Lecture 11/12: Personality disorders 1

Question 1

Clinical features - PD:

Answer 1

• Problems with identity or sense of self

- Chronic interpersonal difficulties

Question 2

DSM - 5 criteria

Answer 2

• 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

Question 3

Cluster A

Answer 3

• Paranoid
• Schizoid
• Schizotypal

Question 4

Cluster B

Answer 4

• Histrionic
• Narcissistic
• Antisocial
• Borderline

Question 5

Cluster C

Answer 5

• Avoidant
• Dependant
• Obsessive – compulsive

Question 6

Difficulties doing research on PD

Answer 6

diagnosing, studying cases, personality traits

Question 7

Difficulties in studying the causes of PDs:

Answer 7

• complex interaction of factors, relatively new area of study, high level of morbidity, rely on retrospective approaches

Question 8

Borderline personality disorder

Answer 8

unstable self image, impulsivity, incomplete self identity, intense and unstable relationships, chronic feelings of bordness and emptiness, self destructive behavior

Question 9

Causes

Answer 9

Multidimensional diathesis stress theory

Question 10

Parental PD as a risk to child development

Answer 10

• Through both transmission of genetic vulnerability and environmental stress of living with parent who has PD that negatively affects their parenting

Question 11

General Socio – cultural causal factors

Answer 11

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?

Question 12

Treatment and Outcomes for PDs

Answer 12

• Antidepressant medication (SSRIs)

- Dialectical behaviour therapy (DBT) – focusing on key characteristic of BPD

Question 13

Dialectical behaviour therapy (DBT)

Answer 13

Linehan CBT to meet needs, deals with very specific problems of BPD

Question 14

Antisocial personality disorder

Answer 14

• 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

Question 15

ASPD and Psychopathy

Answer 15

• 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

Question 16

ASPD

Answer 16

• 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

Question 17

Psychopathy

Answer 17

• 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.

Question 18

Causal factors

Answer 18

• 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

Question 19

Gray’s bio - psychological/motivation theroy of persoanlity

Answer 19

Fight – flight system
Behavioural activation system - BAS (the go system) - overactive
Behavioural Inhibition system - BIS (the stop system) - underactive

Question 20

startle relfex

Answer 20

they lack the startle relfex (patrick et al (1993)

Question 21

fear conditioning

Answer 21

Syngelaki et al. (2013) they were slower at picking up the negative consequences – took longer to condition a fear response

Question 22

Psychosocial causal factors:

Answer 22

Parental factors:

• Early parental loss
• Parental rejection
• Neglect and/or abuse
• Inconsistency in child-rearing practices

Question 23

Are BPD and APD ‘mirror image’ disorders: The role of childhood abuse (lobbestael et al 2005

Answer 23

• 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%

Question 24

Treatment and Outcomes in psychopaths and ASPD

Answer 24

• 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