Lecture 11/12: Personality disorders 1 Flashcards
Clinical features - PD:
- Problems with identity or sense of self
- Chronic interpersonal difficulties
DSM - 5 criteria
- Persuasive and inflexible
- Stable and long duration
- Cause clinically significant distress or impairment in functioning
- Manifested in at least two areas: cognition, affect, interpersonal functioning or impulse control
Cluster A
- Paranoid
- Schizoid
- Schizotypal
Cluster B
- Histrionic
- Narcissistic
- Antisocial
- Borderline
Cluster C
- Avoidant
- Dependant
- Obsessive – compulsive
Difficulties doing research on PD
diagnosing, studying cases, personality traits
Difficulties in studying the causes of PDs:
- complex interaction of factors, relatively new area of study, high level of morbidity, rely on retrospective approaches
Borderline personality disorder
unstable self image, impulsivity, incomplete self identity, intense and unstable relationships, chronic feelings of bordness and emptiness, self destructive behavior
Causes
Multidimensional diathesis stress theory
Parental PD as a risk to child development
- Through both transmission of genetic vulnerability and environmental stress of living with parent who has PD that negatively affects their parenting
General Socio – cultural causal factors
Is our emphasis on impulse gratification, instant solutions, and pain – free benefits leading people to develop the self-centred lifestyles that we see more extreme forms in personality disorders?
Treatment and Outcomes for PDs
- Antidepressant medication (SSRIs)
- Dialectical behaviour therapy (DBT) – focusing on key characteristic of BPD
Dialectical behaviour therapy (DBT)
Linehan CBT to meet needs, deals with very specific problems of BPD
Antisocial personality disorder
- Failure to conform to social norms
- Consistent irresponsibility and lack of remorse
- Deceitfulness: impulsivity or failure to plan ahead
- Irritability and aggressiveness: reckless disregard of safety or others or self
- History of conduct problems with onset before age of 15
ASPD and Psychopathy
- Age 18 years and over
- At least three behavioural problems occurring after age 15 (is this because it needs to be prior to puberty?)
- At least three instances of deviant behaviour before 15
ASPD
- Nervous, easily agitated, volatile and prone to emotional outbursts, including fits of rage
- Less well educated, lives on fringe of society, unable to hold steady jobs or stay in one place for long
- Difficult to form attachments, no regard for society in general or its rules, crimes tend to be haphazard, spontaneous and disorganised rather than planned
Psychopathy
- Unable to form emotional attachments or feel ‘real’ empathy, although they often have charming personalities
- Manipulative, gain trust easily and learn to mimic emotions without feeling them, appear normal
- Well educated and hold steady jobs, can hold long term relations without anyone suspecting true nature
- Crimes are carefully planned and organised, they act calm, cool and meticulous.
Causal factors
- G x E interaction
- Genetic influences (fearless, CU traits)
- Low fear and impaired fear conditioning
- More general emotional deficits (including startle, imaging studies of amygdala
- Punishment insensitivity
- Reward oversensitivity
Gray’s bio - psychological/motivation theroy of persoanlity
Fight – flight system
Behavioural activation system - BAS (the go system) - overactive
Behavioural Inhibition system - BIS (the stop system) - underactive
startle relfex
they lack the startle relfex (patrick et al (1993)
fear conditioning
Syngelaki et al. (2013) they were slower at picking up the negative consequences – took longer to condition a fear response
Psychosocial causal factors:
Parental factors:
- Early parental loss
- Parental rejection
- Neglect and/or abuse
- Inconsistency in child-rearing practices
Are BPD and APD ‘mirror image’ disorders: The role of childhood abuse (lobbestael et al 2005
- Epidemiological figures point to high overlap: 10-47% of BPD patients also meet the criteria for ASPD, and about 7-% display antisocial behavioral, 70% of the ASPD patients meet BPD criteria
- Prevalence of both BPD and ASPD in community is about 2%: the sec distribution for ASPD is 80% male and for BPD 80%
Treatment and Outcomes in psychopaths and ASPD
- Treatment of psychopaths is difficult
- Individuals have little motivation to change
- No biological treatments (drugs) to target specific issues
- CBT targets: increasing self-control, self-critical thinking and social perspective taking, victim awareness, anger management, changing antisocial attitudes, curing drug addiction
Many antisocial personalities show improvement with age - They achieve insight into their self defeating actions
- Only ASPD changes with age, not psychopathy
