Personality Disorders Flashcards
Features for diagnosis
- Pattern manifestation in 2+ areas (Cognition,emotion, interpersonal functioning or impulse control)
- Rigid and consistent pattern across many contexts
- Distress/ impairment
- Stability and long duration of symptoms
- Behaviour not caused by another mental illness
- Behaviour not caused by substance abuse
Areas of pattern manifestation
Cognition
Emotion
Interpersonal Functioning
Impulse control
How should Personality Disorders be assessed
Through structured interviews
Can Personality Disorders be self-assessed
No, they should only be assessed through structured interviews
Diagnostic issues in PDs
Low reliability (time and people) Gender/ Cultural issues Co-morbidity/overlap Weak treatment efficacy Poorly understood etiology
Etiology Theories
Psychodynamic
Attachment Theory
Cognitive Behavioural
Biological
Psychodynamic Theories
Problem in parent-child relationships leads to
inadequate sense of self
Issues relating to other people
Attachment Theories
Poor parent-child attachment > Poor adult attachment > Interpersonal relationship problems
Cognitive Behavioural Theories
Rigid, inflexible schemas
Invalidating environment
Modelling inappropriate behaviours
Biological Theories
Genetics
Brain Functioning
Emotion Regulation
Cluster A Personality Disorders
Odd/Eccentric Disorders
What disorders are included in Cluster A PDs
Paranoid Disorder
Schizoid Disorder
Schizotypal Disorder
Paranoid Personality Disorder
Pervasive distrust and suspicion of others
How many Criterion must be met for a Paranoid PD diagnosis
4+ criteria
Paranoid Personality Disorder more common in which gender
Males
Schizoid Personality Disorder
Pervasive disinterest in social relationships and restricted affect
How many criterion must be met for a schizoid PD diagnosis
4+ criteria
Schizoid PD and social skills
They don’t have social skills and are not interested in learning them
Schizotypal Personality Disorder
Pervasive pattern and social deficits, discomfort in interpersonal relationships, and perceptual distortion or eccentricities
Treatment of Schizotypal Disorder
Anti-Psychotics and Anti-Depressants
Schizotypal PD more common in
Males
How to Cluster A PDs differ from schizophrenia
Schizophrenia is more severe
Schizotypal Pd may be a mild form of schizophrenia
Can Cluster A PDs predict psychotic disorders
Cluster A PDs can be a precursor
When may Cluster A PDs appear
Childhood and Adolescents
Cluster B PDs
Dramatic, Emotional or Erratic Disorders
What disorders are included in Cluster B PDs
Antisocial PD
Borderline PD
Histrionic PD
Narcissistic PD
Are Antisocial and Psychopathy the same disorder
No they are different
Not all people with APD are psychopaths
Which is more severe APD or Psychopathy
Psychopathy is more severe
Is psychopathy a formal diagnosis
No, there is no formal diagnosis of psychopathy
Most psychopaths have APD
True
Most APD individuals are psychopaths
False
Only a small proportion have APD individuals have psychopathy
Antisocial PD
Pervasive disregard for and violation of the rights of others
How many criterion must be met for a APD
3+ criteria
Must have conduct disorder prior to the age of 15 to be diagnosised with APD
True
How much does heiritability account for aggression
44% to 72%
Fearlessness Hypothesis of APD
APD individuals are less prone to fear therefore less inhibited to dangerous and illicit activities
Reliability of APD
High behavioural reliability
Treatment of APD
Psychotherapy (aimed at symptoms and behaviour)
Meds (Manage threatening behaviour)
Factors for psychopathy
- Interpersonal and affective ( superficially charming, grandiose, pathological lying, lack of remorse)
- Antisocial behaviour and lifestyle (Easily bored, lack of realistic long-term goals, impulsive, irresponsible)
- Promiscuous (casual sexual relationships)
- Many short-term relationships
Assessment of psychopathy
Psychopathy checklist
High validity
Can psychopathy predict future violence
Yes it can
Psychopaths commit what types of violence
Cold blooded
Goal oriented
Sadistic and Gratuitous
Biological Theories of Psychopathy
Hypoactive amygdala
Genetics
Environmental theories of Psychopathy
Abusive environment and disturbed living arrangements
Primary Psychopaths
Lack fear
Secondary Psychopaths
Sensitivity to rewards
Treatment of Psychopathy
Treatment- resistant
Contingency management
Intensive supervision
Preventive Detention
Borderline PD
Pervasive instability in interpersonal relationships, self-image, and affect with marked impulsivity
How many criteria are needed for BPD
5+ criteria
What % retain a BPD diagnosis after 10 years
50%
Biological etiology
Mild brain dysfunction
Childhood experiences causing BPD
Child abuse/neglect
Child sexual abuse
Attachment problems with parents
Modelling
Linehan’s Biosocial Theory
Linehan’s Biosocial Theory
BPD is a dysfunction of emotion regulation
Treatment for BPD
DBT
4 Modules over 12 months
BPD medication treatment
Anti-depressants
Anti-psychotics
Anti- Convulsants
What are anti-convulsants used for in BPD
Emotional instability
Impulsivity
Histrionic PD
Excessive emotionality and attention-seeking
How many symptoms are needed for a HPD diagnosis
5+ symptoms
Cultural consideration of HPD
Behaviour must be distressing or impairing functioning
Narcissistic PD
Pattern of grandiosity, need for admiration and lack of empathy
How many symptoms are needed for a NPD diagnosis
5+ symptoms
What is NPD associated with
Frequent internet and social media use
Gender Differences in NPD
50% - 75% are males
Cluster C PDs
Anxious and Fearful Disorders
What disorders are under Cluster C
Avoidant PD
Dependent PD
Obsessive-compulsive PD
Avoidant PD
Social Inhibition, feelings of inadequacy and hypersensitivity to negative evaluation
How many symptoms are needed for an Avoidant PD diagnosis
4+ symptoms
Precursor for Avoidant PD
Shyness
What is Avoidant PD similar to
Social anxiety but more severe
Gender Differences in Avoidant PD
Occurs equally in men and women
Dependent PD
Need to be taken care of, leading to clingy behaviour and fear of separation
How many symptoms are needed for an Avoidant PD diagnosis
5+ symptoms
When should a DPD diagnosis not be made
When dependent behaviour is necessary
Kids
Elders
In which cultures is there a high prevalence of DPD
Individualistic cultures
Obsessive-Compulsive PD
Pattern of perfection, order and control
How many symptoms are needed for an OCPD diagnosis
4+ symptoms
Gender Differences in OCPD
More common in males
How is OCPD different from OCD
There is a pattern of inflexibility and perfectionism in OCPD
Obsessions and Compulsions occur in OCD
What makes the treatment of PDs difficult
PDs are ego-syntonic illnesses (Person doesn’t find a problem)
High drop-out rates
Difficult therapeutic alliance
Therapy for PDs
Object-relations therapy
CBT
CBT for PDs
Cognitive Restructuring
Schema focused Therapy
Dialectical Behavioural Therapy
Social Skills Training