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
