Personality Disorder Flashcards
Define personality and personality disorder
personality = global term describing how we cope and adapt to a wide range of life experiences (inward experience and outward projection)
- relatively enduring and evolving with experience
Personality disorder: fixed, ingrained and unchanging ways of dealing with iofe
- rarely with adaptive responses
- disruption to life
- emotional distress
- social deficits
- unpredictable, mood swings
- stable patterns (makes difficult to treat)
- inflexible (they don’t believe there’s anything wrong with them)
Briefly describe the characteristics of cluster A
odd, eccentric and bizarre
Paranoid: distrust, suspiciousness
Schizotypical: acute discomfort in close relationships, cognitive/perceptual distortion and eccentricities (odd communication but can communicate)
Schizoid: detachment in social - restricted range of expression, avoiding social contact and unaffected by praise and criticism
Briefly describe the characteristics of cluster B
emotional, dramatic, erratic
antisocial: disregard for other rights, violation of them, lack of remorse, superficially charming - hannibal
Borderline: instability of relations, self-images and impulsive, recurrent suicidal/ self-harm attempts - cruella?
Histrionic: excessive emotionality and attention seeking behaviours - harley quinn
Narcissistic: grandiosity, need for admiration but lack of empathy… kevin spacey
Briefly describe the characteristics of cluster C
anxious and fearful
Avoidant: social inhibition, sensitivity to criticism, inadequacy and isolation
Dependent: submissive, clingy and excessive need to be taken care of
Obsessive-compulsive: perfectionism, control and order (not OCD - no obsessions and compulsions)
Describe DSM’s alternative model of personality, described in section III
- not clustered but dimensional scores for personality functioning and pathological traits
- a clinician should assess the level of personality function (scoring for traits etc), evaluate pathological personality traits (5 domains, 26 facets) - seen on notion
- 6 personality disorders (removed the rare/ extremely co-morbid ones)
Evaluate DSM’s alternative model of personality, described in section III
Pros:
- allows for trait-specified disorders (which my not mee the 6 categories)
- provides heterogenic descriptions of functioning and traits
- diagnoses are more stable than a personality disorder
- allows variance in symptoms for people with the same disorder
- traits robustly predict life outcomes, health, expectancy, relationships
- more descriptive, better treatment and feedback
Evaluate DSM’s original definition of personality
- good inter-rater
- but disorders are not stable over time (appear to be in remission when reassessed)
- appear to increase in adolescence and then decrease over time (not as enduring)
- high co-morbidity
Name some risk factors of BPD
- childhood abuse
- neglect/rejection
- inconsistent, loveless parenting
- parental substance abuse and promiscuity
- environment instability, paternal psychopathology: underachievement and low intelligence
Describe the biological explanation for BPD
- running in families; twin studies show concordance for MZ at 35% and DZ at 7%
- traits common in BPD (neuroticism) show strong inheritance
Circumstantial evidence but still support for neurotransmitter activity
- low levels of serotonin
- dysfunctional dopamine activity
- could explain impulsivity and cognitive impairment
- derived from drug treatments being effective in BPD
Neuroimaging
- abnormalities in the frontal lobe, hippocampus and amygdala
- cause or consequence?
- diminished connectivity in brain areas involving emotional experience and regulation = impulsivity and mood swings
Describe the object relations theory in accounting for BPD
Psychodynamic
- people are motivated to respond to the world through perspectives learnt by important people in development
- e.g. experiencing abuse might create the expectation that everyone similar to the abuser is also an abuser
- these people/events become objects in the subconscious - these are then carried into adulthood and used by the subconscious to predict peoples behaviour in interactions etc
Example: breastfeeding
if there is a good environment, an individual is capable of understanding ambiguity and that good and bad things may belong to the same person. In bad environments, they are more black and white, and only attribute one.
- individuals with BPD - received inadequate/abusive experiences creating an insecure ego
- this causes lack of self-esteem, dependency, fear of separation (central features of BPD)
- Insecure ego = splitting (ego defence) - focusing on negative/positive attributes - black and white - division - good or bad
- this diffuses anxiety in complex situations by simplifying it
- reinforces a sense of self by demonising those who do not state opinions and values
- compartmentalization causes distorted reality, restricted thoughts/emotions and affects relationship formation
Describe biological treatments of BPD
- antidepressants, anxiolytic drugs (with patients comorbid with anxiety/depression)
- atypical antipsychotics - reduced impulsivity, hostility and aggression
How can object relations psychotherapy help treat BPD?
- the therapist will be aware of the client’s unconscious attempts to involve them in the same patterns of relationship, but they will provide a safe, caring relational environment that will help the client to work through some of their relational issues.
- The therapist will focus on helping individuals to identify and address deficits in their interpersonal functioning and explore ways in which relationships can be improved - providing insight into patterns of relating
- The therapist will react in ways to encourage insight and help the person achieve greater awareness.
- The individual may then strengthen their ability to form healthy object relations which can be transferred to relationships outside of the counselling environment.
How can dialectical behaviour therapy (Linehan, 1987) help treat BPD?
- the therapist fully accepts the client (which is the opposite of wanting change - antithesis, thesis)
- client-centred empathy and behavioural problem solving
- overtime the goal is to move the client towards change whilst maintaining empathic validation
Individual component (stops suicidal attempts/ certain behaviour interfering with group sessions)
- follow a treatment hierarchy (prioritising suicide)
- keeping diary etc to track emotion
- work towards improving skills and addressing quality of life issues
Group component (application of skills in social context)
- weekly meeting with groups learning to use specific skills
- 4 skills modules: core mindfulness, interpersonal effectiveness, distress tolerance and emotion regulation
- core mindfulness - considered foundation fo all other skills - aids acceptance of powerful feelings while challenging habits
Essentially
- Dbt helps learn to bear pain skillfully
- accept oneself and situation calmly and recognise negative situations/impacts - avoiding overwhelm
- aids logical decisions and avoids destructive behaviour
- helps decrease self-harm, suicide attempts, treatment drop out (at 1 year following)
How may diathesis-stress account for BPD?
- parenting interaction with child vulnerability
- poor emotional regulation diathesis and invalidation in the environment
- see notion for cycle
NOTION CARD
look at notion for DSM criteria and familiarisation
