Personality Disorders Flashcards
What is personality?
A persona (plural personae/personas): Latin for ‘mask’ Outward or surface aspect presented to audience
What determines personality?
NATURE: Innate Temperament (disposition): Genetic & constitutional
NURTURE: Character: Acquired values & attitudes
DSM-5: What is a Personality Disorder?
–> usually onset very early in childhood & develop into PDs
Enduring pattern of inner experience and behaviour that:
• Deviates markedly from the individual’s culture
• It is pervasive, inflexible & stable over time (NOT IN EPISODES, STABLE OVER TIME)
• Leads to distress or impairment
The pattern is manifested in two or more areas: (NOT ALL ARE NEEDED, ONLY 2 OR MORE)
• Cognition (ways of interpreting self, others & events)
• Affect (range, intensity, stability & appropriateness of
emotional response)
• Interpersonal functioning
• Impulse control
Personality Disoders - Core features (Millon, 1981)
- Functional inflexibility
- Failure to adapt to situations: rigid response - Self-defeating
- Behavioural responses damaging - Unstable in response to stress
- Emotional, behavioural & cognitive instability (especially in borderline, harming themselves)
(ALSO LACK OF INSIGHT, failure to recognise dysfunctional aspect of personality)
Two classification systems: DSM-5 & ICD-10
DSM-5
• 10 personality disorders categorised in 3 clusters
ICD-10
• 9 personality disorders but not clustered & with slightly
different labels –> E.g., Antisocial – Dissocial & Obsessive-compulsive - Anankastic
Cluster A
Odd/Eccentric –> often high introversion
- Paranoid
- Schizoid
- Schizotypal
Cluster B
Dramatic/emotional/erratic • Antisocial • Borderline • Histrionic • Narcissistic
Cluster C
Anxious/Fearful
- Avoidant
- Dependent
- Obsessive-compulsive
Categorical vs. dimensional approach
DSM-5 represents a categorical approach
• assumes that personality disorders represent distinct clinical syndromes
• Advantages: clarity and ease of communicating information
• Disadvantages: difficult to distinguish the threshold where the person goes from a ‘normal’ personality traits through to meeting criteria for a personality disorder
• A gradual move towards a dimensional approach to
classifying personality disorders
–> Dimensional approach acknowledges traits on a spectrum
Variable nature
Variable nature of area between clusters, diagnosis very dependent upon psychiatrists subjective opinion
heterogeneity within diagnoses
diagnostic unreliability
lack of robust scientific evidence
DSM-IV: AXIS I vs. AXIS II
AXIS I: Major clinical disorders with acute symptoms that need treatment
AXIS II: Personality disorders (& intellectual disabilities)
• early age of onset
• enduring and more pervasive effects on daily
functioning
• involvement of self & identity
• presumed poorer self-awareness
• lower treatment response
DSM-3 & 4 used 2 axis approach, DSM-5 uses single axial model
Paranoid PD - Cluster A
Not delusional –> distinguishes from schizophrenia
Consistent & pervasive pattern of distrust, suspiciousness
and prolonged grudges held:
• Believes others intentionally exploit, harm or deceive them
• Reluctance to disclose personal information for fear it may be used against them
• Severely sensitive to criticism & threat => hypervigilant for signs of others to harm them
• Misinterprets comments to indicate concealed, hidden or malevolent intent or motivation
• Hostility, aggression & anger to perceived insults
• Jealousy (distrust & misinterpretation)
–> Two thirds meet criteria for other PDs e.g., Schizotypal, Narcissistic, Borderline & Avoidant
Paranoid PD Thought Processes
Assumptions: People are malicious & out to get you, They will take advantage if they can, You will be okay as long as you do not let your guard down
Cognitions: Expectancy of hostility, Vigilance, Guardedness, Confirmatory evidence, Lack of trust
Interpersonal Behaviour: Suspiciousness & guarded against closeness, resentful, failure to trust others, Tendency to elicit hostility & distrust from others
Schizoid PD - Cluster A
- Like talking through glass wall, can see but not connect
Engage in solidarity activities ‘computer nerds’, not anxious just no interest in sociality
Detachment and disinterest in social relationships
• withdrawal into internal world to avoid affect and
maintain distance from others
• Sees others as intrusive and controlling
• Flatness of affect: coldness, aloofness, self-absorption,
social ineptitude or conceit
• Unresponsive to social criticism: sexually apathetic
reflecting incapacity to form interpersonal bonds
• Anhedonia –> lack of ability to feel happiness
• Comorbid with schizotypal and avoidant PDs
Schizotypal PD - Cluster A
Eccentric/odd, often in fringe groups
Marked interpersonal deficits, behavioural eccentricities
and distortions in perception & thinking (that do not meet
criteria for schizophrenia) • e.g. magical thinking, extreme superstition, belief in paranormal phenomenon, bodily illusions, sensory alterations
• Odd thoughts & speech patterns: vague, abstract but
retains coherence
• Often seek treatment for anxiety, depression & affective
dysphoria (constricted or inappropriate affect)
• Comorbid with borderline, avoidant, paranoid and
schizoid PDs
Antisocial PD - Cluster B
lack of empathy
Repeated reckless disregard for others
• Victimizing & blaming others for inadequacies
• Shallow & manipulative interpersonal relationships
• Self-centered focus & failure to adhere to regulations
• Impulsive, aggressive, charismatic, deceitful
• Experience guilt & depression but lack capacity to
empathize
• Anti-social behaviour: criminal behaviours may or may not be present (DON’T HAVE TO BE)
• Co-morbidity with borderline, narcissistic, histrionic &
schizotypal PDs
Borderline PD - Cluster B: Primary disturbances
Emotional lability, often self-harming, can be used for manipulation & attention, splitting & developing conflict for enjoyment, very possessive
Emotional instability/affective dysregulation in
reaction to environmental & interpersonal situations
• wide range of extreme emotions, intense anxiety, anger, dissociation
• Impulse control
• promiscuity, suicidal behaviour (10% suicide), self-harm, spending, binge eating, poor limit setting
• Identity/insecure attachments
• Unstable self-concept, frantic efforts to avoid real or imagined relationships
• Inability to integrate +ve and -ve aspects of self leading to sense of emptiness
Borderline PD - Cluster B
Most prevalent PD in clinical settings: • 10% of outpatients • 15-20% of inpatients Rarely sole diagnosis: comorbid with mood disorders, substance-use disorders & anxiety disorders (PTSD) • 15% Major depression • 10% Dysthymia • 15% Bipolar I • 20% Bulimia/anorexia • 10% Substance abuse Meet criteria for BPD
• Reflects shared impulsivity/disinhibition & affective
instability personality traits
• Arguably associated with the greatest levels of
disability of all the PDs
Histrionic PD - Cluster B
attention seeking, conversion of psychological angst into physical symptoms, very dramatic & self-centred
Roots in the concept of hysteria: conversion
disorders, emotional instability, anxiety & phobias
• Kretschmer (1926): theatrical & egotistical
• DSM-II (1968): hysterical PD
• DSM-III : replaced by histrionic PD
Excessive emotionality, attention-seeking, ego-centric,
flirtatious, seductiveness (focus on grooming),
• Denial of anger and hostility
• Gregarious, manipulative, low frustration tolerance,
suggestibility, somatization
• Displays of emotions: shallow and fickle in
interpersonal relationships
• Comorbid: narcissistic, borderline, anti-social PDs &
psychoactive substance abuse
Narcissistic PD - Cluster B
Important in small levels to have, PD if to huge extent, belief they have special skills, arrogance
Personalities organised around maintenance of self-esteem by eliciting external adulation to compensate for internal sense of falseness
• Fragile self-esteem, envy, self-consciousness, & vulnerability: “image replaces substance”
• Compensatory reaction: self-righteousness, pride, contempt, vanity & superiority
• Pervasive pattern of grandiosity, sense of entitlement,
privilege, or expectation of preferential treatment,
exaggerated sense of self-importance, arrogant behavior & attitudes
• Focus on own issues with insensitivity or impatience to
problem of others: cold, disinterested, snobbish, patronizing
• Comorbid with: anti-social, histrionic, borderline PDs &
substance abuse
Avoidant PD - Cluster C
Pervasive social inhibition, discomfort in social situations, feelings of inadequacy, low self esteem, hypersensitivity to criticism, disapproval, shame, ridicule & rejection
• Avoidance of activities involving personal contact & groups
• Socially inept/incompetent, personally unappealing, inferior to others
• Comorbid with dependent PD & Axis I mood,
anxiety, & eating disorders
Dependent PD - Cluster C
Pervasive need to be taken care of
• Exaggerated fear of being incapable of doing things or taking care of things on their own – reliance on others
• Lacking in self confidence & requiring constant reassurance
• Often find themselves exploited and in abusive
relationships fearing abandonment
- Self view: needy, weak, helpless & incompetent
- View of Others: Strong caretaker idealized. Function well as long as the idealized figure is accessible
- Threats: Rejection or abandonment
- Strategy: Cultivate a dependent relationship by
subordinating - Affect: Anxiety heightened – disruption to the
relationship. Depression if their strong figure is
removed, euphoria/ gratification when dependent
wishes granted
Obsessive-Compulsive PD - Cluster C
Pervasive pattern of perfectionism and orderliness
• Rigidity, inflexibility & stubbornness
• Excessive need for control interfering with ability to
maintain interpersonal relationships or employment
• Preoccupied with rules, minor details, structure
• Attention to detail interferes with ability to complete tasks
• Unrealistic standards of morality, ethics or values
• Reluctance to delegate tasks
• Comorbid: borderline, narcissistic, histrionic, paranoid,
schizotypal PDs
• No significant relationship between OCD & OCPD
Obsessive-Compulsive PD - Cluster C: Views & Affect
- Self view: Responsible for themselves & others.
Driven by ‘shoulds’. - View of others: Too casual, irresponsible, self indulgent
and incompetent - Threats: Any flaws, errors, disorganisation.
Catastrophic thinking: things will be out of control - Strategy: System of rules, standards & ‘shoulds’.
Overly directing, punishing and disapproving - Affect: Regrets, disappointment, and anger toward self
and others because of perfectionistic standards
