Lecture 19 - Personality Disorders Flashcards
General criteria
A. Impairments in personality (self and interpersonal) functioning
B. Pathological personality traits stability across time and consistency across situations
- Not accounted by developmentally or culturally normative personality features and not due to the direct
physiological effects of a substance or medical condition
Categorical Approach: clusters
- Cluster A: odd/eccentric; paranoid, schizoid or schizotypal
- Cluster B: dramatic, emotional, erratic; antisocial, borderline, histrionic, narcissistic
- Cluster C: fearful or anxious; avoidant, dependent, Obsessive compulsive personality disorder
-Other: personality change due to medical condition
Diagnostic Challenges
- Lack of specificity
- Multiple Diagnosis
• Most people receive more than one PD
• Lots of heterogeneity in one disorder (ex: there are SO MANY ways to meet criteria for BPD) - Limited validity/arbitrary thresholds:
- Poor inter-rater reliability (two clinicians might rate one person differently); can use self-report for PD – advantages; more detailed description/more time to freely express BUT disadvantages; biased, as a clinician you can ask more questions and get more details…so it isn’t used as much because the disadvantages are too bad
- Stability sometimes questionable
- In older DSM system: most people diagnosed with PD fell into the “residual” category; Personality disorder not otherwise specified
Traits
- Stability of traits depend on age: stability of normal traits increases as people grow older: it is low in childhood, rises from adolescence to young adulthood, and continues to stabilize at age 60
Personality Disorder - stability over time
o Often has roots in childhood/adolescents
o Is often not diagnosed (labelled)
o However stability over time of a PD is debatable
- STUDY: only 36% kept diagnosis over time
o Several longitudinal studies show low stability of personality disorder diagnosis
o Mismatch clinical practice
Gender Differences
o Women tend to get histrionic personality diagnosis and males tend to get more antisocial - there ARE sex differences in personality disorder
Paranoid Personality disorder - clinical description
• Mistrust and Suspicion (NOT SCARED FOR LIFE) - Pervasive - Unjustified • Few meaningful relationships • Volatile • Tense • Sensitive to criticism • Tend to blame others • Core features: paranoia - In large clinic sample, never diagnosed alone • Poor validity of diagnosis - Suspiciousness and hostility traits
Paranoid Personality disorder - prevalence
Community: 1.7%
Clinical: 9.7%
Schizoid - Clinical description
• Appear to nether enjoy nor desire relationships
• Limited range of emotions
- Cold, detached
• Appear unaffected by praise, criticism
- Unable or unwilling to express emotion
• No thought disorder
Schizoid - Prevalence
- Community: .0.9%
- Clinical: 2.2%
- but they probably stay away from others, so lacking people
- Very little research
- Distinction with avoidant PD: lack of desire for relationship
Schizotypal - Clinical description
• Psychotic-like symptoms - Magical thinking - Ideas of reference - Illusions • Odd and/or unusual - Behaviour - Appearance • Socially isolated • Highly suspicious - Originally introduced to describe non-psychotic relatives of patients with schizophrenia
Schizotypal - Prevalence
• Community: 0.9% • Clinical: 1.9% - Diagnostic criteria - Positive symptoms • Psychotic-like symptoms - Negative symptoms • Deficit-like symptoms
Narcissistic Personality - Clinical description
- Exaggerated and unreasonable sense of self importance
- Require attention
- Lack sensitivity and compassion
- Sensitive to criticism
- Envious
- Arrogant
Narcissistic Personality - Prevalence
• Community: 0.5%
• Clinical settings: 5.7% (don’t need to know the exact numbers; just know around 1-5% overall)
- Grandiosity, need for admiration and impaired empathic capacity
Histrionic - Clinical Description
- Overly dramatic
- Attention-seeking
- Sensational
- Sexually provocative
- Impulsive
- Appearance-focused
- Impressionistic
- Vague, superficial speech
- Common in females
Histrionic - Prevalence/Core symptoms
- Prevalence: 1.5% community
- Core characteristics
• Self-centeredness, attention seeking, excessive emotionality, low frustration tolerance
• Not specific to this disorder - Often comorbid with Borderline
Obsessive-Compulsive PD - Clinical description
- Fixation on doing things the right way
- Rigid
- Perfectionistic
- orderly
- Preoccupation with details
- Poor interpersonal relationships
OCD - Prevalence; greater risk for…; core features
Prevalence • Community: 2.1% • Clinical: 13.1% Greater risk for • Depression recurrence • Suicide attempt during depressive episode • Health care utilization Core features • Rigidity: interpersonal control • Perfectionism: cognitive and intrapersonal control
Dependent Personality - Clinical description
- Rely on others for major and minor decisions
- Unreasonable dear of abandonment
- Clingy
- Submissive
- Timid
- Passive
- Feelings of inadequacy
- Sensitivity to criticism
- High need for reassurance
Dependent Personality - Prevalence
- Community: 0.7%
- Clinical: 5-22%
- Pervasive and excessive need to be taken care of that leads to submissive and clinging behaviour and fears of separation
Avoidant Personality - Clinical Description
- Extreme sensitivity to opinions
- Avoid most relationships
- Interpersonally anxious
- Fearful of rejection
- ** more extreme form of social anxiety disorder**
Avoidant Personality - Prevalence
• Community: 1.7%
• Clinical: 20.4%
- A more severe form of social phobia?
• 42% co-morbidity
• Patterns of comorbidity not consistent with the idea of the same diagnosis
• Genetic overlap with social anxiety disorder
Antisocial Personality Disorder - Clinical Description
• Noncompliance with social norms • Social predators - Violate rights of others - Irresponsible - Impulsive deceitful • Lack conscience, empathy and remorse
Antisocial Personality Disorder - Prevalence, comorbidity, low fear hypothesis, developmental prevalence
- Prevalence
• 1.1% population
• Up to 15% of male prisoners and 7% of female - Frequently co-morbid with substance abuse (60% of people with ASPD)
- DSM does not capture who do not exhibit antisocial behaviour
• Business professional, evangelist, politicians - Developmental perspective
• Antisocial behaviour in childhood: best predictor of development of ASPD - Childhood vs. adolescent onset
• Criminal behaviour tends to decline after age 40 - Low Fear Hypothesis
• Kids who were more difficult to condition a fear response at age 3 were more likely to be criminals at age 23
Models of Personality Disorder
- Categorical: observable symptoms
- Dimensional
- Big 5
- Prototype approach (stereotype description and rate how much does this person fit this stereotype)
- Harder to use
Cognitive model of Personality disorder
o Essence of personality disorder is revealed in the dysfunctional beliefs that characterize and perpetuate it
o These core beliefs influence behaviour, feeling and physiology
- Ex: “no people can be trusted” can be for paranoid; “I’m very special and admirable” histrionic; “I am weak and needy” dependent; “I’m a failure and boring” avoidant
Social-Cognitive Theory of PD - 3 schema processes
- Schema maintenance
• Cognitive distortions that directly reinforce or perpetuate a schema; behaviours that are in line with your schema
• Ex: choose friends who fit with your schema - Schema avoidance
• Person tend to avoid triggering a schema and the related intense affect
• Ex: avoid situations that can trigger the schema - Schema compensation
• Behaviours or cognitions that overcompensate for their schema; are the opposite from what schema is pointing to
• Ex: really demanding in relationships (being unlovable)
