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Personality and personality disorders > Lecture 6: Introduction to personality disorders > Flashcards

Lecture 6: Introduction to personality disorders Flashcards

1
Q

What are personality disorders?

A
  • Characterized by rigid, inflexible thoughts, feelings, actions and impulse regulation
  • Originates in early development
  • Present since late adolescence/early adulthood
  • Dysfunctional, can be experienced by others
  • Related to high healthcare costs, healthcare consumption, societal costs and lower quality of life
  • Not more chronic compared to chronic syndrome disorders
  • ## Psychopathology which is connected to our personality of who we are
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2
Q

Egosyntone

A

Consistent with self-image, aligns with goals, values and self view, seen as normal and cannot imagine otherwise. Can result in personality disorders and chronic syndrome disorders. Like OCPD which involves need for perfectionism which is seen as adaptive and neccessary

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3
Q

Egodystone

A

Not consistent with self-image or part of self, can cause conflict and distress which can result in syndrome disorders. Like major depression which is depression not part of self as there are times that the person is not depressed.

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4
Q

What is normal personality and traits?

A
  • A habitual way of thinking, feeling and acting (Big-5)
  • Consistent across situations but has a large situational variance!
  • Often thought that personality is stable, shaped around 18 years and remains unchanged
  • Personality is often more stable with increasing age, with largest changes around 30
  • Almost no studies find evidence for complete stability
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5
Q

How do certain personality traits change?

A
  • Increase in emotional stability
  • Decrease in extraversion
  • Decrease in openness
  • General personality fluctuates slightly, same with agreeableness and conscientiousness
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6
Q

Why do these changes happen?

A
  • Biological maturation
    (like decrease in impulsivity)
  • Environmental influences
  • Increased responsibility
  • Corrective experiences such as
    feedback from environment
    (conditioning)
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7
Q

How can we distinguish personality from other pathology?

A

Persistent (stable and long duration since early adulthood)
Pervasive (across situations)
Problematic (causes distress and impairment)

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8
Q

Cluster A personality type

A

Includes strange/bizarre and variant psychosis. This involves paranoid personality disorder (distrust), schizotypal personality disorder (ideas of reference, psychotic fear) and schizoid personality disorder (isolation, no desires or flatted affectivity)

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9
Q

Cluster B personality disorder

A

Involves dramatic, emotional, impulsive and variant externalizing disorders. These include: 1. Histrionic PD (Theatrical,
attention-seeking)
2. Narcissistic PD (superiority)
3. Borderline PD (instability)
4. Antisocial PD (No
conformation norms, criminal)

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10
Q

Cluster C personality disorder

A

Includes anxious and avoidant tendencies, variant internalizing disorders. These involve:
1. Avoidant PD (Avoiding)
2. Dependent PD (Clinging
helper)
3. Obsessive-compulsive PD

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11
Q

What are the other categories?

A

Personality change due to another medical condition like stroke brain trauma.
Other specified personality disorder which has a specific diagnosis, satisfied multiple criteria of personality disorders but does not satisfy a personality disorder. Could include no-DSM personality disorders like sadistic personality disorder. Has the highest prevalence.
Unspecified personality disorder

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12
Q

Monothetic

A

Members must meet the same properties of criteria

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13
Q

Polythetic

A

Meeting a minimal number of symptom criteria from a criterion set. Developed for biological classifications and family resemblance

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14
Q

What is the prevalence of minimum 1 personality disorder?

A
  • General population: 9-13%
  • Possibility of overestimation each disorder: 0.5-2%
  • Outpatient care: 30-50%
  • Inpatient care: 50-70%
  • Addiction & forensic setting (prison)
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15
Q

Why are there differences between studies?

A
  • Almost no international studies
  • Different sampling methods
  • Study instruments
  • Poor diagnostic reliability
  • Study setting
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16
Q

What is the life expectancy for those with a personality disorder?

A
  • On average, 18 years shorter (excluding suicides)
  • Risk highest before 44 years (10x mortality rate)
  • Cardiovascular diseases
  • Reasons: Lifestyle, chronic stress, medication
17
Q

What does a risk of intergenerational transmission mean?

A

If a parent has a personality disorder, there is an increased risk of the child developing the personality disorder

18
Q

Which childhood traumas is related to personality disorders?

A
  • trauma (abuse and neglect) is common
  • 11% for sexual abuse and 26.7% for emotional abuse
    -Has been linked to poorer mental health, range of syndrome disorders like PTSD
  • personality disorders
  • general and unique correlations with childhood trauma types
19
Q

Childhood trauma and personality disorder correlations

A
  • Paranoid personality linked to sexual abuse
  • schizotypal linked to emotional abuse
  • borderline linked to sexual abuse, emotional abuse, emotional neglect
  • antisocial linked with physical abuse
  • avoidant, dependent, obsessive-compulsive all linked with emotional abuse
20
Q

What do these correlations suggest?

A
  • Not everyone develops psychopathology/PD
  • Upbringing/behaviour caregivers might have an effect on
    vulnerability
  • Difference between PDs or general negative effects?
21
Q

What does emotional abuse predict?

A
  • Attachment (insecure attachment and distrust of others)
  • Approach-avoidance
  • Emotion regulation (they mainly experience negative
    emotions, and cannot recognize their own emotions)
  • Coping
  • Negative self-views
22
Q

Why does SCID-5 have low reliability?

A
  • Stereotypes
  • Premature closure
  • Confirmation bias
  • Interviews force disconfirmation
    → Important to also assess syndrome disorders
  • E.g.., What causes mood swings/panic attacks?
23
Q

What are the treatment guidelines?

A
  1. Specialized Psychotherapy (e.g., DBT or ST)
    * Determine what should be treated first in case of comorbidity
    * Additional treatment can be effective (e.g., PTSD, phobias)
    * Integrated treatment for syndrome disorders
  2. Social psychiatric treatment (if first choice is not possible, lack of motivation)
  3. Pharmacotherapy is not useful for treatment personality disorders, only dampens symptoms
    * Possible for comorbid disorder or specific symptoms
    * For support psychotherapy, but should not interfere (too much sedation)
    * Prevent polypharmacy
24
Q

What have recent findings suggested about personality disorders?

A
  • great increase in number of type of problematic parental behaviour with prevalence of personality disorder
  • behavioural/emotional problem in child and lifetime parental disorder was mediated by the types of parental behaviour which results in the personality disorder
25
Q

What are the conclusions?

A
  • Important clinical group with a high disease burden and
    high health care utilization/consumption
  • PD criteria must be dysfunctional (sometimes only
    experienced by the environment), are egosyntonic ,and
    must meet the 3 p’s
  • PDs are changeable – just like ‘regular’ personality
  • Childhood trauma and environmental influences play an
    important role
  • Specialized psychotherapy is the treatment of choice

Personality and personality disorders (11 decks)

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