personality disorders

Question 1

How are personality disorders represented in the DSM-4 and the DSM-5?

Answer 1

The DSM-4 used a multiaxial classification system, with clinical disorders on Axis I and the other anxis acting as ‘modifiers’ of these primary disorders. Personality disorders on Axis II. DSM-5 merged axes I-III into one axis and recognized personality disorders as treatable conditions deserving their own focus.

Question 2

What is the definition of personality disorders according to the DSM-4 and DSM-5?

Answer 2

Personality disorders are enduring patterns of experience and behavior that deviate from cultural expectations, are pervasive and inflexible, cause distress or impairment, and are not due to another disorder, drugs, or intoxication.

Question 3

Name and briefly describe the three clusters of personality disorders according to DSM-5.

Answer 3

The three clusters are Cluster A (Odd/Eccentric), Cluster B (Dramatic, Emotional, Erratic), and Cluster C (Anxious or Fearful).

Question 4

Outline the personality disorders associated with the personality disorder clusters in the DSM-5.

Answer 4

Cluster A (Odd/Eccentric)
Paranoia
Schizoid
Schizotypal
Cluster B (Dramatic, Emotional, Erratic)
Antisocial
BPD
Narcissism
Histrionic
Cluster C (Anxious or Fearful)
Avoidant
Dependent
Obsessive-compulsive

Question 5

What are the issues with the personality disorder clusters in the DSM-5/

Answer 5

Lofti et al – the commonness of this co-occurance (within or between categories) may question the utility of these categories

Question 6

What are some characteristics of Paranoid Personality Disorder? (A)

Answer 6

Paranoid Personality Disorder: Characterized by pervasive distrust and suspicion of others, hold grudges

Question 7

What are some characteristics of Schizoid Personality Disorder? (A)

Answer 7

Individuals with Schizoid PD exhibit extreme preference for solitude, detachment from interpersonal relationships, emotional coldness, and indifference to criticism or praise from others.

Question 8

What are some characteristics of Schizotypal Personality Disorder? (A)

Answer 8

Similar to positive symptoms of Sz
Schizotypal Personality Disorder: Characterized by acute discomfort in close relationships, cognitive or perceptual distortions, and eccentric behavior.

Question 9

What are some characteristics of Histrionic PD? (B)

Answer 9

Excessive need for approval , need to be centre of attention
Shallow/over-dramatic emotions, view relationships as a lot more intimate than they are

Question 10

Describe some features of Borderline Personality Disorder (B).

Answer 10

Borderline Personality Disorder: Characterized by instability in interpersonal relationships, self-image, and affects, and marked impulsivity.

Question 11

What are some characteristics of Obsessive-Compulsive PD? Why is it different from OCD?

Answer 11

Preoccupation with orderliness, rules, moral codes, caution and perfectionism, overly devoted to work and conscientiousness and inflexibility
This is not the same as OCD – they may be similar and may co-occur it’s important to recognise them as different, distinct disorders

Question 12

What is the continuity hypothesis regarding personality disorders?

Answer 12

The continuity hypothesis posits that there is no discontinuity between normality and illness, suggesting that personality disorders represent extreme variations of normal personality traits.

Question 13

How did Saulsman and Page contribute to understanding the relationship between Big 5 traits and personality disorders?

Answer 13

Saulsman and Page conducted a meta-analysis of 12 studies exploring correlations between Big 5 traits and personality disorders. They found some correlations but emphasized the need for further research into the facets of each trait.

Question 14

What is the Big 5 Profile Approach in understanding personality disorders?

Answer 14

The Big 5 Profile Approach involves creating symptom profiles for each disorder by breaking down personality traits into facets and determining their association with specific personality disorders.
They indicate risk and not a diagnosis.

Question 15

What research did McCrae et al conduct on the classification system of personality disorder? What was concluded?

Answer 15

McCrae et al. obtained scored on Big-5 using questionnaires an calculated the answers’ ‘profile agreement’
Low levels of correlations between profile maps and ppt scores on tests = flaws in current classification: criticized the extensive comorbidity, low reliability, and not based on empirical personality models

Question 16

What does Section III (emerging measures and models) of the DSM-5 entail regarding personality disorders?

Answer 16

Section III includes measures of severity and style in diagnosing personality disorders.
Criterion A: severity
significant impairments in functioning of self (identity or self-direction) and interpersonal (empathy or intimacy)
Criterion B: Style
one or more pathological traits from the maladaptive trait model

Question 17

How is dissociative identity (‘multiple personality’) disorder defined in the DSM-5.

Answer 17

A mental disorder defined by the presence of two or more distinct identities or personalities. People may also experience, amnesia for prior events. To meet diagnostic criteria, must cause distress and impairment of function and not due to substance abuse, cultural practices or just imaginary friends.

Question 18

What are some of the characteristics of dissociative identity disorder?

Answer 18

Primary ‘host’ personality (usually sad or dependent on others) plus one or more alters.
Alters take turns to control behaviour.
Each alter have distinctive patterns of thinking and behaving.
Different names, ages, genders etc.
Memory loss for experiences for when one of the alters is in control
Patients often associated with ACEs, suggestibility and clustered geographically

Question 19

Describe the Post-Traumatic Model of Dissociative Identity Disorder (DID).

Answer 19

The Post-Traumatic Model suggests that DID is a primitive response to trauma, where dissociation serves as a protective mechanism to escape initial trauma and subsequently becomes a response mechanism for future stress.
Suggestibility = more likely to use this mechanism and disassociate

Question 20

What is the Socio-Cognitive Model of DID, and how does it explain the disorder’s symptoms?

Answer 20

The Socio-Cognitive Model suggests that DID symptoms emerge as a product of therapy, where mechanisms such as hypnosis and leading questions cause patients to reinterpret experiences, often as multiple personalities.
Suggestibility = increases susceptibility to interpret their experiences in this way

Question 21

Outline two pieces of evidence for the Socio-Cognitive Model of DID?

Answer 21

Spanos - could induce beliefs of other identities in healthy individuals
Paris - Transcripts of Sybil’s (The woman who had 16 personalities) show that the belief of multiple personalities was pushed on her

Question 22

Outline Costa and McCrae’s proposed 4-Step System.

Answer 22

Dimensional approach
(1) Assess personality facet profile (NEO-PI-R)
(2) Assess personality-related social/occupational impairments and distress
(3) If dysfunction & distress clinically significant – diagnose PD
(4) Determine if the profile matches with PD category descriptor (this final step may not be necessary as the profile associated with diagnosed PD may be enough)

Question 23

Following McCrae’s suggestions, how did the DSM-5 update its classification of personality disorders?

Answer 23

Retained categorical approach - 10 PD across clusters.
Added Section III - Emerging Measures and Models
Measures severity (significant self and interpersonal impairments) and style (measured using MTM, not Big 5 assessment to measure specific extreme traits/facets)
Section III as 6 of the PD categories and an ‘PD - Trait Specified’ section.

Question 24

What are the 6 PD categories included in the DSM-5 section III?

Answer 24

Borderline
Obsessive-Compulsive PD
Avoidant PD
Schizotypal PD
Antisocial PD
Narcissistic
(NB - extra category added, and these were chosen due to empirical robustness)