lecture 3 &4 Flashcards
Construct validity
the degree to which a test measures what it claims to be measuring
Levels to be considered in construct validity of PDs
a. The conceptualization of the constructs themselves
b. The formulation of the essential diagnostic criteria sets
c. Instruments to assess these constructs
Two-step procedure from DSM5 to diagnose PD
- enduring pattern, deviating, inflexible and pervasive, stable and long duration; onset in adolescence or early adulthood
- dynamics of PD
Personality pathology DSM 5 criteria
- dichotomous and categorical
- polythetic criteria
- all criteria are equal importance
Differential diagnosis
• 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
Five-factor model (FFM)
dimensional model of personality which consists of five broad, higher order dimensions or domains of personality: neuroticism, extraversion, opens to experience, conscientiousness, agreeableness
FFM characteristics
• 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.
FFM limitations
- 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
Alternative model of personality disorders (AMPD)
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
AMPD characteristics
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).
Structured clinical interviews
- golden standard of PD assessing
- good interrater reliability
Self-reports (risk)
personality pathology by definition is ego-syntonic, and personality-disordered individuals may thus be liable to produce biased self-portrayals.
6 domains in integrative psychodiagnostics
- Manifest pathology/symptomatology
- relationship/support system
- cognitions and schemas
- personality structure/dynamics
- attachment/early trauma
- Temperament/biological make up
- Manifest pathology/symptomatology
- 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
- relationship/support system
- 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
- cognitions and schemas
- 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)
- personality structure/dynamics
- 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
- attachment/early trauma
- 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)
- Temperament/biological make up
- Stable personality characteristics/biology
- Trait-oriented
• Instruments: - Temperament and Character Questionnaire (TCI)
- Revised NEO Personality Inventory (NEO-PI-3): tests the Big Five
Dodo bird hypothesis
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.
cognitive contrast hypothesis
CBT is superior to other non-CBT treatments.
Cognitive contrast results
- CBT superior to psychodynamic therapy
- But not superior to IPT, Behavioural treatments, ACT
Type of problem treated results
- not statistically significant
Dodo bird hypothesis - evidence
- research confirmed
- there is some difference among the disorders –> most equivalence for depression
- -> mostly young samples
Meta analysis assessing the psychotherapies for BPD
• 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,
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contradicting systematic claims from individual trials.
Effectivity research plagued by dichotomies
- 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
Facts about psychotherapy
- Psychotherapy is more effective than no treatment
- Psychotherapy is more effective than placebo controls
- Psychotherapy is more effective than medication
- All psychotherapies have similar outcomes
Factors responsible for therapeutic change
- extra therapeutic change 40%
- common factors 30%
- techniques 15&
- Expectancy (placebo) 15%
