Personality Disorders Flashcards
What is personality?
Comes from Greek word for mask - “Persona”
Key pattern of inner experience. Manner of thinking/feeling etc
What is portrayed in interaction with others.
Consists of aspects of Nature (Innate temperament: Genetic, constitutional) and Nurture (Character: Acquired values and attitudes) –> particular traits –> Personality (as expressed in psychosocial context)
What is a Personality Disorder, according to DSM-V?
Enduring pattern of inner experience/behaviour that:
- Deviates markedly from societal norms
- Pervasive, inflexible and stable over time
- Leads to distress or impairment
Pattern manifested in 2 or more areas:
- Cognition
- Affect
- Interpersonal functioning
- Impulse control
(not all areas of personality need to be affected in PDs)
Onset: very early (childhood) or adolescence for adults
What are the core features of PDs? (4)
- Functional Inflexibility: Failure to adapt to situations
- Applying same rigid response to many diff situations, even when inappropriate - Self-defeating: Respond/cope in ways that worsen the situation or is highly damaging
- Unstable in response to stress: Unstable mood, thoughts and behaviours during stressful life events
- Often accompanied by lack of insight: Failure to recognise dysfunctional aspect of personality. They just think it’s part of who they are
History of PD development in the DSM
Just know that it’s variable and volatile.
Classification systems: What are the differences between how DSM-V and ICD-10 have classified PDs?
DSM-V: 10 PDs categorised in 3 clusters
ICD-10: 9 PDs. Not clustered, and have slightly different labels
e.g. Antisocial = Dissocial, Obsessive-compulsive = Anankastic
List all the PDs in their clusters as in DSM-V.
Cluster A (Odd/eccentric) Paranoid Schizotypal Schizoid Cluster B (Dramatic/emotional/erratic) Borderline Antisocial Histrionic Narcissistic Cluster C (Anxious/fearful) Avoidant Dependent OCPD
What are the characteristics of the way the DSM-V PDs have been classified?
- PDs rarely appear in textbook form
- Highly comorbid - Lots of overlap, both within and between clusters (esp within clusters)
- Survey of clinicians: 60% of patients did not fit in these 10 categories
Categorical (Axis-I) vs Dimensional Approach (Axis-II)
DSM-V uses categorical approach
- Assumes that PDs represent distinct clinical syndromes
Adv: Clarity and ease of communicating info
Disadv: Hard to distinguish threshold from “normal” personality traits to meeting PD criteria
- Gradual move towards dimensional/spectrum approach for PD classification
Differences between DSM-IV Axis I vs Axis II?
Axis I: Major clinical disorders with acute symptoms that need treatment
Axis 2: PDs (and intellectual disabilities)
- Early age of onset
- Enduring traits that are clinically significantly distressing/dysfunctional
- Involves self and identity - related to presumed poorer self-awareness (lack of insight)
- Generally poorer response to treatment - often prolonged
But: high degree of co-occurrence of symptoms (comorbid)
- heterogeneity within diagnoses
- diagnostically unreliable
- lack of robust scientific evidence
A1. Paranoid PD: Symptom Description
Consistent/pervasive pattern of distrust, suspiciousness, and prolonged grudges held.
- Believes others intentionally exploit, harm or deceive them
- Severely sensitive to criticism & threat - hypervigilant for signs of others to harm them
- Misinterprets comments to indicate concealed, hidden or malevolent intent/motivation
- Hostile, aggressive and angry response to perceived insults
- Jealousy (distrust and misinterpretation)
2/3rds of them meet criteria for other PDs (Schizotypal, Narcissistic, Borderline, Avoidant)
A1. Paranoid PD: Underlying Assumptions and Thought processes
Assumptions: (very negative in nature)
People are malicious and out to get you –> Expectancy of hostility, Lack of trust, Guardedness –> Suspiciousness and guarded against closness, resentful, failure to trust others –> Tendency to elicit hostility & distrust from others
They will take advantage of you if they can –> Guardedness
You will be ok as long as you do not let your guard down –> Vigilance
(refer to diagram)
A2: Schizoid PD: Symptom Description
Like talking through a glass wall. Cold, hard to connect
Detachment and disinterest in social relationships
- Withdrawal into internal world to avoid affect and maintain distance from others
See others as intrusive and controlling
Flatness of affect: coldness, aloofness, self-absorption, social ineptitude or conceit
Unresponsive to socially criticism:
- Sexually apathetic, reflecting incapacity to form interpersonal bonds
- Anhedonia
Comorbid with Schizotypal and avoidant PDs
A3: Schizotypal PD: Symptom Description
Marked interpersonal deficits, behavioural eccentricities and distortions in perception and thinking (that do not meed criteria for schizophrenia)
(e.g. magical thinking, extreme superstition, etc)
- Odd thoughts and speech patterns: vague, abstract, but coherent
- Often seek treatment for anxiety, depression and affective dysphoria
Comorbid with borderline, avoidant, paranoid and schizoid PDs
- Tend to be at the fringe of eccentric groups - even more eccentric than them (e.g. vegans)
B1: Antisocial PD: Symptom Description
Repeated reckless disregard for others/social norms
- Victimising/blaming others for inadequacies
- Shallow and manipulative interpersonal relationships
- Self-centered focus (related to histrionic/narcissistic) and failure to adhere to regulations
- Impulsive, aggressive, charismatic, deceitful
- Lack empathy, although they experience guilt and depression
- Antisocial behaviour: may/may not have crim history
Comorbid: Borderline, narcissistic, histrionic and schizotypal PDs
B2: Borderline PD: Main Symptoms
- Emotional instability/affective dysreg in reaction to envr/interpersonal problems
- wide range of extreme emotions (anxiety, anger, dissociation) - Low impulse control: Self-harm, promiscuity, suicidal behaviour (10% suicide), spending, binge eating, poor limit setting
- Suicide: stems from feelings of emptiness - makes them feel more real
- Can be attn seeking - Identity/insecure attachments
- Unstable self-concept, avoidance of real/imagined relationships
- Inability to integrate positive and negative aspects of self –> sense of emptiness
B2: Borderline: Prevalence, Comorbidity
Prevalence: most prev PD in clinical settings (due to self-harm)
- 10% of outpatients
- 15-20% of inpatients
Highly comorbid with mood disorders, substance-use disorders & anxiety disorders (PTSD)
(% of people with these disorders also have borderline)
15% MDD
10% Dysthymia
15% Bipolar I
20% Bulimia/Anorexia
10% Substance abuse
- Shared impulsivity/disinhibition and affective instability personality traits
Arguably causing greatest disability of all PDs
B3: Histrionic PD: Symptoms
Attention-seeking behaviour - very dramatic
(Used to be called “Hysterical PD” in DSM-II, 1968)
- Excessive emotionality, attention seeking, egocentric, flirtatious, seductiveness (vain)
- Gregarious, manipulative
- Shallow and fickle displays of emotion - affects interpersonal relationships
Comorbid: Narcissistic, borderline, antisocial, psychoactive substance abuse
B4: Narcissistic PD: Symptoms
Huge sense of self-entitlement
Pervasive pattern of grandiosity, sense of entitlement, exaggerated sense of self-importance, arrogant attitudes/behav
Have fragile self-esteem, envy, self=consciousness and vulnerability
- Compensate with self-righteousness, pride, contempt, vanity and superiority
Cold, disinterested, snobbish, patronising
Comorbid: Antisocial, Histrionic, borderline + Substance abuse
C1: Avoidant PD: Symptoms
Social inhibition, discomfort in social situations, feelings of inadequacy, low self esteem, hypersensitivity to criticism/rejection/ridicule
Avoidance of social activities
Socially inept/incompetent, personally unappealing, inferior to others
Low self-esteem
Comorbid: Dependent and Mood, anxiety, eating disorders
C2: Dependent PD: Symptoms
Exaggerated sense of not being able to take care of themselves - reliance on others
Lack in self-confidence, feel incompetent, constantly needing reassurance
C2: Dependent PD: Key characteristics
Self view: Needy, weak, helpless and incompetent
View of others: Strong caretaker. Function well when idealised figure is accessible
Threats: Rejection/abandonment
Strategy: Cultivate a dependent relationship by subordinating
Affect: Heightened anxiety. Depression if strong figure is removed, euphoria/gratification when dependent wishes are granted
