W8: Personality Disorders Flashcards
When is the typical onset of personality disorders
adolescence or early adult hood
to diagnose before the age of 18 the symptoms need to be present for at least 12 months
Except for antisocial personality disorderThat can only be diagnosed and individuals who are older than 18
Personality disorders can be
Difficult to diagnose it often takes multiple sessions together the information needed to assist the diagnosis
Individuals with personality disorders tend to
Use mental health services at a much higher rate than individuals without personality disorders 
What are the two sections in the DSM that personality disorders can be coded as
Categorical (present/absent)
Dimensional (traits on a continuum)
What is the dimensional approach to personality disorder diagnosis
It involves diagnosing a personality disorder based on pathological personality traits – these personality traits are considered to be a disorder when they are in flexible, maladaptive and cause significant distress or impairment in functioning
What is the level of personality functioning scale used for
Used to provide a global score ranging from no impairment to extreme impairment
What are the pathological personality traits in the dimensional approach to personality disorders (5)
- Negative affectivity (anxiousness, hostility, separation insecurity, submissiveness, restricted/lack of affectivity)
- Detachment (anhedonia, depressive therapy, intimacy avoidance, suspiciousness, withdrawal)
- Antagonism (attention seeking, callousness, deceitfulness, manipulativeness)
- Disinhibition (distractibility, impulsivity, risk taking, irresponsibility)
- Psychoticism (eccentricity, perceptual dysregulation, unusual beliefs and experiences)
What does the dimensional approach of personality disorders say in the DSM
Moderate or greater impairment in personality functioning
One or more pathological personality traits
The impairment in personality functioning and the individuals personality trait expression are:
- relatively inflexible and pervasive across a range of personal and social situations
- relatively stable across time with onset that can be traced back to at least adolescence or early adult hood
Not better explained by another mental disorder, substance or a medical condition and they are not better understood as normal for an individual‘s developmental stage or sociocultural environment
In the categorical approach to personality disorders DSM divides the disorders into three clusters what are these three clusters?
A: odd, eccentric cluster
B: dramatic, emotional, erratic cluster
C: anxious, fearful cluster
What personality disorders are part of a cluster A
Paranoid personality disorder
• Characterized by excessive distrust and suspiciousness
Schizoid personality disorder
• Characterized by severe disinterest in social relationships and restricted range of emotional expression
Schizotypal personality disorder
• Characterized by extreme discomfort in relationships and odd/eccentric behaviour
What personality disorders are a part of cluster B 
Antisocial personality disorder
• Characterized by significant disregard for and violation of the rights of others
Borderline personality disorder
• Characterized by extreme impulsivity, unstable sense of self and instability in interpersonal relationships
Histrionic personality disorder
• Characterized by patterns of intense emotionality and attention seeking
Narcissistic personality disorder
• Characterized by grandiosity and need for admiration
What personality disorders are part of cluster C
Avoidant personality disorder
• Characterized by extreme feelings of inadequacy, hypersensitivity to
negative evaluation and social avoidance
Dependent personality disorder
• Characterized by clingy and submissive behaviour and an excessive need to be taken care of
Obsessive compulsive personality disorder
• Characterized by preoccupation with orderliness, perfectionism and
control
What are the advantages of using the categorical approach
Used for decades
Easy transmission of information between clinicians
Helpful for devising evidence based treatment
What are the disadvantages of using the categorical approach
Diagnoses are not stable they may meet diagnostic criteria only at certain points in life for example severity decreasing with age
Do you not have great interrater reliability
Stigmatising
What are the advantages to using the dimensional approach
Trait descriptions are more stable overtime
Provides more descriptive information for clinicians
Avoids patient getting multiple personality disorder diagnoses
What is a disadvantage to using the dimensional approach to personality disorders
It is not clear when a dimension becomes pathological
Traits vs. clinical significance 
What does the DSM say about Schizotypal personality disorder
Pervasive patterns of social and interpersonal deficits marked by:
– Acute discomfort with and reduced capacity for close relationships
– Cognitive or perceptual distortion and eccentricities of behaviour
Beginning by early adult hood and present in a variety of contexts, 5 or more of the following:
– Ideas of reference – the person often interpret external events has been relevant to them
– Odd beliefs – magical thinking that influences behaviour and is inconsistent with cultural norms for example superstitious 
– Unusual perceptual experiences-sensing that events will occur in the future
- odd thinking and speech
- suspiciousness or paranoid ideation
- inappropriate or constructed affect
- behaviour or appearance that is odd, eccentric or peculiar
- lack of Close friends or confidants other than first degree relatives
-Excessive social anxiety that does not diminish with familiarity and tends to be associated with paranoid fears rather than negative judgements about yourself
This does not occur exclusively during the course of schizophrenia or bipolar disorder or depressive disorder with psychotic features or autism spectrum disorder
What treatment is there for schizotypal personality disorder
Treatment includes medical and psychological treatments
A combination of antipsychotic medication, community treatment and therapy including social skills training
CBT can be used for psychosis to have the thought patterns changed
Early intervention is preferred 
What is social skills training
It can form a part of cognitive behavioural therapy programs and it is a structured and therapeutic approach to teaching clients how to interact with others
It involves teaching the rules of social interaction through psychoeducation modelling role-play and behavioural experiments 
What does the DSM say about borderline personality disorder
Instability of interpersonal relationships, self image, affect, and marked impulsivity
Early adulthood
– Frantic efforts to avoid real or imagined abandonment 
- alternating between extremes of idealisation and evaluation partner
– Identity disturbance through unstable self image or sense of self
– An impulsivity in at least two areas that are potentially self-damaging e.g. substance use reckless driving
– Recurrent suicidal behaviour, gestures or threats
-Effective instability due to marked reactivity in mood (eg. Intense episodic dysphoria, irritability or anxiety usually lasting hours and only rarely more than a few days)
– Chronic feelings of emptiness
-Inappropriate, intense anger or difficulty controlling anger
– Transient, stress related paranoid ideation or severe Dissociative symptoms
Borderline personality disorder and abuse
People with this personality disorder are more likely than individuals with other personality disorders to report and abusive history
What is linehan’s diathesis-stress theory? 
People with borderline personality disorder have a biological diathesis 
They are then raised in an environment that is invalidating and the person‘s feelings are discounted and disrespected
How do you know if it’s borderline personality disorder or complex PTSD
They share things like emotional dysregulation, self-destructive behaviours, suicidal tendencies, dissociation and paranoia, negative self image, feelings of emptiness and sense of numbness
However Borderline personality disorder include things such as impulsivity, fear of abandonment, and inappropriate anger, extreme mood swings and unstable relationships

In complex PTSD they have nightmares, somatic distress, hypervigilance, sense of threat, avoidance, flashbacks and unwanted memories

What is the treatment for borderline personality disorder
A variant of cognitive behavioural therapy called dialectal behavioural therapy – it involves helping the client regulate emotions and cope with stresses that might trigger self-destructive behaviours
It involves for skills that are taught in a rotating fashion:
Mindfulness skills (calm physiological arousal and dampen the sympathetic nervous system)
Interpersonal skills (how to interact with others)
Emotional regulation
Distress tolerance skills (help tolerate stressful life situations so they are less likely to engage in self destructive behaviours) 
What does the DSM say about avoidant personality disorder
A pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation, beginning by early adult hood and present in a variety of context as indicated by four or more of the following:
– Avoids occupational activities that involve significant interpersonal contact because of fears of criticism, disapproval or rejection
– Is unwilling to get involved with people unless certain of being liked
– Shows restraint with intimate relationships because of the fear of being shamed or ridiculed
-Is preoccupied with being criticised or rejected in social situations
-Is inhibited in new interpersonal situations because of feelings of inadequacy
– Views self as socially inept, personally and appealing, or inferior to others
– Is unusually reluctant to take personal risks or engage in any new activity because they may prove embarrassing

Avoidant personality disorder has been considered
An extreme and pervasive form of social anxiety disorder
What treatment is there for avoidant personality disorder
CBT focusing on behavioural activation, behavioural experiments and social skills training is indicated
A therapeutic alliance is vital for all clients but is particularly important for treatment success with this client group – you may need to take it slower and build up a secure base you may begin with phone calls prior to meeting in person
What is the gold standard in assessment for personality disorders
Structured clinical interview for DSM-5 personality (book)
It’s a semistructured interview where you gather information as to whether they make criteria or not
Many people with personality disorders enter treatment for
Reasons other than their personality disorder such as depression anxiety or a crisis
