✅ Topic 4: Personality Disorders Flashcards
1
Q
What is meant by ‘Axis II’ Personality Disorders in DSM-IV?
A
- Five axes:
- Axis I: clinical psychological disorders (diagnosis)
- Axis II: personality disorders & intellectual disabilities (treatment decision)
- Axis III: medical conditions & physical disorders
- Axis IV: psychosocial and environmental factors
- Axis V: functional level - Changes in DSM-5: group Axis I-II-III into a single axis
- Why split before? => Originally to increase clinical/research attention
- Why change? => Categorisation and understanding has been unrelated to personality theories - Definition of personality disorder (Axis II):
- Pattern of inner experience & behaviours that deviates from cultural expectations
- Which are pervasive and inflexible, causing distress and impairment
- Not due to another disorder or drug use, etc.
=> PD are grouped into 3 clusters (A-B-C)
=> Co-occurence of PDs is common (can be in same or cross-clusters)
=> Highly questionable validity & utility of diagnosis group
2
Q
Explain the Personality Disorders in Cluster A?
A
=> Form the schizophrenia spectrum
- Paranoid:
- Paranoia
- Mistrust of others, has irrational suspicions
- Pre-occupied with doubts, reluctant to confide
- Misinterpret innocent remarks
- Hold grudge against people - Schizoid
- Detachment from interpersonal relationships
- Emotional coldness
- Indifference to praise/criticism of others
- Has few friends, choose solitary activities - Schizotypal:
- Distortions in thinking, feeling and perceptions (e.g. magical thinking & perceptual illusions)
- Discomfort in social situations, suspicions and paranoia
3
Q
Explain the Personality Disorders in Cluster B?
A
- Antisocial (dissocial):
- Lack of empathy, remorse and disregard others
- Failure to conform to norms/laws, impulsivity, irresponsibility
- Disregard for safety of self/others - Histrionic:
- Excessive need for approval, need to be centre of attention
- Shallow/over-dramatic emotions
- See relationships as more intimate - Narcissistic:
- Inflated self-importance and sense of entitlement, belief they are special
- Seek attention and admiration from others
- Fantasies of success, arrogance, envy of others, low in empathy - Borderline (Emotionally Unstable) PD:
- Unstable personal relationships
- Frantic attempts to avoid real/imagined abandonment
- Lack of well-formed identity, (unstable) feeling of emptiness/worthlessness
- Frequent suicidal, impulsivity in self-harming behaviours
4
Q
Explain the Personality Disorders in Cluster C?
A
- Avoidant PD:
- Social inhibition, avoid and withdrawal from social situations -> Feel socially-inept
- Low self-worth -> fear rejection, disapproval and criticism
- Reluctant to engage in new things for fear of embarrassment - Dependent PD:
- Persistent psychological dependence on others
- Lack confidence in ability to take responsibility
- Has difficulty doing things alone
- Agreeable tendency & seek new relationships - Obsessive-compulsive PD (OCD?)
- Preoccupation with orderliness, rules, moral codes, caution and perfectionism
- Excessive devote to work
- Inflexibility and overly-conscientious
5
Q
What is the Big 5 approach to explain PD?
A
- Aim: finding PD symptoms correlating with different facets of traits in the Big 5 Model.
- Big 5 facets conceptually associated with PDs
- Example: Schizoid PD -> low Warmth (E1), low Gregariousness (E2), and low Positive emotionality (E6).
=> May indicate risk (NOT diagnosis) of PD
=> Could be useful for ruling out a PD, or characterizing a known PD. - Supporting study:
- Patients from psychiatric hospital filled out PD interview and questionnaire (PDQ) + NEO-PI-R
- Calculated “profile agreement” score for each patient.
- Result: significant correlations, but only “modest to moderate”
=> May need to revise current diagnosis classification system for PD in DSM-4
6
Q
What is a new approach to PDs?
A
- Current limitations of DSM-4 PD classification:
- Extensive co-morbidity (co-occurence of PD)
- Low inter-assessor reliability (inconsistency in diagnosis)
- Not based on empirical personality model - New suggestions for DSM-5 => Dimensional rather than categorical approach
- Assess personality facet profile (NEO-PI-R)
- Assess personality-related impairments and distress -> diagnose PD if significant
- Determine if profile matches with PD category descriptor
7
Q
What are PD diagnosis (changes) in DSM-5?
A
- Changes:
- Retention of all 10 PDs and PD Clusters
- Adding ‘emerging measures and models’ in section III (Criterion A & B) - Criterion A (severity): significant impairments in functioning of: self and inter-personal
- Criterion B (style): >1 pathological of personality traits => measured with Maladaptive Trait Model (MTM)
- New changes in model (section III):
- Retaining only 6 PDs: borderline, obsessive-compulsive, avoidant, schizotypal, antisocial, narcissistic
- Able to diagnose PD based on trait-specified
8
Q
What is Dissociative Identity Disorder (DID)?
A
- DSM-5 definition: a mental disorder defined by the presence of >2 distinct identities or personalities
- Amnesia for prior or recent events
- Cause distress and/or functional impairment
- Not due to substance use, cultural practice or imaginative play. - How is DID classified?
- Not as PD but as a Dissociative Disorder
- Also include: Diss. Amnesia, Depersonalisation Disorder (detach from reality), and other specified/unspecified Diss. Disorder - How DID works:
- Primary ‘host’ personality + >1 alters
- Alters take turns to control behaviours
- Distinctive patterns of thinking and behaving
- Different names, ages, genders
- Memory loss (amnesia) for experiences as other alters - Statistics and observation:
- Common with reports of severe childhood sexual/physical abuse
- Patients high in ‘suggestibility’ (highly responsive to social/other suggestions)
- Case clusters (geographically or by therapist)
- Increase in cases (10s of thousand current)
- Reports becoming more extreme: from 2/3 alters to >100 (incl. animals) & experienced more extreme abuse
9
Q
What are the theories to explain onset of DID?
A
- Post-traumatic model of DID (PTM)
- Dissociation of consciousness to escape initial trauma
- Dissociation become response mechanism for future stress (getting more common)
-> Suggestibility pre-disposes to dissociation - Socio-Cognitive model of DID (SCM)
- Symptoms emerge as a product of therapy
- Hypnosis and leading questions therapeutic technique cause patients to reinterpret experiences
- Mood swings are seen as multiple personalities
- Cultural-bound phenomenon -> influence patients’ expectations of DID portrayals
-> Suggestibility increases susceptibility
=> Account for clustering of cases and rise in prevalence and severity - Supporting evidence for SCM:
- Experimental, hypnotic manipulations can reveal hidden self or past life identities in “normal” individuals.
- Transcripts of Sybil’s therapy sessions show that the multiple personality narrative was imposed upon her.
10
Q
What is the implications of DID?
A
- Debates remain around:
- The disoder’s causes
- Its validity as a scientific concept - Opposing views (against):
- Pope et al.: seen DID as a brief fad that was never accepted by the scientific community
- Paris: only DSM-5 failed to notice that this diagnosis fails to meet valid criteria. - Supporting views (for)
- Spiegel et al.: increasing evidence linking dissociative disorders to trauma & specific neural mechanisms
11
Q
What is meant by mood?
A
- Definition: affective “state of mind” that underlie our subjective mental life.
- Conceptual separation between mood and emotion:
- Asking non-psychology Ps on the difference
- Not using references or others’ opinion, just personal view
- Comparison between literatures - Conclusion? Clear distinction but:
- Some criteria require testing
- Not account for interaction between the two
- Not universally agreed
- Terminology used inconsistently in literature
12
Q
What are the 14 differences: Emotion >< Mind
A
- Anatomy: Heart >< Mind
- Experience: Felt >< Thought
- Physiology: Distinct >< No distinct pattern
- Cause: Specific event >< Less defined cause
- Awareness of cause: Aware >< Unaware
- Intentionality: Specific >< Non-specific
- Clarity: Clearly defined >< Diffuse/nebulous
- Control: Uncontrollable >< Controllable
- Display: Displayed >< Not displayed
- Intensity: Intense >< Mild
- Stability: Fleeting >< Stable
- Timing: Rises and leave quickly >< slowly
- Duration: Brief >< Enduring
- Consequences: Behavioural >< Cognitive
13
Q
Explain individual differences in mood based on 2d and 3d model of mood?
A
- Individual difference in concept of mood traits:
- Dispositions of mood
- Capacity and tendency to experience mood states
- Characteristic patterns of variability of mood states - Two dimensions of mood based on analysing previous studies:
=> Positive affect (PA)
- High: active, elated, excited
- Low: drowsy, sleepy, sluggish
=> Negative affect (NA)
- High: distressed, fearful, nervous
- Low: calm, placid, relaxed - Possible to experience both positive and negative affects
- Bittersweetness
- Reported in certain events (e.g. graduation day), watching a tragic comedy movie, songs on repeat (16%)
- Uncommon feeling - Three dimensions of mood trais:
- Factor analysed responses to 48 items from UMACL
- Components:
+ Tense arousal (similar to NA)
+ Energetic arousal (similar to PA)
+ Hedonic tone (happy >< sad)
=> Happiness = PA + NA
=> Hedonic tone modestly associated with arousal scale
14
Q
How to measure individual difference in mood traits and states?
A
- Retrospective judgments (e.g. self-reports) => subject to bias with introspection, such as:
- current mood
- extreme mood state during period (peak)
- mood state at end period (end)
- beliefs, stereotypes and expectations about mood patterns - Collected contemporaneously with the experience (e.g. right-now moods)
=> Benefits:
- Accurate snapshot of mood state
- Free of memory-related cognitive biases
- Temporal precision of mood
=> Downsides:
- Single snapshot only
- Interfere with everyday activities (annoying)
- Tells nothing about memories of experiences (which influences future behaviours, inform sense of wellbeing, contribute to sense of identity)
15
Q
What are effects of introspection biases for mood measurement? What are some evidence for these?
A
- Cultural mood stereotypes: weekday mood (study 1 & 2)
- Study 1: Asking Ps (in full-time employment) what day of the week (morning & evening) is their mood the best and worst
- Study 2: Asking Ps right-now mood + mood stereotypes + memory of mood
=> Little evidence that mood stereotypes reflect real moods
=> For Mondays: mood stereotypes were a better predictor of remembered mood than actuals moods. - Current mood bias (supporting study):
- Asking Ps about their mood in this moment & life as a whole
- Either on sunny or rainy day
=> Result: overall mood similar to mood feel in-the-moment - Peak-end mood theory (supporting study):
- Study 1: ask pregnant women on momentary pain reports until birth, then pain ratings taken 2 days/months later -> Avg. of Peak + End pain ratings STRONGER predictor than actual avg. pain felt
- Study 2: asymmetries in recall of positive and negative affect -> negative influenced more by peak experiences, positive by end experiences
=> Retrospective ratings were strongly influenced by Peak and End mood experience
=> Lower correlations with duration of experiences (false memory)
