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3.2 neuroclin 2 > personality disorders 2 - diagnostic clusters and treatments > Flashcards

personality disorders 2 - diagnostic clusters and treatments Flashcards

1
Q

cluster A of personality disorders (3)

A

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
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2
Q

cluster B of personality disorders (4)

A

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
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3
Q

cluster C of personality disorders (3)

A

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
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4
Q

issues with diagnostic clusters of PD

A

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

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5
Q

prevalence or incidence used for personality disorders

A

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

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6
Q

prevalence of PD
- men vs women
- 4 most common

A

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
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7
Q

comorbidity of PD

A

high rate of co-occurring PDs - may be not so distinct

comorbidity with:

  • depression
  • substance misuse
  • panic disorder
  • PTSD
  • social phobia
  • eating disorders
  • neurodiversity
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8
Q

aetiology of PDs

A

causes:

biological/neurological factors
environmental factors

specific PDs have differing aetiologies

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9
Q

factors underpinning cluster A PDs - all

A

biological / neurological :

  • genetics
  • enlarged ventricles
  • enhanced startle response
  • cognitive deficits

environmental :

  • parental relationships
  • rejection
  • abuse

lack of link to specific PDs in cluster A

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10
Q

factors underpinning cluster B PDs

overview of all

A

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?
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11
Q

factors underpinning cluster B PDs

apply to all

A

environmental :

  • experience driving schema development
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12
Q

factors underpinning cluster B PDs

narcissistic

A

environmental :

  • doting parents
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13
Q

factors underpinning cluster B PDs

borderline

A

biological / neurological :

  • genetics
  • limbic system dysfunction

environmental :

  • trauma/emotional invalidation
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14
Q

factors underpinning cluster B PDs

  • antisocial
A

biological / neurological :

  • childhood conduct disorder
  • genetics
  • low anxiety
  • weak fear conditioning

environmental :

  • modelling
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15
Q

factors underpinning cluster C PDs

overview of all

A

biological / neurological :
general:

  • physiological predisposition to anxiety

avoidant:

  • genetics

environmental :
general:

  • experience driving schema development

avoidant:

  • childhood negative experiences

dependent:

  • fear of rejection
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16
Q

factors underpinning cluster C PDs

dependent

A

environmental :

  • fear of rejection
17
Q

factors underpinning cluster C PDs

avoidant

A

biological / neurological :

  • genetics

environmental :

  • childhood negative experiences
18
Q

factors underpinning cluster C PDs

apply to all

A

biological / neurological :

  • physiological predisposition to anxiety

environmental :

  • experience driving schema development
19
Q

is personality disorder for life?

A

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
20
Q

treatment of PDs - 3 treatment options

A

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)
21
Q

DBT for PDs

A

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
22
Q

two treatment approaches for PDs

A

dialectal behaviour therapy (DBT)
schema therapy

23
Q

schema therapy for PDs

A

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

3.2 neuroclin 2 (12 decks)

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