Personality Disorders Flashcards
Definition
Variations & exaggerations of ‘normal’ personality traits that “impair well-being and social functioning
Pervasive, inflexible and maladaptive.
General criteria
Moderate+ impairment. 1+ pathological trait.
Inflexible, across range of situations, stable across time.
Adolescence/early adulthood.
Not understood by developmental stage, environment or substance.
DSM
10 categories - 3 clusters, 7- 9 criteria for each.
3 ‘other’ categories.
Criteria A (personality functioning): Self-identity, Self-direction, Empathy, Intimacy.
Criteria B (pathological personality trait): Disinhibition, Antagonism, Detachment, Psychoticism, Negative affectivity.
Clusters
Cluster A (Odd/Eccentric) - Paranoid, Schizoid, Schizotypal Cluster C (anxious) - Dependent, Avoidant, OCD
Cluster B (dramatic/erratic)
Antisocial
Disregard others’ rights, not conform to law/ethics, callous, deceitful, irresponsible, manipulative.
Narcissistic
Variable/vulnerable self esteem, attempts at regulation through approval/admiration seeking, & overt or covert grandiosity.
Histrionic
Excessive emotionality & attention seeking, need to be centre of attention, self-dramatisation, exaggerated expression of emotion.
Borderline
Instability in self-image/emotions/personal goals/relationships, impulsivity, risk taking & hostility.
Dimensional model & DSM Section III
Continuum – everyone on spectrum rather than present/absent.
Section III model – traits on spectrum with 2 opposing poles.
Big Five/Five factor model of personality:
Negative affectivity vs emotional stability Detachment vs extraversion Antagonism vs agreeableness Disinhibition vs conscientiousness Psychoticism vs lucidity
Traits more stable than symptoms.
No one optimal diagnostic label.
More clinically useful than DSM-IV.
Difficulties with diagnosis
Classification - unreliable for treatment planning, measuring outcome but good for clinical communication/research.
Term suggests problem.
Caution when diagnosing children – still developing, labelling.
Culture – society values/sees as ‘healthy’
Comorbidity.
Dimensional view vs. discrete categories?
Dimensional view - too many models.
Diagnostic manual doesn’t include normal adaptive traits.
Dark Triad
Psychopathy- callous, anti-social nature
Machiavellianism – manipulative, calculating
Narcissism – inflated sense of self
People with these traits all around us – survival of fittest.
Causes
Stress-Vulnerability.
Early childhood learning experiences – neglect/abuse
Attachment theory.
Family – alcoholism, unemployment, family breakdown, violence.
Social factors – culture, anti-social peer group, social economic
Resilience factors - temperament, alternative environment, positive attachments.
Theories
Trauma key factor.
Sturrock & Mellor (2014):
BPD: emotional invalidation in relationships a maintaining factor.
Linehan (1993)
Biosocial Theory: children have biological vulnerability to experience intense emotions but emotions are invalidated.
Yalch & Levendosky, 2013
186 participants – invalidation in meaningful relationships = emotional dysregulation & poor distress tolerance.
Bowlby (1997)
Maternal deprivation/separation - traumatic & impacts on personality development/ functioning.
Loss generates responses linked to psychopathology.
Adults - ongoing disturbance from separations in early life.
Eysenck Three Factor System
Extraversion – outgoing, socialability, liveliness
Neuroticism – worries, anxiety, anger, lability of Mood
Psychoticism – aggressiveness, unconventional, impulsive, anti-social
High neuroticism more likely to experience psychiatric disorder
High extraversion & neuroticism – externalizing – personality disorder
Cloninger’s Biosocial Theory of Personality
3 brain systems:
Behavioural Activation – dopamine – tendency seek excitement, exhilaration.
Behavioural Inhibition – serotonin – inhibit behaviour, harm avoidance.
Behavioural Maintenance - norepinephrine - response to rewards/resistance.
Captures dimensions that in extremes = PD.
Assessment
Good psychometric properties.
Combination of assessments – self report, interviews, file information.
Purpose: establish treatment goals, focus therapeutic process, choose intervention and monitor change.
Case formulation
Supports person place experiences in a framework.
Help raise awareness of behaviours, thoughts and emotions.
Detailed understanding of the person.
Different approaches – CBT, CAT, Systemic.
Treatment
Pharmacotherapy – unstable mood
CBT - maladaptive cognitions/behaviours
DBT – CBT to personality disorder & dialects – skills training.
Schema Therapy – early maladaptive schemas (past)
Cognitive Analytic Therapy – Reciprocal Role Procedures
