Lecture 20 PD 1 Flashcards
what is personality
nature: innate temperament/dispositions, genetic and constitutional
nurture: character, acquired values and attitudes
traits expressed in psychosocial context
core features of personality disorders
- functional inflexibility: failure to adapt to situations, rigid response
- self-defeating: behavioural responses damaging
- unstable in response to stress: emotional, behavioural & cognitive instability
- lack of insight: failure to recognise dysfunctional aspect of personality
DSM-5 definition of PD
an enduring pattern of inner experience and behaviour that
- deviates markedly from the expectations of the individual’s culture,
- is pervasive and inflexible,
- has an onset in adolescence or early adulthood,
- is stable over time, and
- leads to distress or impairment.
DSM-5 Generalised PD
- Significant impairments in self (identity or self-direction) and interpersonal (empathy or intimacy) functioning.
- One or more pathological personality trait domains / facets.
In addition, these features must be:
- relatively stable across time and consistent across situations.
- not better understood as normative for the individual’s developmental stage or sociocultural environment.
- not solely due to the direct physiological effects of a substance (e.g. drug of abuse, medication) or a general medical condition (e.g. severe head trauma).
difference between DSM-5 & ICD-10
DSM-5: 10 PDs in 3 clusters
ICD-10: 9 PDs, no clusters, different labels
antisocial = dissocial
OC = anankastic
Cluster A, B, C
A: paranoid, schizoid, schizotypal
B: antisocial, borderline, histrionic, narcissistic
C: avoidant, dependent, obsessive-compulsive
categorical vs dimensional approach
current system: categorical, assumes PDs represent distinct clinical syndromes
advantage: clarity and ease of communicating information
disadvantage: difficult to distinguish the threshold where the person goes from normal to meeting criteria for PD
gradual move towards dimensional approach
DSM-IV multi-axial system
Axis I: major clinical disorders with acute symptoms that need treatment
Axis II: personality disorders and intellectual diabilities -early age of onset -enduring, more pervasive effects on daily functioning -involvement of self & identity -presumed poorer self-awareness -lower treatment response BUT also: -high degree of co-occurrence -heterogeneity within diagnosis -diagnostic unreliability -lack of robust scientific evidence
Paranoid PD
Consistent & pervasive pattern of distrust, suspiciousness and prolonged grudges held:
- Believes others intentionally exploit, harm or deceive them
- Reluctance to disclose personal information for fear it may be used against them
- Severely sensitive to criticism & threat => hypervigilant for signs of others to harm them
- Misinterprets comments to indicate concealed, hidden or malevolent intent or motivation
- Hostility, aggression & anger to perceived insults
- Jealousy (distrust & misinterpretation)
Two thirds meet criteria for other PDs e.g., Schizotypal, Narcissistic, Borderline & Avoidant
Schizoid PD
Detachment and disinterest in social relationships
withdrawal into internal world to avoid affect and maintain distance from others
Sees others as intrusive and controlling
Flatness of affect: coldness, aloofness, self-absorption, social ineptitude or conceit
Unresponsive to social criticism: sexually apathetic reflecting incapacity to form interpersonal bonds
Anhedonia
Comorbid with schizotypal and avoidant PDs
Schizotypal PD
Marked interpersonal deficits, behavioural eccentricities and distortions in perception & thinking (that do not meet criteria for schizophrenia)
e.g. magical thinking, extreme superstition, belief in paranormal phenomenon
Odd thoughts & speech patterns: vague, abstract but retains coherence
Often seek treatment for anxiety, depression & affective dysphoria (constricted or inappropriate affect)
Comorbid with borderline, avoidant, paranoid and schizoid PDs
Avoidant PD
underlying assumptions: I’m no good/worthless/unlovable, if people get to know me they’ll reject me
Pervasive social inhibition, discomfort in social situations
intense feelings of inadequacy, low self esteem, self-loathing
hypersensitivity to criticism, disapproval, shame, ridicule & rejection
Avoidance of activities involving personal contact & groups
self-imposed isolation
Socially inept/incompetent, personally unappealing, inferior to others
Comorbid with dependent PD & Axis I mood, anxiety, & eating disorders
Dependent PD
Pervasive need to be taken care of
Exaggerated fear of being incapable of doing things or taking care of things on their own –reliance on others
Lacking in self confidence & requiring constant reassurance
Often find themselves exploited and in abusive relationships fearing abandonment
Self view: needy, weak, helpless & incompetent
View of Others: Strong caretaker idealized. Function well as long as the idealized figure is accessible
Threats: Rejection or abandonment
Strategy: Cultivate a dependent relationship by subordinating
Affect: Anxiety heightened –disruption to the relationship. Depression if their strong figure is removed, euphoria/ gratification when dependent wishes granted
OCPD
Pervasive pattern of perfectionism and orderliness
Rigidity, inflexibility & stubbornness
Excessive need for control interfering with ability to maintain interpersonal relationships or employment
Preoccupied with rules, minor details, structure
Attention to detail interferes with ability to complete tasks on time
Unrealistic standards of morality, ethics or values
Reluctance to delegate tasks
Comorbid: borderline, narcissistic, histrionic, paranoid, schizotypal PD
Self view: Responsible for themselves & others. Driven by ‘shoulds’.
View of others: Too casual, irresponsible, self indulgent and incompetent
Threats: Any flaws, errors, disorganisation. Catastrophic thinking: things will be out of control
Strategy: System of rules, standards & ‘shoulds’.Overly directing, punishing and disapproving
Affect: Regrets, disappointment, and anger toward self and others because of perfectionistic standards
prevalence of PD
paranoid 2.3-4.4 schizoid 3.1-4.9 schizotypal 3.9-4.6 avoidant 3.9-4.6 dependent 0.5-0.6 OC 2.1-7.9
