set 8 - personality disorders Flashcards
personality disorders
overview
- Special Issues in Personality Disorders
- Cluster A Disorders
- Cluster B Disorders
- Cluster C Disorders
special issues of personality disorders
what is personality?
characteristic ways that a person think and behave across situations
what is a personality disorder?
- personality disorders, unlike anxiety or major mood disorders are things that we have (YOU are the disorder) -> the most controversial section of the DSM
- no episodic moments,
- with all the other disorder, individual experiences distress, it is not always the case with personality disorders (maybe experienced to those around them, which is more unique to PD’s )
- they are less likely to report experiencing distress or impairment
special issues
gender issues
Gender issues
- Men and women tend to be diagnosed with different disorders
- Due to biased criteria, biased tools, or biased clinicians?
- men are tend to be diagnosed with more aggressive, perfectionistic, self assertive, or detached symptoms
- women are more likely to be diagnosed with symptoms relating to submissive, emotional, and insecure
- issue of criteria? Biased? Clinician biased?
- biased clinicians seems to be the driving force, they feed into stereotypes
special issues
age of onset?
Exist in childhood?
Diagnose in late teens or young adulthood
- controversial as well
- childhood, personality that they ever had
- typically you would diagnose early teen, early adulthood
- issues with diagnosing a child with personality disorder -> they’re just developing their personality
- stigmatization, shame, when you assign a label to a child, it will def influence the child
cluster A
Defining characteristics: Odd and eccentric behaviours
Disorders
Paranoid PD : Life% = 2%-5%
Schizoid PD : Life% = 3%-5%
Schizotypal PD : Life% = 1%-5%
notes:
- similar to schizophrenia
- NO PSYCHOTIC FEATURES FOR ALL DISORDERS
- no age of onset
- prevalence rate is pretty high
Cluster A:
1) Paranoid PD
Pervasive distrust and suspiciousness of others, as indicated by:
- Suspects others are exploiting, harming, or deceiving them
- Reads hidden demeaning or threatening meanings into benign remarks or events
- Perceives attacks on their character or reputation that are not apparent to others
notes:
- enduring personality characteristic, they always existed this way
- 4/7 of criteria to meet (note that that they should have displayed this personality always)
- main theme: they are distrusting and suspicious because they believe other’s motives are malicious
- perceive comment very differently, very reactive, quick to counter-attack or be angry
- they believe other people are malicious motives ,do not trust them
- no delusions or hallucinations
- more common in men
Paranoid PD Causes and Treatments
etiological factors:
1) Genetics (linked with psychotic disorders): relative with schizo can have a slightly increase risk of paranoid PD
2) Childhood maltreatment
3) Very negative cognitive schemas: general lens of viewing the world very negatively
treatmet:
CBT to challenge assumptions and behaviours
- they are very unlikely to seek treatment, because they distrust people
- very difficult to form a therapeutic alliance
- treatment rarely works because they drop out
Cluster A:
2) Schizoid PD
Pervasive detachment from social relationships and a restricted range of interpersonal emotional expression, as indicated by:
- Neither desires nor enjoys close relationships
- Lacks close friends or confidants other than first-degree relatives
- Almost always chooses solitary activities
- Shows emotional coldness, detachment, or flattened affectivity
notes:
Schizoid – void / absence of a lot of things
- 4/7 criteria
- not expressive emotionally
- do not want relationships
- they are only close to their family because family members are trying to keep a relationship with them
- they are not super expressive.
- very little interest in having sex
- they do not care about what you think
- they observe others, tend to have very bad social issues
- common in men
- they do not have social relationships and it always has been present
- they do not care about criticism or praise, they just do not care
Schizoid PD Causes & Treatments
Etiological factors
- Genetics (linked with psychotic disorders)
- Possible lower density of dopamine receptors
- Childhood abuse, neglect, shyness
Treatment
- Pointing out the value of relationships
- Social skills training
- relatives bring them in, but they do not really care
- helps them develop social skills
- treatment is not really effective because they don’t really care
- they do not see a problem
Cluster A:
3) Schizotypal PD
5/9 Criteria
Pervasive social and interpersonal deficits marked by acute discomfort with, and capacity for, social relationships, AND cognitive or perceptual distortions and eccentric behaviour, as indicated by:
- Ideas of reference: believing that meaningless events are personally meaningful or significant (believing that everyone in the bus passing by is talking abt them, headlines or news is sending them a message )
- Odd beliefs or magical thinking: they will believe that their thoughts, beliefs, ideas, thoughts, action can influence and change in things (believes that they are telepathic, I can predict the future), they form a connection between their inner experiences and the external world around them
- Unusual perceptual experiences, including bodily illusions: bodily illusions: sensation that someone is beside them while laying down or that they are levitating
schizotypal PD contd
Odd thinking and speech
Odd/peculiar/eccentric behaviour or appearance
Excessive social anxiety that does not diminish, and is associated with paranoia
notes:
- speech can be very vague
- interesting hairstyles or clothing
- they may have that excessive social anxiety but linked to paranoia
- they lack friends, fewer friends are because of their paranoia or restrictive affect that they have
- still aware of their reality but have flares of schizophrenia (distant and aloof, but internally they do experience emotions)
- no delusions and hallucinations
- very distortive thinking (magical thinking)
schizotypal PD causes and treatments
Etiological factors
- Genetics (linked with psychotic disorders)
- Brain abnormalities (some issues with left hemisphere of the brain for languange)
Treatment
- Antipsychotic medications show limited effectiveness
- comorbid with major depressive disorder
- Increase social skills
Cluster B
Defining characteristics
- Elevated impulsivity
- Dramatic, emotional, and erratic behaviours
Disorders
Antisocial PD : Life% = 1%-3%
Borderline PD: Life% = 1%-6%
Histrionic PD: Life% = 2%
Narcissistic PD: Life% = <1%-6%
Cluster B:
1) Antisocial PD
Pervasive disregard for and violation of the rights of others, as indicated by:
- Failure to conform to norms regarding lawful behaviour
- Impulsivity or failure to plan ahead
- Irritability and aggressiveness
- Lack of remorse
Conduct disorder before age 15
Antisocial PD Controversy
psychopathy:
- Glibness/superficial charm
- Grandiose sense of self-worth
- Pathological lying
- Conning/manipulative
- Lack of empathy
notes:
psychopathy is a subset of antisocial PD
15-25% of people who have antisocial PD have psychopathy
Have more intelligent subtype?
Have much less empathy than antisocial pd
If have more intelligence they are more likely to go to jail
Plan out crimes more, so not that impulsive
Far less engaging in treatment
50-80% of male offenders have antisocial PD but only 15-25% have psychopathy
Cluster B
2) Borderline PD
Pervasive instability of relationships, self-image, and affects, as well as marked impulsivity, as indicated by:
- Frantic efforts to avoid real or imagined abandonment
- Impulsivity in two areas that are potentially self-damaging: driving fast / unprotected sex
- Chronic feelings of emptiness
Need 5/9 criteria to be diagnosed
Have pervasive instability of relationships, self-image, affects and impulsivity:
Frantic efforts to avoid real or imagined abandonment, leads to intense relationships, quick to put people on a pedestal, but any threat to them leaving them turns them to a villain
borderline PD causes
etiological factors
Genetic contribution tied to mood disorders
Early sexual or physical abuse
- have been abused or neglected in their life, 60-90% have this, people more abused are more likely to have suicide attempts, more often seen in women cause they experience more sexual abuse than men
Poor coping strategies
- risk behaviours, impulsivity
borderline PD contd
Recurrent suicidal behaviour, gestures, or threats, or self-mutilation
* 10% of BPD people attempt suicide and 6% die by suicide due to,
Affective instability due to reactivity of mood
- experience intense dysphoria (state of unease or dissatisfaction), apathy, irritability, anxiety
Inappropriate/intense anger, or difficulty controlling anger
- Substance abuse is very common
- Symptoms go away after 30 in some people
- More common in men than women
borderline PD treatments
they seek treatment for substance abuse usually or because family tells them
treatment
1) medications
- Tricyclics
- Lithium
- Atypical antipsychotics
2) dialectical behavioural therapy
Includes lots of interpersonal work, based on radical acceptance, accepting feelings while they are happening so they do not control them, distress tolerance is a huge component of DBT, emotion regulation
88% of people who do DBT receive remission from their symptoms within 10 years
borderline PD controversy
Comorbidity with mood disorders
24%-74% have MDD
4%-20% have bipolar disorders
Could borderline PD be a rapid-cycling subtype of bipolar disorder?
- could be a subtype but we are not very sure
- always validate their emotions and validate whatever they are saying
Cluster B
histrionic PD
Pervasive excessive emotionality and attention seeking, as indicated by:
- Uncomfortable in situations when not the center of attention
- Uses physical appearance to draw attention
- Rapidly shifting and shallow expressions of emotions
notes:
Dramatic shifts of emotion, they may be super happy or super sad about something but may not feel that way
Easily influenced by others
Women diagnosed more than men, could be due to therapist bias
histrionic PD causes and treatments
1) Etiological factors
- Female form of antisocial PD?
- All-or-Nothing thinking
2) Treatment
- Examining interpersonal relationships
- Short-term gains vs. long-term costs
notes:
Female form of antisocial PD, it is all or nothing thinking - like simple life events are viewed as major life events
Not attention seeking but connection seeking
Short term gains vs long term costs
Cluster B
narcissistic PD
Pervasive grandiosity, need for admiration, and lack of empathy, as indicated by:
- Grandiose sense of self-importance (believes they are special, uniqu, lack of empathy)
- Believes he/she is special and unique
- Lacks empathy
- Preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love
- Exaggerate talents, think they are incredibly unique and think they are understood only by upper class people
notes:
Antisocial and histrionic mixed together;
More common among men, about 75% of people diagnosed with NPD are men
narcissistic PD causes and treatments
1) etiological factors
Failure to develop empathy
Hypersensitivity to evaluation
- they do not like it when they are criticized
2) Treatment
Decreasing sense of grandiosity and hypersensitivity to evaluation
Increasing empathy
Cluster C
Defining characteristics: Anxious and fearful behaviours
Avoidant PD: Life% = 2%
Dependent PD: Life% = 0.5%
Obsessive-compulsive PD: Life% = 2%-8%
Cluster C
Avoidant PD
Pervasive social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation, as indicated by:
- Avoids occupations that involve significant interpersonal contact
- Unwilling to get involved with others unless certain of being liked
- Restrained in intimate relationships and reluctant to engage in new activities
- Views self as socially inept, personally unappealing, or inferior
notes:
They feel inadequate and inferior, do not want to be criticized or experience disapproval or rejection
Rates equal in men and women and rates lessen with age
avoidant PD causes and treatments
1) Etiological factors
- Parental rejection or lack of love
- Increased behavioural inhibition (they tend to perceive rejection even if it is not there)
2) Treatment
- Graduated exposure to feared situations
- Social skills training in group formats
Avoidant PD - controversy
Social anxiety disorder
- Comorbidity rate of approximately 40%
- Quantitative and qualitative differences
- Avoidant PD may have traits of psychotic disorders
what is the difference between social anxiety disorder and avoidant personality disorder?
Avoidant PD may have traits of psychotic disorders that is the difference between SAD and APD
APD people feel personally inadequate, SAD people feel being negatively perceived
SAD people can have confidence and good self esteem
SAD people see that the world doesn’t judge them as much as they think they do
APD people believe it is the truth that they are worthless and inadequate
APD people have shame but people with SAD do not have that?
APD people are more intense
Cluster C
Dependent PD
5/8 criteria
Pervasive and excessive need to be taken care of, leading to submissive and clinging behaviour and fears of separation, as indicated by:
- Difficulty making everyday decisions without excessive advice and reassurance (even the smallest decisions like what to order)
- Difficulty expressing disagreement with others
- Goes to excessive lengths for support from others
- Urgently seeks new relationships for care and support when one ends
dependent PD notes
- hard for them to make decisions (even the smallest decisions like what to order)
- why would they have difficulty expressing disagreement to others? They fear losing support from people.
- they are afraid of criticism
- they will ask people to assume responsibility for things that people typically do by themselves – paying bills, taxes, can you help me with this
- they need lots of advice and reassurance to carry on
- they will often help other people out even if they’re hurting themselves
- they think they are helpless when they are on their own
- they can easily be taken advantage of, they will do almost anything to keep somebody
- they focus on other’s needs
dependent PD causes
etiological factors
Genetic influence - you can have a general predisposition
Excessive sociotropy - – very much valuing positive social interactions / when they are interacting with somebody, they want to make sure that this person likes them, having fun so they can stay with them (that it’s a positive interaction)
Lack of autonomy - they do not exhibit autonomy or freedom to make their own choice
Influence on relationships - love bombing (initially people would think clinginess feels good and makes them feel special, but it very much supports the behavioural clinginess and reinforces that negative cycle)
dependent PD treatments
- CBT tends to be helpful
- initially people with dependent PD present very well in therapy (they want the therapist to have a positive experience)
Cluster C
obsessive-compulsive PD
4/9 criteria
Pervasive preoccupation with orderliness, perfectionism, and mental or interpersonal control, as indicated by:
- Preoccupied with rules, lists, schedules, etc. (to the point that the activity is lost, they are so preoccupied with the list that they don’t even get on their list)
- Perfectionism that interferes with task completion
- Excessively devoted to work and productivity
- Unable to discard worn-out or worthless objects
- Rigidity and stubbornness
obsessive-compulsive PD causes and treatments
Etiological factors
- Weak genetic contribution
- Parental reinforcement of conformity, neatness, and orderliness
- parents with OCPD tend to be controlling
- control helps them to feel safe
- High levels of perfectionism, worry, and rumination
- they often procrastinate and feel inadequate – they want to get things done so perfectly that they do not even start doing it all
obsessive-compulsive PD controversy
Obsessive-compulsive disorder
- Comorbidity rate of 20%-30%
- Tend to not have obsessive thoughts or compulsions
- Lack ego-dystonic features
notes:
- sounds a lot like OCD
- 20-30% overlap
- no obsessive thoughts or compulsions
- people with OCPD lack ego-dystonic features (thoights do not align their beliefs, so they are completely distressed)
- OCD is very much characterized with ego-dystonic features
- people with OCPD wanting something clean, aligns with their value and beliefs
