Lecture 20: Personality Disorders Flashcards
what is personality?
what is nature vs nurture
nature= innate temperament (disposition), genetic
nurture= character is acquired
nature and nurture elicit traits– these traits become personality
what is important for diagnosis
social interaction
what are core features of personality disorders
- functional inflexibility= can’t adapt to situations
- self-defeating= other people’s reactions are damaging to self
- unstable when stressed= emotional, beh and cog instability
what is overall PDs feature
- lack of insight: can’t realise dysfunctional part of their personality
- can’t reflect
- don’t realise they’re causing trouble
- don’t think they’re wrong
DSM-5 PD
enduring pattern of inner experience + beh that:
- deviates from expectations of ind. culture
- inflexible
- onset in childhood
- stable overtime
- leads to distress (distress from consequences of beh)
ex. why aren’t people listening to me, my ideas are so
great
DSM-5 General PD
- sig. impairment in self (identity) + interpersonal (empathy or intimacy) functioning
- 1 or more pathological personality trait domains
- these features must be:
- stable over time, consistent across situations
- not better understood as normative for person’s env
- not due to direct physiological effects of substance or
general medical condition
what are the 2 classifications systems
DMS-5 + ICD-10
DSM-5
10 PDs categorised in 3 clusters
ICD-10
9 PDs– but not clustered + with diff labels
- ex. antisocial= dissocial
cluster A (DSM-5 PDs)
(odd, eccentric– abnormal)
- paranoid, schizoid, schizotypal
cluster B
(dramatic, emotional)
- antisocial
- borderline
- histrionic
- narcissistic
cluster C
(anxious, fearful)
- avoidant
- dependent
- obsessive-compulsive
what is categorical approach to PDs
categorical= DSM-5
- assumes that PD represents distinct clinical syndromes
- advantage= clear, easy to tell info
dimensional approach?
healthy personality functioning–> some problematic traits–> many problematic traits–> PD–> serious PD–> extreme PD
DSM-IV: multi-axial system
Axis 1 + Axis 2
what is Axis 1
major clinical disorders w/ acute symptoms= need treatment
what is Axis 2
personality disorders
- early age of onset
- affect daily functioning
- involve identity
- not self-aware
- lower treatment response
limitations of multi-axial system?
- co-occurence of symptoms
- unreliable diagnosis
- no scientific evidence
4 features of cluster A
- introverted
- isolate themselves
- suspicious
- prominent in childhood
Paranoid PD
- consistent + pervasive pattern of distrust, suspiciousness, grudge for long time
- think others are deceptive= can’t trust
- always think someones gonna get them
- feel vulnerable
- can’t let guard down
- always expect worst
- lots of jealousy
- could harm others
- hard to build close relationships
- not delusional
- get rly angry to insults
- misinterprets comments
- 2/3 meet criteria for other PDs
- schizotypal, narcissistic, borderline, avoidant
Schizoid PD
- not interested in social relationships
- withdraw from world
- keep distance from others
- v detached– can’t connect with people– can see them, but can’t establish connection
- feel overwhelmed by others
- hate social interaction
- v avoidant
- not introverted or emotionally anxious– just not interested in people
- cold, distant, love yourself
- anhedonia= can’t feel pleasure
- comorbid w/ schizotypal + avoidant PDs
Avoidant PD
- prevalent social inhibition
- discomfort in social situations
- feelings of inadequacy
- low self-esteem
- hypersensitivity to criticism
- disapproval
- shame
- rejection
- avoid contact and groups
- socially incompetent, unappealing, inferior to others
- comorbid w/ dependent PD, Axis 1 mood, anxiety, eatinf disorders
Dependent PD
- prevalent–> need to be taken care of
- scared of being incapable of doing stuff on their own
- heavy reliance on others
- lack self confidence, need reassurance
- often in abusive relationships– fear abondonment
dependent PD: what is self view
weak, needy, helpless, incompetent
dependent PD: view of others
want strong caretaker– function well, as long as caretaker is there
dependent PD: threats
rejection of abondonment
dependent PD: strategy
create dependent relationship by subordinating
dependent PD: affect
- anxiety heightened= disrupts relationships
- depression, if caretaker removed
- euphoria, when wishes granted
obsessive compulsive PD
- prevalent pattern of perfectionism, orderliness
- rigidity, inflexibility, stubborn
- want to control people– hard to maintain relationships, employment
- preoccupied w/ rules, minor details, structure
- super detailed= so hard to complete tasks on time
- unrealistic standards of morality, ethics
- can’t delegate tasks
obsessive compulsive PD comorbidity?
borderline narcissistic histrionic paranoid schizotypal PDs
obsessive compulsive PD: self view
responsible for themselves + others
obsessive compulsive PD: view of others
irresponsible, incompetent
obsessive compulsive PD: threats
any flaws, errors, disorganisation
catastrophic thinking– things will be out of control
obsessive compulsive PD: strategy
system of rules, punishing, disapproving
obsessive compulsive PD: affect
regrets
disappointment
anger towards self + others because of perfectionistic standards
PDs are associated w/
pattern of maladaptive traits which:
- endure over long period– fixed into personality
- traceable to adolescence or early adulthood
- happens in many social situations– not episodic
- important areas of life functioning affected
can specific PD diagnosis be made if not general PD criteria met?
no. specific PD can be made only if general PD criteria are met
shifting towards?
dimensional classification approach
DSM-5 is a…
single axial model
Schizotypal PD
- interpersonal deficits
- behavioural abnormalities
- distortions in perception + thinking
- magical thinking
- extreme superstition
- believe in paranormal phenomenon
- seeing things others can’t= odd thoughts
- believe in this all their life
- not episodic
- seeks trt for anxiety, depression
- comorbid with: borderline, avoidant, paranoid, schizoid
