Personality Disorders - CPch.15 Flashcards
General Info
What is Personality?
A combination of our unique traits that are expressed in thoughts, behavior, feelings and interpersonal functioning.
- Stable over time
- Stable over situations
When do we start considering one’s problems with personality as a disorder?
- Personality traits are:
~ Extreme
~ Inflexible/rigid
~ Dysfunctional - Person is Ego-Syntonous (people doesn’t perceive their personality as a problem, instead they just consider it a part of themselves and that they can’t do anything about it)
(Opposite of Ego-Dystonous: part of me is a big problem and I don’t want it to be part of me, e.g. OCD)
-
What is the definition of Personality Disorders in general?
Defined by enduring problems with forming a stable positive identity and enduring problems with sustaining close and constructive relationships
What are the criteria for Personality Disorders in general (DSM-5)?
- An inflexible pattern of inner experience and behavior that is distinct from cultural expectations and influences 2 of the following:
~ Cognition about self and others
~ Affect
~ Interpersonal functioning
~ Impulse control - The pattern is:
~ Pathological (Causes significant distress/impairment)
~ Pervasive (Is inflexible)
~ Persistent (pervasive across many situations) - Onset in early adulthood, persists for a long duration
- Not explained by another mental/medical disorder or substance
Why is it important that the pattern is distinct from cultural expectations?
- Culture determines how we think, feel, act in general
- Culture determines emotion expression and is relevant for evaluating the cluster C PD’s
What are the 3 clusters of PD’s?
- Cluster A: Odd/eccentric behavior
- Cluster B: dramatic/erratic
- Cluster C: Anxious/fearful
What other types of PD’s does the DSM-5 include?
- Other specified/unspecified PD’s
- Personality changes due to another medical substance
What is the comorbidity of PD’s?
- PD’s are usually comorbid with other PD’s, either within or between clusters. (e.g. dependent + avoidant very often go together, antisocial + borderline very often go together)
- BPD, also with PTSD
- Mood disorders: comorbidity with Cluster B & C
- Anxiety Disorders: Comorbidity with Cluster C Disorders
- Substance Use Disorders: 40% of patients in detox settings have PD
(When comorbid with other disorders, PD symptoms are more severe, social functioning is more impaired)
What is the Epidemiology of PD’s?
- General population: 9-13%
- In prisons: 60-70% of inmates
- PD’s provide high costs for society
What is the onset of PD’s?
Adolescence - early adulthood
!!! BUT !!! Some symptoms that are present in adolescence don’t persist. As patients grow up, symptoms tend to become milder (in most cases)
(Also, previously thought to be untreatable disorders)
What are two important factors when diagnosing PD’s?
- Interrater reliability is important: with structured interview, there’s a 0.70 correlation between observers diagnosis, without structured interview, there’s an inadequate correlation
- !!! Important to use structured interviews !!! (Unfortunately not many psychologists use them)
What are some problems with the DSM-5 approach to PD’s?
- PD’s aren’t stable over time: (Study) 99% of people diagnosed with PD didn’t meet criteria for diagnosis 16 years later
–> PD’s aren’t as stable as the DSM-5 says
~ Still, even after PD goes away, milder symptoms persist - PD’s are highly comorbid: Some PD’s have similar symptoms with other comorbid disorders, difficulty in diagnosing
- Number of symptoms required for a diagnosis is arbitrary: better to use a dimension reflecting severity of symptoms and functional problems than a categorical classification (if there are 8 symptoms, yes/no diagnosis)
What does the alternative DSM-5 model for PD’s do different?
It has a reduced number of PD’s (6 out of 10 original PD’s), and diagnoses them based on extreme scores on personality trait measures.
- Doesn’t include Schizoid, Histrionic, Dependent, and Paranoid PD’s
What are the steps for diagnosing a PD with the alternative model?
1) You start to consider the diagnosis when there are persistent and pervasive impairments in functioning from early adulthood
2) then you consider personality traits that explain those difficulties using 5 personality trait domains and 25 personality trait facets (similar to using BIG 5)
What are some reasons that the Alternative Model for diagnosing disorders in general may be better than the Categorical Model of Classification (Yes/No) in the DSM-5?
- All disorders are dimensional in nature
- Thresholds are never concrete and distinct (they’re determined by consensus, and are always an arbitrary decision)
What are some reasons that the alternative model may be better than the original one in diagnosing PD’s?
- Personality Traits ratings are more stable overtime than PD diagnoses
- 25 dimensional scores provide richer detail than categorical PD’s diagnoses
- Personality Traits are related to many psychological disorders (debatable if this is a reason for it to be better or worse, does it diagnose then PD’s only or other stuff)
- Personality Traits predict important outcomes such as happiness, quality of life, relationships, stress, physical health etc.
- Easier to discuss personality trait profile with clients, and more helpful for treatment planning
Common risk factors
Is the genetic vulnerability for PD’s shared?
Yes (for most PD’s)
35-65% genetic vulnerability
What does this shared genetic vulnerability contribute to?
Personality Traits related to higher risks for certain PD’s
What is the Heritability for PD’s?
For the 6 PD’s of the alternative model –> 0.64-0.78
What Neurotransmitters are associated with PD’s and in what way?
- Dopamine: associated with Cluster A PD’s
- Serotonin: associated with anger and impulse control problems
- MAO: associated with aggression
What Brain areas are associated with PD’s and in what way?
- lack of frontal cortical control (impulses and emotions)
- Dysfunction in amygdala (hypo/hyper-sensitivity)
What are some environmental factors for PD’s?
- Child Maltreatment and abuse/neglect
~ 5x more likely for APD, 7x more likely for BPD, 18x more likely for narcissistic PD - Family:
~ Aversive parental behavior (harsh punishment, loud arguments)
~ Lack of parental affection
~ Modelling - Low SES
- Peer influences
Theoretical models explaining PD’s
What does the Learning/Behavioral model of PD’s state?
- Problems of PD’s arise through classical and operant conditioning. (If I attach to somebody, I’ll be hurt (CC), if I force my way, I’ll get what I want (OC)
- Problems of PD’s also arise through modelling of parents
How might Beck’s Cognitive model explain PD’s?
People’s schemas influence how they interpret and what they think about situations. So negative schemas might lead a person to interpret a certain situation as something a lot worse or bad than what it actually is.
(e.g. Situation: He’s leaving earlier than expected
Schema: People are selfish and abusive
Thought: He doesn’t care about me, he just wants to abuse me)
How does Young’s Schema Theory elaborate on Beck’s Cognitive model?
In childhood, if basic needs are not met (e.g. safety, autonomy, boundaries etc.), then the child is very likely to develop “early maladaptive schemas”
(there are 18 specific “early maladaptive schemas”)
Odd/Eccentric Cluster (Cluster A)
What are the criteria for diagnosing Paranoid PD?
(At least 4 of the following, from early adulthood in many contexts)
- Unjustified suspiciousness of being deceived, harmed, exploited –> reluctance to confide in others
- Doubt about loyalty/trustworthiness of people who we know/are associated with
- Tendency to see hidden meanings in others benign actions
- Angry reactions to perceived attacks on character/reputation
- Suspiciousness of partner’s fidelity
(!!! Descriptive word = distrusting !!!)
