Personality Disorders Flashcards
1
Q
ABNORMAL: STATISTICALLY
A
- stat definition = ^ simplistic
- whatever is dif from normal = abnormal
- can be statistically determined how often something occur; abnormal when rare
2
Q
ABNORMAL: SOCIAL
A
- define abnormal according to society tolerance
- beh deemed socially acceptable = abnormal
- socially unacceptable in 1 society may be acceptable in another; reflects dif way of life/orientation
3
Q
ABNORMAL: EVALUATION
A
- stat/social approaches suffer from changing social/cultural norms over time/between cultures
- beh thought offensive/socially inappropriate in past = acceptable today (ie. homosexuality)
- stat definitions need further caution as “rare” NOT abnormal ie. ^ IQ = statistically rare; could be abnormal BUT desirable
4
Q
ABNORMAL: BROADER APPROACH
A
- given issues w/statistical/social approaches, broader approach = needed
- abnormal beh definition considers psych criteria + stat/social aspects ie:
- distress levels/functioning impairment/subjective feelings/emotional effect/thought patterns
5
Q
METHODS OF ASSESSING PERSONALITY DISORDERS: SCID
A
- Structured Clinical Interview (SCID); 3 versions BUT only SCID-5-PD (Personality Disorders) = applicable here
- used to diagnose PD categorically (present/absent)/dimensionally
- SCID-5-PD = updated SCID for DSM-5 Axis II PD (SCID-II); designed to assess 10 DSM-5 PDs across A/B/C Clusters
6
Q
METHODS OF ASSESSING PERSONALITY DISORDERS: CLINICAL ASSESSMENT
A
- clinical observations by qualified professionals
- may be corroborated by additional info from self-reported experiences/beh/peer observations
- self-report scales also used to diagnose PD:
1. Minnesota Multiphasic Personality Inventory (MMPI)
2. Personality Diagnostic Questionnaire (Revised PDQ-R) - ask whether people experience disorder signs
7
Q
TYPE VS TRAIT/DIMENSIONAL APPROACH
A
LIVESLEY ET AL (1998)
- diagnostic systems use disorder categories to describe people BUT evidence suggests dimensional approach to PD = ^ appropriate
8
Q
TYPE/CATEGORIAL APPROACH
A
- person diagnosed w/disorder or not
- qualitative break between people w/w/o PD
9
Q
TRAIT/DIMENSIONAL APPROACH
A
- each disorder viewed as continuum ranging from normality-severe disturbance
- people w/disorder dif in degree only from those w/o disorder
MOREY ET AL (2000) - diverse methodology range research supports it
TRULL & DURRETT (2005) - PD = one extreme; normal = same continuum
FLETT (2007) - PD = extremes of characteristics we already have OTHER THAN psychopathy (Skilling et al (2002))
10
Q
PERSONALITY DISORDER
A
- extreme/severe disturbance in overall character/behs of individual; affects various personality aspects
MALTLBT EY AL (2010) - always involves personal/social disruption; affects person & those around them
PARIS (2003) - disruption present over life; some symptoms develop in childhood
11
Q
PERSONALITY DISORDERS: CHARACTERISTICS
A
- early life onset; lifelong issue
- most reluctant to ask for/accept help
- challenging to therapist; unresponsive to input
- referred by family/friends/colleagues
- difficult to treat
12
Q
PSYCHOLOGICAL DISORDERS/MENTAL ILLNESS: CHARACTERISTICS
A
- clear start/onset
- clear recovery trajectory
- oft associated w/cause in environment (ie. bereavement/job loss)
- seek therapy; work w/therapist to recover
13
Q
PD VS PSYCH D
A
KENDELL (2002)
- distinction ^ challenged
- tenuous divide; overlap w/symptoms
- recent moves towards trait approach recognises PD lie on continuum/represent extreme common trait ends
- DSM-4 revised; DSM-5 recognises further research examining PD = continuous traits > absolute categories need
- hierarchical model/Axis 3 drives research > diagnosis
14
Q
LABELLING
A
- mentioning PD diagnosis = powerful effect on clinician’s views
- vital for PD concepts to refer to real entities
15
Q
APPLEBY (1988)
A
APPLEBY (1988)
- receiving PD label effect observed by psychiatrists
- 1/6 vignettes sent to 240 practicing psychiatrists
- 1 mentioned patient diagnosed w/PD
- rate patient against statement number
- large effect; judgements ALWAYS less favourable
16
Q
APPLEBY (1988): PD CLINCIAN’S VIEWS
A
- manipulate admission
- overdose for attention
- NOT suicide risk
- unwanted in doctors clinic
- annoying
- unlikely to improve
- NOT mentally ill; unlikely to warrant NHS time
- not suitable for anti-depressants
- unlikely to comply w/treatment
- in debt of own fault
- management problem
17
Q
APPLEBY (1988): RESULTS
A
- just mentioning PD diagnoses powerfully affects clinicians views
- pervasive PD nature/widely accepted belief in limited treatment effectiveness -> development/management emphasis > aetiology/treatment
18
Q
LABELLING & CRIME/JUSTICE
A
- stigma/discrimination resulting from PD/psych D diagnosis highlights evidence based diagnosis importance
- further highlighted as evidence suggests relationships between some PD/criminal beh
19
Q
CLASSIFICATION SYSTEMS: ICD-11
A
- 11th revised International Classification of Diseases and Related Health Problems adopted by 72nd World Health Assembly (2019)
- info effect January 2022; WHO may use ICD-10 until then
- PD section completely overhauled; just 1PD diagnosis based on severity
20
Q
CLASSIFICATION SYSTEMS: DSM-5
A
- Diagnostic/Statistical Manual of Mental Disorders (2013)
- taxonomic/diagnostic tool published by APA; used by mental health professionals in USA/UK
- 10 PD categories
- DSM-5 Alternative PD Model (AMPD) = further research trait model
21
Q
CLASSIFICATION SYSTEMS: DSM-5
A
- Diagnostic/Statistical Manual of Mental Disorders (2013)
- taxonomic/diagnostic tool published by APA; used by mental health professionals in USA/UK
- 10 PD categories
- DSM-5 Alternative PD Model (AMPD) = further research trait model
22
Q
ICD-11
A
- moving away from categorical typology approach > making primary PD classification 1/5 severity lvls
SEVERITY - 3 lvls: mild/moderate/severe PD
PROMINANT TRAIT QUALIFIER - negative affectivity/detachment/disinhibition/dissociality/anankastia (rigid perfectionism; emotional/beh constraint)
23
Q
DSM-5
A
- retains categorical approach w/10 PDs
- unaccepted revisions approved as alternative hybrid dimensional-categorical model; included Section III for further work
- using alternative methodology -> PD diagnosis based on individual’s particular personality functioning difficulties/pathological trait patterns
- hybrid retains 6 PD types each defined by specific impairment/trait pattern
24
Q
DSM-5: HYBRID
A
- Borderline PD
- Obsessive-Compulsive PD
- Avoidant PD
- Schizotypal PD
- Antisocial PD
- Narcissistic PD
25
DSM-5: PERSONALITY DISORDER-TRAIT SPECIFIED (PD-TS)
- part of hybrid approach
- PD present BUT specific criteria not met
- personality functioning impairment severity/problematic personality traits assessed
- attempts to address existing issues w/categorical approach; APA specifically encourages research supporting this model in patient diagnosis/cure/treatments/causes
26
ICD-11 VS DSM-5
- trait domains used as specifiers contributing to individual personality disturbance expression + overall severity classification
- specifiers inform clinical management of diagnosed patients incl. choosing intervention target
- both describe 4 trait domains (negative affectivity/detachment/antagonism/disinhibition)
- DSM-5 AMPD incl. separate psychoticism domain
- ICD-11 incl. separate anankastia domain
27
CLASSIFYING PD
DSM-5
- lists 250 dif disorders
- PD represent small possible psychopathologies detailed in DSM-5
- 10 dif PDs included/grouped in 3 clusters
- recognises considerable PD/psych D overlap
28
APA: PERSONALITY DISORDER
- enduring pattern of inner experience/beh that deviates markedly from cultural expectations of exhibiting individual
- DSM-5 detail several general/specific criteria
28
APA: PERSONALITY DISORDER
- enduring pattern of inner experience/beh that deviates markedly from cultural expectations of exhibiting individual
- DSM-5 detail several general/specific criteria
29
DSM-5: GENERAL CRITERIA
- deviation from expectations needs to manifest in at least 2 of following ways:
30
DSM-5: FIRST GENERAL CRITERIA
1. deviation from expectations needs to manifest in at least 2 of following ways:
COGNITIONS
- ie. thinking ways; perceiving/interpreting things/events/situations/people
AFFECT
- ie individual emotions
- may include emotional intensity/lability/appropriateness range
INTERPERSONAL FUNCTIONING
- how individual relates to/interacts w/others
IMPULSE CONTROL
- lack of control; need gratification
31
DSM-5: SECOND GENERAL CRITERIA
2. experience/beh patterns have to be:
- enduring/flexible/maladaptive/dysfunctional; constant across broad personal/social situation range (aka. not limited to a specific triggering)
- -> personal distress/clinically sig impairment to individual's personal/social/occupational life
- stable/present over long time periods; onset traced back to adolescence/early adulthood
- cannot be explained as manifestation/consequence of other mental disorder
- cannot be attributed to substance/medical condition physiological effects (ie. drugs/TBI)
32
DSM-5: 10 PERSONALITY DISORDERS
- grouped in 3 clusters; each shares common thread:
CLUSTER A (schizoid/schizotypical/paranoid)
- tendency to be odd/eccentric; most to do w/interaction w/others
CLUSTER B (antisocial/borderline/histrionic/narcissistic)
- dramatic/emotional/erratic
CLUSTER C (avoidanct/dependent/OCD)
- anxious/fearful
33
DSM-5: CLUSTER A
- schizotypal NOT = schizophrenia despite clear symptom/cause overlaps
- schizophrenia = clinical/psychological diagnosis; serious mental illness w/hallucinations/delusions/perceptual aberrations
- schizoid/schizotypal PDs show low nonpsychotic schizophrenia symptoms
- likely to possess genotype making them ^ vulnerable to schizophrenia
34
CLUSTER A: PARANOID PD
- extreme distrust/irrational suspicions of others
- 0.5-2.5% prevalence of general pop
- "get them before they get you"
35
CLUSTER A: PARANOID CRITERIA
- 4+ required for DSM-5 diagnosis:
1. suspicious others truing to exploit/deceive them
2. preoccupied w/unjustified doubts about trustworthiness of friends/family
3. pathological jealousy; recurring fidelity suspicions
4. reluctance to confide; concerned info used maliciously
5. misinterprets social events; innocent/benign remarks = threatening/demeaning
6. persistently holds grudges against people; rigid views; unforgiving to those who insulted/hurt them
7. hypersensitive; innocent comments = attacks
36
CLUSTER A: SCHIZOID PD
- restricted emotions
- detachment/disconnection/indifference to interpersonal/social relations pattern
- don't respond to social cues; may be inept/socially clumsy (1.7% general pop)
- "I hate being tied to others"
37
CLUSTER A: SCHIZOID CRITERIA
- 4+ required for diagnosis:
1. won't seek/enjoy close personal relations ie. family
2. nearly always choose solitary pursuits/jobs
3. little/no interest in sexual experiences
4. few/no close friends
5. indifferent to praise/critique of others
6. flattened emotions; cold; low/no attachment
38
CLUSTER A: SCHIZOTYPAL PD
- extreme discomfort w/close relations
- thinking/feeling/perception distortions
- sometimes eccentric beh (0.6% in general pop)
39
CLUSTER A: SCHIZOTYPAL CRITERIA
- 5+ required for diagnosis:
1. reference ideas aka. world revolves around them
2. magical thinking/odd beliefs (ie. clairvoyance/telepathy)
3. unusual perceptions/distortions/bodily experiences
4. odd thinking/speech (ie. confusing/abstract)
5. suspicious/paranoid world ideas
6. inappropriate/lacking emotional expression/close friends/relations
7. extreme social discomfort
8. general social anxiety via paranoia
40
CLUSTER B
- exhibit hostile interpersonal beliefs; others =
1. existing primarily to use/take advantage of (antisocial/borderline)
2. admirers for attention/adoration (narcissistic/histronic)
- psychopathy related to antisocial PD BUT not it
- only subset w/antisocial PD meet psychopathy crit
41
CLUSTER B: ANTISOCIAL PD
- general disregard of others
- little care for feelings/rights/happiness
- 0.7-3% general pop
- beh shown must NOT result from other disorder (ie. schizophrenia)
- "I'm different; laws don't apply to me"
42
CLUSTER B: ANTISOCIAL CRITERIA
- 3+ required for diagnosis:
1. failure to socially conform (ie. repeatedly breaking law)
2. repeatedly lying/conning for profit/pleasure
3. impulsivity/repeated failures to plan
4. irritability/aggressive beh (ie. repeatedly fighting)
5. reckless disregard for others safety
6. repeated irresponsible acts (ie. not holding job/financial obligations)
7. lack of remorse (indifferent to others' pain/hurt)
43
CLUSTER B: BORDERLINE PD
- instability in relations/beh/emotions/self-image
- 0.7-2% general pop
- "if you leave me I'll kill myself"
44
CLUSTER B: BORDERLINE CRITERIA
- 5+ required:
1. repeated suicidal beh/threats/self-harm/self-mutilating beh
2. abandonment fear
3. impulsivity in at least 2 damaging areas (ie. financial/sexual beh; substance abuse; reckless driving)
4. unstable/intense relations (ie. idealisation/devaluation)
5. disturbances in identity characterised by persistent unstable self-image
6. unstable emotions/feelings; marked mood/irritability/anxiety changes
7. persistent emptiness/worthlessness feelings
8. aggressiveness/difficulty in controlling anger (ie. frequent fight/tempers)
9. paranoia/delusions/dissociation under stress
45
CLUSTER B: HISTRIONIC PD
- attention seeking beh to be at attention centre
- overly dramatic mood swings
- excessive approval need
- "I'm so interesting/attractive; everyone likes me"
46
CLUSTER B: HISTRIONIC CRITERIA
- 5+ required for DSM-5 diagnosis:
1. excessive attention seeking (constant need to be at its centre)
2. sexually provocative/seductive interactions
3. excessive/exaggerated/changeable/lacking depth emotions
4. physical appearance used to draw attention
5. impressions > facts/rationale; shallow opinions dramatically expressed BUT v suggestible
6. over-dramatic about themselves
7. exaggerates personal relations intimacy
47
CLUSTER B: NARCISSISTIC PD
- strong need to be admired
- pervasive grandiosity pattern
- inflated self-importance
- lack of empathy
- ^ self-esteem BUT fragile w/criticism; rage when admiration = absent
- "I'm more important than you, I don't need to listen to you"
48
CLUSTER B: NARCISSISTIC CRITERIA
- 5+ required for DSM-5 diagnosis:
1. excessive admiration need
2. inflated self-importance/grandiosity
3. self = unique/special
4. prosperity/power/influence/adoration daydream preoccupation
5. strong entitlement sense
6. exploitative in intimate relations
7. lacks insight in others needs/feelings
8. envious/believes others are envious of them
9. superiority/arrogance tendency
49
CLUSTER C
- fear causes = rejection (avoidant)/being along (dependent)
BRENNAN & SHAVER (1998)
- PD symptoms links w/anxious/fearful/preoccupied attachment style
- beh patterns aimed at avoiding anxiety/fear
- certain beh patterns may solve certain issues BUT also create issues (ie. avoidant beh -> isolation/^ social situation fear)
50
CLUSTER C: AVOIDANT PD
- social inhibition/inadequacy
- criticism/judgement fear
- low self-esteem/shyness tendency
- avoid criticism situations
- 0.8% general pop
- "I wish you'd like me but I'm sure you don't as I'm so inept"
51
CLUSTER C: AVOIDANT CRITERIA
- 4+ required for DSM-5 diagnosis:
1. restricts personal/occupational activities to avoid criticism/negative appraisal
2. inadequacy/inferiority feelings in social situations/complete avoidance
3. rejection fear; inadequacy restrains new relations
4. new activity avoidance for criticism/embarrassment fear
5. preoccupied w/rejection/criticism fear in social situations
52
CLUSTER C: DEPENDENT PD
- pervasive psychological dependence on others
- lack of self-confidence; others take responsibility for major life aspects
- 1.5% pop affected
- "my worst nightmare is being abandoned/alone"
53
CLUSTER C: DEPENDENT CRITERIA
- 5+ required for DSM-5 diagnosis:
1. pervasive need to be cared for due; concerned about not doing it themselves
2. ^ difficulty making normal everyday decisions; seek out reassurance
3. needs others to take responsibility for major life areas
4. rare initiative/disagreement w/others for fear of losing support/approval
5. independent work = difficult
6. excessive lengths to gain others' support (ie. horrible tasks)
7. hates being along; preoccupied w/fears of it/not being able to cope
8. swiftly seeks other relation post break-up
54
CLUSTER C: OBSESSIVE COMPULSSIVE PD
- preoccupation w/order/perfectionism
- strong rule conformity/moral code
- 2% general pop
- "the only right way to do it is my way"
55
CLUSTER C: OCPD CRITERIA
- 4+ required for DSM-5 diagnosis:
1. detail/rule preoccupation overshadows task purpose
2. high perfectionism interferes w/task completion
3. excessive devotion to work leaves little personal/social life time
4. inflexible beliefs/values/morals
5. thing MUST be done the way they want them to
6. oft miserly w/money
7. rigid/stubborn attitudes/beh
56
CLUSTER C: OCPD IS NOT OCD
