Topic 4a - Personality Disorders

Question 1

How does DSM 5 group disorders?

Answer 1

Axis I-III (psychological disorders, personality disorders and medical conditions)

Question 2

What is the definition of a personality disorder?

Answer 2

Enduring pattern of inner experiences and behaviours that deviate from cultural expectations and are pervasive and inflexible causing distress or impairment (not due to another disorder or drug)

Question 3

What are Cluster A personality disorders?

Answer 3

‘odd or eccentric ‘
Paranoid
Schizoid
Schizotypal

Question 4

What are Cluster B personality disorders?

Answer 4

‘dramatic, emotional, erratic’
Antisocial
Borderline
Histrionic
Narcissistic

Question 5

What are Cluster C personality disorders?

Answer 5

‘anxious or fearful’
Avoidant
Dependent
Obsessive-compulsive

Question 6

What are the symptoms of Paranoid PD? Cluster A

Answer 6

Mistrust of others, suspicious
Preoccupied with doubts, reluctant to confide, hold grudges

Question 7

What are the symptoms of Schizoid PD? Cluster A

Answer 7

Detach from interpersonal relationships, cold, indifferent to praise / criticism, few friends

Question 8

What are the symptoms of Schizotypal PD? Cluster A

Answer 8

Distorted thinking (magical, illusions), discomfort in social situations, paranoid

Question 9

What are the symptoms of Antisocial PD? Cluster B

Answer 9

Lack empathy and remorse, fail to conform to norms, impulsive, irresponsible, no regard for safety

Question 10

What are the symptoms of Histrionic PD? Cluster B

Answer 10

Excessive need for approval, centre of attention, shallow, over dramatic, sees relationships as overly intimate

Question 11

What are the symptoms of Narcissistic PD? Cluster B

Answer 11

Inflated self importance and entitlement, seek attention and admiration, arrogant, low empathy, can lead to dissatisfaction with life achievements and high jealousy of others

Question 12

What is Borderline PD?

Answer 12

Emotionally unstable
Unstable relationships, imagined abandonment, lack identity, feel empty and worthless, unstable feelings, suicidal, self harm, impulsive in self damaging behaviours

Question 13

What are the symptoms of Avoidant PD? Cluster C

Answer 13

Social inhibition, avoid social interactions, low self worth, fear rejection and criticism, don’t engage in new things, fear embarrassment

Question 14

What are the symptoms of Dependent PD? Cluster C

Answer 14

Persistent psychological dependence on others, lack confidence in ability to take responsibility, difficult being alone, agree with others

Question 15

What are the symptoms of Obsessive-compulsive PD? Cluster C

Answer 15

Preoccupied with orderliness, rules, moral codes, caution and perfectionism, devoted to work, inflexible (SEPARATE TO OCD)

Question 16

What is the link between personality disorders and the Big 5 personality traits? - Saulsman & Page, 2004

Answer 16

Meta analysis- 12 studies
Cluster A associated with low E - socially withdrawn, few friends
Antisocial PD = low agreeableness, low empathy and disregard for others
Dependent PD = high agreeableness
However, magnitude of correlation is not huge, should look at facet level instead of trait

Question 17

How do facets of Neuroticism correlate with Paranoid PD? - Widiger et al. 1994

Answer 17

N1 = anxiety
N2 = anger hostility MOST CORRELATED WITH PARANOID PD
N3 = depression
N4 = self conscious
N5 = impulsive LOW CORRELATION WITH PARANOID PD
N6 = vulnerable LOW CORRELATION WITH PARANOID PD

Question 18

How are facets of conscientiousness associated with obsessive compulsive PD?

Answer 18

C1 = high competence
C2 = high order
C3 = high dutifulness
C4 = high achievement striving
C5 = high deliberation

Question 19

How does extraversion and neuroticism (facets) link to avoidant personality disorders?

Answer 19

E2 = low gregariousness
E3 = low assertiveness
N1 = high anxiety
N4 = high self consciousness
N6 = high vulnerability

Question 20

How can agreeable and neuroticism (facets) link to dependent personality disorders?

Answer 20

N1 = high anxiety
N4 = high self consciousness
N6 = high vulnerability
A3 = high altruism
A4 = high compliance
A5 = high modesty

Question 21

How are facets of extraversion linked to Schizoid PD?

Answer 21

E1 = low warmth
E2 = low gregariousness
E6 = low positive emotionality

Question 22

What does McCrae et al. 2001 find when testing the big 5 and personality disorders?

Answer 22

• Profiles may indicate risk but not diagnosis of PD (ruling out or categorising PD)
• Patients from psychiatric hospitals, PD interview and questionnaire, facet scores
• Correlated but only small - need to revise diagnostic system
• Extensive co-morbidity with diagnostic system for PD
• Low temporal and inter assessor reliability

Question 23

How should the DSM 5 approach personality disorders now?

Answer 23

Dimensional rather than categorical
Assess personality facet trait profile
Assess personality related social and occupational impairment and distress
It is causing distress / dysfunction = PD

Question 24

Did the DSM change?

Answer 24

No - retained 10 personality disorders and clusters (kept the same) but added emerging measures and models section

Question 25

What is the DSM 5 emerging measures and models section?

Answer 25

Criterion A: severity
- significant impairments in functioning of self (identity) and interpersonal (empathy or intimacy)
Criterion B: style
- one or more pathological personality trait
domains or facets measured with Maladaptive Trait Model

Question 26

What is the Dissociative Identity Disorder?

Answer 26

Previously known as multiple personality disorder - mental disorder categorised by presence of two or more identities / personalities
Experience amnesia in memory
Causes distress and functional impairments
Not due to substance use

Question 27

What does Haslam (2007) propose as the symptoms of Dissociative Identity Disorder?

Answer 27

• Not considered personality disorder as its a detachment from the body
• Primary host personality plus one or more alters
• Alters take turns to control behaviour
• Distinctive patterns of thinking and behaviours
• Different names and genders
• Memory loss for experiences as other alters
• People often have experienced severe childhood sexual / physical abuse
• Patients high in suggestibility trait - easily influenced and hypnotised

Question 28

What is the evidence for the socio-cognitive model of dissociative identity disorder?

Answer 28

• DID emerges as a response to trauma
• Dissociation of consciousness to escape trauma (self protection)
• Dissociation becomes response mechanisms for future stress
• High in suggestibility = more likely to dissociate in first place
• Fragmented consciousness

Question 29

How does the socio cognitive model suggest symptoms emerge?

Answer 29

• Emerge as a product of therapy to treat other symptoms
• Hypnosis and leading Q’s cause patients to reinterpret experiences as multiple personalities
• Mood swings expressed as multiple personalities
• Culture bound phenomenon
• Suggestibility increases susceptibility
• Accounts for clustering of cases and rise in prevalence - more therapists aware of disorders or better at recognising

Question 30

What acts as a limitation for the socio-cognitive model to diagnosing DID?

Answer 30

• Reported cases restricted to USA, few elsewhere
• Cluster around certain clinicians
• Could be related to them and how they diagnose

Question 31

What evidence supports the socio-cognitive model for DID?

Answer 31

Spanos 1994 - experimental, hypnotic manipulations can reveal apparent hidden self or past life identities in psychologically healthy individuals

Question 32

What is the link between dissociative disorders to trauma and brain areas? - Spiegel et al. 2011

Answer 32

Brain scan in ‘host’ state = abnormalities in blood flow to orbital frontal regions, neural patterns different to depression and anxiety (for trauma patients too)