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PEL > Personality disorders > Flashcards

Personality disorders Flashcards

1
Q

A personality disorder is defined as

A

An enduring pattern of inner experience and behaviour that deviates markedly from the expectations of the individual’s culture and is manifested in 2 or more of the following areas:

  • COGNITION (ways of thinking and interpreting self, others, events)
  • AFFECTIVITY (range, intensity, lability and appropriateness of emotional response.)
  • INTERPERSONAL functioning
  • IMPULSE control
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2
Q

What are the four ways/places that the PERSONALITY DISORDER (PD) must manifest to meet criteria

A

Must be two of the following:

  • COGNITION (ways of thinking and interpreting self, others, events)
  • AFFECTIVITY (range, intensity, lability and appropriateness of emotional response.)
  • INTERPERSONAL functioning
  • IMPULSE control
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3
Q

Name the three core features of PERSONALITY DISORDERS (PD)

A
  1. Functional inflexibility
  2. Self defeating behaviour patterns
  3. Tenuous stability under stress
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4
Q

Back in the days of DSM IV, what axis were PERSONALITY DISORDERS (PD) in?

A

Axis 2

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5
Q

What is the key aspects of the general PERSONALITY DISORDER (PD) diagnostic characteristics?

A

STABLE and long duration (traced at least to early adulthood or adolescence)

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6
Q

What are the five things mentioned as posing challenges to diagnosing PERSONALITY DISORDERS (PD)?

A
  1. Establishing prevalence over time
  2. Age requirements
  3. Role of genes norms
  4. Impact of cultural background
  5. Diagnosis process
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7
Q

When were PERSONALITY DISORDERS (PD) introduced into the DSM

A

1980

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8
Q

What are the Cluuuuusters

A

Mad, Bad, Sad

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9
Q

What’s the bottom age limit for diagnosing PDs?

A

18

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10
Q

What is in Cluster A (mad)

A

PARANOID
SCHIZOID
SCHIZOTYPAL

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11
Q

What’s the key thing about diagnosis PARANOID PD (Cluster A)

A

The paranoia needs to not occur exclusively during an episode of SCZ or other disorders w/ Psychotic features

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12
Q

Aetiology of PARANOID PD

A

Research is sparse

  • More common in relatives of those with schizophrenia (genetic loading?)
  • Low self-esteem
  • Deficits in emotional and social processing
  • Can find ecological niche where PD works in favour
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13
Q

What are the three key things about diagnosis SCHIZOID PD (Cluster A)

A
  1. Loner, detachment - think the Hermit
  2. Restricted emotional expression
  3. Needs to not occur exclusively ding an epos of SCZ or there order w/ Psychotic features
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14
Q

What is the aetiology of SCHIZOID PD

A

Very little research – some calls for it to be removed from DSM-5 pre publication

  • Speculation that linked to Aspergers
  • Barren upbringing, underpowered limbic system

Not associated with schizophrenia spectrum disorders

High level of dysfunction

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15
Q

Which is the PD that is associated with having an ‘underpowered limbic system’ following a barren upbringing?

A

SCHIZOID PD

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16
Q

What are the two key things about diagnosis SCHIZOTYPAL PD (Cluster A)

A
  1. Loner and can’t be close to people - lack of lose friends
  2. Distortions of perception and cognition (like psychosis)
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17
Q

What’s the difference between SCHIZOID PD and SCHIZOTYPAL PD?

A

The former includes perceptual/cognitive distortions

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18
Q

Whats the difference between SCHIZOTYPAL PD and SCZ

A

State vs trait

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19
Q

What is the aetiology of SCHIZOTYPAL PD

A
  1. Link with schizophrenia - milder form of schizophrenia
  2. Cognitive abnormalities - attention, memory deficits;
  3. Higher levels of dopamine neurotransmitter (Siever and Davis, 2004).
  4. Crossover to schizophrenia-spectrum disorders
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20
Q

What are the four key things about diagnosis ANTISOCIAL PD (Cluster B)

A
  1. Focused on behaviours
  2. Disregard for others
  3. Failure to conform to social norms
  4. Must be conduct disorder before 15 years
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21
Q

What is the aetiology of ANTISOCIAL PD?

A
  • High sensation-seeking; childhood conduct disorder, low psycho-physiological arousal
  • Elevated in family members, as is higher levels of criminality, high levels of impulsivity (genetic contribution)
  • Low levels of serotonin; Frontal problems
  • High levels of childhood aggression and associated with physical abuse, harsh and neglectful parenting
  • Link with psychopathy (but not the same)

What should be the implications for sentencing?

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22
Q

What’s the key difference between Psychopathy and ANTISOCIAL PD?

A

Psychopathy is more about a lack of emotions, whereas antisocial PD is more about behaviour

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23
Q

What’s the key thing about diagnosis BORDERLINE PD (Cluster B)?

A

Instability of interpersonal relationships

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24
Q

What is the aetiology of BORDERLINE PD?

A
  1. Torgersen et al. (2000) found genetic contribution
  2. Associated with sexual, physical abuse and neglectful and invalidating environments
  3. Low serotonin
  4. Increased hippocampal volumes and heightened activation in amygdala
  5. Have insecure attachment and fearful of abandonment, desire intimacy but anxious about dependency on others
25
Q

What are the key differences between BPD and complex PTSD, symptomatically?

A

In BPD but not PTSD:

  1. frantic effort to avoid abandonment
  2. unstable sense of self
  3. unstable and intense interpersonal relationships
  4. impulsiveness
26
Q

What are the key psychopharmacological differences between BPD and complex PTSD?

A

BPD does not respond to mood stabilising medication

27
Q

What’s the one key thing about diagnosis HISTRIONIC PD (Cluster B)

A

Attention seeking

28
Q

Aetiology of HISTRIONIC PD (Cluster B)

A

Don’t know much

Family studies show other Cluster B Personality Disorders in the family.

29
Q

What are the key four things about diagnosis NARCISSISTIC PD (Cluster B)

A
  1. Grandiosity
  2. Lack of empathy
  3. Exploitative
  4. Not aligned with objective reality
30
Q

Aetiology of NARCISSISTIC PD

A

TWO THEORIES

  1. Barren/aggressive upbringing (Kernberg), which can lead to compensatory falsies (Stone, 1993)

OR

  1. Too much praise - inflated ego

Livelsey et al. (1993) say this PD has the highest genetic loading

31
Q

Factor analysis reveals two types of NARCISSISTIC, what are they?

A
  1. Gradiosity / Overt Narcissism - like you’d expect

2. Covert Narcissism - Grandiose behaviour is mask for sense of inadequacy

32
Q

What’s the key things about diagnosis AVOIDANT PD (Cluster C)

A

Social inhibition

33
Q

How do you differentiate AVOIDANT PD from from SOCIAL ANXIETY DISORDER (SAD)?

A

Persistence across time and contexts

34
Q

What is the aetiology of AVOIDANT PD?

A
  • High in restraint as children, high neuroticism, low extroversion, shyness in childhood; higher incidence of avoidant PD in first-degree relatives
  • Punished for adventure as children, cold distant and neglectful parenting.
  • Jovev and Jackson (2004) found schemas related to defectiveness and abandonment.
35
Q

What are the two key things about diagnosis DEPENDENT PD (Cluster C)

A

Need to be taken care of

Fear of separation

36
Q

Which is the lowest prevalence Personality Disorder?

A

Dependent D

37
Q

What is the aetiology of DEPENDENT PD

A
  • Separation anxiety disorder and agoraphobia more elevated in family members
  • high neuroticism and low extroversion.
  • Speculation that overprotected attachment (the world is a dangerous place and that they are incompetent to be able to deal with it alone)
38
Q

What are FIVE key things about diagnosis OBSESSIVE COMPULSIVE PD (Cluster C)

A

Ordilness

Expense of efficiency and flexibility

Over consciienstuosu

Some hoarding

Don’t like delegating

39
Q

What is the aetiology of OBSESSIVE COMPULSIVE PD

A
  1. High perfectionism

Millon and Davis (1996) – the child learned to suppress feelings and perform approved behavioral routines in order to avoid punishment or disapproval by parental figures

40
Q

What % of people have PERSONALITY DISORDERS

A

6.5% in Aust

Maybe 12% in OECD

20-40% of people in clinical settings

41
Q

What did Beck find with PERSONALITY DISORDERS

A

CBT not as effective

42
Q

What was Beck and Young’s bright idea when CBT didn’t work for PDs?

A

Schemas

Each PD is characterised by a schema

Schemas are resistant to change

43
Q

What is Young’s theory of schema?

A

Early maladaptive schema result from mixture of biological disposition and repeated failure to meet child’s core emotional needs:

(i) secure attachments to others;
(ii) develop a sense of identity, competence and independence;
(iii) to express one’s desires and emotions;
(iv) to have realistic limits set by others so as to learn self-control;
(v) spontaneity and play.

44
Q

Schema mapping - What are the Disconnection/rejection ones?

A 
Abandonment/Instability
Mistrust/Abuse
Emotional Deprivation
Defectiveness/Unlovability
Social Isolation
45
Q

Schema mapping - What are the Impaired autonomy ones?

A

Dependence/Incompetence
Vulnerability to harm or illness
Enmeshment/undeveloped self
Failure to achieve

46
Q

Schema mapping - What are the Impaired limits ones?

A

Entitlement/superiority

Insufficient self-control/self-discipline

47
Q

Schema mapping - What are the Overvigilance/inhibition ones?

A

Negativity/Pessimism
Self-punitiveness
Emotional inhibition
Unrelenting standards

48
Q

Schema mapping - What are the Other-directedness ones?

A

Subjugation
Self-sacrifice
Approval seeking/Recognition seeking

49
Q

What are the three ways people perpetuate their schema

A
  1. Schema surrender (just go right into it)
  2. Schema Avoidance - block out, avoiding
  3. Schema overcompensation - opposite extreme (abandons before others can abandon them)
50
Q

Dialectic Behaviour Therapy (DBT) model - three components

Linehan

A
  1. Emotional dysregulation - partly biological/ part experiential (emotionally restricted environment)
  2. Temperament - (ie for BPD - high in neuroticism, heightened baseline arousal, increased intensity of responses to emotional stimuli;
  3. Child is subjected to drastically invalidating environments, e.g., deprivation, neglect, and physical and emotional abuse.

becoming increasingly relevant

51
Q

What are some issues with the DSM approach to diagnosis of PERSONALITY DISORDERS?

A
  1. Some DSM PD criteria are behaviours, e.g., criminal acts, others are traits, e.g., emptiness
  2. Some DSM PD criteria are harder to assess (identity disturbance) than others, e.g., impulsivity.
  3. Diagnostic criteria determined by consensus
  4. Some features of PDs are found in other disorders and also in people without PDs
52
Q

What are the options for dimensional PERSONALITY DISORDER models?

A

NEO big five

Temperament and character inventory (Robert Cloninger) (not that informative for treatment apparently)

ICD-11 model

53
Q

What is the ICD model for PERSONALITY DISORDERS?

A

Focus on impairment of self and interpersonal functioning, global assessment

Classified according to severity (Mild, Moderate, Severe)

One or more prominent trait qualifiers:

  1. Negative affectivity
  2. Detachment
  3. Dissociality
  4. Disinhibition
  5. Anankastia

Includes Borderline Patterns qualifier

54
Q

What treatments work for PERSONALITY DISORDERS?

A

DBT or variants (Young Schema theory, DBT, CAT)

Group vs individual? (Jury out)

Nothing promising from drugs

55
Q

What are the treatment outcomes per cluster for PERSONALITY DISORDERS?

A

Cluster A – Adaptive failures and least treatable

Cluster B - Major social problems – variable treatment success (some progress with CBT

Cluster C – Least severe adaptive failures best outlook

56
Q

What are the issues with treatment of PERSONALITY DISORDERS?

A

Comorbidity

No consensus on how to measure improvement

Social/interpersonal function often remain impaired

Major lack of evidence-based treatment

57
Q

What is in Cluster B (bad)

A
  1. ANTISOCIAL
  2. BORDERLINE
  3. HISTRIONIC
  4. NARCISSISTIC
58
Q

What is in Cluster C (sad)

A
  1. AVOIDANT
  2. DEPENDENT
  3. OBSESSIVE COMPULSIVE

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