Task 8 Flashcards
Personality disorders
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
Origins of PDs
o Generally the same as for Personality traits o Traumas (esp. borderline)
PDs as a general genetically trait-based construct
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
Stability and change
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
´DSM-5 Model
Hybrid model
Schizoid (DSM-5)
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
Schizotypal
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
Paranoid
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
Antisocial
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
Borderline
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
Histrionic
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
Narcissistic
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
Avoidant
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
Dependent
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
Obsessive compulsive
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)
Cluster A
odd and eccentric
schizoid, schizotypal and paranoid PD
• Least adaptive and treatable
Cluster B
Dramatic and erratic
antisocial, borderline, histrionic and narcissistic PD
• Major social adaption difficulties and variable treatability
Cluster C
anxious fearful
avoidant, dependent and obsessive-compulsive PD
Problems with DSM-5
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
Dimensional system in DSM-5
divided in those involving self and those that are involving interpersonal impairment
Identity problems (A DSM-5)
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
Self-direction problems (A DSM-5)
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
Empathy problems (A DSM-5)
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
Intimacy problems
o Lacking in positive sustained relationships
o Unable to engage in close caring relationships
o Might be unable/unwilling to cooperate
Diagnosing with alternative system of DSM-5
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
ICD 11
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
PD criterion in ICD 11
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
Mild personality disorder ICD 11
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
Moderate personality disorder ICD 11
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
Severe personality disorder ICD 11
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
Problems in diagnosing PDs
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
Diagnosing PDs in young children
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)
PDs later in life (>65)
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
Problems in treating PDs
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
Psychodynamic psychotherapy
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)
Cognitive behavioural therapy (CBT)
o Aims to understand the irrational beliefs that a patient holds and show the irrationality to them.
o Less based on psychodynamic
Dialect behaviour therapy (DBT)
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
Pharamacotherapy
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
Pharamcotherapy for Cluster A
antipsychotics show improvement but risk to benefit rationis unclear. No robust evidence available
Pharmacotherapy for Borderline
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
Pharmacological treatment for Antisocial PD
should not be used despite comorbid PDs
Pharamacological treatment of cluster C
might have an effect on phobias but no scientific evidence is available
Psychosocial treatment
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
Psychosocial treatment for Cluster A
no treatment trails of people with paranoid symptoms are being done
Psychosocial treatment for Borderline
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
Psychosocial treatment for Cluster C
Psychodynamic therapy improved social functioning and reduced distress
Cognitive behavioural is more effective than psychodynamic
Most success in treatment
Treatment for Antisocial PD
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
Improvements caused by treatments
o Control over symptoms can be enhanced (e.g. for suicidal actions and impulsive behaviour)
Identity problems will probably remain
Prevelance of PDs
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)
Intersection of mental state disorder and personality disorder
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
Dark Personality
middle ground between normal personality & clinical level pathology (= subclinical)
Dark Triad
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
Machiavellianism (dark triad)
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
Narcissism (dark triad)
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
Psychopathy (Dark Triad)
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
Normal range measures (dark triad)
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
Other reports (dark triad)
Advantages: capable of reporting their destructiveness
Disadvantages: no access to individuals’ inner thoughts but traits are largely attitudinal + often have hidden agendas
Conditional reasoning test (dark triad)
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
