U11 Flashcards
3 clusters of personality disorders
A - odd/eccentric
B - dramatic, emotional, erratic
C - fearful/anxious
personality disorders
persistant pattern of emotions cognitions and behaviours resulting in emotional distress to individual and/or those around them
why are personality disorders hard to diagnose
hard to determine personality variations from disorders
commonalities across personality disorders
- onset in early adulthood
- fixed and consistent across situations
- not diagnosed in childhood or adolescence
- lack of sense of self
- difficulty in relationships
- little self awareness / insight into difficulties
- cannot be attributed to a psychotic disorder
histrionic PD biased towards ______ and antisocial is biased towards ____
females
males
cluster A disorders
- paranoid
- schizoid
- schizotypal
paranoid PD criteria
- pervasive distrust and suspiciousness of others (that they have malevolent motives)
causes of paranoid PD
genetics (relatives with schizophrenia)
traumatic childhood experiences
cognitive cultural factors
treatment of paranoid PD
CBT to change mistaken assumptions about others
associated features of paranoid PD
- argumentative
- quiet
- suicidal
- relationship with paranoid schizophrenia and delusional disorder
schizoid PD criteria
pattern of detachment from social relationships and restricted range of expression of emotions beginning early adulthood
causes of schizoid PD
- childhood shyness
- abuse and neglect
- low density dopamine receptor
treatment of schizoid PD
social skills training (role playing)
associated features of schizoid PD
- homelessness
- social deficiencies/isolation
- constricted affect
schizoid PD is often misdiagnosed as _____
ASD
what is the main difference between psychotic disorders and personality disorders
psychotic believe thought/hallucinations/delusions are real and PD can rationalize them (aware of reality)
schizotypal PD criteria
pervasive pattern of social/interpersonal deficits marked by discomfort and low capacity for close relationships
cognitive and perceptual distortions
causes of schizotypal PD
- genetics
- L hemisphere brain damage (brain abnormalities
- abnormalities in semantic association abilities
treatment for schizotypal PD
antipsychotic meds
community treatment
social skills training
CBT
associated features of schizotypal PD
- hypersensitive to criticism as children
- same spectrum as schizophrenia without debilitating hallucinations/delusions
- ideas of reference (paranoia)
- magical thinking
cluster c disorder
avoidant
dependent
obsessive-compulsive
avoidant PD criteria
pattern of social inhibition, feelings of inadequacy and hypersensitive to negative evaluation
causes of avoidant PD
- born w difficult temperament, parental rejection, uncritical love
- low self esteem
- social alienation
- overactive behavioural inhibition system
- may be part of the social anxiety spectrum
treatment for avoidant PD
- better evidence
- social skills training
- CBT
- medical interventions (like those for anxiety )
associated features of avoidant PD
- interpersonally anxious
- fear of rejection
- pessimistic about self and future
- restraint in personal relationships
dependent PD criteria
pervasive and excessive need to be taken care of that leads to submissive and chasing behaviour
fears separation
causes of dependent PD
disruptions in early childhood (leads to fears of abandonment)
high socio-tropic traits
treatment of dependent PD
developing confidence (ensuring the patient doesn’t depend on the therapist)
obsessive compulsive PD criteria
pattern of preoccupation with perfection and order, mental/interpersonal control at the expense of flexibility
associated features of OC PD
- preoccupied w rules and schedules
- overconciencious and inflexible
- exclusion of leisure
- poor interpersonal relationships
- quest for perfectionism
causes of OC PD
genetics
treatment of OC PD
relaxation techniques
CBT to reframe compulsive thoughts
cluster b PD
histrionic
narcissistic
antisocial
histrionic PD criteria
pervasive pattern of excessive emotionality and attention seeking
causes of histrionic PD
- “hysteria”
- co-occurs with antisocial personality disorder
treatment of histrionic PD
improving interpersonal relationships
teaching appropriate ways of negotiating wants and needs
associated features of histrionic PD
- vauge speech
- self centred
- dramatic
narcissistic PD criteria
pattern of grandiosity, need for admiration and lack of empathy
causes of narcissistic PD
failure of empathetic mirroring from parents
child remains fixated at self centred grandiose stage of development
treatment of narcissistic PD
- CBT
- coping strategies
- focus on feelings of others
associated features of narcissistic PD
frequently depressed
borderline personality disorder associated features
- most commonly diagnosed personality disorder
- big fear of abandonment
- self harm/suicidality
- high rates of substance use
- less sense of self
criteria for borderline personality disorder
pattern of instability of interpersonal relationships, self image, and affect
- marked impulsivity
- big intense mood swings
causes of borderline personality disorder
- genetics
- changes in limbic system
- memory bias towards negatives
- early trauma and biological predisposition (childhood sexual abuse)
- rapid culture changes
treatment of borderline personality disorder
- antipsychotics and antidepressants
- DBT
what is DBT
dialectical behaviour therapy
- reduces suicide attempts
- includes efforts to improve mindfulness, emotional regulation, interpersonal effectiveness, and distress tolerance
components of DBT (if all components are present what is it called)
individual DBT, skills group, phone coaching, therapist consults in teams
- full DBT
wise mind
between rational and emotions mind (includes intuitive thinking and mindfulness)
emotion regulation vs distress tolerance
e - identifying and labeling emotions
d - distract and self soothe
what does it mean to be DBT informed
therapist uses skills involved in DBT but not full DBT
associated features of antisocial PD
- psychopathy
- often present in male criminal offenders
- called conduct disorder in kids
- high risk behaviour
(aggressive, lying, cheating, no remorse, substance abuse)
criteria of antisocial PD
- pattern of disregard for violation of rights of others occurring since age 15
- at least 18 years of age
- evidence of conduct before 18
- antisocial behaviour isn’t due to bipolar or schizophrenia
on the spectrum of disruptive behaviour disorders _________ is seen as the most severe where as ________ is seen as the least
- conduct
- oppositional defiant disorder (ODD)
ODD
characterized by angry/irritable mood, augmentative/defiant behaviour
must be vindictive 2 times in 6 months
behaviour persists for 6 months+ not just with a sibling
conduct disorder criteria
repetitive pattern of behavior in which the basic rights
of others or major age-appropriate societal norms or rules are violated
at least one of
- aggression towards people/animals
- destruction of property
- deceitfulness and theft
- serious violation of rules
disturbance causes significant impairment in social, academic, or occupational functioning
conduct disorder subtypes
- childhood onset (younger then 10)
- adolescent onset (older then 10)
environmental influences of conduct disorder
- delinquent influences (peers)
- dual failure model
- less structure
- parent (failed monitoring)
- single parent families
- SES and indigenous youth
affective factor of psychopathy (CU traits)
- lack of empathy, shallow affect
- severe or chronic aggressive behaviour
- low emotional responsiveness to others
factors of psychopathy (3)
- irresponsible behaviour
- interpersonal style (grandiose)
- affect
how do CU traits and psychopathy develop
- under/hypo aroused amygdala (causes sensation seeking to boost activation)
- cortical immaturity (impulsive childlike behaviour)
- fearlessness hypothesis
- maltreatment
dual failure model
people around you don’t want to spend time with you because of your deviant behaviour so you commit more deviant behaviour (cycle)
primary CU traits
- don’t feel bad when they hurt others and have a lack of moral emotion
- genetically based
- hypo-aroused
- low anxiety
secondary CU traits
- involves dissociation to reduce stress and leads to the development of CU traits
- relationally based
- develops mask
- hyper-aroused
- high anxiety
treatment for CU traits and psychopathy
- early prevention/early identification
- parent child interaction therapy
- CBT (limited effectiveness)
what is included in behavioural programs for CU trait treatment
- positive and negative reinforcement
- teaching communication skills
- introducing home rules
rebound effect is often seen
what is included in SNAP programs for CU trait treatment
- focus on emotional regulation, self control, problem solving, parent child relationships
- reduces aggression, rule breaking behaviours and conduct problems
what is included in attachment programs for CU trait treatment
- attachment based intervention
- psycho education
- roleplay
