Personality Disorder Flashcards
What is personality?
There is no universally agreed definition - behaviour is due to personality and situation
BPS - coherant and enduring features of individual + processes underlying these
View of self and others, attitudes/beliefs
Made up of traits which influences situations
Big 5
What is personality disorder?
Variations/exaggerations of normal personality attributes
Impairs wellbeing and social functioning
Not necessarily antisocial behaviour
Reduces effectiveness of usual treatments
What is ICD-11 definition of PD?
An enduring disturbance characterised by problems in functioning in aspects of the self and in interpersonal functioning
Self made up of identity, self-worth, accuracy of self-view, self-direction
What is the difference between ICD and DSM?
DSM is the American version
How were PD characterised in the past?
Diagnostic systems characterise them into a number of different types - borderline, emotionality personality disorder, narcissistic, avoidant etc
What are the problems with the way PD used to be characterised?
Few people fit neatly into one box - often characteristics of several and reliability of diagnosis is poor between different practitioners
In practise, only a few of the categories are used in clinical practise (borderline/emotionally unstable, antisocial and narcissistic)
What is a better way to categorise PD?
A dimensional model of degree of severity is more helpful (into different clusters) - also identifies different traits or domains which represent the more pathological end of the OCEAN personality factors
ICD identifies negative affectivity, detachment, disinhibition, dissociality and anankastia
What is borderline personality disorder / emotionally unstable PD?
Significant instability of interpersonal relationships, self-image and mood Impulsive behaviour Rapid fluctuations of mood Fear of abandonment and rejection Suicidal behaviour and self-harm Transient psychotic systems - voices Substantial impairment
What are the issues around diagnosing a PD?
Validity of diagnosis and classification systems - low reliability, not discrete categories
Atheoretical basis of diagnositic classification (no theory)
Overlap with over diagnosis - such as complex as PTSD
Hard to pick up in females
Stigma - bad person, negative views of themselves
What are the benefits of retaining concept of PD?
Pragmatism - success of doing it
Communication between staff - awareness of someone with BP is good
Choice of treatments with better outcomes - specialised treatment for them
Service development and research
Basis for internal conceptual framework for staff
Increasing use of term ‘complex emotional difficulties’ - people more likely to open up and feel less scared
How common is PD?
10% of general population
Higher prevalence in MH population
50-70% of adult prisoners
Similar incidence in men and women diagnosis of PD
Differences in which categories more frequently in men and women
Are females and males as likely to develop a PD?
Yes - similar incidence but there are differences in which categories they have
What are the causes of PD?
Combination of biological, psychological and social factors:
biology - variable heritability genetic difference impact resilience insecure early attachments emotional neglect biggest factor social and psychological dysfunction in family (parents who are substance users/domestic abuse) childhood trauma - complex
Stress vulnerability model - interaction between early vulnerability and stress
What is the attachment theory?
Developed by Bowbly, later developed by Ainsworth
Believes attachment is the universal human need to form close relationships to obtain protection - attachment involves a behavioural system triggered by need a fear, which is reciprocated by care-giving behaviour
If we have a secure attachment - learn world is safe and learn what our feelings are by our caregiver monitoring out feelings so we know world isn’t frightening
What are the types of attachment?
Either secure or insecure
3 types of insecure attachment: avoidant, ambivalent, disorganised
When do the types of insecure attachment develop?
Avoidant attachment develops when distress is ignored: child turns emotions in on itself and rejects carers
Ambivalent attachment develops when there are inconsistent responses: child becomes both resistant and over dependent
Disorganised attachment develops when there is a frightened/frightening caregiver: child experiences fear without solution and alternates between flight, freezing, fighting
Disorganised attachment particularly associated with later development of BPD
What are the models of disorganised attachment?
Attachment system triggered by fear
When feel stressed, activate attachment system so that they will seek proximity
but if the person they are seeking, is the one who causes problems and they aren’t attached too, will cause more stress and expose them to maltreatment - fear without solution
What are the models of therapy for BPD?
Mentalistion based therapy Dialectical behavioural therapy Schema based theory STEPPS programme Structured clinical management
What is metallisation based therapy (MBT)?
Developed in England
Based on attachment
Mentalisation - working out what is going on in your mind and the minds of others (mental states)
Understanding that behaviour arises from own mental states
Capacity to mentalists arises from attachment relationships - internalise representation of self from responses of attachment figues
What happens in disorganised attachments develop in MBT?
If disorganised attachment develops, capacity to mentalize fails to develop sufficiently and attachment system tigger too easily
In later life develop intense, dependent relationships
Difficulties with mentalization underlie all BDP features
How does MBT work?
Focus on promoting mentalization about the self, others and relationships
Aim to develop capacity even when in an emotional state
Attitude of curious enquiry
Collaborative approach
Emphasis on working to understand breakdowns in mentalization
Theraputic relationship focusses on keeping emotional arousal at optimum level
Delivered via weekly group and 1.1 therapy
What is dialectical behavioural therapy?
Developed in America
Incorporates CBT and Zen buddhist techniques
Views primary dysfunction as difficulty in emotional regulation
Biosocial model - biological factors interacting with invalidating early environment
What is taught in dialectical behavioural therapy?
Skills training to improve emotion regulation, distress tolerance and interpersonal functioning (CBT based)
Key skill taught is “Mindfulness” (Zen approach)
Mindfulness = open attention to current experience or present reality
Dialectics = balancing opposites e.g. acceptance and change
Delivered via weekly skills group and 1:1 therapy (18 months)
What is schema based therapy?
Comes from cognitive therapy tradition
Behaviours are expressed of underlying core belief/schema (people are going to leave me)
Schema is deep structure concerning beliefs about nature of self and others
PD involves early maladaptive schemas (EMS) - which provides templates for processing later experiences
Interfers with self-expression, autonomy, interpersonal relatedness, social validation, social integration
