Personality disorders Flashcards
Personality
- consistent patterns of thinking, feeling and behaving.
- factors such as one’s values, attitudes, expectations, interpersonal interactions, coping strategies and self-perception.
personality disorder (DSM)
enduring pattern of inner experience and behaviour that deviates markedly from expectations of the individual’s culture, is pervasive and inflexible, has onset in adolescence or early adulthood, is stable over time and leads to distress or impairment’
The DSM-5 approach to classification
(A) odd or eccentric behaviour
(B) dramatic, emotional or erratic behaviour
(C) anxious or fearful behaviour
prevalence of personality disorders
- 1 out of every 10 people meet criteria
- PD is more common among people with a psychological disorder (major depressive disorder & anxiety disorder)
- anxiety, mood and substance are more associated with cluster B (dramatic/emotional/erratic)
- comorbid personality disorders are associated with more severe symptoms, poorer social functioning and worse treatment outcome
assesment of DSM5 personality disorders
o most PD have good reliability when structured interviews involved
o schizoid personality disorder: low interrater reliability.
o antisocial and obsessive-compulsive personality disorders= inadequate reliability estimates
o interrater reliability for BPD = adequate
o clinicians often using unstructured clinical interviews often miss personality disorder diagnoses
- Interviews with people who know the patient well improve the accuracy of diagnosis and enhance the ability to predict social outcomes across a several-year follow-up
Problems with the DSM-5 approach to personality disorders
- personality disorders are not stable over time (1/2 of people PD at one point in time had achieved remission)
- highly comorbid (50% + of people diagnosed with a personality disorder meet another PD –>
DSM not ideal for classifying PD, (lack of test–retest stability and the high rates of comorbidity)
Alternative DSM-5 model for personality disorders
o 5 personality trait domains
o25 more specific personality trait
o rated on self-report items
- diagnosing PD on extreme scores on personality trait dimensions.
- similar to five-factor model –> using personality domain and facet scores to decide best fit.
-eg. OCPD –> high scores on rigid perfectionism, along with high scores on at least two of the three dimensions of perseveration, intimacy avoidance and restricted affectivity.
personality traits have several advantages. Some of the key strengths include the following.
- clinicians can specify which personality traits are of most concern for a given client (The 25-dimensional scores provide richer detail)
- trait ratings are more stable over time
- trait dimensions are related to many aspects of psychological adjustment and predicts important interpersonal outcomes
- enables broad research literature on personality
children in the community study
- 2 major studies examined all 10 PD assessing the links between childhood adversity and personality disorders.
- personality disorders were strongly related to early adversity.
- 4 interviews throughout the years
- Childhood abuse or neglect was related to significantly higher risk of six of the PD: paranoid, antisocial, borderline, narcissistic, dependent and obsessive-compulsive personality disorders.
- Parenting style also predicted six PD
- Offspring who had experienced aversive or unaffectionate parental styles –> 7x more likely to develop a personality disorder .
heritability of personality disorders
- Norwegian birth registry to recruit a representative sample of twins.
- heritability estimates for all of the personality disorders were at least moderately high.
odd eccentric cluster (CLUSTER A)
- paranoid personality disorder, schizoid personality disorder and schizotypal personality disorder.
- similarities to the types of bizarre thinking and experiences seen in schizophrenia (less severe)
paranoid personality disorder +4
involves unjustified challenging, suspicious, and
mistrustful behavior. believes people are belittling, hostile or abusive towards them (emotionally cold or quite serious)
• may also exhibit irritability and anger, and a demanding,
oppositional interpersonal style.
• more frequently in men than in women.
• Lifetime prevalence is 1%
experience 4 or more from early adulthood
o unjustified suspiciousness of being harmed, deceived or exploited
o unwarranted doubts about the loyalty or trustworthiness of friends or associates
o reluctance to confide
o find hidden meanings in benign actions of others
o bears grudges for perceived wrongs
o angry reactions to perceived attacks on character or reputation
o unwarranted suspiciousness partner’s fidelity.
differs from schiz
- no hallucinations, no cognitive disorganisation
- full-blown delusions are not present.
• co-occurs most often with schizotypal, borderline and avoidant personality disorders.
- often inhibit their emotional experience to prevent vulnerability and criticism
schizoid personality disorder +4
involves a pervasive pattern of detachment from social relationships.
• Very limited range of emotions in interpersonal situations.
(withdrawn, detached, uninterested/ cold interpersonal style)
• engage in few pleasurable activities. show indifference to praise or criticism.
• Prevalence is less than 1%
• occurs more commonly in men than women.
experience 4 or more of from early adulthood
- lack of desire or enjoyment of close relationships
- prefers solitude
- little interest in sex
- few or no pleasurable activities
- lack of friends
- indifference to praise or criticise
- flat affect, emotional detachment or coldness/aloofness
low freq behaviour
key: not seeing a need for relationships
schizotypal 5+
- Prevalence: 3%
- occurs slightly more commonly in men than women.
- Genetically associated with Schizophrenia,
- Many also meet criteria for major depression
- dress weirdly
- so much variability
5 or more from early adulthood across
o ideas of reference
o odd beliefs or magical thinking, (belief in extrasensory perception) genetic link with schiz~ a way of thinking
o unusual perceptions
o odd thought and speech (“talkable person”
o suspiciousness or paranoia
o inappropriate or restricted affect odd or eccentric behaviour or appearance
o lack of close friends
o social anxiety and interpersonal fears that do not diminish with familiarity
- deficits in cognitive and neuropsychological functioning that are similar BUT MILDER than schizophrenia
- enlarged ventricles and less temporal lobe grey matter
- genetic factors and childhood adversity are likely both involved.
dramatic/erratic cluster (CLUSTER B)
- antisocial personality disorder, borderline personality disorder, histrionic personality disorder and narcissistic personality disorder
key factor ; impulsivity
- symptoms range from highly inconsistent behaviour to inflated self-esteem, rule-breaking behaviour and exaggerated emotional displays, including anger outbursts.
DSM5 Antisocial personality disorder 3+
a pervasive pattern of disregard for the rights of others from the age of 15
\+ 3 of the following: o repeated law breaking o deceitfulness, lying o impulsivity o irritability and aggressiveness o reckless disregard for own safety and others o irresponsibility (unreliable employment or financial history) o lack of remorse.
display evidence of conduct disorder before age 15.
- People with antisocial personality disorder are aged at least 18.
- Men 5x more likely than women
- substance abuse being very common
- relief in regulatory emotions (fear and anxiety)
use substances to relieve boredom
psychopathy clinical descriptions
- psychopathy predates the DSM diagnosis of antisocial personality disorder.
characteristics
- poverty of emotions
- no sense of shame
- superficially charming (used to manipulate others)
- three core traits : boldness, meanness and impulsivity
- Psychopathy Checklist–Revised (PCL-R;)
20-item scale –> based on interview and review of criminal records and mental health charts.
a lack of empathy; central deficit driving the callous exploitation of others observed in psychopathy
aetiology of APD
social environment
- Parenting qualities of (negativity, inconsistency and low warmth)
- environmental (poverty and exposure to violence)
genetics
- polymorphism of the MAO-A gene who had experienced childhood physical or sexual abuse or maternal rejection
neurobiological
- deficits in regions of the prefrontal cortex that are involved in attending to negative information during goal pursuit
Few seek treatment on their own
• Antisocial behavior is predictive of poor prognosis, even in children.
• Emphasis is placed on prevention and rehabilitation.
• Often imprisonment is the only viable alternative
- psychopathy a concept from APD
aetiology of psychopathy
- deficits in the experience of fear and threat.
- lower-than-normal levels of skin conductance thus less reactive to things
- don’t how this expected increase in amygdala activity.
- psychopathy predicts unresponsiveness to threats when trying to gain a reward,
psychological
- immune to the anxiety
- deficits in the experience of fear and threat.
deficits in developing conditioned fear responses.
Borderline Persoanlity Disorder 5+
5 + following signs of instability in relationships, self-image and impulsivity from early adulthood across many contexts:
- frantic efforts to avoid abandonment
- unstable interpersonal relationships in which others are either idealised or devalued
- unstable sense of self (world in extremes, viewing others as either “all good” or “all bad”.)
- self-damaging, impulsive behaviours in at least two areas, such as spending, sex, substance abuse, reckless driving and binge eating
- recurrent suicidal behaviour, gestures or self-injurious behaviour (e.g., cutting self) cutting self regulates emotions –> helps them feel better
- marked mood reactivity
- chronic feelings of emptiness
- recurrent bouts of intense or poorly controlled anger
- during stress, a tendency to experience transient paranoid thoughts and dissociative symptoms.
aetiology of BPD
neurological
- people with BPD demonstrate lower serotonin function
- increased activation of the amygdala to emotional pictures
- Deficits in the prefrontal cortex are thought to contribute to impulsivity and people with BPD show deficits in the prefrontal cortex and disrupted connectivity between the prefrontal cortex and the amygdala
social
- Social factors: childhood abuse in the context of genetic vulnerability
- BPD has been tied to extremely high rates of childhood abuse or neglect, as well as to high estimates of heritability
- lots of trauma (therefore their beliefs may make sense in the context they have been brought up in)
- invalidation of emotion
ideas of reference
belief that events have a particular and unusual meaning for them personally
differences between schizotypal and schizophrenia
o recurrent illusions (inaccurate sensory perceptions
o most don’t develop delusions or schizophrenia
o develop more severe psychotic symptoms over time, and a small proportion do develop schizophrenia over time
o may experience brief episodes of delusions or hallucinations –> not as frequent or intense as schizophrenia.
o possible to make someone with schizotypal personality disorder aware of the difference between their distorted ideas and reality.
How do we measure personality
Personality Assessment Inventory (PAI)
Minnesota Multiphasic Personality Inventory-2 (MMPI-2;)
NEO Personality Inventory (NEO-PI)
