Personality Disorder II Flashcards
1
Q
Antisocial PD Assumption and Causes
A
- Assumption: People act in a rational manner guided by logic, rules & social convention/mores
- So why does a subgroup of individuals engage in repeated behaviours that are:
- Carried out with scant regard for consequences
- Reflect an inability to delay gratification
- Apparently self-defeating (cause harm to themselves or to others)
- Irrational in that aversive outcomes outweigh reward?
2
Q
Aetiology of Antisocial PD
Constitutional Factors
A
- Causes not fully understood
-
Constitutional factors (neurobiological correlates) establishes predisposition with expression of antisocial variant determined by environmental & familial influences
- Externalising vulnerabilities: heritable broad trait-dispositional factor reflecting disinhibitory personality & risk-taking found in childhood conduct disorders, adult antisocial behaviour, and substance-use disorders
3
Q
Aetiology of Antisocial PD
Biological Factors
A
- Reduced levels of serotonin (impulsive behaviours)
- Low resting heart rate >> physiological hypo-arousal >> sensation seeking
- Neuropsychological deficits on frontal lobe executive functioning
- Weak behavioural inhibition & emotional reactivity (less responsive to threat & punishment)
- Evolutionary advantage(?)
4
Q
Aetiology of Antisocial PD
Psychosocial Factors
A
- Personality & temperament, shaped by environment & learned coping skills to deal with stress
- Social factors: childhood dysfunctional role modelling & interactions with family
- Peer group interactions: deviant sub-cultures - cause or effect?
5
Q
Antisocial PD: Treatment
A
- Literature reviews indicate inherent difficulties and ineffectiveness of psychological interventions (e.g., CBT, psychotherapy)
- Pharmacological agents to reduce aggressive impulsivity (lithium, serotonin selective reuptake inhibitors)
- Multifaceted interventions targeting impulsivity, aggression, addictive urges, and narcissistic traits required BUT outcomes not positive, particularly for the severe end of the spectrum (psychopathy)
6
Q
Aetiology of Borderline PD
Genetic Factors
A
Brain structure
- Threatening/aversive stimuli activate amygdala >> anterior cingulate >> prefrontal cortices
- Anterior cingulate: cognitive evaluation/processing of mood & affect regulation (implicated in response to conflicts)
- Prefrontal cortex: inhibition of impulsive aggression by regulating amygdala
Brain chemistry
- Serotonin regulates impulses, aggression & affect: linked to emotional instability, suicidal behaviours & impulsivity behaviours
- Low levels of serotonin impair control of destructive urges
7
Q
Aetiology of Borderline PD
Childhood complex traumas
A
- Emotional/sexual/physical childhood abuse implicated in aetiology >> developmental arrest
- BUT abuse alone neither necessary/sufficient
- Child-parent relationship mediating factors (unstable, non-nurturing, lack of parental empathy & invalidation of experiences) hinders/distorts development of secure attachments >> emotion dysregulation
- Exacerbated if family member is perpetrator
- Attachment theory: infants construct internalised concepts of self & others based on experiences
- Sense of security & self-worth enhanced by family members shapes personality traits
- Parental failure to teach child to label & regulate emotional arousal, tolerate emotional distress, and when to trust own emotional responses during distress
- In adulthood, individuals invalidate their own emotional experiences & depend on others for accurate reflections of external reality
8
Q
Primary characteristics manifestations of BPD psychopathology
A
- Emotional dysregulation
- Behavioural dysregulation
- Interpersonal dysfunction
9
Q
What does BPD treatment target?
A
IMPULSIVE
- Impulsive
- Moodiness
- Paranoia under stress
- Unstable self-image
- Labile & intense relationships
- Suicidality
- Inappropriate anger
- Vulnerability to abandonment
- Emptiness (sense of identity)
10
Q
Dialectical behaviour Therapy (DBT) for BPD
A
- Developed for Borderline PD by Marsha Lineham (1993)
- CBT-based intervention for chronically suicidal behaviours
- A bio-psycho-social model that builds on / modifies traditional behavioural approaches
11
Q
Goals of DBT
A
- CHANGING behaviours causing suffering whilst simultaneously
- ACCEPTING oneself and current situation/life circumstances
- to enhance behavioural, emotional thinking & interpersonal interactions
12
Q
4 modules of DBT
A
Each containing coping skills used to achieve specific goals:
- ACCEPTANCE skills
- Mindfulness
- Distress tolerance
- CHANGE skills
- Interpersonal effectiveness
- Emotion regulation
13
Q
DBT Mindfulness
A
- Observing/attending to events, emotions & behavioural responses even if distressing
- step back & allow experience with awareness rather than leave or terminate emotions
- Learning to apply verbal labels to behaviours and environmental events
- overcome tendency for literal reflection – “I feel unloved” interpreted literally as “I am unloved”
- Participating with attention as opposed to mindlessly engage in an activity
14
Q
DBT Distress tolerance
A
- Assumes ability to tolerate and accept distress is essential for mental health
- Skill is to accept non-judgmentally current situation
- Experience current emotional state without attempt to change it
- Observe own thoughts & actions without controlling or stopping these
- Acceptance of reality does not mean approval of reality
- distress is accepted but does not mean that it is not nevertheless still painful
15
Q
DBT Emotion regulation skills
A
- Difficulties in regulating pain emotions are central to behavioural reactions
- Assumption is that emotional distress is a secondary response to intense shame, anxiety or rage
- Skills in identifying and labelling affect. Observe & describe:
- Event triggering emotion
- Interpretation of event
- Phenomenonological experience (physical & emotional feelings)
- Behaviours associated with emotions
- After effects on functioning
