Lecture 22 & 23 - Personality Disorders 1 & 2 Flashcards
What are the key factors and issues concerning (DSM-5) classification of personality disorders?
Categorical vs. dimensional approach
DSM-5 represents a categorical approach
• assumes that personality disorders represent distinct clinical syndromes
• Advantages: clarity and ease of communicating information
• Disadvantages: difficult to distinguish the threshold where the person goes from a ‘normal’ personality traits through to meeting criteria for a personality disorder
• A gradual move towards a dimensional approach to classifying personality disorders
What are the 3 core features of personality disorders?
Millon, 1981
- Functional inflexibility
- Failure to adapt to situations: rigid response - Self-defeating
- Behavioural responses damaging - Unstable in response to stress
- Emotional, behavioural & cognitive instability
What are the 3 core features of personality disorders?
Millon, 1981
- Functional inflexibility
- Failure to adapt to situations: rigid response - Self-defeating
- Behavioural responses damaging - Unstable in response to stress
- Emotional, behavioural & cognitive instability
How are personality disorders organised in the ICD-10?
• 9 personality disorders but not clustered & with slightly different labels
• E.g., Antisocial – Dissocial
Obsessive-compulsive - Anankastic
Which PD does this represent?
Consistent & pervasive pattern of distrust, suspiciousness and prolonged grudges held:
• Believing others intentionally exploit, harm or deceive them
• Severely sensitive to criticism & threat
• Misinterprets comments to indicate concealed, hidden or malevolent intent or motivation
• Hostility, aggression & anger to perceived insults
• Jealousy (distrust & misinterpretation)
Paranoid PD
What is Paranoid PD co-morbid with?
Two thirds meet criteria for other PDs
• e.g., Schizotypal, Narcissistic, Borderline & Avoidant
Which PD does this represent?
• 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
Schizoid PD
What is Schizoid PD co-morbid with?
schizotypal and avoidant PDs
Which PD does this represent?
- Marked interpersonal deficits, behavioural eccentricities and distortions in perception & thinking (that do not meet criteria for schizophrenia)
- e.g.magicalthinking,extremesuperstition,beliefin paranormal phenomenon, bodily illusions
- Odd thoughts & speech patterns: vague, abstract but retains coherence
- Often seek treatment for anxiety, depression & affective dysphoria (constricted or inappropriate affect)
Schizotypal PD
Which PD does this represent?
- 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, bodily illusions
- Odd thoughts & speech patterns: vague, abstract but retains coherence
- Often seek treatment for anxiety, depression & affective dysphoria (constricted or inappropriate affect)
Schizotypal PD
Which PD does this represent?
- Repeated reckless disregard for others
- Victimizing & blaming others for inadequacies
- Shallow & manipulative interpersonal relationships
- Self-centered focus & failure to adhere to regulations
- Impulsive, aggressive, charismatic, deceitful
- Experience guilt & depression but lack capacity to empathize
- Anti-social behaviour: criminal behaviours may or may not be present
Antisocial PD
Which PD does this represent?
- Repeated reckless disregard for others
- Victimizing & blaming others for inadequacies
- Shallow & manipulative interpersonal relationships
- Self-centered focus & failure to adhere to regulations
- Impulsive, aggressive, charismatic, deceitful
- Experience guilt & depression but lack capacity to empathize
- Anti-social behaviour: criminal behaviours may or may not be present
Antisocial PD
What is Antisocial PD co-morbid with?
borderline, narcissistic, histrionic & schizotypal PDs
Which PD does this represent?
• Emotional instability/ affective dysregulation in reaction to environmental & interpersonal situations
• wide range of extreme emotions, intense anxiety, anger, dissociation
• Impulse control
• promiscuity, suicidal behaviour (10% suicide),
self-harm, spending, binge eating, poor limit setting
• Identity/insecure attachments
• Unstable self-concept, frantic efforts to avoid real or
imagined relationships
• Inability to integrate + and - aspects of self leading
to sense of emptiness
Borderline PD
Which is the most most prevalent PD in clinical settings?
Borderline PD
• 10% of outpatients
• 15-20% of inpatients
What is Borderline PD comorbid with?
Rarely sole diagnosis: comorbid with mood disorders, substance-use disorders & anxiety disorders (PTSD)
In fact: • 15% Major depression • 10% Dysthymia • 15% Bipolar I • 20% Bulimia/anorexia • 10% Substance abuse Meet criteria for BPD
Which is arguably associated with the greatest levels of disability of all the PDs?
Borderline PD
Which PD does this represent?
• Excessive emotionality, attention-seeking, ego-centric, flirtatious, seductiveness (focus on grooming),
• Denial of anger and hostility
• Gregarious, manipulative, low frustration tolerance,
suggestibility, somatization
• Displays of emotions: shallow and fickle in interpersonal relationships
Histrionic PD
What is Histrionic PD Comorbid with?
narcissistic, borderline, anti-social PDs & psychoactive substance abuse
Which PD does this represent?
Fragile self-esteem, envy, self-consciousness, & vulnerability: “image replaces substance”
• Compensatory reactions: self-righteousness, pride, contempt, vanity & superiority
• Pervasive pattern of grandiosity, sense of entitlement, privilege, or expectation of preferential treatment,
exaggerated sense of self-importance, arrogant behaviour & attitudes
• Focus on own issues with insensitivity or impatience to problem of others: cold, disinterested, snobbish, patronizing
Narcissistic PD
What is Narcissistic PD comorbid with?
anti-social, histrionic, borderline PDs & substance abuse
Which PD does this represent?
- Pervasive social inhibition, discomfort in social situations, feelings of inadequacy, low self esteem, hypersensitivity to criticism, disapproval, shame, ridicule & rejection
- Avoidance of activities involving personal contact & groups
- Socially inept/incompetent, personally unappealing, inferior to others
Avoidant PD
What is Avoidant PD comorbid with?
dependent PD & Axis I mood, anxiety, & eating disorders
Which PD does this represent?
- 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
Dependent PD
Explain the view of Dependent PD, what makes them feel threatened, their strategy and affect?
• 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
Which PD does this represent?
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
• Unrealistic standards of morality, ethics or values
• Reluctance to delegate tasks
Obsessive-Compulsive PD
What is Obsessive-Compulsive PD comorbid with?
borderline, narcissistic, histrionic, paranoid, schizotypal PDs
Explain the view of Obsessive-Compulsive PD, what makes them feel threatened, their strategy and affect?
• 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
Name 2 treatments for Borderline PD?
- Dialectic Behavioural therapy(DBT)
* Schema-focused therapy
FIX CARD
Epidemiology, Aetiology & Treatment of personality
disorders
