Personality disorder Flashcards
What is a personality disorder
- Need to have: a SINGLE, ENDURING, INFLEXIBLE, PERVASIVE, STABLE pattern of inner experience and behaviour
that results in enduring emotional distress for the person affected and/or for others and may cause difficulties with work and relationships.
PD presentation in women vs men
- Men with PD are characterized as more aggressive, structured, self-assertive, and detached
- Women with PD are characterised as more submissive, emotional, and insecure
BPD and countries
- Countries with higher income had higher rates of BPD
- Could be due to: capitalism, competition, individualism etc
Cluster A- Odd or Eccentric Disorders - WIERD
Paranoid
A pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent.
Schizoid
A pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings.(loner- want to be alone, flat affect)
Schizotypal
Pervasive pattern of social and interpersonal deficits marked by acute discomfort with reduced capacity for close relationships, as well as by cognitive or perceptual distortions and eccentricities of behaviors. (wear weird clothes, have weird fantasies and beliefs, take senses in in an odd way, odd thinking and speech speak in metaphors, inappropriate affect)
Cluster A differentials
Autism (neurodev & restrictive interests),
Schizophrenia (hallucinations eg paranoid PD may look similar to paranoid delusions “ they’re after me” in schizophrenia but no hallucinations), similar to both is reduced social aspect
Cluster B – Dramatic, Emotional, Erratic Disorders - WILD
Antisocial
A pervasive pattern of disregard for and violation of the rights of others.
- Noncompliance with social norms
- Irresponsible, Impulsive, Deceitful
- Control of others with a lack of conscience, empathy, and remorse
Borderline
A pervasive pattern of instability of interpersonal relationships, self-image, affects, and control over impulses.
Histrionic
A pervasive pattern of excessive emotion and attention seeking.
Narcissistic
A pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy.
Cluster B differentials
Bipolar dif BPD (both risky activities, but bipolar eg 3-4 changes throughout year, borderline rapid changes emotions in day/week), BPD hyperpermeability of self/goals and instability relationships, and BPD can look like emotion dysregulation
Cluster C – Anxious or Fearful - WORRIED
Avoidant
A pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation.
Dependent
A pervasive and excessive need to be taken care of, which leads to submissive and clinging behavior and fears of separation.
Obsessive
A pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency.
Cluster C differentials
Social anxiety vs avoidant personality disorder
- SAD= recognize that their fears may be disproportionate.
- APD= may lack this insight. Fears are driven by overwhelming feelings of worthlessness. They believe these core beliefs are true, so they think others also believe they’re inadequate.
- One school of thought suggests that the two disorders exist on a continuum, with avoidant
- ASD essentially being a more severe variant of social anxiety disorder.
- APD is more stable/ pervasive across time and situations
- while SAD may be specific situations
- PDs tend to develop in childhood whereas SAD onset is often mid-adolescence
OCPD and ASD (ASD has social communication deficits)
Psychopathy
- Superficial charm
- Grandiose sense of self-worth Proneness to boredom/need for stimulation
- Pathological lying
- Conning/manipulative
- Lack of remorse
Psychometrics
- MMPI
- Millon (normed for clinical populations)
- Young Schema Questionnaire
Linehan’s Biosocial Theory of Emotion Regulation
Emotionally vulnerable child (doesn’t have solid predictable upbringing, abuse, neglect - automatic nervous system reacts excessively to relatively low levels of stress and takes longer to return to baseline won’t be able to regulate affect as well as everyone else)
> Upbringing invalidating environment (personal experience and responses of the child are disqualified or invalidated not seen as accurate, therefore can’t make meaning of their experience “gas lighting” being told their experience isn’t true.
> Poor emotional regulation / BPD symptoms
Mentalisation - Fonagy and Bateman
Mentalisation = to understand the other’s (or ones’ own) behaviour in terms of activity that has taken place inside their minds. “I feel this way because of what I’ve gone through and that’s why I’m reading that way.”
Attachment dysregulation + separation intolerance + reduced mentalisation = BPD
If mentalisation fails (particularly when high arousal) use default thinking (eg psychic equivalence: whats in my mind accurately reflects reality, if I feel abandoned then I am being abandoned)
Youngs - Schema focused therapy
Schemas: mental maps (made of past experiences eg cognitions, body sensations, memories) developed throughout life that we use as a mental filter for future experiences
Schema modes: Each person is a house and has many rooms (each room is a schema) in different context we usually have more than one schema turned on. Activation of different schema is called schema modes
(victor calls all C** Danny principle punishes people)
- Vulnerable/abandoned child: feels lonely, overwhelmed, doubts self, needy, helpless, frightened, anxious, victimized, fragile, excluded
- Angry Child: feels intensely angry, enraged, infuriated, frustrated, impatient because the core emotional (or physical) needs of the vulnerable child are not being met
- Detached Protector: detaches emotionally from people and rejects their help; feels withdrawn, spacey, distracted, disconnected, depersonalized, empty or bored; pursues distracting, self-soothing, or self-stimulating activities in a compulsive way or to excess
- Punitive Parent: feels that oneself or others deserves punishment or blame and often acts on these feelings by being blaming, punishing, or abusive towards self (e.g., self-mutilation) or others. This mode refers to the style with which rules are enforced rather than the nature of the rules.
Treatment
- Figure out what to treat first (if comorbidities eg PD if interpersonal factors are blocking rapport prior to depression)
DBT - Linehan
- DBT is an evidence-based cognitive behavioural treatment designed to treat long-standing patterns of emotional, cognitive, and behavioural dysregulation
- Aim to build
1 mindfulness
2 emotional regulation
3 distress tolerance capacities
4 interpersonal effectiveness
Schema-focussed Therapy
Mentalisation Based Therapy
CBT
