Lecture 11: Personality Disorders

Question 1

Criteria (DMS-5)

Answer 1

• An enduring pattern of inner experience and behaviour
• Differs markedly from expectations of individual’s culture
• Manifested in 2 or more of following:
  = 1) Cognition (ways of seeing others)
  = 2) Affectivity (range, intensity etc.)
  = 3) Interpersonal functioning
  = 4) Impulse control
• Inflexible & pervasive
• Cause significant distress & impairment in functioning
• Stable & of long duration - traced back to adolescence or early childhood

Question 2

Other features

Answer 2

• Often co-occurs with another disorder
• Onset in adolescence or early adulthood
• In practice, not common to diagnose before adulthood - although signs of earlier disturbance through adolescence
• If under 18, symptoms must have been present for a year (antisocial can only be diagnosed after 18)
• Relatively stable over time
• Ego-syntonic = fits with them, who they are, don’t think they are the problem
• Most evident in persistent relationship patterns
• Tends to remit over time in later adulthood

Question 3

How is a ‘personality disorder’ differentiated from ‘normal personality functioning’?

Answer 3

• Functional inflexibility = seen across env./situations
• Self defeating behaviours
• Inability to learn from experience
• Instability under stress - changes in mood, behaviour+ thinking

Question 4

Cluster A Personality Disorders

Answer 4

• Odd or eccentric behaviour and social isolation
  1) Paranoid = distrust & suspiciousness of others e.g. neighbours stealing mail
  2) Schizoid = detachment from social relationships & restricted emotional expression
  3) Schizotypal = acute discomfort in social relationships with cognitive or perceptual distortions & eccentric behaviour

Question 5

Cluster B Personality Disorders

Answer 5

• Dramatic, emotional, erratic
  1) Antisocial = disregard for & violation of rights of others, criminal behaviour, lack or remorse
  2) Narcissistic = grandiosity, need for admiration & lack of empathy
  3) Histrionic = shallow emotionality & attention seeking
  4) Borderline = instability in self image, interpersonal relationships & affect as well as impulsivity
  = lack of emotional regulation

Question 6

Cluster C Personality Disorders

Answer 6

• Anxious, fearful traits or behaviours
  1) Dependent = submissive & excessive need to be taken care of
  2) Obsessive compulsive personality = preoccupation with orderliness, perfectionism & control
  3) Avoidant = social inhibition, feelings of inadequacy & hypersensitivity to criticism

Question 7

General aetiological considerations in personality disorders

Answer 7

• Early adverse experiences
• Disrupted attachment, neglect, trauma, deprivation in childhood
• Experience interacts with genes
• Personality Disorder is an extension of variation in normal personality functioning
• Maintained by rigid & dysfunctional core beliefs/schemas

Question 8

Challenges/barriers to treating personality disorders

Answer 8

Responds less well to short-term symptom focused treatments because clients:

• Want changes but may not recognise own contribution to problems
• Have rigid, inflexible problem solving issues
• Tend to block distressing thoughts + feelings
• May experience life disruptions that make it hard to follow through on tasks & strategies suggested in therapy
• Problems tend to be more pervasive & affect relationship
• Problems in forming ‘working alliance’ with therapist

Question 9

General approach to treating personality disorders

Answer 9

• Address underlying issues e.g. core schemas
• Pay attention to relationship developed between the psychologist & client
• Be longer term