Lecture 17 Flashcards
What is the prevalence of personality disorders?
- Figures vary from 0.05% to 13% of the population
- In clinical samples, 25% to 40%
- Problem with assessment
Summarise the sexist biases related to certain personality disorders
- Certain personality disorders may have sexist underpinnings
- The DSM seems to more often label stereotypical feminine behaviours as pathological than stereotypical masculine behaviours
o E.g. Histrionic PD
♣ A caricature of the traditional male stereotype of the feminine personality: flighty, emotional, seductive, attention-seeking
What is ‘aetiology’?
- Attenuated forms of mental (symptom-based) disorders (latent taxa)
- Quantitative and/or qualitative exaggerations of normal personality variations (The Eysenckian model)
What are some examples of aetiological psychobiology?
o Monoamine oxidase (MAO) – Low levels: increased aggression, extraversion and sensation-seeking
o Dopamine (Cluster A) – High levels: psychosis or addiction
o Serotonin (Clusters B & C) – Low levels: anger, pessimism, depression
o Norepinephrine (Cluster A & B) – Anxiety-proneness, dependency, fight or flight responses, sociability
o Differential arousability (of NS)
o Brain abnormalities (e.g. frontal lobe brain injury)
o Genetic disposition (especially for antisocial, schizotypal, and borderline)
What are some (non-shared) environmental examples of aetiology?
- (Non-shared) environment
o Attachment, trauma (both psychological and physical), neglect, deprivation, diseases, diet, etc.
What are the classification and diagnosis problems with the categorical (binary) approach (the clinical approach) to personality disorders?
o Not evidence-based (e.g. Cluster C is very poorly defined)
o A heuristic device for descriptive purposes
o Serious problems with diagnostic reliability (alpha as low as 0.1)
o Problems with construct validity (e.g. schizotypy – schizophrenia phenotype)
o Low agreement on the distinction between normal and abnormal behaviour
♣ False positives/negatives
♣ No room for “healthy” types or expressions
o Limits scientific enquiry (requires far larger N to achieve sufficient statistical power)
o Genetic influences are usually based on single genes
o The (major) problem of comorbidity
♣ The more severe the dysfunction, the greater the number of PDs diagnosed
♣ A 75-85% chance that one will be diagnosed with more than one PD
• Regardless of severity
♣ 50-80% of BPD individuals have a mental illness diagnosis that accounts for all their symptoms (primarily of the bipolar spectrum)
What are the classification and diagnosis problems with the quasi-dimensional approach?
o Determination of the existence of a PD (categorical pathogenesity)
o Determination of the nature/severity of a PD (dimensional pathoplasticity)
What are the problems with treatment and intervention?
- No clear evidence of effective therapies (for every personality disorder)
- Concentration on clinical mental illnesses
- People with personality disorders usually see their behaviours, even when maladaptive or self-defeating, as normal (egosyntonic)
- They are unlikely to perceive their own behaviour as the cause of their distress
o Externalisation of locus of distress - Unlikely they will voluntarily seek treatment
- May cause problems during therapy
Define the Hybrid model
o Definition: Personality disorders represent the failure to develop a sense of self (identity and direction) and the capacity for interpersonal functioning (empathy and intimacy) that are adaptive in the context of the individual’s developmental stage or cultural norms and expectations”
Describe the Hybrid model
♣ Can be partly (but not exclusively) related to other disorders, substance abuse, general medical or physiological conditions, or head injury
♣ The impairments in personality functioning and the individual’s personality trait expressions are relatively stable across time and consistent across situations
♣ Impairment onset traced to at least adolescence or early adulthood
What are the 6 personality disorder types in the Hybrid model of personality disorders?
- Antisocial/Psychopathic
- Avoidant
- Borderline
- Narcissistic
- Obsessive-Compulsive
- Schizotypal
What are the diagnostic criteria (multidimensional assessment) for personality disorders in the Hybrid model?
- Criterion A: Levels of personality functioning
(5 severity levels from “No impairment” to “extreme impairment”) - Criterion B: Five related personality domains; 25 specific trait facets
(Assessment on 4-point Likert-type scale) - Criteria C & D: Pervasiveness and Stability
- Criteria E, F & G: Differential diagnosis
In Criterion A of the Hybrid model’s diagnostic criteria, describe the two components, the self and interpersonal
♣ Self
• Identity: Uniqueness of the self, stability, ability to regulate emotional experiences
• Self-direction: Pursuit of meaningful goals, constructive prosocial internal standards, ability to self-reflect productively
♣ Interpersonal
• Empathy: Comprehension and appreciation of others’ experiences and motivations
• Intimacy: Depth and duration of connection with others, desire and capacity for closeness
What are the 5 related personality domains (and their specific trait facets) in Criterion B of the Hybrid model?
- Negative affectivity – Facets: Anxiousness, depressivity, insecurity, etc.
- Detachment – Facets: Withdrawal, anhedonia, intimacy avoidance, etc.
- Antagonism – Facets: Hostility, deceitfulness, grandiosity, etc.
- Disinhibition – Facets: Irresponsibility, impulsivity, risk-taking, etc.
- Psychoticism – Facets: Eccentricity, cognitive-perceptual dysregulation, etc.
What must be determined in Criterion B of the Hybrid model to diagnose a personality disorder?
♣ Impairment in at least one personality domain and at least one specific trait facet
