Lecture 3: Co-occurring Disorders Flashcards
Odd, Eccentric:
Paranoid
Schizoid
Schizotypal
Cluster A
Dramatic, Erratic
Antisocial
Borderline
Histrionic
Narcissistic
Cluster B
Anxious, Fearful
Avoidant
Dependant
Obsessive-Compulsive
General Big Five profile
High neuroticism
And if we remove dependent personality disorder, considering just the alternative model (DSM-5 appendix)… then the remaining 2 (avoidant, obsessive-compulsive) both have low extraversion
Cluster C
Comorbidity
- Also referred to as Dual Diagnosis or Co-Occurring Disorders is when 2 disorders are present
- Important to consider ADDICTION as primary before personality disorder.
- Too easy to diagnose personality disorder based on addiction behaviour.
Concomitant Factors
Things that occur together
Schizophrenia Comorbidity
80% of Canadians with ________ will experience a substance abuse problem in their lifetime.
Roughly 4x the average risk.
Cannabis Comorbidity
- gateway drug; frequent users have much greater lifetime probability than non-users to use ‘dangerous substances’; opioids or cocaine.
- Cocaine = 12%
- Methamphetamine = 6%
- Heroin or other Opioids = 2%
- 25-80% of people with SUD report use of cannabis
Substances with Substances
50% / 90% / 90%
- if you’ve had any other substance use disorder you have a roughly _______ chance of developing an alcohol use disorder in your lifetime
- Of those on methadone maintance treatment (recovering opiod users) _______ are smokers.
- Of those in inpatient treatment for alcoholoism, _______ are smokers.
Lifetime Prevalence
21.6%
The proportion of a population who, at some point in life has ever had the characteristic.
- Approximately ______ of Canadians (6 million) meet criteria for SUD during their lifetime.
Prevalence | Yearly Prevalence
6.4% / 2.5%
The proportion of a population that has the characteristic at any point during a given time period of interest, usually a year.
- Changes of having an SUD in a given year
- _____ for males
- _____ for females
Personality Disorder
A persistent pattern of emotions (across situations), cognitions, and behaviour that results in enduring emotional distress for the individual or others. Assessed in terms of dysfunction (adaptive problems) and requires life long course (since at least adolescence).
- far less researched than other disorders
- most research is on APD
- relegtated (DSM-IV) to Axis II. Treated as “not quite real.”
- only some insurance providers cover them
- Axis II defered means “this client likely has but I don’t have time or need to get to bottom of it.”
- researchers dismissive (we’re all a little narcissistic”).
- If you see 3 clients for SUD expect one will have a PD.
Personality Disorder Comorbidity
28.6% / 47.7%
Percentage of population with addictive disorder who also have a PD:
- Of those with current Alcohol UD, _____ had at least one PD
- Of those with current Drug UD, _____ had at least one PD
Those with addiction disorder and more likely in having a PD
CO-OC and Community Samples
(Canadian vs NA included)
Canadian (community samples)
- 37 % of those with AlcoholUD have a Mental Illness
- 53 % of those who abuse drugs have Mental Illness
North American (community samples)
- 28.6 % of those with AlcoholUD had at least one PD
- 47.7 % of those with DrugUD had at least one PD
Percentage of population with a PD also with addictive disorder
- 16.4% had a current alcohol use disorder
- 6.5% had a current SUD
Community Samples tell us:
- If you meet a random person with a PD, there is a fair (but not huge) chance they’ll also have an addiction or two.
- If you meet a random person with Addiction, there’s a good chance they’ll also have a PD or two.
Co-Occuring and Clinical Samples
Clinical samples (have more comorbidity):
- Of those with a current SUD:
- 57-73% had at least one PD
- 35-50% had at least two PDs
OC-OC Clinical Opiate Samples
Craig (1988) assessed 121 opiate addicts (in Chicago):
100% had at least one PD and 27% had more than one
- Antisocial = 22%
- Narcissistic = 18%
- Borderline = 16%
- Dependent = 16%
CO-OC Clinical Cocaine Samples
Cocaine abusers
- 71 % had at least one PD
- 40 % had two or more
Most common
- Antisocial = 21 %
- Borderline = 18 %
Personality Disorder Debate
- Personality traits are dimensional
- Diagnoses are categorical (either have or don’t)
- Should PD be dimensional or categorical?
Dead Disorders
DSM-1: Inadequate Personality, Learning Disturbance, Sexual Deviation, Speech Disturbance, Enuresis (bed-wetting), Somnambulism (sleep-walking)
DSM-2: Explosive, Hysterical, Asthenic (weak) neurasthenia (lassitude, fatigue, headache, and irritability, associated chiefly with emotional disturbance).
DSM-3R: Masochistic, Self-Defeating
Personality PDs has been relatively unchanged since 1980s (DSM-3)
Paranoid Personality Disorder
Cluster A: Odd, Eccentric
A pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent
- Not in the proposed alternative model (DSM-5 appendix)
- Removal recommended due to little research on the disorder
________
- 0.5-2.5% prevalence (yearly)
- More common in males
- Most comorbidity with Schizotypal
- Suspects, without sufficient basis, that others are exploiting, harming, or deceiving him or her
- Is preoccupied with unjustified doubts about the loyalty or trustworthiness of friends and associates
- Is reluctant to confide in others because of unwarranted fear that the information will be used maliciously against him or her
- Reads hidden demeaning or threatening meanings into benign remarks or events
- Persistently bears grudges
- Perceives attacks on character/reputation that are not apparent to others and quick to react angrily or to counterattack
- Has recurrent suspicions, without justification, regarding fidelity of spouse or sexual partner
Schizoid Personality Disorder
Cluster A: Odd, Eccentric
A pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings
- Not in the proposed alternative model (DSM-5 appendix)
- Removal recommended due to little research on the disorder
______________
- <1% prevalence
- More common in males
- Most comorbidity with schizotypal
Schizotypal Personality Disorder
Cluster A: Odd, Eccentric
A pervasive pattern of social and interpersonal deficits marked by acute discomfort with, and reduced capacity for close relationships, as well as by cognitive and perceptual distortions and eccentricities of behaviour. / schizoid symptoms, magical thinking and odd behaviour - more letters - more symptoms
- In the proposed alternative model (DSM-5 appendix)
__________
- Typical features: impairments for social/close relationships, eccentricities in cognition, perception, behaviour associated with distorted self-image, incoherent personal goals, accompanied by suspiciousness and restricted emotional expression
______________
- 3-5% prevalence;
- More common in males;
- Most comorbidity with paranoid personality disorder.
Schizo vs. Schizotypal
Schizotypal seen as “closer” to schizophrenia (e.g., genetically). It is listed also in the Schizophrenia Spectrum category of the DSM-5
- Schizoid seen as having less social interest and less affect (schizotypal may have more social fear)
- Schizotypal is better researched and supported diagnostic category of the two
Antisocial Personality Disorder
Cluster B: Dramatic, Erratic
Typical features are a failure to conform to lawful, ethical behaviour and an egocentric, callous lack of concern, accompanied by deceitful ness, irresponsibility, manipulativeness, and/or risk taking.
- Disorder is in the proposed alternative model (DSM-5 appendix)
_________
- pervasive pattern of disregard for / violation of rights of others
- 3% prevalence in males
- 1% prevalence in females
- Most comorbidity with narcissistic personality disorder
Psychopathy (extreme APD)
Psychopathy a specifier in proposed alternative model (DSM-5 appendix):
“marked by a lack of anxiety or fear and by a bold interpersonal style that may mask maladaptive behaviours (e.g., fraudulence). […] low levels of anxiousness and withdrawal and high levels of attention seeking.”
- 0.75 % prevalence in males
- 0.25 % prevalence in females
Yet psychopaths count 15-25% of imprisoned Canadian offenders
Key Characteristics
- Glibness/superficial charm
- Grandiose sense of self-worth
- Proneness to boredom/need for stimulation
- Pathological lying
- Conning/manipulative
- Lack of remorse
Borderline Personality Disorder
Cluster B: Dramatic, Erratic
A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity
- This disorder is in the proposed alternative model (DSM-5 appendix)
_____
- 1-3% prevalence
- More common in females
- Most comorbidity with schizotypal personality disorder
Typical features are instability of self-image, personal goals, interpersonal relationships, and affects, accompanied by impulsivity, risk-taking, and/or hostility.
Big Five Profile
- High extraversion
- High neuroticism
- Low agreeableness
- Low conscientiousness
