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Clinical Psychology > Personality Disorders > Flashcards

Personality Disorders Flashcards

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1
Q

Personality Disorder (ICD-11 2018)

A
  • enduring disturbance characterised by issues w/functioning of:
    SELF
    INTERPERSONAL DYSFUNCTION
  • endures +2y
  • maladaptive patterns of inflexible/poorly regulated cognition/emotional experience or expression
  • manifests across social/personal situation range
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2
Q

PD: Associations

A
  • substantial distress

- significant family/social/educational/occupational function deficit

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3
Q

PD: “Explanation”

A
  • developmentally inappropriate (not only due to society/culture/medication/substance abuse)
  • unexplainable via other mental/behavioural disorders/NCS diseases
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4
Q

PD: The Self

A
  • identity
  • self-worth
  • self-view
  • self-direction
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5
Q

PD: Interpersonal Function

A
  • development ability
  • maintenance of satisfying relationships
  • alternative perspective understanding
  • conflict management
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6
Q

PD: Persistence

A
  • not episodic
  • ZANNARINI (2012); 93% remission (less acute symptoms/better psychosocial functioning) in borderline personality disorder at 16y follow up
  • MCMAIN (2012); most sufferers show persistent social functioning impairment despite therapy
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7
Q

PD: Diagnostic Systems

A
  • DSM-5 (APA)
  • ICD 11 (WHO)
  • categorical approaches include:
    CLUSTER A:
  • paranoid/schizoid/schizotypal
    CLUSTER B:
  • antisocial/borderline/histrionic/narcissistic
    CLUSTER C:
  • avoidant/dependent/obsessive-compulsive
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8
Q

PD: Diagnostic Systems (Criticisms)

A 
DMS-5 (APA):
- remains categorical
ICD 11 (WHO):
- dimensional
- diagnosis present (?)
- level of severity
- descriptive trait domains
- borderline pattern qualifier
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9
Q

PD: Diagnostic Systems (ICD-11 Severity)

A

MILD:
- disturbances affect some personality functioning; unapparent under some contexts
MODERATE:
- disturbances affect multiple personality functioning areas; some may be less relatively affected
SEVERE:
- severe disturbances in function of self (ie. unstable; no sense of identity OR excessive identity rigidity)
- self-view = self contempt/grandeur; highly eccentric

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10
Q

PD: Trait Domains

A

NEGATIVE AFFECTIVITY (our of proportion frequency/intensity)
DETACHMENT (social/emotional)
DISSOCIALITY (disregard for others feelings/empathy; self-centeredness)
DISINHIBITION (acting rashly w/o consideration of negative consequences)
ANANKASTIA (focus on rigid perfection standards/controlling self/others behaviour)

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11
Q

PD: Trait Domain Qualifiers/Features

A

NEGATIVE AFFECTIVITY = anxiety/anger/fear/vulnerability/shame/depression/guilt
DETACHMENT = reserved/aloof
DISSOCIALITY = self-centeredness/manipulation/deceit
DISINHIBITION = impulsivity/recklessness
ANANKASTIA = concern w/rules/norms; emotional/behavioural constraint

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12
Q

Borderline Personality Disorder

A
  • defined by pervasive pattern of interpersonal relationship/self-image instability
  • marked impulsivity
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13
Q

BPD: Qualifiers

A
  • hypersensitivity to real/imagined abandonment/rejection
  • pattern of unstable/intense interpersonal relationships characterised by alternating extremes/idealisation/devaluation
  • marked unstable identity (contempt/isolated)
  • recurrent self-harm episodes (ie. suicide attempts/mutilation)
  • emotional instability via mood reactivity triggered internally (ie. own thoughts)/externally resulting in hour/day long dysphoria
  • chronic “emptiness”
  • inappropriately intense/uncontrollable anger
  • transient dissociative/psychotic symptoms (ie. hallucinations/paranoia) during highly arousing events
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14
Q

PD: Why is it Important?

A
  • common (1-16% worldwide)
  • BJORKENSTAM (2015); presents w/significant morbidity/mortality; PD men die 18y early; PD women die 19y early; 8-10% suicide success
  • co-morbid conditions harder to treat
  • NEWTON-HOWES (2010); substantial health economic burden; cost frequent hospital attendance
  • treatable
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15
Q

PD: Distribution

A
  • 12% = community
  • 10-20% = primary care
  • +30% = secondary care
  • 60% = inpatient
  • +70% = prisons
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16
Q

PD: Co-Morbid Mental Health Issues

A
  • SKODOL et al (1999); 40% BPD w/depression (chronicity risk); 13% bipolar disorder
  • CRIMLISK et al (1998); 45% w/Mus Motor symptoms w/PD
  • SUBSTANCE ABUSE = 37% drug misusers; 53.2% alcohol misusers
  • EATING DISORDERS = bulimia nervosa w/BPD; anorexia nervosa w/OCPD
17
Q

Complex Trauma

A
  • HERMAN (1992)
  • chronic repetitive trauma w/PTSD symptoms; includes:
    DISSOCIATION
    SOMATISATION
    RE-VICTIMISATION
    AFFECT DYSREGULATION
    IDENTITY DYSRUPTIONS
18
Q

Complex PTSD (ICD-11)

A
  • re-experiencing the past
  • avoidance
  • excessive current threat
  • disturbances in self-organisation
  • affect dysregulation
  • negative self-concept
  • relationship disturbances
19
Q

CT: Adverse Childhood Experiences (ACE)

A 
- FELITTI et al (2002); USA; 17,000 pps; linked w/toxic stress response affecting child physical/mental health; 10 abuse categories (% = TSR):
PHYSICAL ABUSE (28%)
PARENTAL SUBSTANCE MISUSE (27%)
SEPERATION/DIVORCE (23%)
SEXUAL ABUSE (22% (28% women))
HOUSEHOLD MENTAL ILLNESS (17%)
EMOTIONAL NEGLECT (15%)
VIOLENT MOTHER (13%)
OVERT EMOTIONAL ABUSE (11%)
PHYSICAL NEGLECT (10%)
INCARCERATED RELATIVE (6%)
20
Q

BPD: Psychosocial Factors

A
  1. Parental separation/loss for at least 3 months in first 5 years
  2. History of mood disorder/substance abuse.
  3. Abnormal parenting attitudes (ie. low care w/high overprotection).
  4. Childhood trauma (high reported neglect).
21
Q

PD: Genes

A
  • little evidence of BPD/schizophrenia/mood disorder link

- SKOGLUND et al (2021); BPD heritability (degree of phenotype trait in pop via genetic variation) = 46%

22
Q

PD: Theoretical Models

A

ICD-11 ATHEORETICAL
COGNITIVE MODEL (LINEHAN (1993))
PSYCHOANALYTIC (KERNBERG (1975))
- excessive aggression + childhood adversity = splitting
ATTACHMENT THEORY (BOWLBY (1969))
- increased anxious-ambivalent/avoidant attachment in BPD

23
Q

PD: Medication Treatment

A
  • GUNDERSON (2018); issues of overmedication via treating symptoms rather than conditioning; limited effectiveness of mood stabilisers; used current clozapine
24
Q

PD: Psychosocial Treatment

A 
BPD NICE Guidelines (2009):
- poor evidence base for PD treatment
- best evidence in psychosocial BPD therapy programmes:
DIALECTICAL BEHAVIOUR THERAPY (DBT)
MENTALISATION-BASED THERAPY (MBT)
TRANSFERENCE FOCUSED THERAPY (TFT)
THERAPEUTIC COMMUNITY 
SCHEMA FOCUSED CBT
25
Q

PD-PT: DBT Biosocial BPD Theory

A 
- LINEHAN (1993): triad of:
EMOTIONAL VULNERABILITY (genes/biology)
- high sensitivity = immediate reactions/low emotional threshold
- high reactivity = extreme reactions/high arousal dysregulates cognition
- slow baseline return = long reactions/contributes high sensitivity via emotional stimulus
EMOTIONAL DYSREGULATION (maladaptive coping)
PERVASIVE INVALIDATION (sociobiography)
26
Q

PD-PT: Dialectical Behaviour Therapy

A 
- reduces:
SUICIDE ATTEMPTS/SELF-HARM
MEDICAL RISK
PREMMATURE DROP-OUT
INPATIENT DAYS
DRUG ABUSE
DEPRESSION/HOPELESSNESS/ANGER
- increases:
- GLOBAL/SOCIAL ADJUSTMENT
27
Q

PD-PT: Mentalisation-Based Therapy

A
  • SCHORE (2001); neurological basis of mentalisation in right hemisphere specialised for emotion/social cognition
  • ToM argues optimal development associates w/development of affect regulation associated w/VMPF cortex
  • ARNSTEN (1999); mentalisation linked w/arousal
  • BATEMAN & FONAGY (2004); reflective function/attachment; intergenerational transmission
  • mentalising/secure attachment go together w/care giver associated w/coherent child working model; richly imbued w/internal state representations
28
Q

PD-PT: Mentalisation-Based Therapy (Failures)

A

PSYCHIC EQUIVALENCE
TELEOLOGICAL STANCE
HYPERACTIVE MENTALISATION/PRETEND MODE

29
Q

PD-PT: Transference Focused Therapy

A
  • KERNBERG (2002); identifying dyads in positive/negative object representations:
    1. Tolerance.
    2. Define dominant object relations.
    3. Name the protagonists.
    4. Identify/interpret role reversal in dyad.
    5. Identify defensive links between dyads.
    6. Identify differences in the real relationship.

Clinical Psychology (11 decks)

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