Personality disorders Flashcards
what is the DSM-5 general definition of a personality disorder?
An enduring pattern of inner experience and behaviour that deviates markedly from the expectations of the individual’s culture, is pervasive and inflexible, has an onset in adolescence or in early adulthood, is stable over time, and leads to impairment
what are the DSM-5 General Diagnostic Criteria for Personality Disorders?
- The pattern of inner experience is manifested via two of more of: (1) cognitions, (2) affectivity, (3) interpersonal functioning and (4) impulse control
- is inflexible and pervasive across personal and social contexts
- leads to clinically significant distress or impairment in social, occupational or other areas
- is stable and can be traced back to adolescence or earlier
- is not better accounted for by another mental disorder
- is not due to physiological effects of substance or general medical condition
what is the mnemonic for personality disorders?
P - persisting
I- Inflexible
M - Maladaptive
S - Significant impairment or distress
what are the two classifications of PDs?
- categorical classification
- Dimensional classification
what is categorical classification of a PD?
- presence or absence of a PD
- PDs are qualitatively distinct from each other, and form normal personality
- no assumptions are made about the underlying dimensions or structure of PDs
what are the characteristics of dimensional classification?
- personality manifests on continuous dimensions of traits
- PDs are quantitively distinct from normal personality
- PDs manifest as extreme and maladaptive levels of personality traits
what are cluster A personality disorder?
characterised by eccentric and odd behaviour
- paranoid
- schizoid
- schizotypal
What are cluster B disorders?
characterised by erratic and emotional behaviours
- antisocial
- borderline
- histrionic
- narcissistic
what are cluster C disorders?
characterised by fearful and anxious behaviours
- avoidant
- dependent
- obsessive-compulsive
How would you diagnose Paranoid personality disorder?
Cluster A disorder. Distrust and suspicion of others across contexts and without basis
Must show 4 or more:
1. Suspects others of harming, plotting or deceiving.
2. Doubts trustworthiness of friends.
3. Suspects infidelity in relationships.
4. Reluctant to confide in others.
5. Reads hidden meaning into. remarks.
6. Bears grudges and does not forgive.
7. Perceives attacks and reacts quickly with anger.
How would you diagnose Schizoid personality disorder?
cluster A disorder: Detachment from relationships and restricted emotional expression.
Must show 4 or more:
1. Does not seek or enjoy relationships.
2. Little interest in sexual relationships.
3. Prefers solitary activities.
4. Enjoys very few activities.
5. Lacks close confidants.
6. Indifference to praise or criticism.
7. Emotional coldness, detachment and flattened affect.
How would you diagnose Schizotypal personality disorder?
Cluster A: Pervasive discomfort with relationships. Eccentric behaviour and cognitive or perceptual distortions.
Must show 5 or more:
1. Odd beliefs, outside norms.
2. Odd thinking and speech patterns.
3. Perceptual illusions.
4. Odd or incorrect interpretations of events.
5. Peculiar behaviour.
6. Suspicious or paranoid.
7. Lack of confidants.
8. Social anxiety that does not lessen with familiarity with others.
9. Inappropriate or constricted affect.
How would you diagnose antisocial personality disorder?
Cluster B disorder: Persuasive disregard of the rights of others since or before 15 years of age.
Must show 3 or more:
1. Lack of conformity to social norms.
2. Lying, deceiving others for profit or pleasure.
3. Impulsivity.
4. Irresponsibility and failure to maintain obligations.
5. Irritability and aggressiveness.
6. Reckless disregard for safety of self and others.
7. Lack of remorse.
how would you diagnose histrionic personality disorder?
cluster B disorder. Persuasive and excessive emotionality and attention seeking behaviours.
Must show 5 or more:
1. Uncomfortable if not centre of attention.
2. Interactions often inappropriately sexual or provocative.
3. Rapidly shifting and shallow emotional expression.
4. Gains attention through physical appearance.
5. Speech is impressionistic and lacking in detail.
6. Self-dramatization, theatrical expression of emotion.
7. Suggestable.
8. Considers relationships more intimate than they are.
How do you diagnose Borderline personality disorder?
Cluster B disorder: Pervasive instability of inter-personal relationships, self-image, and affect. Marked impulsivity.
Must show 5 or more:
1. Frantic efforts to avoid abandonment (real or imagined).
2. Extreme idealization and devaluation in relationships.
3. Identity disturbance.
4. Impulsivity in at least two areas – sex, spending, drinking.
5. Recurrent suicidal gestures and/or self-harm.
6. Persistent feelings of emptiness.
7. (Short lived) reactivity in mood.
8. Inappropriate anger.
9. Transient, stress-related paranoia or severe dissociative symptoms.
How would you diagnose Narcissistic personality disorder?
cluster B disorder. Grandiosity, need for admiration and lack of empathy
Must show 5 or more:
1. Grandiosity (without commensurate achievements).
2. Preoccupied with fantasies of power or success.
3. Requires excessive admiration.
4. So gifted, few people can understand them.
5. Arrogance.
6. Sense of entitlement.
7. Interpersonally exploitative.
8. Lacks empathy.
9. Envious of others, and believes others envy them.
how would you diagnose Avoidant personality disorder?
Cluster C disorder. Persuasive social inhibition, inadequacy, and hypersensitivity to negative evaluation.
Must show 4 or more:
1. Avoids interpersonal contact due to fear of rejection or disapproval.
2. Only involved with people where certain to be liked.
3. Restraint in relationship to avoid ridicule.
4. Preoccupation with social rejection.
5. Reluctant to take socials due to fear of failure or embarrassment.
6. Views self as socially inept.
How would you diagnose dependent personality disorder?
cluster C disorder. Persuasive need to be taken care of. Submissive and clingy behaviour.
Must show 5 or more:
1. Difficulty making everyday decisions without advice or reassurance.
2. Needs other to take responsibility.
3. Difficulty expressing disagreement due to fear of loss.
4. Difficulty initiating projects.
5. Goes to great lengths to gain support and nurturance.
6. Uncomfortable when alone.
7. Immediately seeks new relationship when one ends.
8. Preoccupied with fears of being left to care for oneself.
how would you diagnose Obsessive-compulsive personality disorder?
Pervasive pre-occupation with order, perfection and control at the cost of flexibility.
Must show 4 or more:
1. Preoccupied with details, rules, lists.
2. Perfectionism hinders completion.
3. Devoted to work at expense of leisure and relationships.
4. Inflexible about morals/ethics.
5. Rigidity and stubbornness.
6. Reluctant to delegate unless others follow exact instructions.
7. Unable to discard items (even with no value).
8. Misery form of spending on self and others.
challenges with categorical classifications - Hopwood et al. (2018) Commentary: The time has come for dimensional personality disorder diagnosis
- No evidence supporting presence of 10 discrete PD categories DSM-V tells you there is
- Diagnostic comorbidity between 10 PD categories. - if you have 1 PD you often have 2 or 3, if these are distinct categories how can individuals have multiple
- Within-disorder heterogeneity. - qualitative experience in symptoms differs
- Few validated interventions for the 10 distinct PD categories.
- Categorical approach lacks evidence base when compared to trait approach.
issues of comorbidity in PD classification, Marinangeli et al. (2000)
- 156 participants (90 women) voluntarily admitted to a psychiatric ward for many interviews
- Semi-structured clinical interview (SCID-II) for PD classification based on DSM-3 criteria.
- found huge percentage of people with multiple diagnosis
How is the five factor model associated with personality disorders?
Psychoticism also considered a dimensional personality trait
(Eysenck, 1952)
Meta-analysis on relationship between FFM and PD, Samule and Widiger (2008)
- To be included, studies had to measure all thirty facets of the FFM + all 10 DSM categorical personality disorders.
- In total, 16 studies were included, comprising 18 independent samples and 3207 participants.
- found that they aren’t distinct fro eachother
- clusters have a relationship
- however not always a lot to distinguish each disorder
Dimensional approach to PDs with 5 traits, Widiger & Simonsen (2005)
- Reviewed 18 proposals that could update DSM-3 with a dimensional approach to PD classification.
- Proposals can be integrated into a hierarchical structure of maladaptive personality traits
- Theoretically proposed 5 broad traits
- Extraversion – Introversion
- Antagonism – Compliance
- Constraint – Impulsivity
- Negative Affect – Emotional Stability
- Unconventionality – Closed to Experience
