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4.2 personality disorders > lecture 3 &4 > Flashcards

lecture 3 &4 Flashcards

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1
Q

Construct validity

A

the degree to which a test measures what it claims to be measuring

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2
Q

Levels to be considered in construct validity of PDs

A

a. The conceptualization of the constructs themselves
b. The formulation of the essential diagnostic criteria sets
c. Instruments to assess these constructs

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3
Q

Two-step procedure from DSM5 to diagnose PD

A
  1. enduring pattern, deviating, inflexible and pervasive, stable and long duration; onset in adolescence or early adulthood
  2. dynamics of PD
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4
Q

Personality pathology DSM 5 criteria

A
  • dichotomous and categorical
  • polythetic criteria
  • all criteria are equal importance
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5
Q

Differential diagnosis

A

• Especially important is the inner motivation of an individual for his/her behavior.
• Looking solely at the behavior of an individual can be too short-sighted.
• It’s recommended to structure the diagnostic process with a set of different steps:
1. Self-report instruments 2. Interview

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6
Q

Five-factor model (FFM)

A

dimensional model of personality which consists of five broad, higher order dimensions or domains of personality: neuroticism, extraversion, opens to experience, conscientiousness, agreeableness

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7
Q

FFM characteristics

A

• The most studied operationalization of the FFM is the NEO-PI-R.
• FFM captures the essential feature of personality and any personality construct can be mapped onto the domains.
• It makes sense to take the FFM of normal personality as a point of departure in deriving a dimensional description of maladaptive
personality functioning.

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8
Q

FFM limitations

A
  • Not all factors have been found to be equal; particularly the interpretation of the fifth factor (referred to as intellect, culture,
    openness, or unconventionality)
  • The factorial “home” of impulsiveness seems variable across different versions of the FFM
  • Not sure if FFM adequately captures more severe manifestations of personality psychopathology, for example the
    deliberate self-harm behaviors of BPD
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9
Q

Alternative model of personality disorders (AMPD)

A

a. the level of personality functioning
b. dimensional model of 25 personality traits based on:
1. negative affectivity
2. detachment
3. antagonism
4. disinhibition
5. psychoticism

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10
Q

AMPD characteristics

A

it’s assumed that PDs are characterized by problems in self-functioning (identity and self-direction) and problems • Dimensional personality traits are based on the five domains of 25 maladaptive personality traits, based on the factors of the FFM.
• In the AMPD
in interpersonal functioning (empathy and intimacy).
• The official measure of the DSM-5-dimensional model is the personality inventory for DSM-5 (PID-5).

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11
Q

Structured clinical interviews

A
  • golden standard of PD assessing

- good interrater reliability

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12
Q

Self-reports (risk)

A

personality pathology by definition is ego-syntonic, and personality-disordered individuals may thus be liable to produce biased self-portrayals.

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13
Q

6 domains in integrative psychodiagnostics

A
  1. Manifest pathology/symptomatology
  2. relationship/support system
  3. cognitions and schemas
  4. personality structure/dynamics
  5. attachment/early trauma
  6. Temperament/biological make up
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14
Q
  1. Manifest pathology/symptomatology
A 
- Objective and subjective symptoms
• Instruments
- File research, clinical judgment
- WAIS-V (intelligence)
- SCID-5-PD or PID-5 (criteria for DSM-V)
- UCL, SCL-90
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15
Q
  1. relationship/support system
A
  • Does the client have a support system?
  • How can we best describe the client’s support system?
  • What way is the client’s support system of help?
    • Instruments
  • Clinical interview/hetero-anamnesis
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16
Q
  1. cognitions and schemas
A
  • Everyone has implicit and explicit schemas
  • Dominant theme regarding yourself, others and the world
  • Rigid, non-adaptive
  • Arise in childhood
  • Conscious, familiar
    • Instruments
  • Young Schema Questionnaire (YSQ)
  • Nederlandse Persoonlijkheids Vragenlijst-2 (NPV-2)
17
Q
  1. personality structure/dynamics
A
  • Not about diagnosis but about generating hypotheses about the structural, underlying vulnerability of the patient
    • Projective tests
  • TAT: you project your inner world into these pictures, so the story you make up about the picture tells you something about your inner structure
18
Q
  1. attachment/early trauma
A
  • To get an idea of someone’s attachment style, i.e., their interpersonal dynamics in short-term and long-term interpersonal relationships
    • Types of attachment: - Secure
  • Dismissive/avoidant (prefer to be by yourself)
  • Preoccupied (prefer to be with others; questions such as who am
    I to you, do you even like me as a friend?)
  • Fearful/avoidant (difficult to be with self and others)
19
Q
  1. Temperament/biological make up
A
  • Stable personality characteristics/biology
  • Trait-oriented
    • Instruments:
  • Temperament and Character Questionnaire (TCI)
  • Revised NEO Personality Inventory (NEO-PI-3): tests the Big Five
20
Q

Dodo bird hypothesis

A

when bona fide (treatment that targets a clinically relevant problem or issue and is tailored to the patient) treatments are compared they yield roughly equal outcomes.

21
Q

cognitive contrast hypothesis

A

CBT is superior to other non-CBT treatments.

22
Q

Cognitive contrast results

A
  • CBT superior to psychodynamic therapy

- But not superior to IPT, Behavioural treatments, ACT

23
Q

Type of problem treated results

A
  • not statistically significant
24
Q

Dodo bird hypothesis - evidence

A
  • research confirmed
  • there is some difference among the disorders –> most equivalence for depression
  • -> mostly young samples
25
Q

Meta analysis assessing the psychotherapies for BPD

A

• Various independent psychotherapies demonstrated efficacy for borderline-relevant symptoms, self-harm, suicide, health service use, and general psychopathology in BPD.
• Effects were small, inflated by publication bias, and particularly unstable for follow-up.
• Treatment intensity didn’t seem to influence outcomes.
• They found no evidence that treatment retention would be higher for specific psychotherapies than for control interventions,
lOMoARcPSD|9762893
contradicting systematic claims from individual trials.

26
Q

Effectivity research plagued by dichotomies

A
  • Client vs. therapist
  • Therapy A vs. therapy B
  • Brief vs. long-term
  • Specific techniques vs. common factors
  • Process vs. outcome
  • Qualitative vs. quantitative
  • Statistical vs. clinical significance
  • Practice vs. evidence-based
27
Q

Facts about psychotherapy

A
  1. Psychotherapy is more effective than no treatment
  2. Psychotherapy is more effective than placebo controls
  3. Psychotherapy is more effective than medication
  4. All psychotherapies have similar outcomes
28
Q

Factors responsible for therapeutic change

A
  1. extra therapeutic change 40%
  2. common factors 30%
  3. techniques 15&
  4. Expectancy (placebo) 15%

4.2 personality disorders (8 decks)

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