Task 8 - Personality Disorders Flashcards
The DSM-5 Personality Disorder
CLUSTER A = ODD AND ECCENTRIC
SCHIZOID
Extreme degree of detachment from social relationships and very limited expression of emotions in interpersonal setting
Social isolation
Emotional detachment, no expression of affection for others
Indifferent to their praise or criticism
Little joy or pleasure
SCHIZOTYPAL
Detachment from social relationships
Also involves extreme discomfort with relationships, and a pattern of odd thinking and eccentric behaviors
Unusual ideas of reference, perceiving special personal meaning in everyday events or objects
Highly superstitious or fascinated with the paranormal
May even have bizarre perceptual experiences
Generally odd, peculiar or eccentric
PARANOID
Strong suspiciousness of others’ motives and a sense of being persecuted
Suspect other try to harm, deceive or exploit them with no good reason
Quick to take offence or feel insulted
CLUSTER B = DRAMATIC AND ERRATIC
ANTISOCIAL
Tendency to disregard and to violate the rights of others
Very deceitful, repeatedly lying to others and “conning” them for personal gain, and feel no remorse for the harm their actions caused to others
Tend to be aggressive, irresponsible, impulsive and reckless
BORDERLINE
Extreme instability in one’s own self-image and in one’s relationships with others, along with extreme impulsivity in various contexts
Intense and unstable “love/hate” relationships with others, tend to worry frantically about possibility of being abandoned
Pattern of impulsive behavior (drug/alcohol abuse, eating binges, spending sprees, sexual escapades)
Extreme moodiness and temperament
Little sense of personal identity or meaning in life
HISTRIONIC
Exaggerated display of emotions and excessive attention seeking
Intense need to be in center of attention
Felling uncomfortable when not the focus of others’ attention
Overly dramatic, exaggerated style of expressing their emotions
Suggestible or easily influenced by others, tend to consider casual acquaitanceships as being cloer relationships than they actually are
NARCISSISTIC
Involves grandiosity and selfish lack of concern for others’ needs
Seeing oneself as being entitled to special treatment and admiration, and generally have arrogant style, often exploiting others
Tend to fantasize about having high status and to envy those who are highly successful
CLUSTER C = ANXIOUS AND FEARFUL
AVOIDANT
Social inhibition and shyness, by feelings of inadequcy, and by oversensitivity to possible negative evaluation
Strong fears of criticism, disapproval, or rejection that their social interactions are severely resticted
Unwilling to participate socially unless certain of being liked
Tend to avoid work activities that involve interpersonal contact
Low self-esteem and inferiority
Shame
Extreme sensitivity to embarrassment, criticism, and rejection
Avoidant person wants tocial contact but it to afraid of rejection, different from schizoid/schizotypal
DEPENDENT
Excessive need to be taken care of and by submissive, clinging behavior and fears of separation
Require great deal of advice and reassurance even in making everyday decisions
Lack confidence to undertake project on their own
Need other people to take responsibility for important features of their lvies
Feel unable to take care of themselves when alone
If close relationships end, tend to desperately seek new one
OBSESSIVE-COMPULSIVE
Preoccupation with orderliness, perfection and control
Tends to be preoccupied with details that entire point of an activity is lost
May be so concerned with attaining perfection and following specific rules that they fail to complete tasks/projects
Tends to put work ahead of personal relationships, and to be highly stubborn and inflexible
Tendency to hoard objects/money unnecessarily
NOT OCD -> but tend to be
Problems with DSM-5
Symptoms of given disorder do not necessarily go together
2 disorders may have overlapping symptoms, tend to be diagnosed together
“Cluster” of disorders don’t match factor analysis results
Personality disorder should be seen as continuum, not as category
Pathological personality traits
Classified into 5 Broad domains
NEGATIVE AFFECTIVITY
intense and frequent experience of negative emotions
-> Similar to Neuroticism
-> Similarity with several HEXACO factors including emotionality, low extraversion and low agreeableness
DETACHMENT
withdrawal from social interaction and from other people
-> Similar to low Extraversion
ANTAGONISM
acting in ways that create difficulties for other people
-> Similar to low Agreeableness
-> Also similar to low Honesty-Humility because it emphasizes traits such as manipulating, deceitfulness, and grandiosity
DISINHIBITION
Behaving on impulse, without thinking of consequences
-> Similar to low conscientiousness
-> Opposite pole of DSM-5 Disinhibition is compulsitivty
Psychoticism
Unusual, bizarre thoughts and perceptions
-> Limited similarities to Big Five / HEXACO
-> Traits of eccentricity or oddness somewhat related to Openness to experience and to low conscientiousness
5 steps of diagnosing in Literature
Treatment of Personality Disorders
PSYCHODYNAMIC PSYCHOTHERAPY
Clinician tries to help patient to express emotions and identify recurring patterns in behavior and to examine important relationships and interpersonal experiences in patient’s life
Aim of approach is to encourage patient to speak freely
Helping patient to reflect on and explore their mintal life to improve patient’s self-understanding, therby improving funcitoning -> self-awareness
COGNITIVE-BEHAVIORAL THERAPY (CBT)
Personality disorders involve dysfunctional views about oneself, about surrounding world, or about future
Aim: understand irrational beliefs and to show patient that those views are maladaptive
try to get patient to realize that perceptions are inaccurate and harmful, then try to change those perceptions
Difference to PDP: CBT focuses on telling patients what’s wrong
DIALECTIC BEHAVIOR THERAPY (DBT)
For Borderline Disorder
Making patient aware of what they’re thinking & feeling, get patient to reflect and accept thoughts and feelings openly
By developing “mindfulness”, patients find it easier to handle thoughts and feelings
Clinician tries to avoid conflict, rather than criticizing he points out that feelings and behaviors can be maladaptive
Clinician can then try to help patient develop plans for developing adaptive responses
–> All 3 methods have been found effective, but there is not enough evidence to recommend which one is most effective
PSYCHOBIOLOGICAL / PSYCHOPHARMACOLOGICAL TREATMENTS
some researchers suggest personality disorders can be understood in terms of imbalances of chemical substances in brain
Drugs to counteract underlying imbalances, thereby reducing symptoms
Research on drug treatment has indicated modestly positive results
Most drugs come with harmful side effects
Changes in ICD-11
Proposed ICD-11 Classification abolishes all type-specific categories of personality disorder apart from main one (presence of disorder)
Personality dysfunction is best represented on a continuum or dimension -> different degrees of severity are defined to show what point on the continuum best represents the person’s personality functioning
Acknowledge the fluctuating natures of the disorder would be a major help in destigmatisation of its diagnosis
Severity and form of disorder fluctuates over time depending on many factors
Removes confusing comorbidity of different categories of personality disorder
Degree of severity can be qualified by a description of domain traits
NOT CATEGORIES, BUT SET OF DIMENSIONS
Traits of ICD-11 differ to DSM-5 in that they include an anakastic domain and not a psychoticism domain
Domain traits are not inherently pathological, but represent profile of underlying personality structure
Proposed category names and essential features of personality disorders in ICD-11
PERSONALITY DISORDER
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 behavior
Relatively inflexible and associated with significant problems in psychosocial functioning
Disturbance is manifest across range of personal and social situations; and relatively stable over time
usually arises in childhood and gets evident in adolescence
LATE ONSET QUALIFIER
Disturbance has origin in adulthood, qualifier for “late-onset” may be added. The “late-onset” qualifier should be used for cases in which there is no evidence of disorder prior to age 25
MILD PERSONALITY DISORDER
Notable problems in many interpersonal relationships, and performance of expected occupational and social roles, but some relationships are maintained and/or some roles carried out
Typically not associated with substantial harm to self or others
MODERATE PERSONALITY DISORDER
marked problems in most interpersonal relationships and in performance of expected occupational and social roles across wide range of situations
Often associated with past history and future expectation of harm to self or others, but not to degree that causes long term damaged or endangered life
SEVERE PERSONALTIY DISORDER
Severe problems in interpersonal functioning affecting all areas of life. 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 disorders usually is associated with a past history and future expectation of severe harm to self or others that has cause long-term damage or has endangered life
Examples to all cases are provided in the literature
Five common characteristics of evidence-based treatments for borderline personality disorder
- Structured (manual directed) approaches to prototypic borderlne personality disorder problems
- Patiens are encouraged to assume control of themselves
- Therapists help connections of feelings to events and actions
- Therapists are active, responsive, and validating
- Therapists discuss cases, including personal reactions, with others
Proposed characteristics for a generalist approach to treating borderline personality disorder
Treatment providers have previous experience with borderline personality disorder
Supportive (i.e.: encouraging, advisory, and educational)
Focus on managing life situations (not on the in-therapy interactions)
Non intensive (i.e.: once per week, with additional sessions as needed)
Interruptions are expected, consistent regular appointments are optional
Psychopharmacological interventions are integrated, group or family interventions are encouraged when encessary
Reccommendations for the use of drugs in borderline personality disorder
Drugs should NOT be used as primary therapy for borderline disorder
The time-limited use of drugs can be considered as an adjunct to psychosocial treatment, to manage specific symptoms
Cautious prescription of drugs that could be lethal in overdose or associated with substance misuse
The use of drugs can be considered in acute crisis situations but should be withdrawn once the crisis is resolved
Drugs might have a role when patient has active comorbid disorders
If patients have no comorbid illness, efforts should be made to reduce or stop the drug
Dark Triads
MACHIAVELLIANISM
=manipulative personality, derived from questioning individuals on how much they agree with statements derived from Machiavelli’s writing
Individuals in this are characterized by lack of empathy, low affect, possessing an unconventional view of morality - a willingness to manipulate, lie to, and exploit others - and focus exclusively on their own goals/agenda, not those of others
-> more willing but not necessarily superiorly able
NARCISSISM
=Grandiosity, entitlement, dominance, superiority; tendency to engage in self-enhancement and can therefore appear charming or pleasant in the short term
Long term: difficulty maintaining successful interpersonal relationships, lacking trust and care for others
PSYCHOPATHY
=Impulsivity and thrill seeking combined with low empathy and anxiety
Antagonistic and have belief in their own superiority and tendency toward self-promotion
Unique affective experience, such that it has been suggested that the definitive marker of psychopathy is lack of the self-conscious emotion guilt and absence of conscience
Do not experience anxiety and fear to extend normal people do, and are also less prone to experience embarrassment
INFLUENCES OF DARK TRIADS ON LIFE FOUND IN LITERATURE
