Personality Disorders Flashcards
Personality
Relatively stable psychological behaviour characteristics:
- predictable, consistent, what distinguishes one person from the next. Inherited, learned or both.
But for most people it is flexible- can ‘fit’ with most cultures; society often particularly welcomes certain personalities while others are less favoured (eg. controlling, emotionally unstable).
Personality disorder: General personality diagnosis
All PD diagnoses start with ‘general personality disorder’ criteria: apply to all 10 PDs.
A. Enduring pattern of inner experience and behaviour that deviates from expectations of the individual’s culture, pervasive and inflexible, onset in adolescence or early adulthood, leads to distress or impairment. Pattern is manifested in two or more areas:
- Cognition (ways of perceiving and interpreting self, others, and events.
- Affectivity (range, intensity, appropriateness or emotional response).
- Interpersonal functioning.
- Impulse control.
B. Enduring pattern is inflexible and pervasive across a broad range of personal and social situations.
C. Enduring pattern leads to clinically significant distress or impairment in social, occupational, or other areas of function.
D. The pattern is stable and of long duration, and its onset can be traced back to adolescence or early childhood.
E. The disturbance not explained by other mental disorder.
F. The disturbance is not due to direct physiological effects of substance abuse or a general medical condition.
Personality disorder diagnosis
Each of 10 disorders also has its own specific set of diagnostic criteria.
Also a ‘personality disorder not otherwise specified’ diagnosis for behavioural patterns that don’t match the 10 disorders but exhibits characteristics of a PD.
PDs grouped into 3 clusters.
DSMV clusters
A: odd/eccentric:
- paranoid
- schizoid
- schizotypal
B: dramatic/erratic:
- antisocial
- borderline
- histrionic
- narcissistic
C: anxious/fearful:
- avoidant
- dependent
- obsessive-compulsive
+ PD not otherwise specified
Criticisms of categorical diagnosis approach
The current categorical method of diagnosing seen as inadequate.
- high level of comorbidity amongst PDs within and between clusters.
- heterogeneity amongst patients with same diagnosis (eg. borderline requires 5 of 9 symptoms).
- arbitrary cut off point for diagnosis- eg. 5 of 9 symptoms = BPD, 4 of 9 not diagnosed but still may suffer.
- over use of PD not specified (Verheul & Widiger, 2004).
- broad genetic and environmental risk factors for PDs that cut across clusters.
Alternative method of diagnosis?
Before DSMV published, discussion about moving to dimensional method of diagnosing (eg. Widiger & Trull, 2007).
- severity on a continuum instead of presence/absence.
- no boundary between normal/abnormal.
- people with PDs would be who shows extremes.
Thought DSMV would be organised using hybrid dimensional/categorical system.
But all that changed was amalgamating axis 1 & 2. Section 3 has ‘alternative model’- just a proposal.
Most clinicians acknowledge dimensional properties but still use DSMV system.
Alternative model: big 5?
Some approaches to personality use dimensional system.
- Big 5 (Costa & McCrae, 2005).
Populations vary on continuum across 5 domains- neuroticism, extroversion, openness to experience, agreeableness, conscientiousness.
Contain 30 sub-domains.
People described in term high-low of each.
Widiger & Trull (2007) argue:
- evidence supporting big 5 domains is better than supporting DSM PD categories.
- dimensional PD system based on big 5 would address some limitations of DSM categorical system.
- using big 5 might help de-stigmatise PD.
General PD features
Long term.
Pervasive.
Can be associated with risky behaviours.
High levels of comorbidity with axis 1 disorders.
Predictive of poor treatment outcomes.
Common- prevalence 4-15% in adult community samples.
But little research and treatment development.
PD prevalence
4-9% UK adult community samples (Croid et al, 2006).
15% US community sample (Grant et al, 2004).
36-67% psychiatric inpatient (NIMHE, 2003).
Similar high prevalence within prison population.
PD thought to be under diagnosed in both settings (Lamont & Brunero, 09).
PD age and gender
More common in younger adults.
But PDs shouldn’t be diagnosed in children and adolescents because personality development is not complete and traits may not persist to adulthood.
Males= females across all diagnoses, but varies from PD to PD:
eg. BPD: F > M; ASPD: M > F.
General causes: genetics
Twin studies (eg. Kendler et al, 08) identified genetic risk factors.
- one broad factor: negative emotionality/emotion dysregulation, contributing to 6 PDs.
- two additional specific factors:
borderline and antisocial PDS- impulsive aggression.
schizoid and avoidant PDs: inhibition/introversion.
These genetic risk factors do not reflect 3 PD clusters.
Authors described heritabilities for PDs in their sample as ‘modest.’
Ranging from 20% (schizotypal) to 41% (antisocial).
Environmental factors play important role.
General causes: environmental
Longitudinal studies (eg. Johnson et al, 1999; 06) identified several environmental risk factors:
- one broad factor: childhood parental neglect; contributing to 7 PDs.
- other more specific factors: eg. childhood physical abuse significantly contributing to ASPD.
The enironmental risk factors that Kendler et al (2008) identified, were reasonable fit to 3 PD clusters.
So its possible environmental experiences could be implicated in tendency of cluster A, B and C PDs to co-occur.
Causes of PD
These data from twin and prospective studies support hypothesis that there are broad vulnerabilities to poor personality functioning as well as risk factors for some specific categories of PD.
This undermines argument that the 10 PDs are separate disorders.
Many people who experience genetic and environmental risk factors don’t develop PD.
Researchers therefore look for mediating variables- help explain why some people do and others don’t.
Cluster A: odd/eccentric
Paranoid
Often emotionally detached
Suspicious of other people and their motives
May hold longstanding grudges against people
Believe others are not trustworthy, other people are deceiving, threatening, making plans against them
Schizoid
Difficulties in expressing emotions, particularly around warmth or tenderness
Often feel shy in company, but may come across as aloof or remote
Have difficulty in developing or maintaining social relationships
Schizotypal
Has problems around developing interpersonal relationships.
The condition is characterised by thought disorders and paranoia.
To other people they may appear odd or eccentric; they may dress or behave inappropriately, e.g. talking to themselves in public
Cluster B: Dramatic/erratic
Antisocial
Characterised by a lack of regard for the rights and feelings of other people,
A lack of remorse for actions that may hurt others.
Often ignore social norms about acceptable behaviour, often may disregard rules and break the law.
Borderline
Characterised by unstable personal relationships
Impulsive behaviour in areas such as personal safety and substance misuse.
They may self-harm, feel suicidal and act on these feelings,
experience instability of mood, or have episodes of psychosis.
They may have feelings of chronic emptiness and fears of abandonment by friends or partners.
Histrionic
Characterised by extreme or over-dramatic behaviour.
May form relationships quickly, but be demanding and attention-seeking.
They may appear to others as being self-centred, having shallow emotions, craving attention, or being inappropriately sexually provocative.
Narcissistic
Exaggerated sense of their own importance.
They are frequently self-centred and intolerant of other people.
The condition is typified by grandiose plans, ideas and cravings for attention and admiration
