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Personality Disorder Flashcards

1
Q

Personality Disorder

A

Pattern of behaviour:

Chronic
* Early onset (childhood or adolescence)
* Stable and longstanding
* Pervasive across life areas

Identity
* Inflexible
* Deviate from cultural expectations
* Clinical distress or impaired functioning:
-Cognition
-Affect(emotions)
-Interpersonal functioning
-Impulse control

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2
Q

Personality Disorders Cluster

A

Cluster A
* Paranoid
* Schizoid
* Schizotypal
Characteristics: odd, eccentric, avoid social contact

Cluster B
* Antisocial
* Histrionic
* Borderline
* Narcissistic
Characteristics: dramatic, erratic, punitive, hostile

Cluster C
* Avoidant
* Dependent
* Obsessive-Compulsive
Characteristics: anxious, fearful

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3
Q

Personality Disorders: Cluster A

moder herritability

A

SchizotypalStrange (often magical) thinking; perception &
speech interferes with communication

  • SchizoidInability to form attachments (& no interest),content to be by themselves
  • ParanoidSuspicious, mistrustful, expect attacks(havent lost touch with reallity)
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4
Q

Personality Disorders: Cluster B

highly comobordility between each other

A
  • Borderline: Cluster BImpulsive; extreme emotional reactivity; drastic mood shifts; self-injury/suicide attempts
  • AntisocialDisregard and violation of others rights; serious violation of social norms; deceitful, manipulative; conduct disorder in childhood
  • HistrionicDramatic, attention-seeking (temper outbursts if can’t
    achieve); emphasis on attractiveness
  • NarcissisticGrandiosity; attention-seeking; lack of empathy; self-promoting
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5
Q

Personality Disorders: Cluster C

A
  • Obsessive-compulsiveExcessive concern with order, rules, and trivial details; rigidity; perfectionism; lack of warmth
  • DependentExtreme discomfort being alone; suppress own needs to keep relationships; indecision
  • AvoidantShy, hypersensitive to rejection, extreme social insecurity, self-conscious and self-critical
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6
Q

Prevalence

A

10–12% meet criteria for ≥1 personality disorder

  • Cluster A: ~4%
  • Cluster B: ~4%
  • Cluster C: ~7%
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7
Q

Difficulties in Studying PDs

A

Diagnostic issues

  • Criteria not sharply defined
  • Categories not mutually exclusive(a lot of diagnoses overlap)
  • Personality characteristics are dimensional(at what point do they count as a disorder?)
  • Lack of agreement on assessment measures
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8
Q

Personality Traits

5 Factor Model (OCEAN)

A
  1. Openness to experience: fantasy,asthetics,actions,ideas,values,feelings
  2. Conscientiousness
    confedence,self-decipline,order.achivement,striving
  3. Extraversion
    worthness,exciment seeking,positive emotion
  4. Agreeableness
    trust,tendermindness
  5. Neuroticism
    anger,anxiety,hostility,depression,vulvnerability
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9
Q

Personality Traits vs. Disorder

A

PDs = Extreme levels of typical traits?

Example: Antisocial PD

Negative affectivity
* High Neuroticism
Detachment
* Low Extraversion
Antagonism
* Low Agreeableness
Disinhibition
* Low Conscientiousness

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10
Q

Difficulties in Studying PDs

A

Limited studies on etiology

  • PDs only recognized as of DSM-III (1980) - dosnt have a lot of time looked into these disorders
  • High comorbidity of PDs
  • Retrospective approaches: asking to think back in time, if you have a skeed idea of who you are, you are going to be bias which can make harder to understand who you were truly
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11
Q

Controversies in Diagnosing PDs

A

Reliability – decent: multiple people will diagnose the same disorder

Stability – iffy: but overtime if u test them again (they get different results more often) - not stable overtime (treatment?)

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12
Q

Treatment

A

Difficult to treat

  • Varied goals
  • Patient’s belief in need to change
  • Patient response
  • Relationships hard to develop(betwen clients and therapist) - is hard for them to create relationships
  • Clinician motivation/patience
  • 37% drop out early!!!
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13
Q

Treatment

A

Very few studies

CBT/cognitive therapy sometimes effective

Techniques adapted based on disorder

Schizotypal
* Antipsychotic and/or antidepressant medication

Avoidant
* CBT and/or antidepressant medication

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14
Q

Borderline Personality Disorder (BPD)

A

Borderline Personality Disorder”
on the “borderline” between neurosis & psychosis

  • Impulsivity
    -Impulsive reaction to dysphoria(bad feelings) => self-injury,substance abuse

Affective/emotinal instability
-Rapid mood changes
(often mistaken for bipolar disorder)

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15
Q

BPD vs. Bipolar Disorder

A

Main differences

Baseline mood in BPD: dysthymia & emptiness** (+ anger & anxiety)**

Mood in BPD: highly responsive to environmental changes

Mood change in BPD: hours vs. weeks-months (bipolar disorder)

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16
Q

Symptoms of Dysregulation

A

Emotional
* High emotional reactivity
* Unstable mood (depression, anxiety, irritability, anger)

Interpersonal
* Fears of abandonment
* Unstable & intense relationships

Behavioral
* Extreme impulsivity
* NSSI, suicidal behaviour

Of the Self
* Feeling of emptiness
* Unstable sense of self
* Stress-related paranoia/dissociation

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17
Q

Course

A

Young adulthood
* Greatest impairment & suicide risk

30s & 40s
* Greater stability

≥ 50% diagnosed with BPD do not meet full criteria 10 years later(even without intervention)

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18
Q

Prevalence

A

1%-2% of population

High among psychiatric inpatients (20%)

Women = men

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19
Q

Comorbidity

A

Mood disorders (85%)(depression)

Anxiety disorders (83%)

Substance abuse (78%)

Eating disorders

PTSD

Other cluster B personality disorders

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20
Q

Etiology: Bio - Genes

A

Genes
Traits
* Neuroticism
* Impulsivity

  • 5x more common among 1st degree relatives
  • Relatives – impulse spectrum disorders
    (e.g., ASPD, substance abuse)
  • Twin studies – impulsivity & affective instability
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21
Q

Etiology/Presentation: Bio - Brain

A

Brain

  • Smaller Orbitofrontal volume
    Impulsivity, aggression, mood instability?
  • Smaller Hippocampal volume
    Stress overreactivity, higher fear responses?
  • Amygdala hyperactivity
    Affective lability?
  • Low/decresed 5-HT
    Impulsive behavior, disinhibition?
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22
Q

fMRI: Amygdala Hyperactivity

A

Amygdala hyperactivity:

  • Hypervigilance
  • Emotional dysregulation
  • Neutral = threatening!!!
  • sensitive to threta or anger
23
Q

Etiology/Presentation: Psycho

A

Emotion
* Perceived rejection => intense rage( rage is a big difference betweeb BPD and Depression)
* Misperception of anger

Cognition
* “Thinking mistakes”
Dichotomous (black & white) thinking,
catastrophizing, etc.

  • thinking mistakes as a result of fear of abandonment and rejection
24
Q

Etiology: Social

A

Invalidating environment

Early adverse events

  • Trauma/maltreatment
    90% childhood physical, sexual abuse, and/or neglect
  • Early separation or loss
  • Abnormal parenting
    -Abnormal bonding
    -Neglectful & overprotective
    -less family cohesion
    -expressed emotions
25
Child Maltreatment
Childhood physical abuse, sexual abuse, & neglect ** 7.95x risk for Cluster B PDs (esp. BPD) in adulthood**
26
**Diathesis-Stress!!!**
Biosocial theory: **Biological diathesis for emotional reactivity**(quick biological reaction/sensitive to the enviorment) **+** **Invalidating environment** Efforts to communicate inner experience disrespected or punished
27
**Invalidating Environment**
1. * Child suppresses emotions => explodes * Gets parents’ attention * Attention reinforces outburst 2. Dysregulated child difficult to manage 3. Parents ignore or punish emotionality 4. again child supress emotions > explodes * Gets parents’ attention * Attention reinforces outburst and it goes on and on
28
**Treatment: Bio**
**Comorbid mood disorders** * SSRIs * Mood stabilizers **Psychotic/dissociative symptoms** * Antipsychotics
29
Treatment: **Psycho**
**Dialectical behavior therapy (DBT)**(CBT) * Intensive * Expensive **Mentalization** * Client-therapist relationship * Perspective-taking **Transference-based psychodynamic psychotherapy** * Client-therapist relationship * Expensive * Takes years
30
**DBT**
**Acceptance + Change**
31
**DBT principles**
**Acceptence:** Individuals are doing the best they can, They want to improve **Change:** They need to do better, try harder, be more motivated to change Their lives are often unbearable as they are currently being lived They must learn new behaviours in many contexts
32
**DBT: Components**
**CBT (change)** **Validation (acceptance)** **Dialectics (finding the “middle” path)**
33
**DBT: Modes** | dbt includes skill groups
**Individual therapy** **Skills group** **Phone coaching** **Consultation group**(for cliniacians)
34
**DBT: Skills Training**
**Mindfulness**: develop awarness of emotions **Emotion regulation**: **Distress Tolerance**: ex impulsiveness, how to deal with an episode **Interpersonal effectiveness** ***Dialectics **
35
DBT: Skill Example **Radical acceptance**
Distressing situation  Acknowledge  Endure (it will pass)  Don’t give up/give in  Can work to change when it’s effective
36
**Antisocial Personality Disorder (ASPD)**
**Inadequate conscience development** **irresponsible and impulsive behaviour** **Ability to impress and exploit others**
37
**ASPD: Symptoms**
* **Disregard for & violation of the rights of others** * **Deceitfulness** * **Impulsivity** * **Aggressiveness** * **Reckless disregard for safety of self or others** * **Consistent irresponsibility** * **Lack of remorse**
38
Comorbidity
Substance abuse Other cluster B PDs
39
Prevalence
Community 3% **men** 1% women Prison 47% **men** 21% women **Younger adults** **Lower SES**
40
**Etiology: Bio**
**PFC dysfunction** * Poor executive control(planning,and ihabiting impulses) **Genes** * **Low MAOA** -Resulting in **low 5-HT** * Traits -Aggressiveness -Impulsivity -Low anxiety
41
**Etiology: Psychosocial**
Low income Low parental supervision Parent psychopathology Delinquent sibling/peers Neglect Abuse (physical or sexual) Harsh discipline
42
**Diathesis-Stress!**
low MAOA + severe childhood maltreatment = antisocial disorder
43
**Developmental Course**
**Strong Risk:** **ODD**(opositional defience disorder) **by age 6** => **CD**(conduct disorder) **by age 9** => **ASPD** (antisocial disorder) **ADHD + CD** (conduct disorder)=> **ASPD** (possibly psychopathy)
44
**Sociopathy ≠ Psychopathy**
Some overlap with ASPD * **ASPD is broader category** * More behavioural symptoms (criminality, etc.) **more behaviour** * **Psychopathy is narrow** * Personality structure **more drive**
45
Prevalence
Successful vs. unsuccessful * Ex: corporate vs. incarcerated
46
Dimensions
**Core** * **Interpersonal**(relationship) * Superficial charm, pathological lying * **Affective**(emotions) * Lack of remorse, guilt, empathy **Behaviour** * **Lifestyle** * Need for stimulation, impulsivity * **Antisocial** * Poor behavioural control, criminality
47
**Etiology: Bio**
**Genes** ~50% of variance **Callous/unemotional traits (heritable)** **Brain structure** **Amygdala volume*** **Brain function** **PFC dysfunction*** we are studying unsucessful psychopaths so their might have differences
48
**Etiology/Presentation: Psycho**
**Callous/unemotional traits!!** **Low levels of fear/poor conditioning of fear** * Cognitive encoding * Low physiological and emotional encoding **General emotional deficits** **High reward sensitivity** **Attentional directedness (tunnel vision)**
49
**Etiology: Social**
**Early parental loss** **Parental loss or rejection** **Callous/unemotional traits evoke negative parenting responses** * Anger * Frustration * Harsh discipline
50
Etiology: Sociocultural
**Socialized aggression differs**(how its expressed is different **Individualistic vs. collectivistic culture**
51
**ASPD vs. Psychopathy**
Developmental Risk Factors **ASPD** * Difficulty learning to regulate emotions * High emotional reactivity (aggressive, antisocial) in response to stress (more impulsive) **Psychopathy** * Fearlessness, low anxiety * Poor conscience * Premeditated aggression (less impulsive)
52
**Treatment**
**Punishment ineffective** Treatment is very difficult **Early intervention is CRITICAL** * Decompression treatment Principles of treatment * **Focus on social skills** => improves manipulation (rather than underlying lack of empathy, etc.) (esp true for group therapy) * **Better to work toward redirecting their skills toward prosocial goals**
53
**Decompression Treatment Study!!!**
**Participants** Adolescent violent offenders Low to moderate psychopathy scores **Intervention** **Interpersonal bond** (reduce antagonistic responses) Intense (several hours/day) Daily Typically >1 year 1:1 with therapist **Address underlying emotional issues** - no punishments, just no rewards if they didnt comply
54
Decompression Treatment Study
Outcome: Recidivism 2 years post-treatment Best predictor – length of treatment they were less likely to offend in the 2 yers after (not 0 but less!)

psyc 300 (15 decks)

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