Personality Disorders Flashcards
Personality
- Enduring features of individuals that determine how they respond to life events and experiences
- Ways of expressing emotion
- Patterns of thinking about ourselves and others
- How a person copes with life events
- A person’s ability to adapt to situations
When is personality considered to be disordered?
- Brings a person into conflict with others
- Prevents a person from initiating or maintaining personal relationships
- Limits a person’s ability to adapt to new situations
- Causes personal distress
- Causes other people distress and hardship
- Maladaptive consequences
- Impairs functioning
Associated Features of PDs
- Unusual ways of interpreting events
- Unpredictable mood swings
- Poor or unstable self-image
- Ego-Syntonic (rather than Ego-Dystonic)
- The person is not distressed by their symptoms and they do not view their behaviour as pathological
- They don’t associate their own difficulties with their inflexible ways of thinking and behaving
- They often view other people as the source of their problems
Categorical Approach to Diagnosing PDs
- PDs seen as discrete disorders (either has it or doesn’t)
- personality traits must be inflexible, maladaptive, cause significant impairment or distress
- must meet criteria for a general personality disorder AND for a specific personality disorder
General Personality Disorder DSM V
A
A. An enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s culture. This pattern is manifested in two (or more) of the following areas:
- Cognition (i.e., ways of perceiving and interpreting self, other people, and events)
- Affectivity (i.e., the range, intensity, lability, and appropriateness of emotional response)
- Interpersonal functioning
- Impulse control
GAD
B
The enduring pattern is inflexible and pervasive across a broad range of personal and social situations.
GAD
C
The enduring pattern leads to clinically significant distress or impairment in social, occupational, or other important areas of functioning.
GAD
D
The pattern is stable and of long duration, and its onset can be traced back at least to adolescence or early adulthood.
GAD
E
The enduring pattern is not better explained as a manifestation or consequence of another mental disorder.
GAD
F
The enduring pattern is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., head trauma).
three clusters of PDs
- odd/eccentric
- dramatic/emotional
- anxious/ fearful
Cluster A- odd/ eccentric
- Paranoid Personality Disorder
- Schizoid Personality Disorder
- Schizotypal Persoanlity Disorder
Cluster B - Dramatic/emotional
- Antisocial Personality Disorder
- Borderline PD
- Narcissistic PD
- Histrionic PD
Cluster C- Anxious/Fearful
- Avoidant PD
- Dependent PD
- OCPD
General goals of treatment
- Acquire life skills
- Learn emotional control strategies
- Acquire the skill of mentalisation
Psychodynamic and Insight approaches
- aim to explore and resolve developmental experiences related to problematic relationships with parents, childhood abuse and neglect
CBT
aims to identify and change the person’s dysfunctional schemas and problematic behaviours
Several factors make PDs difficult to treat
- The ego-syntonic nature of the PDs
- Often don’t seek treatment
- Often drop out of therapy prematurely (37%)
- High rates of comorbidity with other disorders
- Ingrained behaviour styles are likely to continue to cause life difficulties and trigger symptoms of other disorders
- Some of the features of PDs make it difficult to treat e.g. difficulty forming trusting relationships, manipulative, suspicious, difficulty regulating emotions
Criticisms of the categorical approach
- Many argue that PDs are not discrete disorders
- PDs may simply represent extreme cases on conventional personality dimensions
- Characteristics of the different PDs overlap
- People exhibiting a wide range of behaviour meet the criteria for the same PD
- Some people meet the criteria for more than one PD
- PDs may not be as stable over time as DSM-5 implies
- Several PDs are rare and may not represent useful independent disorder categories (Histrionic PD and Dependent PD)
DSM-5’s Alternative Model
- Proposed as a basis for future research
- Dimensional approach to the diagnosis of PDs
- Reduces the number of PDs from 10 to 6
- 3 discrete types of personality ratings that contribute to a diagnosis:
- Level of personality functioning
- Personality trait and domain facets
- Personality disorder types
Schizotypal PD- development and course
- Apparent in childhood and adolescence – solitary, poor peer relationships, social anxiety, underachievement, hypersensitivity, prone to peculiar thoughts and language, bizarre fantasies
- Appears ‘odd’ or ‘eccentric’ and attracts teasing
Schizotypal PD- prevalence
0.6% to 4.6%
More commonly diagnosed in males
Schizotypal PD DSM V
Pervasive pattern of social and interpersonal deficits marked by acute discomfort with, and reduced capacity for, close relationships as well as by cognitive or perceptual distortions and eccentricities of behavior, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:
Schizotypal PD syptoms
- Ideas of reference
- Odd beliefs or magical thinking that influences behavior and is inconsistent with subcultural norms
- Unusual perceptual experiences, including bodily illusions
- Odd thinking and speech
- Suspiciousness or paranoid ideation
- Inappropriate or constricted affect
- Behavior or appearance that is odd, eccentric, or peculiar
- Lack of close friends or confidants other than first-degree relatives
- Excessive social anxiety that does not diminish with familiarity (associated with paranoid fears not negative self-judgments
Genetic factors of Schizotypal PD
- Increased risk if a relative has schizophrenia
- Adoption studies support these findings
Brain abnormalities of Schizotypal PD
- Resemble those found in schizophrenia
- Abnormalities in frontal lobe and temporal lobe activation
- Enlarged ventricles
Physiological Abnormalities
of Schizotypal PD
- Impairment of smooth pursuit of eye movements
- Inability to inhibit the startle response to weak stimuli
Cognitive and Executive Functioning Deficits
of Schizotypal PD
- Impaired working memory, episodic memory and spatial attention
- Reduced verbal IQ
Drug Treatments of Schizotypal PD
- Antipsychotic drugs used to reduce the symptoms exhibited by the individual
- This treatment is used to treat all of the Cluster A personality disorders
Psychodynamic and Insight-Oriented Therapies for Schizotypal PD
- Clients do not respond well to insight-oriented therapies
- May not see themselves as having a psychological problem
- Very uncomfortable with close relationships
- A supportive educational approach focused on fostering basic social skills may be beneficial if the treatment goals are modest
- No controlled studies of psychological treatments with schizotypal personality disorder
Paranoid PD DSM 5
A pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) symptoms
Paranoid PD DSM 5 symptoms
- Suspects, without sufficient basis, that others are exploiting, harming, or deceiving him or her.
- Is preoccupied with unjustified doubts about the loyalty or trustworthiness of friends or associates.
- Is reluctant to confide in others because of unwarranted fear that the information will be used maliciously against him or her.
- Reads hidden demeaning or threatening meanings into benign remarks or events.
- Persistently bears grudges (i.e., is unforgiving of insults, injuries, or slights).
- Perceives attacks on his or her character or reputation that are not apparent to others and is quick to react angrily or to counterattack.
- Has recurrent suspicions, without justification, regarding fidelity of spouse or sexual partner
Development and Course
Paranoid PD
- Apparent in childhood and adolescence – solitary, poor peer relationships, social anxiety, underachievement, hypersensitivity
- Appears ‘odd’ or ‘eccentric’ and attracts teasing
Prevalence of Paranoid PD
2.3% to 4.4%
More commonly diagnosed in males
Biological Theories
of Paranoid PD
May be part of a schizophrenia spectrum disorder
Psychodynamic Theories of Paranoid PD
- The person’s relationship with their parents is a key factor
- Parenting style that was demanding, distant, overly rigid and rejecting
- Lack of love provided leads the person to be suspicious of others and unable to trust people