Lecture 7 - Personality Disorders Flashcards
What are the 5 axes in multiaxial DSM-IV?
Axis I: clinical psychological disorders
II: personality disorders + intellectual disabilities
III: medical conditions + physical disorders
IV: psychosocial + environmental factors
V: functional level
Recent DSM puts Axis 1-3 in single axis
Separate axis originally to increase clinical/research attention, categorisation + understanding unrelated to empirical theories until recently
What is a personality disorder?
Enduring pattern of inner experience + behaviour that deviate from cultural expectations, pervasive + inflexible, cause distress/impairment, not due to other disorder/drugs/intoxication
What is Cluster A of personality disorders?
Odd/eccentric disorders
Paranoid: paranoia, mistrust of others, irrational suspicions, preoccupied w/ doubts, reluctance to confide, misinterprets innocent remarks, hold grudges
Schizoid: detachment from interpersonal relationships, emotional coldness, indifference to praise/criticism of others, few friends + choose solitary activities
Schizotypal: distortions in thinking/feeling/perceptions (ideas of reference, magical thinking, perceptual illusion), discomfort in social situation (suspicions, paranoia)
What is Cluster B of personality disorders?
Dramatic/emotional/erratic disorders
Antisocial: lack of empathy/remorse, disregard for others, failure to conform to norms, impulsivity, deceitfulness, irresponsibility, disregard of safety for self/others
Borderline: unstable personal relationships, frantic attempts to avoid real/imagined abandonment, lack of well-formed identity, feelings of emptiness//worthlessness, unstable feelings, frequent suicidal/self-harming/mutilating behaviours, impulsivity
Sensationalised media portrayal (lots of stigma)
Histrionic: excessive need for approval, need to be centre of attention, shallow/over-dramatic emotions, sees relationships as more intimate than they are
Narcissistic: inflated self-importance + sense of entitlement, belief that they’re special, seeks attention/admiration from others, fantasies of success, arrogance, envy of others, low in empathy
What is Cluster C of personality disorders?
Anxious/fearful disorders
Avoidant: social inhibition, avoids/withdraws from social situations, low self-worth, fear rejection/disapproval/criticism, feel socially-inept, reluctant to engage in new things for fear of embarrassment
Dependent: persistent psychological dependence on others, lack confidence in ability to take responsibility, difficulty doing things alone, agree with others, seeks out new relationships
Obsessive-compulsive: preoccupation w/ orderliness/rules/moral codes/caution + perfectionism, excessive devotedness to work, inflexibility/overly conscientious
How are the co-occurrence of personality disorders?
Common
Eg. Avoidant + Dependent (same cluster) or Narcissistic + Paranoid (inter-cluster)
What is the continuity hypothesis?
There is no discontinuity between normality and illness
What did Saulsman/Page find about personality trait/disorder correlations?
Meta-analysis of 12 studies, found significant correlations between disorders and some personality traits (Big 5) but magnitude of correlations not huge
What is the Big 5 Profile Approach to personality disorders?
Conceptual profile for Paranoid PD, rated facets related to each disorder (eg. N1 – Anxiety, N2 – Anger hostility, etc.)
Big 5 facets conceptually associated with PDs
High competence, order, dutifulness, achievement striving, deliberation –> obsessive-compulsive personality disorder
Low gregariousness, assertiveness, high anxiety, self-consciousness, vulnerability –> avoidant personality disorder
High anxiety, self-consciousness, vulnerability, altruism, compliance, modesty –> dependent personality disorder
Low warmth, gregariousness, positive emotionality –> schizoid personality disorder
What did McCrae find about personality profiles and disease diagnosis?
Profiles may indicate risk but not diagnosis of PD, may be useful for ruling out/characterising known PD
1926 patients from psychiatric hospitals, did personality disorder interview/questionnaire + NEO-PI-R, calculated profile agreement scores for each
Found significant correlations but not particularly huge (moderate at best)
Potential need to revise diagnostic classification system for personality disorders?
What are limitations of DSM-IV PD classification?
Extensive co-morbidity, low temporal/inter-assessor reliability, not based on empirical personality models
How can DSM-IV criteria be improved?
Dimensional rather than categorical approach
Widiger/Costa/McCrae (2002): Assess personality facet profile (NEO-PI-R)
Assess personality-related social/occupational impairments + distress
If dysfunction & distress clinically significant –> diagnose PD
Determine if profile matches with PD category description
How is classification system in DSM-V?
Retention of all 10 PDs + Clusters in main DSM-5 but additional emerging measures and models section (Section III)
Criterion A: severity –> significant impairments in functioning of self/interpersonal
Criterion B: style –> one or more pathological personality trait domains/facets (measured w/ Maladaptive Trait Model)
Only 6 categories: borderline, obsessive-compulsive, avoidant, schizotypal, antisocial, narcissistic, PD-Trait Specified
What is Dissociative Identity Disorder? (DID)
Mental disorder defined by presence of two or more distinct identities/personalities
Amnesia for prior/recent events, cause distress/functional impairment, not due to substance use/cultural practice/imaginative play
Listed as dissociative disorder (eg. Dissociative amnesia/depersonalization disorder/etc.)
What does DID typically look like?
(Haslam) Primary host personality + 1 or more alters, alters take turns to control behaviour
Distinctive patterns of thinking/behaving
Different names/ages/genders
Memory loss for experiences as other alters
