Task 8 Flashcards

1
Q

Personality disorders

A

extreme level of a personality trait
o Stable and enduring pattern of thought feelings and behaviour, and are pervasive and inflexible across many aspects of one’s life
o Leading to distress and impairment
o Must have negative consequences on well-being of yourself or others

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2
Q

Origins of PDs

A
o	Generally the same as for Personality traits
o	Traumas (esp. borderline)
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3
Q

PDs as a general genetically trait-based construct

A

o Genes might predispose for PDs (Personality traits are .50 heritable so it suggested that PDs are too)
o Early-life epigenetic variability as a result of early-childhood adversity might account for differential gene expression
o Elements of PD change over lifetime

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4
Q

Stability and change

A

o Weak to moderate individual differences occur between 3 yrs till 18
 No real scientific validation (just assumed based on normal personality traits)
o Highest stability is reached with 30
o Odd or avoidant PDs tend to increase over time
o Features of personality disorder peak at about age 13-14 years and reduce monotonically from age 14 to 28
 Due to decrease in impulsivity, attention seeking and dependency

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5
Q

´DSM-5 Model

A

Hybrid model

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6
Q

Schizoid (DSM-5)

A

 Extreme degree of detachment from social relationships (isolation) and a very limited expression of emotions in interpersonal settings (emotional detachment)
 They prefer to be alone but even when they are they feel little joy or pleasure

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7
Q

Schizotypal

A

 Also detachment form social relationships, but they experience extreme discomfort in such relationships
 They are considered as eccentric and have a tendency to perceive personal meanings in everyday events or objects
 Tend to be highly superstitious or fascinated with the paranormal
 Considered to be extremely odd, peculiar, or eccentric

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8
Q

Paranoid

A

 Have an especially strong suspiciousness of others motives, and a sense of being persecuted
 They are quick to take offense or to feel insulted, even in response to innocent actions

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9
Q

Antisocial

A

 A tendency to disregard, lying, and to violate the rights of others
 The don’t feel guilt for their actions
 Tend to be aggressive, irresponsible and impulsive and reckless
 Cognitive therapy is most successful

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10
Q

Borderline

A

 Has intense and unstable love/hate relationships with others
 Paired with impulsive behaviours such as drug abuse, eating binges or sexual escapades, often self-harming behaviour
 Tends to be extremely moody and temperamental, has little sense of personal identity or of meaning in life

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11
Q

Histrionic

A

 Exaggerated display of emotions and excessive attention seeking (need to be centre of attention)
 Use physical appearance to draw attention, and have seductive, sexually provocative style
 They tend to be suggestible or easily influenced by other, consider causal relationships as much closer as in reality

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12
Q

Narcissistic

A

 Tendency to consider oneself as superior individual who deserves the admiration of others and a selfish lack of concern for others
 Tends to fantasise about having high status and to envy those who are highly successful

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13
Q

Avoidant

A

 Defined by social inhibition and shyness, by feelings of inadequacy and by oversensitivity to possible negative evaluation
 Are unwilling to participate in socially unless certain of being liked
 Low self-esteem along with an extreme sensitivity to embarrassment, criticism and rejection
 The avoidant persons wants social contact but is afraid of rejection

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14
Q

Dependent

A

 Characterized by an excessive need to be taken care of and by submissive, clinging behaviour and fears of separation.
 Need reinsurance for everyday life decisions and feel unable to take care of themselves when alone
 Try to gain support by doing unpleasant things voluntarily or by avoiding expression of disagreement

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15
Q

Obsessive compulsive

A

 Involves preoccupation with orderliness, perfection and control
 Tends to put work ahead of social relationships and to be highly stubborn and inflexible
 Tendency to hoard money and objects unnecessarily
 No repeated behaviour such as handwashing (that is the difference to obsessive compulsive disorder so the PD version)

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16
Q

Cluster A

A

odd and eccentric
schizoid, schizotypal and paranoid PD
• Least adaptive and treatable

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17
Q

Cluster B

A

Dramatic and erratic
antisocial, borderline, histrionic and narcissistic PD
• Major social adaption difficulties and variable treatability

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18
Q

Cluster C

A

anxious fearful

avoidant, dependent and obsessive-compulsive PD

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19
Q

Problems with DSM-5

A

 Symptoms of a given disorder do not necessarily go together
• Some symptoms are just about unrelated to each other
• Two persons with the same disorder can have completely different symptoms
 Two disorders may have overlapping symptoms and tend to be diagnosed together
• Comorbidity: joint occurrence of two or more disorder at the same time
• Caused by the fact that some symptoms tend to co-occur despite being listed in different personality disorders
 Clusters of disorder do not match factor analysis results:
 A personality disorder should be seen as a continuum not as a category
• Should not be seen in all or nothing fashion, but as spectrum where you can score high or low on
 Doesn’t consider the development over lifetime

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20
Q

Dimensional system in DSM-5

A

divided in those involving self and those that are involving interpersonal impairment

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21
Q

Identity problems (A DSM-5)

A

o Does not have a sense of themselves as unique persons or identifies to much or to little (independence) with some other persons
o Highly unstable self-esteem, threated easily by negative experiences, distorted appraisal of own strengths and weaknesses
o Might be unable to regulate and/or recognizes one owns emotions

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22
Q

Self-direction problems (A DSM-5)

A

o Might not be able to set realistic or meaningful goals in his or her life
o Lack of internal standards for behaving prosocially
o Might be unable to reflect constructively on his or her own experiences

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23
Q

Empathy problems (A DSM-5)

A

o Might be unable to understand experiences or motivations of others
o Might be unable to understand or unwilling to see others perspective
o Might have little understanding how her/his actions affect others

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24
Q

Intimacy problems

A

o Lacking in positive sustained relationships
o Unable to engage in close caring relationships
o Might be unable/unwilling to cooperate

25
Q

Diagnosing with alternative system of DSM-5

A

 Structured interview with the client and relatives, might observe behaviour
 Than clinician rates every domain on an 4 point scale
 Impairments have to be stable over time
 Age/culture differences have to be respected
 No effect of substances has to be insured

26
Q

ICD 11

A

No categories
 Negative affective feature: describes the extent to how strong a person reacts negatively (e.g. anxiety) to a relatively minor stressor
 Dissocial factors:
• disregard for social obligations and the rights and feelings of others
• manifested in an overly positive view of the self and a tendency to be manipulative and exploitative of others
 Features of disinhibition: tendency to act impulsively, no long-term effect consideration, as well as irresponsibility and recklessness
 Anankastic features: concerned with controlling behaviour of self and others to conform ones own ideal
• Perfectionism, preservation, orderliness, stubbornness
 Features of detachment: Emotional and interpersonal distance, marked in social withdraw
• Coldness in relation to other people and reduced experience and expression of (mostly positive) emotions

27
Q

PD criterion in ICD 11

A

 A pervasive disturbance in how an individual experiences and thinks about the self, others, and the world, manifested in maladaptive patterns of cognition, emotional experience, emotional expression, and behaviour
 The maladaptive patterns are relatively inflexible and are associated with significant problems in psychosocial functioning that are particularly evident in interpersonal relationships
 The disturbance is manifest across a range of personal and social situations (ie, is not limited to specific relationships or situations)
 The disturbance is relatively stable over time and is of long duration. Most commonly, personality disorder has its first manifestations in childhood and is clearly evident in adolescence

28
Q

Mild personality disorder ICD 11

A

 There are notable problems in many interpersonal relationships and the performance of expected occupational and social roles, but some relationships are maintained and/or some roles carried out
 Mild personality disorder is typically not associated with substantial harm to self or others

29
Q

Moderate personality disorder ICD 11

A

 There are marked problems in most interpersonal relationships and in the performance of expected occupational and social roles across a wide range of situations that are sufficiently extensive that most are compromised to some degree
 Moderate personality disorder often is associated with a past history and future expectation of harm to self or others, but not to a degree that causes long-term damage or has endangered life

30
Q

Severe personality disorder ICD 11

A

 There are severe problems in interpersonal functioning affecting all areas of life. The individual’s general social dysfunction is profound and the ability and/or willingness to perform expected occupational and social roles is absent or severely compromised
 Severe personality disorder usually is associated with a past history and future expectation of severe harm to self or others that has caused long-term damage or has endangered life

31
Q

Problems in diagnosing PDs

A

o Often people do not recognize that they, and not others, are defective in their interpersonal relations
o Has to be consistent over time and has to effect interaction with others
o Threatened by stereotypes which lead to overdiagnoses

32
Q

Diagnosing PDs in young children

A

o Wasn’t accepted yet because they were afraid of stigmatisation
o This is now overruled by personality difficulty category which represents sub-threshold PD, there is something but I won’t label it now (tries to counteract stigmatisation)

33
Q

PDs later in life (>65)

A

o Symptoms can be caused by other factors such as moving away from friends in a retirement home
o PD related to neuroticism and negative affectivity diminish over time
o Schizoid, paranoid and schizotypal presentation increase
o Health problems might confound the symptoms of PDs

34
Q

Problems in treating PDs

A

o Generally hard because it is not based on external factors, but in internal ones that are relatively stable over time
 Dysfunctional behaviour can be treated
o Some disorders are based on personality characteristics that make people less willing to cooperate
o Symptomatic improvement of a comorbid disorder during treatment is difficult to distinguish from true underlying personality change
o Features of PD, substantial impairment of interpersonal function, identity problems and recognisable social dysfunction are all difficult to measure
o Research concentrates on a few disorders, borderline and antisocial, as result any review is necessarily biased towards them

35
Q

Psychodynamic psychotherapy

A

o Clinician helps patient to express his/her emotions and to find reoccurring patterns of behaviour.
o Overarching aim: encourage the patient to speak freely about what is on in her/his mind
o Tries to improve the patients self-understanding and thereby improve his/her functioning
o (Projective test)

36
Q

Cognitive behavioural therapy (CBT)

A

o Aims to understand the irrational beliefs that a patient holds and show the irrationality to them.
o Less based on psychodynamic

37
Q

Dialect behaviour therapy (DBT)

A

o Developed for patients with borderline
o Aimed to making the patient more aware of what he or she is currently thinking and feeling and to reflect on them
o The gained mindfulness helps the person to handle feeling/thoughts that would cause distress
based on CBT

38
Q

Pharamacotherapy

A

o Based on neurochemical abnormalities of the CNS
o Should only be used in combination with psychosocial treatment and only to over come especially critical periods
o Improvements might arise through comorbidity with depression which can be treated with drugs

39
Q

Pharamcotherapy for Cluster A

A

antipsychotics show improvement but risk to benefit rationis unclear. No robust evidence available

40
Q

Pharmacotherapy for Borderline

A

 Should generally be avoided because of high risk of misuse and addiction accept in a crisis
 Can help to stabilize mood (SSRIs)
 Only short term improvement
 If no comorbid illness pharmacotherapy should be stopped

41
Q

Pharmacological treatment for Antisocial PD

A

should not be used despite comorbid PDs

42
Q

Pharamacological treatment of cluster C

A

might have an effect on phobias but no scientific evidence is available

43
Q

Psychosocial treatment

A

o Recommended as the primary treatment for borderline PD and other PDs
o Ranges from behaviour therapy to psychoanalytical treatment
Aim:reduce acute life-threating symptoms and improve distressing mental state symptoms

44
Q

Psychosocial treatment for Cluster A

A

no treatment trails of people with paranoid symptoms are being done

45
Q

Psychosocial treatment for Borderline

A

schema focused cognitive therapy
 Treatment provider should have experience with borderline
 Supportive (educational, encouraging)
 Focus on managing life situation
 Non-intense (i.e. once per week, with additional sessions as needed)
 Interruptions are expected; consistent regular appointments are optional
 Psychopharmacological interventions are integrated

46
Q

Psychosocial treatment for Cluster C

A

 Psychodynamic therapy improved social functioning and reduced distress
 Cognitive behavioural is more effective than psychodynamic
 Most success in treatment

47
Q

Treatment for Antisocial PD

A

o Often patients pretend to feel guilt and understand the fault they did
o Increases confidence and competence in exploiting other for Psychopathic offenders
o Approach for criminal persons with antisocial PD, is to make it in the persons own self-interest to avoid exploiting other people
 Not used to change personality but at reducing the gap between that persons self-interest and the society expectations of acceptable behaviour

48
Q

Improvements caused by treatments

A

o Control over symptoms can be enhanced (e.g. for suicidal actions and impulsive behaviour)
 Identity problems will probably remain

49
Q

Prevelance of PDs

A

o In North America and western Europe 4-15%
o Cross cultural 6.1% (lowest in Europe and highest in south and north America)
o Highest prevalence is noted in people in contact with the criminal justice system 2/3 (Cluster B)

50
Q

Intersection of mental state disorder and personality disorder

A

o PD can be diagnosed in up to half of patients with mental state disorder
o PD might underlie treatment resistance in mental state disorder

51
Q

Dark Personality

A

middle ground between normal personality & clinical level pathology (= subclinical)

52
Q

Dark Triad

A

 Focus: pathologies characterised by motives to elevate the self & harm others
 All are negatively correlated with A and related to Honesty-Humility
 May be short-term evolutionary strategies for success

53
Q

Machiavellianism (dark triad)

A

Manipulative personality
Take certain pleasure in successfully deceiving others but aren’t necessarily better in doing so
High-machs: lack of empathy & affect, unconventional view of morality, self-focused
Negatively correlated with C and Honesty-Humility, positively correlated with neuroticism,
Destructive learders

54
Q

Narcissism (dark triad)

A

Grandiosity, entitlement, dominance, superiority
Can’t maintain relationships, lack trust & care for others
Tendency to engage in self-enhancement: appear charming in short-term but have difficulty to keep that up long-term
Positively associated with openness, extraversion & neuroticism, Low Honesty-Humility
bad negotiators

55
Q

Psychopathy (Dark Triad)

A

Impulsivity & thrill seeking combined with low empathy & anxiety
Antagonistic + tendency toward self-promotion and superiority
Lack of self-conscious emotions: guilt, anxiety, fear, embarrassment  fail to learn from punishment
Negatively correlated with C & neuroticism, positively correlated with O, Honesty-Humility

56
Q

Normal range measures (dark triad)

A

based on overlap of five factor model with dark personality
 Can be effective if you appropriately combine items
 Advantage: doesn’t engender much suspicion from test takers
 Disadvantage: not complete assessment

57
Q

Other reports (dark triad)

A

 Advantages: capable of reporting their destructiveness

 Disadvantages: no access to individuals’ inner thoughts but traits are largely attitudinal + often have hidden agendas

58
Q

Conditional reasoning test (dark triad)

A

 Justification mechanisms linked to implicit motives may be measured by asking individuals to solve inductive reasoning problems with multiple correct answers
 Advantage: directly assesses biases used to justify motive-driven behaviour