Problem 8 -Personality disorders Flashcards
What is a personality disorder?
- stable and enduring patterns of thoughts, feelings, behavior (personality trait)
- emerge in adolescence or early adulthood
- deviate from norms
- pervasive and inflexible
- lead to distress/impairment
structure Diagnostic and Statistical Manual of Mental Disorders, volume 5 DSM-5
- 10 personality disorders
- classified into 3 groups/clusters according to their similarity of their symptoms
Cluster A - odd, eccentric (3)
- Schizoid
- Schizotypal
- Paranoid
Schizoid
- extreme detachment and lack of interest in social or personal relationships
- very limited expression of emotions in interpersonal settings
- prefer almost always to be alone
- emotional detachment
- no affection for others
- indifferent to praise/criticism
- even in nonsocial settings
- > little joy/pleasure
Schizotypal
- discomfort in close relationships
- eccentric behaviors and thoughts
- having unusual ideas of reference
- perceiving special meaning in everyday events or objects
- highly fascinated with paranormal / having bizarre perceptual experiences
- example: seeing what is happening somewhere far away
ekzentriker
-person die deutlich von der sozialen norm abweicht
Paranoid
- extreme distrust and suspiciousness of others
- quick to take offence/feel insulted
-antecedent for schizophreny
Cluster B - dramatic, emotional, erratic (4)
1) Antisocial
2) Borderline
3) Histrionic
4) Narcissistic
Antisocial
- disregard for and violation of the rights of others
- lying to others
- conning (betrügen) others
- feel no remorse for actions
- aggressive
- irresponsible
- impulsive
- reckless
Borderline
- extreme impulsivity (drug abuse, eating binges, sexual escapades, spending sprees (kaufrausch), self harming)
- instability of relationships, self-image and emotions
- intense and unstable relationships
- worry frantically (wie wahnsinnig) about possibility of being abandoned
Histrionic
- excessive attention seeking
- exaggerated expression of emotions
- use physical appearance to draw attention
- seductive, sexually provocative style
- easily influenced by others
Narcissistic
- excessive sense of self-importance and entitlement
- grandiosity
- seeing oneself as being entitled to special treatment
- arrogant style
- often exploit others
- failing to appreciate others needs
Type C - anxious, fearful (3)
1) Avoidant
2) Dependent
3) Obsessive- compulsive
Avoidant
- extreme shyness
- low self-esteem
- strong fear of rejection, criticism, disapproval
- unwilling to participate socially unless certain of being liked
- lack of social contact (different reasons than schizoid and schizotypal)
Dependent
- excessive need to be taken care of
- submissive, clinging behavior
- fears of separation
- require great deal of advice
- need other people take responsibility for important features of their lives
- often go through great lengths to maintain support/nurturance
Obsessive- compulsive
- excessive preoccupation with order, perfection and control
- fail to complete tasks/projects
- highly stubborn
- inflexible
- tendency to hoard money and objects unnecessarily
- NOT the same as obsessive-compulsive disorder (repeated washing hands, tapping etc)
Problems with the DSM-5 Personality Disorders
-1)
1) symptoms of a given disorder do not necessarily ‘go together’
- a person with one symptom is no more likely than anyone else to have another symptom
-two persons diagnosed with the same disorder might not have any symptoms in common
Problems with the DSM-5 Personality Disorders
-2)
2) two disorders may have overlapping symptoms, and may tend to be diagnosed together
- comorbidity-> joint occurrence of two or more disorders
- tends to make system inefficient
- would be better to develop a system in which the various disorders showed little/no overlap
Problems with the DSM-5 Personality Disorders
-3)
3) ‘clusters’ of disorders do not match factor analysis results
Problems with the DSM-5 Personality Disorders
-4)
4) a personality disorder should be seen as a continuum, not as a category
- having a personality disorder is a matter of degree
- shouldn’t be only having or not having
Alternative system for personality disorders - ICD 11
- new system has 2 essential features:
- one get assessed on those:
- impaired personality functioning
- presence of pathological personality traits
Impaired personality funcitioning (2)
1) ‘Self’ problems (identity and self-direction)
2) Interpersonal problems (empathy and intimacy)
1) self problems - identity problems
- identity problems
- > not having a sense of self as unique person
- > unstable self esteem
- > easily threatened by negative experiences
- > distorted appraisal of strengths/weaknesses
- person might not be able to regulate emotions/ recognize what emotions he/she experiences
1) self problems- self-direction problems
- not being able to set realistic/meaningful goals
- unable to reflect constructively on experience/motivations
2) Interpersonal problems - empathy
- unable to understand others’ experiences/motivations
- unable to understand/consider others’ perspectives
- little understanding of how behavior affects others
2) interpersonal problems - intimacy
- lacking in positive, sustained relationships
- unable/unwilling to cooperate with others
pathological personality traits
- new system ICD 11
-new system recognizes 25 specific personality traits as being potentially pathological -> when an individual shows a high level of the trait
-> classified into 5 broad
domains
5 domains of new personality trait system
1) negative affectivity
2) detachment
3) antagonism
4) disinhibiton
5) psychoticism
-> can be compared to Big 5
1) negative affectivity
- emotional lability
- anxiousness
- separation insecurity
- perseveration (continuing a behavior that is no longer effective)
- submissiveness
- hostility
- restricted affectivity (emotional coldness)
- depressivity
- suspiciousness
2) Detachment
- withdrawal
- anhedonia (lack of enjoyment/pleasure)
- intimacy avoidance
- restricted affectivity
- depressivity
- suspiciousness
3) antagonism
- manipulativeness
- deceitfulness
- grandiosity
- attention seeing
- callousness (gefühlslosigkeit)
- hostility
4) disinhibition
- irresponsibility
- ridgid perfectionism
- distractibility
- risk taking
5) psychoticism
- unusual beliefs and experiences
- > hearing/seeing things
- eccentricity
- cognitive and perceptual dysregulation (feeling disconnected from own thoughts and body)
diagnosing personality disorders in the proposed new system
- constructed interview
- observe behavior directly/records
- 2 features: 1) impaired personality functioning and 2) pathological personality traits must be present for the disorder to be diagnosed
rating impairment of personality functioning - ICD 11
- clinician rates each problem in personality functioning on a scale from 0 (no impairment at all) to 4 (extreme impairment)
- 3 and 4 -> indicate personality disorder
rating pathological personality trais - ICD 11
- from 0 (very little or not at all descriptive) to 3 (extremely discriptive)
- 2/3 indicate a personality disorder
other essential features necessary to diagnose a PD
- relatively stable across time and consistent across situations
- traits must not be considered as normal for the person’s stage of development or society
- must not be due to substance use/ medical conditions
borderline heritability
- rather high heritability
- symptoms might be caused by various kinds of trauma during childhood (sexually or physically abused)
schizotypal symptoms heritability
- about 10% have genetic tendency toward abnormal pattern of brain functioning which can produce schizotypal symptoms
- > depending on a person’s social learning experiences when growing up
treatments of personality disorders (5)
1) psychodynamic psychotherapy
2) cognitive behavioral therapy (CBT)
3) Dialectical behavior therapy (DBT)
4) Psychobiological treatments
5) treatment of antisocial personality disorder
1) psychodynamic psychotherapy
- clinician tries to help express emotions (including troubling, distressing ones)
- help examine important relationships and experiences in patient’s life
- encourage patient to speak freely about what is on his/her mind
- reflect and explore own mental life
- > improve self-understanding and functioning
2) cognitive behavioral therapy (CBT)
- understand irrational beliefs patient holds
- > show patient that those are maladaptive
- get the patient to realize that perceptions are inaccurate and harmful
- > try to change perceptions
3) dialectical behavior therapy (DBT)
-especially developed for Borderline
-making patient aware of thoughts/feelings
-> accept them without judgement
-makes it easier to handle them
-trying to avoid conflict in patient
-clinician can try to develop plans for developing more adaptive responses
-
4) psychobiological treatments
- drugs to counteract imbalances of chemical substances in the brain
- some antidepressant and mood stabilizing drugs helped managing borderline
- antipsychotic drugs (reduce delusions and hallucinations) helped managing Borderline and Schizotypal symptoms
treatment of antisocial personality disorder
-problem: many people are motivated to appear as they have been cured of tendency to exploit others
psychodynamic group therapy for antisocial PD
- intended to develop feelings of empathy and responsibility toward one’s peers
- > future violent offending is decreased in nonpsychopathic offenders
- > in psychopats it is increased
- > similar results for cognitive behavioral therapy
Most successful method for antisocial PD
-make it in person’s own self-interest to avoid exploiting other people
-goal is not to change
them
-goal is to reduce gap between person’s self interest and society’s expectations of behavior
Article - Dark personality
- focus on Dark Triad
- > Machiavellianism
- > Narcissism
- > Psychopathy
- > all negatively related with agreeableness
Machiavellianism
- lack of empathy
- low affect
- possessing unconventional view of morality
- willingness to manipulate, lie, exploit others
- focus on own goals
- pleasure in deceiving others
- negative with conscientiousness
Narcissism
- grandiosity
- entitlement
- dominance
- superiority
- difficulty maintaining interpersonal relationships
- lacking trust and care for others
- positive mit openness and extraversion
Psychopathy
- impulsivity and thrill seeking
- low empathy and anxiety
- self-promotion
- unique affective experience
- lack of self-conscious emotion guilt
- do not experience anxiety and fear as normal people do
- fail to learn from punishment
- negative with conscientiousness
- positive with openness and extraversion
categorical system of classification
-clearly defined disorders
dimensional classification
- based on trait-based personality theory
- > pathological effects show themselves increasingly as one moves across the severity of the dimension
categorical VS dimensional approach focus!!!
- categorical approach is flawed
- > tried to add a dimensional approach
- > part 3 in DSM 5
- > but dimensional approach is also flawed
problems categorical approach
-
problems dimensional approach
-when to administer treatment?
difficulty of comorbidity
- risk to over-diagnose
- patients are often identified with 3-10 PD
- > cannot be separated
article main message -treatment
- no treatment really supported
- 2 approaches
- evidence of treatment of PD limited because of short follow ups, poor control of coexisting psychopathology
article - dark triad relation to big 5
- each one of Dark Triad -> negatively associated with Agreeableness
- Machiavellianism + Psychopathy -> negatively related to conscientiousness
- Narcissism + Psychopathy -> positively related to Openness and Extraversion
- Narcissism + Machiavellianism positively associated with Neuroticism
- Psychopathy -> negatively with Neuroticism
hogan development survey??
- rate people on dark triad
- formulated in a nice way
subclinical
-score high , but not having a disorder
conditional reasoning task
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