unskilled at expressing love and affection or they are neglecting and abusive. A lot of people with it have had to take responsibility in a dysfunctional family and as a result miss their childhood. Serotonin is involved so it has some biological causes. It’s treated via social skills training, relaxation training, encouragement of risk taking, cognitive training to gain cognitive flexibility. They like structured, goal orientated methods.

Question 20

Describe avoidant PD

Answer 20

They are fearful of being rejected, they don’t give anyone an opportunity to reject or accept them. They yearn for social ties but are unable to establish them. Unlike social phobias, they fear relationships themselves, not specific social contexts. There are biological factors like dysfunctioning in the lymbic system. It can be treated by reducing the anxiety via drugs, or desensitisation to rejection, this involves assertiveness training, social skills training and cognitive therapy.

Question 21

Describe dependent PD

Answer 21

Mainly women have it. They rely on others to make decisions for them, they can’t do any project alone, they need praise, sensitive to rejection, fear of losing relationships, demean themselves to please others, self sacrificing. It’s caused by a reinforcement scheme which is passive, others-focused and negative. This can also involve internet dependence; 60 hours a week online, 16% obsessed, mainly men. Electronic cocaine/mobile phone dependence; 30% of women would give up sex for a year over losing their phone for a weekend. 50% would rather lose their engagement ring than their phone.

Question 22

What are the problems with the diagnosis of PD?

Answer 22

There is a huge overlap within and between clusters so the validity and reliability of PD diagnosis is low. It involves a dimensional being so the categorical diagnosis may not fit. Their symptoms and personality can regularly change. Is PD due to individual problems or because of the surrounding people as most criteria involves the effects of others or relationships. People argue that it’s best conceptualised as between people. The individual focus in the DSM may reflect our westernised cultural preferences.