Personality disorders Flashcards
What are the core features of personality disorders?
- Inflexibility, rigid responses that are not adaptive to the situation
- Self-defeating behaviours
- Instability under stress
What is the difference between DSM-5 and ICD-10 classification of PDs?
DSM-5: 10 PDs in 3 clusters
ICD-10: 9 PDs not clustered and with slightly different names e.g. BPD is under emotionally unstable: impulsive/borderline type, OCPD is Anankastic.
What are the differences between the clusters of PDs?
Cluster A: odd/eccentric
- Paranoid
- Schizoid (extreme introversion)
- Schizotypal
Cluster B: dramatic/emotional
- Antisocial
- Borderline
- Histrionic
- Narcissistic
Cluster C: anxious/fearful
- Avoidant
- Dependent
- Obsessive-compulsive
What are the advantages and disadvantages of a categorical approach?
Categorical approach: PDs are different from normal personality and other mental disorders.
Advantages:
- Clear distinction between normal and abnormal
- As you either have a PD or not, it makes it easier to give a diagnosis and communicate info with clinicians
Disadvantages:
- As PDs are not on a spectrum ranging in severity from normal traits to pathological, it is hard to tell when a person begins to have abnormal traits
What is the difference between DSM-IV Axis I and Axis II disorders?
Axis I refers to major clinical disorders with acute symptoms that need treatment.
Axis II refers to personality disorders and intellectual abilities. PDs have an early onset, are enduring, pervasive, involve the self and identity, people have poorer self-awareness and lower treatment response.
- There can be heterogeneity within diagnoses: two people with the same symptoms can present differently e.g. anti-social PD in politicians/criminals
Describe paranoid PD.
- Distrust, suspsiciousness, prolonged grudges
- Thinks people will hurt them
- Reluctant to disclose personal information
- Hypervigilant for signs of harm
- Misinterprets events and actions, perceives bad intent when there is none
- Jealousy
Their thought process:
- Assume people are out to get you, will take advantage, will be fine as long as you do not let your guard down
- Cognitions: expect hostility, distrust, are guarded, vigilant
- Interact with others in a guarded, resentful, distrusting manner which tends to make others hostile towards them
Describe schizoid PD.
- Detached and not interested in social interactions
- Emotionally cold
- Apathetic to criticism or praise
- Solitary work
Describe schizotypal PD.
- Uncomfortable with close relationships, paranoid about others
- Odd behaviour, perceptual and cognitive distortions
- Often seek treatment for anxiety, depression, inappropriate emotion
Describe antisocial PD.
- Law, rule breaking
- Disregard for others
- Manipulative, blame others
- Impulsive, aggressive, charismatic, deceitful
- Experience guilt and depression but not empathy for others
Describe borderline PD.
- Emotional instability, impulsiveness, self-harm
- Lack of identity, cannot integrate positive and negative aspects of self
- Insecure attachment, fear of abandonment
- Comorbid with axis I mood disorders, eating disorders, substance abuse
- Most prevalent PD
Describe histrionic PD.
- Excessive attention seeking
- Inappropriate flirtation, seductiveness
- Need for approval, to be the centre of attention
- Shallow and fickle in relationships
- Consider relationships to be more intimate than they actually are
- Manipulative, suggestible, low frustration tolerance
Describe narcissistic PD.
- Arrogant, concerned with own power and abilities
- Interpersonally exploitative
- Entitlement, expect special treatment
- Fragile self-esteem, compensate for internal sense of falseness with superiority, vanity, contempt
- Focus on own problems with impatience listening to others
Describe avoidant PD.
- Fearful of being negatively judged, criticised, therefore avoid social situations
- Feel inadequate, inferior, unappealing
- Restraint and nervousness in social situations
Describe dependent PD.
- Need to be taken care of, need others to help them
- Lack self-confidence, require assurance
- Fear abandonment, may be exploited in relationships
- Feel weak, needy, helpless
- Function well as long as idealised figure is accessible
- Anxious when alone
Describe obsessive-compulsive PD.
- Perfectionism, orderliness
- Rigid, stubborn, do things their way
- Preoccupied with rules, minor details, structure which interferes with ability to complete tasks
- Does not delegate tasks
- Feels responsible for themselves and others
- Overly directing, punishing
- Regrets, disappointment, angry
- No sig rel with OCD
What is the prevalence of PDs and the sex differences?
- 5% in Australia, worldwide average 9.7%
- Younger single males tend to have higher anxiety, mood disorder, substance use than those without PDs
- Antisocial PD in 3% males vs 1% females, in greater proportion of male prisoners
- Females: borderline (1-5%), histrionic
- BPD under-diagnosed as the mood swings, suicidal behaviour occurs in other mental disorders
What is the aetiology of antisocial PD?
Constitutional factors:
- More common in those with relatives who have APD
- Inherited predisposition to high impulsivity
- Externalising disorders
Biological factors:
- Higher testosterone level
- Low physiological arousal, need to seek external sources of stimulation
- Abnormalities in frontal lobe -> less responsive to threat
- Prefrontal lobe deficits -> poor impulse control, planning, problem solving
- Interact with complications with birth and negative home environment
What are the thought processes in antisocial PD?
- Assume everyone is out to get what they want for themselves, rules can be bent
- Do not show weakness, deceive others, don’t think about consequences
- Avoid closeness, exploit others, impulsive
Describe the treatments for antisocial PD.
- Lithium, anitpsychotics, SSRIs to reduce aggression and impulsive behaviours
- Social skills training
- Anger management
What are the thought processes in borderline PD?
- Assume that the world is dangerous, they are weak and vulnerable, their feelings are unacceptable
- They are anxious, fearful, have low self-efficacy, frustration intolerance, dependent, anticipate rejection
- Become depressed, hopeless, suicidal as they have few relationships, unstable, manipulate others
What is the aetiology of borderline PD?
- High neuroticism
- Impulsive aggression and mood dysregulation transmitted
- Environmental: inconsistent, neglectful parenting leading to emotion dysregulation, insecure attachment styles
- Stressful events causing HPA axis dysfunction -> suicidal behaviour
- Low level of serotonin impairs control of impulsive behaviours
Outline the treatments for borderline PD.
Dialectical Behaviour Therapy
- Cognitive-behavioural + mindfulness, interpersonal effectiveness, distress tolerance, emotion regulation (identify, label emotion) modules
- Acceptance of life circumstance and change behaviours causing suffering
- Moderate effect for suicidal and self-harming behaviours
- Drop out rate 27%
Schema-focused therapy
- Change schemas that were developed in childhood e.g. I’m unlovable
- Composed of memories, emotions, cognitions that define self and others e.g. abandonment, mistrust, entitlement, insufficient self-control
- Stages: assessment, emotional awareness, behavioural change
- Significant improvement in 66% (2 session/week)
What is the difference between coping styles and modes in schema therapy?
Coping style = trait e.g. avoidance, overcompensation
Mode = current mood state e.g. vulnerable, demanding, critical
