TASK 8 - PERSONALITY DISORDERS Flashcards
personality disorder
= extreme levels of some personality characteristics
- stable and enduring
- emerge in adolescence/early adulthood
- deviate from norms of one’s culture
- inflexible across many aspects of one’s life; maladaptive
- ego-syntonic: they not feel ‘unnormal’
- must involve negative consequence for functioning of individual or of others around him/her; lead to distress or impairment
DSM-V
- cluster A
= odd, eccentric - prevalence of 5.7% SCHIZOID SHIZOTYPAL PARANOID
DSM-V
- cluster A
SCHIZOID
= extreme detachment, lack of interest in social/personal relationships, very limited expression of emotions in interpersonal settings
- no affection for others, indifference to praise/criticism
- even in nonsocial preferred settings, little joy or pleasure
DSM-V
- cluster A
SCHIZOTYPAL
= discomfort in close relationships, combined with eccentric behaviours
- unusual ‘ideas of reference’
- tend to be highly superstitious, fascinated by paranormal, may have bizarre perceptual experiences
- similarity with schizoid PD: detachment from social relationships
DSM-V
- cluster A
PARANOID
= extreme distrust, suspiciousness of others’ motives, sense of being persecuted
- suspect others are trying to harm/deceive/exploit them, hold grudges against those perceived as causing harm
- quick to take offence/feel insulted
- response to stress: experience brief psychotic episodes
- may be an antecedent to schizophrenia
DSM-V
- cluster B
= dramatic, emotional, impulsive, unstable, erratic - prevalence of 1.5% ANTISOCIAL BORDERLINE HISTRIONIC NARCISSISTIC
DSM-V
- cluster B
ANTISOCIAL
= total disregard for and violation of rights of others
- deceitful, repeatedly lie to others for personal gain, feel no remorse for harm caused to others
- tend to be aggressive, irresponsible, impulsive, reckless
DSM-V
- cluster B
BORERLINE
= extreme impulsivity, instability of relationships (love/hate and fear of abandonment), self-image, and emotions
- impulsive behaviour: drug/alcohol use, eating binges, spending sprees, sexual escapades, self-harming behaviours
- extremely moody, temperamental individuals
- little sense of personal identity/meaning in life
DSM-V
- cluster B
HISTROINIC
= excessive attention seeking (physical appearance/provocative style)
- exaggerated expression of emotions (which are shallow and rapidly changing)
- intense need to be centre of attention, uncomfortable if not so
- easily influenced by others, tend over interpret new relations
DSM-V
- cluster B
NARCISSISTIC
= grandiosity (thinking one is superior, deserves admiration); selfish lack of concern for others’ needs.
- arrogant style, often exploit others
- tend to fantasise about having high status, envies highly successful people
DSM-V
- cluster C
= anxious, fearful - prevalence of 6% AVOIDANT DEPENDENT OBSESSIVE-COMPULSIVE
DSM-V
- cluster C
AVOIDANT
= social inhibition, shyness, feelings of inadequacy (low self-esteem), oversensitivity to possible negative evaluation
- similarity with schizoid and schizotypal: avoid social contact –> avoidant person wants social contact but is afraid of rejection
DSM-V
- cluster C
DEPENDENT
= excessive need to be taken care of, submissive/clinging behaviour, fear of separation
- need other people to take care of important things of their lives, feel unable to take care of themselves when alone
- when a close relationship ends: may desperately look for a new one
DSM-V
- cluster C
OBSESSIVE-COMPULSIVE
= excessive preoccupation with orderliness, perfection, control (unnecessarily hoarding money and objects)
- may lead to failure to complete activities, tasks
- difference to obsessive-compulsive DISORDER: repeated behaviours such as hand washing or counting
DSM-V
- NOS
= not other specified
- person has disorder but is not clearly specifiable into one type
- passive-agressive, depressive…
critique/limitations to DSM-V
- symptoms of given disorders do not necessarily go together: two people diagnosed with same disorder, could have different symptoms
- comorbidity: two disorders may have overlapping symptoms –> tend to be diagnosed together
- makes the system inefficient - ‘clusters’ of disorders do not match factor analysis results
- dimensional models: should be seen as continuum
- NOT either have disorder, or not –> some people have slightly disorder, whereas others may have it severely - NOS: many people don’t seem to fit in the given categories
prevalence of personality disroders
- reported point prevalence of 6.1%,
- lowest prevalence in Europe
- highest prevalence in North and South America
- as common in men than in women
- as common in people from ethnic minorities as in majority populations
- higher in people in contact with health-care services; in clinical settings, higher in women than in men
- highest prevalence of PD in people in contact with criminal justice system
implications of personality disorders
- higher morbidity, mortality
- -> increased suicide and homicide
- -> cardiovascular and respiratory diseases
- -> life expectancy at birth is shorter (19 years W, 18 years M)
- difficulties in interpersonal relationships
- -> effect on relationships with health-care professionals (poorer quality care)
- high prevalence of smoking, alcohol, drug misuse
assessment of personality disorder
- clinical practice: rarely diagnosed, accounts for less than 5% of all hospital admissions
- complex nature of diagnostic system: those diagnosed are usually assigned categories of borderline, antisocial or NOS
- -> few clinicians doing effort to assess personality status in all its components
- -> stereotyped thinking: self-harm = BPD; aggressive = antisocial
- difficulty in assessment : absence of quick, reliable instruments
- -> complexity of reviewing all (often inferential) criteria
- -> self-report questionnaires too long for general clinical settings
- -> simplest: Standardised Assessment of Personality Abbreviated Scale and Iowa Personality Disorder Screen (but over-diagnosis)
alternatives to DSM-V
dimensional systems
1) disorder as extreme version of normal personality dimension
- five-factor model
√ eliminates comorbidity
x some people have extreme traits but no PD
2) disorder on dimension with other disorders (Axis I)
- e.g. schizophrenia spectrum
ICD-11
- APA decided to keep its earlier system and include new one only as a topic of study
- people must have (A) impaired personality functioning + (B) pathological personality tratis
A. decide whether person has personality disorder, categorical
B. classify which personality disorder, dimensional - hybrid model: combo of categorical + dimensional model
ICD-11
A. impaired personality functioning
- self problems
a) identity: not have sense of being unique person; unstable self-esteem, being easily threatened by negative experiences
b) self-direction: not be able to set realistic/meaningful goals; lack internal standards for behaviour; unable to reflect constructively on own experiences/motivations - interpersonal problems:
a) empathy: unable to understand experiences/motivations of others; unwilling to consider others’ perspective; little understanding of how own behaviour affects others.
b) intimacy: lack positive, sustained relationships; unable to engage in close/caring relationships with anyone; unable/unwilling to cooperate with others - self-regulation of emotions (impulsivity)
ICD-11
B. pathological personality traits
- 25 personality traits (= ‘trait facets’) classified into five broad domains:
1. negative affectivity: intense, frequent experience of negative emotions - similar to Neuroticism in Big 5 and Emotionality, low Extraversion and low Agreeableness in HEXACO
2. detachment: withdrawal from social interactions - similar to low Extraversion in Big 5, HEXACO
3. antagonism: acting in ways that create difficulties for others - similar to low Agreeableness in Big 5 and HEXACO as well as low Honesty-Humility in HEXACO
4. disinhibition: impulsive behaviour - similar to low Conscientiousness in Big 5, HEXACO
5. psychoticism: unusual, bizarre thoughts and perceptions - limited similarities (eccentricity/oddness are a bit related to Openness to Experience and low Conscientiousness in HEXACO)
ICD-11
C. temporal stability
= some degree of stability of disorder over time
ICD-11
D. non-normatitivity
= not normative in culture (antisocial behaviour more normal in some cultures)
ICD-11
E. medical exclusion
= traits must not be caused by medical interventions (phineas gage)
ICD-11
- advantages/disadvantages
√ distinguish between patients having more or less severe cases–> severity of functional impairments & pathological traits
√ distinguish between many different varieties of PD –> considering which pathological traits are shown
origins of personality disorders
- roots in childhood/ adolescence
- gene-environment interactions
- similar as for personality traits
- neurobiological differences
- childhood adversities, rape incidents, trauma
- insecure attachments to parents, parental substance abuse –> maladaptive coping styles
life course of personality disorders
- evolve continuously over life span
- epigenetics
- similar to normal trait change
- moderately stable during childhood
- increases in stability from adolescence to adulthood
- disorder peak at 13-14 –> reduce monotonically until 28 years
- change more over time than people without PD, typically (not always) in the direction of improvement
- general psychological functioning poor but stable
- change in trait predicts change in disorder, not vice versa
difficulties in treatment
- disorders are based on individual’s own personality characteristics –> tend to be stable across long periods of time, across different circumstances
- some disorders entail characteristics that make individual less likely to be ‘good patient’ (emotional reactions in BPD or deceitfulness in Antisocial)
treatment of antisocial PD
- problematic –> might try to appear as though they have been cured
- psychopathic offenders show poor outcome in CBT, group therapy
√ best approach: show other ways to obtain what they want without harming others - aims at reducing gap between person’s self-interest and society’s expectations of acceptable behaviour
√ cognitive behavioural therapy combined with training in social skills & problem solving gave most positive results (early intervention important)
treatment
- cluster A
- hardest to treat (least adaptive + easily fake)
- psychosocial treatment: cognitive therapy can affect change in cognitive & social disabilities of schizotypal patients
- pharmacotherapy: some improvement in overall severity, risk benefit ratio unclear
treatment
- cluster B
- psychosocial: improved outcomes on life-threatening behaviours & psychiatric symptoms
- -> generalist models: no extended training, no specialist in BPD
- -> evidence-based treatment: more intensive, BPD-specific treatment
- pharmacotherapy
- -> BPD: generally be avoided
- -> Antisocial PD: can be used for comorbid mental disorders; not routinely
treatment
- cluster C
- psychosocial: improves social function & reduces distress
- pharmacotherapy: antidepressants work for people with social phobias –> might be effective in people with avoidant PD
psychosocial treatment
- idea: personality and its disorders arise from complex interaction between genes, developmental processes and adverse life events
- interpersonal difficulties
- mix of group and individual treatments, integrated with other services available –> optimum
pharmacotherapy/psychobiological treatments
- idea: behavioural traits associated with PD might be associated with neurochemical abnormalities of CNS/PD could be understood in terms of imbalances of chemical substances in brain –> certain kinds of drugs were said to counteract these imbalances and reduce symptoms
- model is still untested because clinical trials focus mostly on BPD
psychosocial treatment
- psychodynamic psychotherapy
- aim: encourage patient to speak freely about everything, including dreams and fantasies, by improving patient’s self-understanding
- help patient express emotions (even troubling/distressing ones), help identifying recurring patterns in behaviour and examine important interpersonal experiences in patient’s life
psychosocial treatment
- Cognitive-Behavioral Therapy (CBT)
- aim: understand irrational beliefs patient holds about oneself, surrounding world and future; show that views are inaccurate, harmful –> try to change those perceptions
psychosocial treatment
- Dialectical Behavior Therapy (DBT)
- aim: make patient more aware of own thoughts/feelings, getting patient to reflect on, accept those thoughts and feelings openly and without judgement (to avoid conflict)
- specifically for people with BDP
subclinical
= middle ground between normal personality & clinical level pathology
dark triad
- machiavellianism
- manipulative personality
- take certain pleasure in successfully deceiving others but aren’t necessarily better in doing so
- HIGH: lack of empathy & affect, unconventional view of morality, self-focused
- negatively correlated with C, positively correlated with neuroticism
- more willing & skilled to fake in employment interviews
- manipulation in negotiations
dark triad
- narcissism
- 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
- motivated to be the best in their chosen area, put effort in development
- use appearance to charm others in negotiations
dark triad
- psychopathy
- 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
- threats in negotiations
dark triad
- workplace outcomes
- weakly related to poor job performance
- negative relationship to citizenship behaviour
- ineffective vs. destructive leadership
- -> psychopathic leaders = less cooperate social responsibility & diminished organisational support for employees
- -> toxic leaders = shitty feeling subordinates = less creativity
- -> leader failures (what gets you to the top doesn’t necessarily keep you there) –> unable to maintain relationships
- workplace deviance
- unethical decision making in organisations
- creativity
- less job satisfaction & high levels of interpersonal conflict (there is exceptions though)
- context-dependent whether positive or negative role
- big wins + losses; less stable year-to-year performance
- successful negotiators
dark triad
- taxonomy
- potentially destructive intention, not necessarily result in negative outcome
- result in negative outcomes (= traits as channels for implicit motives)
- harm is a necessary consequence of label “dark”
