personality disorders Flashcards
1
Q
why does experience matter?
A
- diversity of experience across individuals
–> beware of stereotypes - need to get away from stigmatising representations
–> dangerous
–> willful
–> self-obsessed - high prevalence of personality disorder diagnosis
2
Q
experiences of personality disorder
A
- multiple voices and perspectives in your head
- positive and negative personal attributions
3
Q
emotional and interpersonal sensitivity
A
- conditions and core beliefs
–> condition = what i do impacts people’s interpretations - core beliefs
–> regardless of what i do and say people with think of me in this way
–> unconditional - things can act as triggers to certain emotional responses
4
Q
interpersonal relationships and lack of trust
A
- linked to personality disorder
- high lack of trust
- less relationships
- those with fear of abandonment may cling onto current relationships regardless of the quality
- born out of past experiences and maintained by current behaviour
5
Q
diagnosis can be paradoxical
A
- some people feel written off after diagnosis (problem person with no chance of change)
- for some it can be a huge relief
–> recognises there is a problem - lack of clarity in diagnosis and treatment can be frustrating too
6
Q
how do we define personality?
A
- long term
- not mood
- collection of traits across multiple situations, contexts and time
- tendency towards patterns of behaviour, emotion, cognition and interaction that come through regardless of the situation we are in
–> trait not state
7
Q
influence of personality
A
- can have positive influence if it fits the demands of the world
- can be negative influence if it does not fit the world around us or its rules
8
Q
personality problems in context
A
- sometimes it doesn’t fit the context
- sometimes it doesn’t fit any context
- an aggressive nun and an anxious surgeon can both be problems due to the context
9
Q
socio-political perspectives of personality disorders
A
- a way of saying ‘that person is weird’?
- a way of saying ‘that person is not acceptable?
- a way of saying ‘that person is not within social bounds’?
- a way of saying ‘that person is not diagnosable, but it pretty close and will have an issue soon’?
10
Q
early definitions of borderline personality disorders
A
- early definitions were about being borderline psychotic
- not in an episode yet but might be soon so lets act now
–> behaviour as changed
11
Q
the medico-legal perspective
A
- are we entitled to jail/detain people on the basis of what we believe they might do?
- what if we do not and they go on to offend?
- levels of caution and politics can still get in the way
12
Q
categories vs dimensions
A
- personality varies along dimensions
- are personality disorders just clumps at either extreme end?
- or are those with a disorder those clumped at just one end
- efforts to define disorders used to assume that it was simple categories (DSM-IV)
–> but now a more mixed approach is used (DSM-5)
13
Q
DSM-IV definition of personality disorder (1994)
A
- An enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s culture
14
Q
DSM-5 definition of personality disorder (2013)
A
The essential features of a personality disorder are impairments in personality (self and interpersonal) functioning and the presence of pathological personality traits
15
Q
criteria for DSM-5 (2013) definition
A
- impairments in self or interpersonal functioning
- one or more pathological personality trait domains or trait facets
- stable across times and situations
- impairments are not better understood as normative for developmental stage or socio-cultural environment
- not directly due to substance or medication
16
Q
issues with DSM-5 (2013) personality disorder
A
- defining ‘significant’ and ‘normative’
- clinicians tend to use diagnosis regardless of substance use, nutrition issues, injury etc…
17
Q
similarities and differences between 1994 and 2013 definitions
A
- both have the same 10 personality disorders
- But DSM-5 included research proposals to allow for future potential change in diagnosis
–> level of personality functioning
–> personality trait domains and facets
–> personality disorder types
18
Q
alternative DSM-5 proposal for diagnosis
A
- look at personality functioning and the severity of impairment
- look at 5 different personality traits (negative and core) and rate them on a four-point dimensional scale
- the scores relate to personality types
- then the diagnosis of a personality disorder type is linked to the ratings on impairment and on personality traits
19
Q
the 5 trait domains in the DSM-5 alternative proposal
A
- negative affectivity
- detachment
- antagonism
- disinhibition
- psychoticism
20
Q
the 6 personality disorder types
A
- antisocial personality disorder
- avoidant personality disorder
- borderline personality disorder
- narcissistic personality disorder
- obsessive compulsive personality disorder
- schizotypal personality disorder
21
Q
justification for the proposed changes
A
- poor conceptualisation and low prevalence of diagnoses (paranoid, schizoid, histrionic and dependent)
- need for scores on measures of personality functioning
–> indicate the presence of a personality disorder - scores on specific personality traits/facets
–> e.g. detachment; disinhibition; antagonism
–> tells you which personality disorder you have
22
Q
summary of changes of DSM-4 to DSM-5
A
- DSM-5 maintains diagnostic criteria from DSM-4 and continues to define personality disorders on categorical basis
- but it discusses a dimensional approach to the diagnosis of personality disorders and encourages further research on these
23
Q
key issues in reaching diagnosis
A
- long-term presentations
- independent of biological factors
(e.g., drug use; starvation; actual threat) - usually do not diagnose in childhood and adolescence
- diagnoses cannot be made at a single clinical meeting
24
Q
the different personality disorder clusters
A
- cluster A
- cluster B
- cluster C
25
personality disorders in cluster A
- paranoid
- schiziod
- schizotypal
26
personality disorders in cluster B
- antisocial
- histrionic
- narcissistic
- borderline
27
personality disorders in cluster C
- avoidant
- obsessive-compulsive
- dependent
28
cluster A
- odd and eccentric
- personality disorders (PD) with some schizophrenia-like features
--> lacking active symptoms, such as hallucinations
- paranoid PD
--> pattern of distrust and suspiciousness
--> resistant to challenge by others
- schizoid PD
--> pattern of separation from social relationships
--> limited emotional expression and experience
- schizotypal PD
--> pattern of eccentric ideas, magical thinking
29
cluster B
- dramatic/erratic
- personality disorders characterised by impulsive/erratic and/or self-centred behaviours, emotions and thinking
- antisocial PD
--> pattern of disregard of other’s rights
--> strong links to conduct disorders and criminality
--> selfishness and lack of empathy
- borderline PD
--> pattern of unstable relationships, mood, and behaviour
--> efforts to control emotion (e.g., drink; self-harm) and avoid rejection
30
cluster B continued
- narcissistic PD
--> pattern of overestimation of own abilities and accomplishments
--> pervasive need for admiration, while not caring about others
--> anger when not recognised for their ‘specialness’
--> fragility of self-esteem
- histrionic PD
--> attention-seeking, need to be the centre of attention
--> dramatic behaviour, undue emotional expression
--> exaggerated presentation
31
cluster C
- personality disorders characterised by anxiety that is lifelong
--> not related to any trigger
- avoidant PD
--> pattern of social avoidance
--> inadequacy, and sensitivity to others’ views of them
- dependent PD
--> pattern of dependence on others’ care
--> submissive, clinging, seek others’ approval/support
- obsessive-compulsive PD
--> excessive perfectionism (focus on doing the task: forget the goal)
--> need for order, patterns and control
32
summary of diagnostic clusters
- three broad clusters with ten diagnoses:
1. odd/eccentric (A)
2. dramatic/erratic (B)
3. anxious/fearful (C)
- big overlap across clusters and diagnoses – it is rare for people to only meet one personality disorder criteria
- expected to identify which cluster a diagnosis belongs to but not the criteria for each personality disorder
33
prevalence
- focus on prevalence not incidence
--> no clear onset
- rate depends on how thorough the assessment is
--> many are weak and overestimate prevalence
--> gender bias in diagnosis?
- most reliable studies suggest rate of 10-15% for all personality disorders
--> most common = borderline, schizotypal, antisocial and obsessive-compulsive
- figure vary hugely
34
comorbidity
- high rate of co-occurring personality disorders
--> likely to meet criteria for more than one
35
mental health issues comorbid with personality disorders
- depression
- substance misuse
- panic disorder
- PTSD
- social phobia
- eating disorders
- neurodiversity
36
is personality disorder for life?
- old viewpoint
--> yes but the symptoms tend to fade after 40 years of age
--> untreatable
- new viewpoint
--> no as a large number of cases are not diagnosable a few years later
--> some treatments are efficient and helpful
37
aetiology framework
- biological/neurological factors
- personality disorder
--> specific personality disorders
- environmental factors
38
biological/neurological factors underpinning cluster A PDs
general factors:
- genetics
- enlarged ventricles
- enhanced startle response
- cognitive deficits
- lack of link to specific PDs
39
environmental factors underpinning cluster A PDs
general factors:
- parental relationships
- rejection
- abuse
40
biological/neurological factors underpinning cluster B PDs
1. antisocial PD
- childhood conduct disorder
- genetics
- low anxiety
- weak fear conditioning
2. borderline
- genetics
- limbic system dysfunction
41
environmental factors underpinning cluster B PDs
1. antisocial
- modelling
2. borderline
- trauma
- emotional invalidation
3. narcissistic
- doting parents?
4. general factors
- our experience drives schema development
42
biological/neurological factors underpinning cluster C PDs
1. avoidant
- genetics
2. general factors
- physiological predisposition to anxiety?
43
environmental factors underpinning cluster C PDs
1. avoidant
- childhood negative experiences
2. dependent
- fear of rejection
3. general factors
- our experience drives schema development
44
limited evidence for most disorders
- range of clinical suggestions about treatment
--> all evidence is psychological and not neurological
- Beck et al. (2016) provide a range of clinical guidance based on CBT
- some evidence for other, more integrative therapies
--> cognitive analytic therapy (Ryle)
--> mentalization-based treatment (Bateman)
45
the best 2 distinct treatment approaches
1. Dialectical behaviour therapy (Linehan, 1993)
2. Schema therapy (Arntz & van Genderen, 2009; Young, 2003)
46
Dialectical behaviour therapy (Linehan, 1993)
- behaviourally-based programme
- managing impulsive behaviours and thought processes in borderline PD
- elements of contingency management, operant conditioning, mindfulness etc...
- very resource intensive
- designed to manage symptoms effectively, but not to remove the cognitions
47
Schema therapy (Arntz & van Genderen, 2009; Young, 2003)
- addresses the cognitions that underpin the behaviours and emotions
--> core beliefs/schemas
- a lot of exploration of how those beliefs developed, and modification of the beliefs and emotions
--> very commonly related to long-term responses to trauma and experience of being parented inadequately
48
most common personality disorder?
borderline personality disorder
- field focuses on this type
49
summarise
- PDs are not well defined
- diagnoses still bein refined
- causes are more linked to developmental experiences than about neurological factors
- effective treatments for borderline PD
- limited understanding of factors underpinning PDs
