Lecture 12 - Personality Disorders Flashcards
1
Q
Define a personality disorder
A
- enduring pattern of inner experience and behaviour
- deviates markedly from cultural expectations
- pervasive and inflexible
- onset in adolescence/early adulthood
- stable over time
- distress or impairment
- affects: cognition, affectivity, interpersonal functioning, impulse control
2
Q
According to Millon, what are the 3 core PD features?
A
FUNCTIONAL INFLEXIBILITY
- failure to adapt to changing and varied life experience
- tendency to rigidly apply a range of behavioural strategies/responses across diverse life situations (even when appropriate)
SELF-DEFEATING BEHAVIOUR PATTERNS
- typical ways of responding/coping that worsen the current situation or are explicitly damaging for the person
- person demonstrates limited capacity to intervene constructively/learn from experience
TENUOUS STABILITY UNDER STRESS
- marked instability in mood, thinking and behaviour during difficult periods
3
Q
What are the 5 general caveats re diagnosis?
A
- persistence over time
- cultural background
- children/adolescents
- gender
- confusing labels with explanations
4
Q
What are the clusters of PDs?
A
CLUSTER A: odd, eccentric
- paranoid
- schizoid
- schizotypal
CLUSTER B: dramatic, emotional, erratic
- antisocial
- borderline
- histrionic
- narcissistic
CLUSTER C: anxious, fearful
- avoidance
- dependent
- obsessive compulsive
5
Q
Paranoid PD. What is is associated with?
A
- distrust + suspiciousness (others motives interpreted as malevolent)*
- easily slighted, suspicious, holds grudges, reads hidden meaning into benign remarks, questions loyalty of others, expects to be exploited
ASSOCIATED: schizophrenia
6
Q
Schizoid PD. What is is associated with?
A
- detachment from social rships + restricted range of emo expression*
- no close friends, indifferent to praise/criticism, solitary, rarely experience strong emotions, doens’t want/enjoy close rships, constricted affect, little desire for sexual experiences
ASSOCIATED: Asbergers + ASD (underpowered limbic system?)
7
Q
Schizotypal PD. What is is associated with?
A
- acute discomfort in close rships, cog or perceptual distortions, behavioural eccentricities*
- ideas of reference, excessive social anxiety, odd beliefs/magical thinking, odd speech + behaviour, unusual perceptual experiences, no close friends, suspicious, inappropriate or constricted affect
ASSOCIATED: schizophrenia
- mild form of SCZ?
- similar cog abnormalities (attn., memory) + higher DA levels
8
Q
Antisocial PD. What is the aetiology of it?
A
- disregard for + violation of others’ rights*
- don’t conform to social norms (steal, cheat, fight, cruelty, fire-setting)
- irritable, impulsive, aggressive, limited concern for safety of self/others
AETIOLOGY
- genetics: predispose to impulsivity?
- low 5HT (impulsivity, aggression)
- low arousal (skin conductance, HR)
- higher testosterone in pregnancy (increased brain dev > aggression)
- abnormal frontal brain areas
- psychosocial: abuse, harsh/rejecting parents + low supervision + inconsistent discipline
- GxE: maltreatment + low MAOA activity
9
Q
Borderline PD. What is the aetiology of it?
A
- instability in interpersonal rships, self-image and affect + marked impulsivity*
- lack solid sense of self, unstable but intense rships, impulsive, affective inability, inappropriate/intense anger, recurrent suicidality/self-harm, chronic feelings of emptiness or boredom, frantic attempts to avoid real/imagined abandonment
AETIOLOGY
- genetics (twin studies)
- neuroimaging: increased hippo volume, amygdala activity
- neurotic
- childhood trauma + sexual abuse
- inconsistent + neglectful + overly intensive parenting (insecure attachment)
10
Q
Histrionic PD. What is the aetiology of it?
A
- excessive emotionality + attn seeking*
- dramatic, attractiveness/sexuality used to gain attn. from others, inappropriately sexually seductive, overly concerned with physical attraction
- exaggerated emotional, demand reassurance/approval/praise, rapidly shifting and shallow emotions
- self-centered: no tolerance for frustration or delayed gratitude, must be centre of attn., speech excessively impressionistic and lacks detail
AETIOLOGY
- inconsistent, intense and non-empathetic parenting > attn.-seeking behaviour
11
Q
Narcissistic PD. What is the aetiology of it?
A
- grandiosity, need for admiration, lack empathy*
- concerned with power/influence
- interpersonally exploitative, grandiose sense of self-importance, sense of entitlement, envious, lack empathy
- reacts with feelings of rage/shame/humiliation, preoccupied with fantasies of unlimited success/power/brilliance/beauty/ideal love
- believes their problems are unique and can only be understood by special people
AETIOLOGY
- non-empathetic + invalidating + inconsistent parenting (need for nurturing continues into adulthood)
- neglectful/indifferent parenting (compensatory beliefs about superiority)
- highest heritability of all PDs
- high E, low A (inherited temperament?)
12
Q
Avoidant PD. What is the aetiology of it?
A
- social inhibition, feelings of inadequacy, hypersensitive to -ve evaluation*
- preoccupied with/fearful of negative evaluation, criticism and rejection
- avoid social or occupational activities, few close friends, unwilling to get involved with people unless certainty of being liked
- self-view: inadequate, inferior, socially inept, unappealing
AETIOLOGY
- high restraint in childhood
- cold + rejecting parenting
- defectiveness/abandonment schemas
13
Q
Dependent PD. What is the aetiology of it?
A
- submissive and clinging related to excessive need to be taken care of*
- strong urge to be physically close to others, need others to do things + make decisions + help initiate tasks
- lacks initiative, easily hurt by criticism/disapproval, agreeable when they believe the other person is wrong (fear of rejection)
- uncomfortable being alone, fearful of being abandoned, does unpleasant things to be like
AETIOLOGY
- fam fx separation anxiety + agoraphobia (genetics?)
- overprotective parenting (world dangerous»_space; cannot cope alone)
14
Q
Obsessive Compulsive PD. What is the aetiology of it?
A
- preoccupation with orderliness, perfectionism and control*
- rigid, moralistic, perfectionistic (preoccupation with minor detail interferes with performance/completion of tasks), indecisive
- restricted affect expression, lack generosity of time/money/gifts, hoards
- overly conscientious, scrupulous and inflexible; unreasonable insistence that others do things exactly as they insist
AETIOLOGY
- high perfectionism
- behaviour dev in childhood > manage -ve interpersonal experiences > learn to suppress feelings + behave in approved manner to avoid punishment
15
Q
Prevalence rates of PDs
A
- all PDs: 6.5% Aus adults (9%, 13% US)
- MH settings: 25-40%
- individual PDs 1-2% (except OCPD 2-4%)
- BPD: 2% general pop, 10% MH outpatient, 20% MH inpatient
16
Q
What are the difficulties in obtaining epidemiological data in PDs?
A
- semi-structured interview
- trained clinicians
- takes 1-3hrs
- good to get collateral data
- ‘overshadowing’ due to high comorbidity
17
Q
Explain the cognitive models of PDs
A
- each PD characterised by a specific maladaptive core belief/schema
- Beck + Freeman: core beliefs are resistant to change > maintainence of dysfunctional beliefs, emotions and behaviours
YOUNG
- core beliefs influence cognitions, emotions, behaviours + bodily sensations
- early maladaptive schema result from bio factors + repeated failure to meet child’s core emo needs:
1. secure attachment
2. dev sense of identity, competence + independence
3. express one’s desires + emos
4. realistic limits set by others (learn self-control)
5. spontaneity and play
18
Q
According to Young, what are the 4 features of early maladaptive schemas?
A
- highly resistant to change
- associated with high levels of affect
- sig. impair functioning
- person selectively perceives + distorts info that confirms schema (filters out info that disconfirms them)
19
Q
In what 3 ways are schemas perpetuated?
A
- SURRENDER: accept schema as true; fully experiences the associated intense emotions + behaves according to schema
- AVOIDANCE: block thoughts/images/feelings that are not part of schema due to distressing nature (eg. substance use) or avoid situations that trigger schema (eg. rships)
- OVERCOMPENSATION: reacts in extreme opposite to the schema > schema remains intact but also creates more problems
20
Q
Explain the basis of DBT
A
- BPD results from dysfunctional emo regulation system + drastically invalidating environments»_space; child left with limited capacity to identify and cope with own feelings
- DBT integrates bio, social, cog and behavioural theories with Buddhism
- “dialectic” = integration of opposing elements in thinking and behaving
- focus on acceptance and change
- concurrent group + personal sessions
- 1st priority: reduce self-harm/suicidality
- 2nd priority: mindfulness, distress tolerance, interpersonal effectiveness, emo reg.
21
Q
Explain the overlap in PDs
A
Some overlap more than others:
- histrionic + BPD
- dependent + avoidant
- paranoid + schizotypal
- narcissistic + anti-social
Overlap of clusters:
- some belong to 1 cluster (eg. anti-social and narcissistic)
- some belong to >1 cluster (eg. BPD and histrionic in both B and C)
22
Q
What are the 4 current issues in PDs?
A
CATEGORICAL v. DIMESIONAL
- some features of PDs found in other dx, as well as in healthy people
CULTURE
- prev rates across cultures: do some social structures favour some PDs over others? are some behaviours rewarded in some cultures more than others? ecological niche model
- changes in PD rates over time
- are some behaviours recognised as ‘abnormal’ in some cultures, but not others?
GENDER
- M: antisocial, schizoid
- F: histrionic, BPD
- does dependent PD diagnosis in females stigmatise women who have been socialised into dependent roles?
BPD IN YOUNG PEOPLE:
- 3% of teens/young people in community; 22% of outpatients
- HYPE (15-25yrs) > meet 2/9 BPD criteria
- 1+ in childhood: PD sx, disruptive behaviour dx sx, low SES, dep sx, hx abuse/neglect
- Cognitive Analytic Therapy better than Good Clinical Care (both improve, but CAT more quickly)
- predicts current psychopathology + general functioning + peer rships + self-care + family and rship functioning
- predicts poor outcomes up to 20yrs later: future BPD diagnosis, increased risk of other MI (substance, mood dx), interpersonal problems, distress, reduced QOL
23
Q
What is the general model for PD aetiology?
A
genetic predisposition + life events»_space; personality
- pathological personalities associated with experience of disrupted attachment with primary carers + trauma + neglect + deprivation
24
Q
What are Young’s 5 schema domains and the schemas that map onto them?
A
DISCONNECTION/REJECTION (5)
- abandonment/instability
- mistrust/abuse
- emotional deprivation
- defectiveness/unlovability
- social isolation
IMPAIRED AUTONOMY (4)
- dependence/incompetence
- vuln to harm/illness
- enmeshment/undeveloped self
- failure to achieve
IMPAIRED LIMITS (2)
- entitlement/superiority
- insufficient self-control/self-discipline
OVERVIGILANCE/INHIBITION (4)
- negativity/pessimism
- self-putativeness
- emotional inhibition
- unrelenting standards
OTHER-DIRECTEDNESS (3)
- subjugation
- self-sacrifice
- approval seeking/recognition seeking
