Personality Disorders Flashcards
nature of personality disorders
enduring and relatively stable predispositions (ie ways of relating and thinking)
predispositions are inflexible and maladaptive, causing distress and or impairment
used to be coded on axis 2 in 4
difficult and resistant to treatment
we dont know much about their causes or treatments
controversy of personality disorders
labelling core bit of you as a human being = disordered
one point suggested removing almost all but clinicians oushed against it
cateogircal vs dimensional approach
controvery which should be used
see reading for more info
new model for further research in DSM 5 of PD
DSM5 did not substantially change criteria for pers dis instead new model
only 6 personality types defined yb
-impairments in self and interpersonal functioning
pathological personality traits (negative affect, detachment, antagonism, disinhibtion and psychoticism)
included
antisocial
avoidant
boderline
narcissitic
obsessive-compulsice
schizotypal
cluster a characteristics
odd or eccentric
cluster b characteristics
dramatic, emotional, erratic
cluster c characteristics
fearful or anxious
prevalence of pers dis
adults only - kids personality is still forming so wrong to pathologise them
rates are higher in inpatient and outpatient settings = comorbities and they pull you to treatment
origins and course of personality dis
thought to begin in childhood
tend to run a chronic course if untreated
role of caregivers responses
roel of tempermament
long term development of personality, unlikely thing to change even if diagnosed.. so resistant to treatment
comorbidities of pers dis
high!
gender distribution of pers dis
gender bias exists in the diagnosis of pers dis
such bias may be a result of criterion or assessment gender bias
pathologise gender stereotyped behaviour?
clinical features of paranoid pd
-what cluster
pervasive and unjustifies mistrust and suspicion
A
causes of paranoid PD
bio and psych contributions are unclear
may result from ealry learning that people and the world is a dangeous place
list of paranoid pd symptoms and how many is required for diagnosis
4 suspects without evidence that others are exploiting, harming or deceiving doubts the loyalty of others reluctant to confide due to mistrust negativity in benigin remarks bears grudges perceives attacks on character suspicions of infidelity
treatment options for paranoid pd
few seek help on their own
focuses ondevelopment of trust
cognitive terapy to counter negativistic thinking
lack good outcome studies showing that treatment is effective
schizoid ps
overview, clinical features and which cluster
pervasive pattern of detachment from social relationships
very limited range of emotions in interpersonal situations
A
causes of schizoid pd
etiology is unclear
preference for social isolation resembles austism but no studies linking
syptoms of schizoid pd and how mnay required for diagnosis
neither desires nor enjoys close relationships
mostly chooses solitary activities
little to no interest in sex with another
take spleasure in few activities
lacks close friends other than first degree relatives
indifferent to praise or criticism
emotionally distant and flat
treatment schizoid pd
few seek help themself
focus on value of interpersonal relationships, empathy and social skills
treatment prognosis is generally poor
lack good outcome studies showing treatment is effective
clinical features of schizotypal and which cluster
behaviour and dress is odd or unusual
socially isolated and may be highly suspicious of others
magical thinking, ideas of reference and illusions
risk for developing schizophrenia is high
A
causes of schizotypal pd
phenotype of a schizophrenia genotype = schizophrenia light?
left hemisphere and more generalized brain deficits
symptoms of schizotypal and how many needed for di
5 or more ideas of reference (not delusions) odd beliefs or magial thinking unusual perceptual experiences odd thinking and speech suspicious or paranoid ideation inappropriate or constricted affect odd behaviour or appearance few close friends excessive social anxiety
treatment options for schizotypal
main focus on developing social skills
also address comorbid depression
medical treatment similar to that used for schizophrenia
prognosis is poor
clinical features of antisocial pd and which cluster
failure to comply with social norms and violation of rihts of others
irresponsible, impulsive and deceitful
lack of conscience, empathy and remorse
many have early histories of behavioural problems inc conduct dis
many come from families with inconsistent parental discipline and support (operatn conditioning principles)
families often have histories of criminal and violent behavoiur
modelling
genetics?
psychopathology
incorporates affective / personality traits to a greater degree
most psychopaths meet criteria for ASPD, but most individuals with APD are not psychopaths
criminal behaviours and psychopaths
high
sudden dorp off at aged 40
don’t understand why
unlike normal population
early behaviours in ASPD
many have early histories of behavioural problems inc conduct disorder
many come from families with inconsistesnt parental discipline and support
families often have histories of criminal and violent behaviour
neurobio theories of ASPD
underarousal hypothesis - cortical arousal is too low
cortical immatturity hypothesis - cerebral cortes is not fully developed
fearlessness hypothesis - psychopaths fail to respond with fear to danger cues
treatment of ASPD
few seek
antisocial behaviour is predictive of poor prognosis, even in children
emphasis is placed on prevention and rehabilitation
often incarceration = only viable alternative
borderline PD
- gender
- cluster
75% are women - potential gender bias
cluster B`
treatment options borderline PD
few good outcome studies
antidepressants = short term relief
dialectical behaviour therapy = most promosing psych approach (originially used for sexual abuse surviviors)
histrionic pd
cluster
clinical features
causes
b overlay dramatic, sensational and sexually provocative need to be centre of attention perceived as shallow causes -unknow -female variant of antisocial pd?
histrionic pd symptoms
5 or more uncomfortable when not centre of attention inappropriately seductive or provocative shifting and shallow emotions physical appearance to draw attention impressionistic speech theatrical and dramatic in expression highly suggestible thinks reltionships are more intimate than they really are
treatment options histrionic PD
few good treatment outcome studies
treatment focuses on attention seeking and long term negative consequences
targets may also include problematic interpersonal behaviours
little evidence that treatment is effective
narcissistic pd
cluster
clinical features
causes
b
exaggerated and unreasonable sense of self-importance
preoccupation with receiving attention
lack of empathy
highly sensitive to criticism
envious and arrogant
causes
early failure to learn empathy as a child
sociaological view - a product of “me” generation
narcissistic pd symptoms
5 or more grandiose fantasies of success, power, brilliance etc believes he / she is special or unique requires excessive admiration self entitiled exploits others for his or her benefit lacks of empathy envious of others or believes they are envious of him or her arrogant or haughty
narcissistic pd treatment options
extremely limited treatment research
treatment focuses on grandiosity, lack of empathy, unrealistic thinking
treatment may also adress co-occuring depression
little evidence treatment is effective
avoidant pd
cluster
overview and clinical features
c
extreme sensitivity to the opinions of others
highly avoidant of most interpersonal relationships
are interpersonally anxious and fearful of rejection
avoidant pd causes
numerous factors have been proposed
early development - a difficult temperment produces early rejection
avoidant pd symptoms
avoids activites requiring interpersonal contact out of fear of rejection
needs to be certain of being liked
holds back in relationships out of fear
preoccupies with criticism or rejection
inhibited due to feelings of inadequacy
sees self as inept, unappealing or inferior
reluctant to take risks (embarrassing)
treamtment options avoidant pd
several well-controlled treatment outcome studies exist
treatment is similar to that used for social phobia
treatment targets include social skills and anxiety
dependent pd cluster
clinical features
c
excessive reliance on others to make major and minor life decisions
fear of abandonment
clingy and submissive
causes dependent pd
still largely unclear
early disruptions in learning independence
symptoms dependent pd
indecisive without advice or reassurance
neesd others to be responsible for decisions
wont disagree due to fear of support or approval
difficulty initiating or doing things on own
excessive attempts at nurturnce and support
uncomfortable when alone
must always be in a relationship
preoccupied with having to take care of self
treatment options dependent pd
research on treatment efficacy is laking
therapy typicalyy progresses gradually
treatment targets include skills that foster independence
obsessive compulsive pd
cluster
clinical features
causes
c
excessive and rigid fixation on doing things the right way
highly perfectionistic, orderly and emotionally shallow
obsessions and compulsions are rare
causes = largely unknown
symptoms obsessive compulsive pd
preoccupied with details, rules, order
perfectionism interferes with tasks
devoted to work to the exclusion of leisure
overconscientious and inflexible about morality, ethics or values
cannot discard old or worthless objects
reluctant to delegate unless done in their way
misery
rigid and stubborn
treatment options obsessive - compulsive pd
sata supporting treatmen are limited
treatment may adress fears related to the need for orderliness
other targets include rumination, procrastination and feelings of inadequacy
