Session Twelve (Personality Disorders) Flashcards
Define personality?
- An individual’s characteristic patterns of thoughts, emotions and behaviours, as well as the psychological mechanisms (hidden or otherwise) which dictate them.
- Relatively consistent traits and unique characteristics that give a sense of consistency to a person’s identity
What is a personality disorder?
- An enduring pattern of inner experiences or behaviours that is markedly different from the cultural norms.
- Affecting the way a person relates to others and themselves.
- Causing significant differences in Cognition/ Affectivity/ Interpersonal functioning/ Impulse control
- Behaviour patterns are normally pervasive over time and inflexible.
- Individuals are normally highly stubborn.
- And normally have significantly reduced emotional range with which to cope with life stress.
- Must be distressing to the individual or others to count as as PD.
- Leads to clinically significant impairment in social life, occupation, relationships…
What aspects of a person are influenced by having a personality disorder?
- Cognition
- Affect
- Interpersonal functioning
- Impulse control
(this then usually leads to other issues, such as isolation, depression, addiction).
Who is most likely to experience a personality disorder?
- Most likely age of diagnosis is early adolescence
- 70% of those diagnosed are women
- It is believed men with the condition are more likely to enter the criminal justice system or spiral into addiction than receive a formal diagnosis
- (prison population prevalence of ASD might be as high as 60%)
- Although affects 1% of population so generally common
What common co-morbidities exist in Personality Disorder patients?
- Dissociation and self-harm are immensely common
- Suicidal ideation
- Depression, dysthymia, bipolarism, psychotic phenomena are all pretty common
- Link to PTSD, a very high percentage of PD sufferers were victims of some form of abuse
What health inequalities are experienced by PD patients?
Morel likely to…
- Suffer from depression or anxiety
- Have issue with drugs or alcohol
- Suffer from CVD or obesity
- Live a shorter life (average is roughly 20 years shorter)
- Die an unnatural death (high suicide rate, but also high homicide and accident rates)
For this reason there has been significant impact on improving accessibility and care for these patients.
Broadly, what are the 3 clusters of Personality Disorders (according to ICD-10 and DSM-IV)?
Cluster A = Paranoid, Schizoid, Schizotypal
Cluster B = Antisocial, Borderline, Narcissistic, Histrionic
Cluster C = Avoidant, Dependent, Obsessive compulsive
N.B: Some differences between DSM and ICD, ICD doesn’t recognise Schizotypal or Narcissistic.
What are the ‘3 main areas of difficulty’ which therapists look to address in these patients?
- Affect Regulation (difficulties and variations in emotions)
- Relationships (how people relate to themselves and others)
- Identity (fragile self-esteem, poor sense of identity)
What are the 3 Ps of PD diagnosis, all of which must be present for a diagnosis to be considered?
PROBLEMATIC: Outside the norm for the society in which they live, source of unhappiness for the patient or those around them, sever limitations in their ability to live their lives.
PERSISTENT: Problematic characteristics continue over time, normally emerging in adolescence but remain relatively stable into later life.
PERVASIVE: Affects most if not all aspects of the person’s life; their intimate, family and social relationships as well as the world around them, their work life etc…
What is distinct about the ICD-11 treatment of Personality Disorders compared to ICD-10 or DSM-IV?
One diagnosis; ‘Personality Disorder’.
- Based on the logic that you cannot reliably distinguish PD diagnoses from one another in clinical practice.
- Instead terms people as mild, moderate or severe. Reflects psychologies move towards viewing conditions on a spectrum with normal conditions.
What are the arguments for and against diagnosing people with a personality disorder?
Cons:
- Immensely stigmatising
- Disempowering to the patient
- Insulting and unhelpful
- Since so many are caused by events in their past, is it fair to describe a person reacting to trauma as a disorder rather than just an understandable response to immense stress>
Pros:
- Many people like the label, gives a name to thoughts and feelings they’ve been living with for years
- Allows them to explain themselves to friends and family easier, more forgiving
- Access to support groups
- Can normalise it
- Often need diagnosis to access services
Define Borderline Personality Disorder.
“Pervasive pattern of instability of interpersonal relationships, self-image and affects combined with marked impulsivity which begins in early adulthood and is present in a variety of contexts”.
What are the diagnostic criteria for BPD?
5 out of 9 of…
- Frantic efforts to avoid real or imaginary abandonment
- A pattern of unstable and intense interpersonal relationships characterised by jumping between extremes of liking and hating the person
- Identity disturbance (persistent distortion of self-image or perceived self)
- Impulsiveness
- Recurrent suicidal threats or behaviours
- Affective instability (marked reactivity of mood)
- Chronic feelings of emptiness
- Inappropriate, intense anger
- Transient stress-related dissociative symptoms or paranoid ideation
What are the issues with the 5/9 diagnostic criteria for BPD?
Since you only need 5 of 9 two people with wildly different clinical pictures can receive the same diagnosis, is this internally valid?
What are the 5 types of problems caused by BPD, that clinicians tend to focus on?
- Behaviour problems (impulsivity, self-harming, suicide, violence)
- Emotion problems (emotions change quickly, very strong emotions such as anger or anxiety)
- Thinking problems (rigid thinking, black and white, suspicion or paranoia, dissociative experiences when stressed out)
- Identity problems (not knowing who you are, feelings of emptiness)
- Relationship problems (unstable relationships, fears of abandonment)
What are the 5 domains affected by BPD?
BITER
Behaviour, Identity, Thinking, Emotion, Relationship
What is the diagnostic criteria for Antisocial Personality Disorder?
Pervasive pattern of disregard for (and violation of) the rights of others + occurring since the age of 15 + in a person over the age of 18 + 3 of….
- Failure to conform to social norms (normally means the law)
- Deceitfulness (e.g. lying or coning)
- Impulsivity
- Irritability and aggressiveness
- Disregard for safety
- Irresponsibility (e.g. with money, with work)
- Lack of remorse after hurting or otherwise mistreating another
(can’t be explained by Sz or mania)