Lecture 4: personality disorders Flashcards
Personality disorders
Deviant enduring/ chronic pattern of thinking, feeling, perceiving, relating (to oneself and other), and behaving that is stable over time. This includes:
- Persuasive pattern
- Stable and inflexible
- Onset in adolescence or early adulthood
- Deviated form the expectation of the culture.
- Causing significant distress / impairment in major life areas.
- Not better explained by something else.
Different types of personality disorders (DSM)
- Cluster A: odd, eccentric cluster.
- Cluster B: emotional, dramatic cluster.
- Cluster C: anxious, fearful cluster.
Cluster A: odd eccentric
Symptoms similar to schizophrenia (flat affect, odd content of thought or speech, paranoia), but still having a grasp on reality. Consists of:
- Paranoid personality disorder
- Schizoid personality disorder
- Schizotypical personality disorder
Cluster B: emotion, dramatic
Emotional, impulsive, interpersonal problems, risk and potentially self-harming behaviour. Consists of:
- Antisocial personality disorder
- Histrionic personality disorder
- Borderline personality disorder
- Narcissistic personality disorder
Cluster C: anxious, fearful
Extremely concerned about being criticised or abandoned by others, relationship problems.
- Avoidant personality disorder
- Dependent personality disorder
- Obsessive-compulsive personality disorder
The dimensional model of personality disorders
People often have multiple disorders and don’t belong in one cluster. This is why there is a new system, the dimensional model, where a person is described based on their personality traits relating to:
- Affectivity (emotional sensitivity)
- Inhibition
- Detachment (withdrawal avoidance)
- Dissociation
- Anakastia (perfectionism, compulsiveness)
It’s described if these traits are on their high or low end (severe or not).
BUT: there is one exception: the borderdeline pattern.
Borderline pattern
Meeting all the criteria for borderline personality disorder.
Symptoms:
- Fear of abandonment
- Unstable relationships
- Unstable self-image
- (Self-damaging) impulsivity
- Self-harm and chronic suicidality
- Mood instability
- Chronic feelings of emptiness
- Problems regulating anger
- Dissociation or psychotic symptoms during stress
- New criteria: a deep sense of loneliness and alienation (problems with trust, misinterpretation of social signals, increased rejection sensitivity).
The core domains of BPD are:
- Emotion dysregulation
- Identity diffusion
- Interpersonal problems
Etiology of personality disorder
It’s a complex interplay of genetic, neurobiological predispositions and environmental factors (invalidating environment). These factors influence emotional and behavioural dysregulation and maladaptive beliefs, which causes negative social reaction and a maladaptive coping response.
Self-fulfulling prophecy: people often try to compensate for their ‘weird’ behaviour and traits, but other behaviour which only causes more extreme behaviour and feeling of negativity about oneself.
The mentalisation theory of BPD
Individuals who are constitutionally vulnerable and/ or exposed to psychological trauma can cause the disruption of social/ cognitive capacities necessary for mentalisation (the ability to ‘read’ and reflect on the mental state of ourselves and others).
Invalidating environement
An environment in which the child does not learn to understand, label, regulate or tolerate emotional responses. Intolerance towards the expression of emotions can be the cause of:
- Emotional expression are seen as unwanted/ bad.
- Emotions are expected to be coped with without support.
- Overprotection alternating with neglect: unclear boundaries, privacy and autonomy are unwanted or ignored.
- Traumatic invalidation: dysfunctional response to disclosure of abuse.
This is not always on purpose, but can also result form intergenerational trauma or mismatch between the needs and responses.
Childhood maltreatment in people with BPD
The rates of childhood abuse and neglect (particularly emotional abuse and neglect) are very high in people with BPD. People who experienced this are 14 times more likely than healthy controls to developed BPD.
Sensitive periods for brain development combined with neglect are an important risk factors for BPD.
Neurobiological alterations in BPD
- Imbalance in the cortico-limbic network
- Amygdala hyperactivity to social stimuli (also compared with depressed samples)
- Reduced amygdala habituation to aversive stimuli
(Brain activity can change along with psychotherapy).
Emotional dysregulation symptoms
- Strong overwhelming emotions
- Unstable emotions
- Emotional vulnerability
- Limited access to affection strategies
- Use of strategies that increase vulnerability
- Lack of awareness
- Non-acceptance of emotional response
- Impulsivity and difficulty focussing attention.
Disturbances in affective-cognitive-social processing (self and others related)
- Greater emotional sensitivity and reactivity towards social cues.
- Marked tendency to interpret neutral or happy cues more negatively.
- Self-stigma, self-invalidation, toxic shame
- Rejection sensitivy
- Problems with feeling accepted
- Mistrust, intimacy fear
- Identity diffusion
- Chronic dissociation
Dissociation
Disruption of/ discontinuity of the normal, subjective integration of one or more aspects of psychological functioning, including memory, identity, consciousness, perception and motor control.
These dissociations are most experienced in:
- Interpersonal situations (eg family fights)
- Preceding or co-occurring emotions and overwhelm (eg fear, panic, stress)
- Having the wish to escape (physical stress reactions)
