personality disorders 2 - diagnostic clusters and treatments Flashcards
cluster A of personality disorders (3)
odd / eccentric
SZ type features but lacks active symptoms e.g. hallucinations
paranoid:
- distrust and suspiciousness
- resistant to challenge
schizoid
- pattern of separation from social relationships
- limited emotional expression and experience
schizotypal
- pattern of eccentric ideas, magical thinking
cluster B of personality disorders (4)
dramatic / erratic
impulsive/erratic and/or self-centred behaviours, emotions and thinking
antisocial
- pattern of disregard of other’s rights
- strong links to conduct disorders and criminality
- selfishness and lack of empathy
borderline
- ICD calls this one emotionally unstable PD
- pattern of unstable relationships, mood, and behaviour
- efforts to control emotion (e.g., drink; self-harm) and avoid rejection
narcissistic
- 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
- attention-seeking, need to be the centre of attention
- dramatic behaviour, undue emotional expression
- exaggerated presentation
cluster C of personality disorders (3)
anxious / fearful
lifelong anxiety personality disorders - not related to any trigger
avoidant
- pattern of social avoidance
- inadequacy, and sensitivity to others’ views of them
dependent
- pattern of dependence on others’ care
- submissive, clinging, seek others’ approval/support
obsessive-compulsive
- excessive perfectionism (focus on doing the task: forget the goal)
- need for order, patterns and control
issues with diagnostic clusters of PD
three broad clusters with ten diagnoses: odd/eccentric, dramatic/erratic and anxious/fearful
big overlap across clusters and diagnoses – it is rare for people to only meet one personality disorder criteria
prevalence or incidence used for personality disorders
prevalence
there is no clear onset so don’t use incidence (incidence = no. of newly diagnosed cases)
frequency within a population at a given time point = prevalence
prevalence of PD
- men vs women
- 4 most common
rate depends on how thorough the assessment is –> use of weak measure, overestimation of prevalence, gender bias
women more diagnosed with B/C, men more with A
doesn’t reflect necessarily experience - more bias from those diagnosing it
stereotypical female traits of anxiety, erratic
stereotypical male traits of being socially detached
10-15% for all PDs (from most reliable studies - these numbers vary loads depending on study)
most common:
- borderline
- schizotypal
- antisocial
- obsessive-compulsive
comorbidity of PD
high rate of co-occurring PDs - may be not so distinct
comorbidity with:
- depression
- substance misuse
- panic disorder
- PTSD
- social phobia
- eating disorders
- neurodiversity
aetiology of PDs
causes:
biological/neurological factors
environmental factors
specific PDs have differing aetiologies
factors underpinning cluster A PDs - all
biological / neurological :
- genetics
- enlarged ventricles
- enhanced startle response
- cognitive deficits
environmental :
- parental relationships
- rejection
- abuse
lack of link to specific PDs in cluster A
factors underpinning cluster B PDs
overview of all
biological / neurological :
antisocial:
- childhood conduct disorder
- genetics
- low anxiety
- weak fear conditioning
borderline:
- genetics
- limbic system dysfunction
environmental :
general:
- experience driving schema development
antisocial:
- modelling
borderline:
- trauma/emotional invalidation
narcissistic:
- doting parents?
factors underpinning cluster B PDs
apply to all
environmental :
- experience driving schema development
factors underpinning cluster B PDs
narcissistic
environmental :
- doting parents
factors underpinning cluster B PDs
borderline
biological / neurological :
- genetics
- limbic system dysfunction
environmental :
- trauma/emotional invalidation
factors underpinning cluster B PDs
- antisocial
biological / neurological :
- childhood conduct disorder
- genetics
- low anxiety
- weak fear conditioning
environmental :
- modelling
factors underpinning cluster C PDs
overview of all
biological / neurological :
general:
- physiological predisposition to anxiety
avoidant:
- genetics
environmental :
general:
- experience driving schema development
avoidant:
- childhood negative experiences
dependent:
- fear of rejection
factors underpinning cluster C PDs
dependent
environmental :
- fear of rejection
factors underpinning cluster C PDs
avoidant
biological / neurological :
- genetics
environmental :
- childhood negative experiences
factors underpinning cluster C PDs
apply to all
biological / neurological :
- physiological predisposition to anxiety
environmental :
- experience driving schema development
is personality disorder for life?
old view:
- yes - but symptoms tend to fade after 40 years of age
- untreatable
current evidence:
- no - many cases are not diagnosable a few years later
- some treatments are efficient and helpful
treatment of PDs - 3 treatment options
limited evidence for most PDs - most on borderline
clinical suggestions about treatment - all evidence for psychological interventions, not neurological
Beck et al (2016) –> clinical guidance based on CBT
some evidence for other more integrative therapies:
- cognitive analytic therapy (Ryle)
- mentalisation-based treatment (Bateman)
DBT for PDs
dialectal behaviour therapy (Linehan, 1993)
- behaviourally-based programme
- managing impulsive behaviours and thought processes in BPD
- elements of contingency management, operant conditioning, mindfulness, etc.
- very resource intensive
- designed to manage symptoms effectively, but not to remove the cognitions
two treatment approaches for PDs
dialectal behaviour therapy (DBT)
schema therapy
schema therapy for PDs
Arntz and 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
