Task 8 - Personality Disorders Flashcards
Personality Disorder
Stable & enduring patterns of thought, feeling, and behavior emerging in adolescence or early adulthood
- > deviate from culture and are pervasive and influexible in many life aspects
- > lead to distress or impairment
Criteria of Disorders
Must involve negative consequences for functioning and happiness of individuals and/or others around him/her
DSM-5
Diagnostic and Statistical Manual of mental disorders volume 5
-> classified into three groups/clusters according to their similarity of symptoms
Cluster A
“odd, eccentric”
Schizoid
Schizotypal
Paranoid
Schizoid
Extreme detachment from social relationshps, limited expression of emotions interpersonally
-> prefer to be alone, feel little joy or pleasure even in nonsocial settings
Schizotypal
Detachment from social relationships
- > extreme discomfort with relationships, odd thinking and eccentric behaviors
- > e.g. highly superstitious
Paranoid
Detachment from social relationships
- > strong suspiciousness of others motives and feel persecuted (without reason)
- > quick to take offence and being insulted
Cluster B
"dramatic, emotional, erratic" Antisocial Borderline Histrionic Narcissistic
Antisocial
Tendency to disregard and violate rights of others
- > deceitful, lying, and conning for personal gain
- > feel no guilt
- > aggressive, irresponsible, impulsive, reckless
Borderline
Extremely instabile self-image and relationships with others
- > impulsive
- > intense and unstable relationships with others, fears of abandonment
Borderline typical behaviors
Drug & alcohol abuse Binge eating Spending sprees Sexual escapades Self-harming behavior
Histrionic
Exaggerated display of emotions and excessive attention seeking
- > crave to be center of attention (typically draw attention by physical appearance)
- > are suggestible, easily influenced by others (consider casual relationships as closer than they are)
Narcissistic
Grandiosity: consider themselves superior and deserving of admiration
- > selfish, lack of concern for others
- > often arrogant and exploiting
- > status oriented
Cluster C
“anxious, fearful”
Avoidant
Dependent
Obsessive-compulsive
Avoidant
Social inhibition, shyness, feelings of inadequacy, oversensitive to negative evaluation
- > low self-esteem, afraid of embarassment, criticism, rejection
- > lack of social contact (even though they want it)
Dependent
Excessive need to be taken care of,
- > submissive clinging behavior
- > always need advice and reassurance
- > lack of confidence: need others to make decisions
Obsessive-Compulsive
Preoccupied with orderliness, perfection and control
- > too perfectionistic: sometimes fail to complete tasks, don’t delegate tasks
- > work over relationships, stubborn, inflexible
- > not OCD (involves repeated behaviors)
DSM-5 classification criticism
Symptoms of a disorder often not correlating
- > possible that two persons diagnosed with same disorder do not have symptoms in common
- > comorbidity: overlapping symptoms,
- > disorders do not match factor analysis
- > disorders as continuum not category
Convergent construct validity
A disorder is exptected to always show similar symptoms
-> not given with DSM-5
Discriminant construct validity
No comorbidity,
- > correlations of symptoms higher within a disorder than with other disorders
- > lacks in DSM-5
Alternative System for Diagnostic of Personality Disorders
Distinction between self-problems and interpersonal problems
- pathological personality traits
- continuum system
Self problems
Impairment in one’s identity and self-direction
- > Identity problems (unstable self-esteem, inability to regulate emotions)
- > self-direction problems (goal-setting, inability to reflect)
Interpersonal problems
Empathy problems: inability to take others perspective (e.g. understand emotions)
Intimacy Problems: lack relationships, inability to engage in relationships, unwillingness to cooperate
Pathological Personality traits
Alternative to DSM-5:
- negative affectivity
- detachment
- antagonism
- disinhibition
- psychoticism
Diagnosing personality disorders
Conducting structured interview;
-> patient has to display oth impairment in self- and interpersonal functioning and pathological personality traits
Essential for PD diagnosis
Stable across time and situations
- behavior must deviate from person’s stage of development and culture
- effects can’t be due to effects of substances or a medical condition
Origins of Personality Disorders
Represent maldaptive levels of personality dimensions
- Borderline: high heritability (.4)
- schizotypal: may be personality type
- > origins still highly unknown
Treatment Methods for Personality Disorders
Psychosocial treatment: -Psychodynamic psychotherapy -Cognitive-Behavioral Therapy (CBT) -dialectical Behavior Therapy (DBT) Pharmacotherapy -Psychobiological treatments
Difficulties of PD treatment
Disorders not based on external conditions that can be modified
- > individual: stable
- Extreme reactions (borderline) or deceitfulness (Antisocial) hard to treat
- egosyntonic: see no issues with themselves
Psychodynamic psychotherapy
Trying to help patient with expression of emotions
- identifying recurring behavior patterns
- examining relationships
- helping patient to explore own mental life
- > improving self-understanding and self-functioning
Cognitive Behavioral Therapy
For personality disorders involving dysfunctional self-views and surrounding world or future
- > goals: understanding beliefs
- showing patient that beliefs are maladaptive
Dialectical Behavior Therapy
For Borderline
- making patient aware of current thoughts and feelings
- > goals: self-reflection, mindfulness
Psychobiological treatment
Disorder as due to imbalances of chemical substances in brain
-> drugs admistered to reduce symptoms and restare balance
Issue with treatment of Antisocial Personality Disorder
It’s in patient’s best interest to appear as though they’re cured:
- deceive and lie to clinician calculatedly
- > higher probability of future offence after therapy
- > better: showing them consequences (e.g. jail)
Main PD classification systems
International Classification of Diseases (ICD)
DSM-5
Prevalence of Personality Disorders
4-15% in Europe and NA
-> ~10%
Issues with diagnosis of PDs
No quick and reliable way to diagnose
- comorbidity problem
- overdiagnosing
Mild personality disorder
- still able to maintain and be interested in friends
- intermittent, minor conflicts with peers
- occasionally withdrawn, isolated
- capable of sustaining employmnet
- > no substantial harm to self and others
Moderate Personality Disorder
Problems in most interpersonal relationships and in occupation
- > past history and future expectation of harm to self and others
- > no long-term damage or life-endangerment
Severe personality disorder
Severe problems in interpersonal functioning
- affects all areas of life
- no friends, unwilling to sustain occupation
- past history and future expectation of harm to self and others; long-term damage, life-endangering
Personality disorder across life span
Evidence: PDs have roots in childhood and adolescence
- effects of PD related to neuroticism or negative affect diminish later in life (>65)
- personality becomes increasingly stable and adaptive later in life
Influence of PD late in life
Sooner mortality,
- more functional loss
- worse health
- more cognitive decline
Pharmacotherapy
Assumes behavioral traits associated with personality disorders associated with neurochemical abnormalities in CNS
-> drug treatment
Aims of drug treatment
Focus on specific aspects of PD e.g. cognitive-perceptual disturbances
Aims of Psychosocial treatments
Reduce life-threatening symptoms
- improve distressing mental state symptoms
- targetting of practical issues
Cluster A treatment
-Most difficult to treat Psychosocial: -bareley done -schizotypal: CBT Pharmacotherapy: -schizotypal: antibiotics (unclear risk to benefit ration): improvement in symptoms -not much evidence
Cluster B treatment
Psychosocial treatments: improved symptomatic outcomes, no significant improved social funcitoning
-> generalist approach succesful
Generalist approaches
Supportive,
Focus on managing life situations
Non-intensive
Interruptions expected (not constant)
Psychopharmacological interventions when necessary
-> widely successful even without extensive training
Cluster C treatment
-best treatable cluster
Psychosocial treatment: improved social function and reduced distress (Psychodynamic)
CBT: more effective for avoidant
Pharmacotherapy: antidepressants
Verdict PD treatment
Psychosocial treatments show promise
-> especially borderline
Pharmacological treatments need improvement
-> should be aid but not main focus
Dark Triad
Machiavellianism
Narcissim
Psychopathy
Machiavellianism
Manipulative personality
- lack empathy, low affect
- unconventional views of morality
- manipulate, lie, exploit
Narcissism
- grandiosity, entitlement, dominance, feelings of superiority
- good first impression: difficulty maintaining long term interpersonal relationships
- > lack trust and core for others
Psychopathy
Impulsivity, thrill seeking
- low empathy and low anxiety
- antagonistic: feelings of superiority, self-promotion
- don’t experience fear and anxiety same as normal people
Dark personality classification
Subclinical: between normal personality and clinical-level pathology
Dark personality and Work outcomes
Can be destructive in nature or its effect (intention & outcome)
- personality characteristics associated with corporate success
- extreme levels on dark triad: problematic for leaders
- modest dark triad levels optimal
