Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Clinical psychology > Lecture 5- Personality Disorders > Flashcards

Lecture 5- Personality Disorders Flashcards

You may prefer our related Brainscape-certified flashcards:
Psychology 101 flashcards GRE® Psychology flashcards AP® Psychology flashcards
1
Q

define personality

A

a stable psychological and behavioural set of characteristic
these are usually predictable and consistent, how the person relates to the world, what distinguishes us to on another

also is flexible

some personality are favoured/ unfavoured by society

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

how many different types of personality disorders are there

A

10 different PD diagnoses- this is the general criteria

  • also general PD not otherwise specified- meet general criteria but not an individual one
  • often apparent in adolesence/ early adulthood often goes on for decades
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

describe the DSM for personality disorders ( the general one)

A

ALL PD diagnoses start with ‘General Personality Disorder’ diagnostic criteria: Apply to all 10 PDs

  • A. Enduring pattern of inner experience and behaviour that deviates markedly from the expectations of the individual’s culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time, and leads to distress or impairment”. This pattern is manifested in two or more of the following areas:

o Cognition (ways of perceiving and interpreting self, other people, and events

o Affectivity (range, intensity, lability, and appropriateness of emotional response)

o Interpersonal functioning

o Impulse control

  • B. Enduring pattern is inflexible and pervasive across a broad range of personal and social situations
  • C. Enduring pattern leads to clinically significant distress or impairment in social, occupational, or other important areas of functioning
  • D. The pattern is stable and of long duration, and its onset can be traced back to at least adolescence or early childhood
  • E. The disturbance is not better explained by another mental disorder
  • F. The disturbance is not due to the direct physiological effects of substance abuse or a general medical condition
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what is it called when you have a PD that doesnt fit with the crtieria

A

PD not otherwise specified

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what are the 3 main clusters for PD

A

A : ODD/ ECCENTRIC
B: DRAMATIC/ ERRATIC
C: Anxious / fearful

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

name some personality types in cluster a

A

A : ODD/ ECCENTRIC
Paranoid

o Schizoid

o Schizotypa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

name some personality types in cluster b

A

Cluster B: Dramatic/erratic

o Antisocial

o Borderline

o Histrionic

o Narcissistic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

name some personality types in clusterc

A

Cluster C: Anxious/fearful

o Avoidant

o Dependent

o Obsessive-compul

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

name some criticisms of the clusters for PD

A
  • current categorical method of diagnosing PDs is widely seen as inadequate (e.g. Skodol & Bender, 2009; Widiger & Trull, 2007) BECAUSE :

o High level of co-morbidity amongst PDs, within and between clusters

o Heterogeneity (variability) amongst patients with the same diagnosis

  • E.g. borderline PD requires a minimum of 5 of 9 symptoms
  • So, there are 126 possible combinations!

o Arbitrary cut-off point for diagnosis. E.g.:

  • If someone meets 5 of the 9 criteria, they are given diagnosis of BPD
  • If the meet 4 of the 9, they are not diagnosed
  • But they may still have significant levels of suffering

o Over use of the ‘personality disorder not otherwise specified’ diagnosis (Verheul & Widiger, 2004)

o Broad genetic and environmental risk factors for PDs that cut across clusters (as well as more specific risk factors)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

name some alternate ways of diagnosing PD

A
  • measuring the severity on a continuum
  • have no boundary betwen normal and abnormal
  • people who have PDs only those who show extremes
    It was thought that DSM-V would be organized using a hybrid dimensional/ categorical system
  • In fact, all that changed was amalgamating Axis I & Axis II
  • Instead ‘Section III’ of DSM-V has an ‘alternative model’ of PD classification/diagnosis: just a proposal, subject to investigation
  • Most clinicians & researchers in the field acknowledge the dimensional properties of PD; but we still use DSM-V diagnostic system
  • See APA PD Fact Sheet
  • BIG 5
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

An alternate way of measuring personality by costa and mcrae

A

Costa + mcrae 2995= Big 5 personality theory
- populations vary on a continuum across 5 domains
Neurotic-ism
extroversion
openness to experience
agreeableness
conscientiousness

these domains have 30 sub domanis
people described as high/ low
People are described in term high-low on each dimension

  • Someone who might diagnosed with avoidant PD might show high neuroticism, medium agreeableness and conscientiousness, and very low extroversion and openness to experience
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Explain widieger and trull (2007) arguement for the BIG 5 for personality

A
  • Evidence supporting Big 5 dimensions/domains is much better than that supporting DSM PD categories

o A dimensional PD diagnostic system based on Big 5 would address at least some of the limitations of the DSM categorical system

o Using Big 5 might help de-stigmatise a diagnosis of PD

o Will Section III of DSM-5 better address dimensional diagnosis of PD than this approach?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Personality disorderds general features

A

Long term

  • Pervasive
  • Can be associated with risky behaviours
  • High levels of co-morbidity with ‘Axis I’ disorders
  • Predictive of poor treatment outcomes
  • Common

o Prevalence: 4 - 15% in adult community samples

  • And yet, relatively little research and treatment development
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Prevelance of PD

A

General PD prevalence:

o 4 - 9% UK adult community samples (Coid et al., 2006; Samuel et al., 2002)

o 15% US community sample (Grant et al., 2004)

o 36% - 67% psychiatric inpatient (NIMHE, 2003)

o Similar high prevalence within the prison population

  • PD is thought to be under-diagnosed in both community and in-patient settings (Lamont & Brunero, 2009)
  • See Lamont & Brunero (2009) for an overview of PD prevalence and treatments
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Age and Gender relations for PD

A
  • more common in young adults
  • PD shouldnt be diagnosed in kids or adolescents as personalitys arent fully developed
  • Males = Females across all diagnoses, but this varies from PD to PD

o E.g. BPD: F>M

o ASPD: M>F

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Give a reason for genetic cayses of PD

A
  • Twin studies have shown risk factors for PD
  • o One broad factor: “negative emotionality/emotion dysregulation,” contributing to 6 PDs across all 3 clusters

o Two additional, more specific factors contributing to

o (i) Borderline and antisocial PDs: “Impulsive aggression”

o (ii) Schizoid and avoidant PDs: “Inhibition/introversion”

  • These genetic risk factors do not reflect the 3 PD clusters
  • The authors described the heritabilities for PDs in their sample as “modest”
  • Ranging from 20% (schizotypal) to 41% (antisocial)
  • Implying that environmental factors play an important role
17
Q

explain some heritability factors and statistics linking to PD

A 
PARANOID= 23.4 
schizoid= 25.8 
schizotypal = 20.5

avoidant = highest - 37.3
and
antisocial= 40.9

18
Q

General causes : enviornmental

A

Longitudinal studies e.g. Johnson et al., (1999; 2006) have identified several environmental risk factors for PDs:

o One broad factor: “childhood parental neglect,” contributing to 7 PDs across all 3 clusters

o Other, more specific factors contributing to specific diagnoses or clusters. E.g. “Childhood physical abuse” significantly contributing to antisocial PD

  • The environmental risk factors that Kendler et al., (2008) identified, were a reasonable fit to the 3 PD clusters
  • So, its possible that environmental experiences could be implicated in tendency of cluster A, B, and C PDs to co-occur
19
Q

name some causes of cluster a ( odd / eccentric) personality types

A

Paranoid

o Often emotionally detached

o Suspicious of other people and their motives

o May hold longstanding grudges against people

o Believe others are not trustworthy, other people are deceiving, threatening, making plans against them

  • Schizoid

o Difficulties in expressing emotions, particularly around warmth or tenderness

o Often feel shy in company, but may come across as aloof or remote

o Have difficulty in developing or maintaining social relationships

  • Schizotypal

o Has problems around developing interpersonal relationships.

o The condition is characterised by thought disorders and paranoia.

o To other people they may appear odd or eccentric; they may dress or behave inappropriately, e.g. talking to themselves in public

20
Q

name some causes of cluster b ( odd / eccentric) personality types

A

Antisocial

o Characterised by a lack of regard for the rights and feelings of other people,

o A lack of remorse for actions that may hurt others.

o Often ignore social norms about acceptable behaviour, often may disregard rules and break the law.

  • Borderline

o Characterised by unstable personal relationships

o Impulsive behaviour in areas such as personal safety and substance misuse.

o They may self-harm, feel suicidal and act on these feelings,

o experience instability of mood, or have episodes of psychosis.

o They may have feelings of chronic emptiness and fears of abandonment by friends or partners.

  • Histrionic

o Characterised by extreme or over-dramatic behaviour.

o May form relationships quickly, but be demanding and attention-seeking.

o They may appear to others as being self-centred, having shallow emotions, craving attention, or being inappropriately sexually provocative.

  • Narcissistic

o Exaggerated sense of their own importance.

o They are frequently self-centred and intolerant of other people.

o The condition is typified by grandiose plans, ideas and cravings for attention and admiration

21
Q

name some causes of cluster c personality types

A

Avoidant

o fears being judged negatively by other people, leading to feelings of discomfort in group or social settings

o May come across as socially withdrawn and have low self-esteem

o Though they may crave affection, fears of rejection can be overwhelming.

o Avoidant personality disorder is associated with anxiety disorders (especially social phobia)

  • Dependent

o Typified by someone who assumes a position of passivity, allowing others to assume responsibility for most areas of their daily life.

o They usually lack self-confidence

o May feel unable to function independently of another person

o Feel their own needs are of secondary importance

  • Obsessive-compulsive

o Difficulties in expressing warm or tender emotions to others.

o Frequently perfectionists, things must be done in their own way.

o Often lack clarity in seeing other perspectives or ways of doing things.

o Rigid attention to detail may prevent them from completing tasks

22
Q

where does borderline PD result form on the cluster system

A

cluster B- odd/ eccentric

- it is the most researchrf snf has more emperical knowledge / treatments based upon it

23
Q

Name some features of BPD

A

People with BPD diagnoses:

o Often experience crisis after crisis – due to impulsivity, difficulty maintaining relationships etc.

o Can feel chaotic inside – due to extreme and frequently changing emotions and lack of stable sense of self

o Can be a risk to themselves (but very rarely to other people)

o Often have other co-morbid diagnoses: depression, anxiety disorders, eating disorders, substance misuse, other PDs etc.

24
Q

EXPLAIN some of the elements in the dsm for BPD

A

A. Pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity, beginning … variety of contexts, as indicated by 5 or more of:

o Frantic efforts to avoid real or imagined abandonment

o Unstable/intense interpersonal relationships (alternating between extremes of idealisation and devaluation)

o Markedly and persistently unstable self-image

o Impulsivity in at least two (potentially self-damaging) areas (e.g. overspending, sex, substance abuse, reckless driving…)

o Recurrent suicidal behaviour/threats or self-mutilating behaviour

o Rapidly changing mood (often swings lasting just a few hours)

o Chronic feelings of emptiness

o Inappropriate, intense anger or difficulty controlling anger

o Transient, paranoid ideation or severe dissociation

25
Q

DESCRIBE biological treatments and theories of bpd

A

Lower serotonin – esp. in impulsive/suicidal/aggressive types

o 5-HTT gene linked to depression, suicide, impulsivity

o Hyper-reactive amygdala

  • Moderate family inheritance risk - Heritability: 37.1% (Kendler et al., 2008) – we’ll talk about what exactly is inherited, later)

*

  • Drug treatment can help, though there is not a specific drug to treat BPD
  • People are often prescribed several different drugs (see Tyrer & Bateman, 2004)

o Antidepressants, mood stabilisers, antipsychotics

o Probably best in conjunction with psychotherapy

26
Q

describe the psychodynamic theories of BPD

A

Psychodynamic theories focus on ‘unaccepting’ parents

o Leads to loss of self-esteem, increased dependence, inability to cope with separation

  • Childhood may feature multiple parent figures
  • Trauma common – including physical/sexual abuse

o Mentalisation Based Therapy (MBT)

o Mentalisation is the ability to understand our own and other people’s mental states and behaviour

o Psychodynamic-based group and individual therapy programme (Bateman & Fonagy, 1999; 2001)

  • “increase the reflective or mentalising capacity of the patient” (Bateman & Tyrer, 2004)

o Some evidence from RCTs supporting its use with BPD

27
Q

describe a cognitive theory of BPD

A

Beck et al, (2004); Davidson (2008)

  • Interaction between biological/ temperamental factors and early environment leading to:
  • Formation of schemas and self beliefs
  • E.g. “I’m unlovable”
  • “Everyone will leave me”
  • Leading to overdeveloped behavioural strategies such as suicide attempts to try and stop people leaving
  • Underdeveloped behavioural strategies such as poor self-car
28
Q

describe a bio- social theory of BPD

A

Bio-social Theory (Linehan, 1993)

  • BPD is a pervasive dysfunction of the emotional regulation system
  • BPD is conceptualised as a disorder of emotion regulation

o emotional difficulties negatively impact interpersonal, behavioural, self and cognitive functioning

  • The model describes an on-going transactional process that can commence early in childhood, through which biologically based emotional vulnerabilities and environmental invalidation and consequent poor emotion-modulation, interact, amplifying emotion dysregulation and its subsequent negative impact on other areas of experience
  • The model is testable, and there is some evidence supporting it (Crowell et al.,2009)
  • See Crowell et al for an overview of the model
  • Biological vulnerabilities:

o High emotional sensitivity

o High emotional intensity

o Slow return to baseline

  • Invalidating environment:

o Characterized by intolerance towards the child expressing emotions, in particular emotions that are not supported by observable events

o It is repeatedly communicated to the child that these shows of emotion are unwarranted and that emotions should be coped with internally, without parental support

29
Q

describe and explain Dialectical Behaviour Therapy (DBT for BPD

A

Dialectical Behaviour Therapy (DBT

  • Linehan (1993) Originally developed to treat women with diagnoses of BPD engaging in parasuicidal behaviours (suicide attempts and self-harm) – based on the biosocial model

o Integrates:

  • Dialectical philosophy
  • Behaviourism
  • Mindfulness

o Dialectics assumes that every event or experience contains polarity, with each opposing position (referred to as the ‘thesis’ and ‘antithesis’) being seen as valid, even if apparently oppositional and contradictory

o The fundamental dialectic in DBT is between on the one hand, fully accepting the patient as they are, and on the other, the urgent need for them to change

o Dialectics permeates all of DBT

  • Before DBT there were no empirically supported treatments for people with PDs
  • DBT revolutionised treatment for people with BPD (which is associated with long-term suffering and risk of suicide)
  • DBT aims to help people change their behaviour; reducing some behaviours (e.g. self-harm), and increasing others (e.g. self-care and life-enhancing behaviours such as eating healthily, socialising etc.)
  • aims and skills

o “With the overall goal of helping patients not only to survive, but also to build a life worth living.” (Lynch, Trost, Salsman, and Linehan, 2007, p. 183)

o DBT is a skills-focussed psychological intervention

  • Acceptance skills – mindfulness (core skill) + distress tolerance
  • Change skills- interpersonal effectiveness emotional regulation
30
Q

WHAT is the evidence for Dialectical Behaviour Therapy (DBT being effective

A

Meta-analysis of 5 RCTs (Panos, Jackson, Hasan & Panos, 2013):

  • DBT > TAU for parasuicidal behaviours
  • DBT barely better than TAU for attrition
  • DBT = TAU for comorbid depression

o DBT recommended in NICE guidelines as an evidence-based treatment for BPD

31
Q

name some limitations and critiques of Dialectical Behaviour Therapy (DBT

A

Even though parasuicidal behaviours may reduce, often still high levels of depression, anxiety etc.

o Poor quality of early RCTs in particular (Scheel, 2000; Brazier, 2006)

  • Small samples, under-powered
  • Poor quality control conditions
  • Relatively short follow-up periods (given that BPD is a long-term condition)

o Almost all the evidence is based on female participants

o Little investigation of mechanisms of change so far – i.e. how it works; what the ‘’active ingredients” are

32
Q

evaluate CBT VS mpd for BPD

A
  • CBT USES A SMALL NO. OF RCTS
  • DIDNT OUTPERFORM tau
  • however did reduce risky behaviours and hospital admissions
MBT 
- mentalization based tratemt 
- psychodynamic 
- 2 RCTS- Mbt outperformed structured psychiatric care for both trials 
and good for parasuicidal behaviours
33
Q

why can psychotherapy for BPD be challenging ?

A

Psychotherapy can be very challenging for therapist

o Finding empathy towards dependency/anger

o Emotionally draining

o Therapist dealing with their own anxieties

o Clients may violate boundaries of client-therapist relationship

  • None of this is the patient’s fault, in the sense that threats of suicide, boundary-pushing etc. are not deliberate attempts to be difficult or controlling
  • These behaviours are maladaptive coping strategies
  • The patient’s behaviour is, of course, their responsibility
  • Warm, empathic therapy styles may work better than other more ‘business-like’ approaches
34
Q

explain the efficacy for BPD

A

There has been significantly less research focused on developing and testing interventions for PDs compared to other common mental health problems

  • Most research has focused on BPD
  • The only psychotherapy for PD currently viewed as “evidence based” is Dialectical Behaviour Therapy for BPD

Clinical psychology (10 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions