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Personality Psychology > Week 10 - Personality Disorders > Flashcards

Week 10 - Personality Disorders Flashcards

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1
Q

Outline the 4 types of fluid that conceptualise personality? (Galen, 180 AD)

A
  1. Black bile = melancholia and depressive personality
  2. Yellow bile choleric personality with aggressive and explosive outbursts
  3. Blood = sanguine personalities with positive forceful and great drive
  4. Phlegm = passive and negative, detached personality
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2
Q

Who was one of the first people to group traits and personality types?

A

Theophrastus (371-287 BC)

Describes people with their foibles (difficulties that they may face)
Describes 30 different characteristics which are similar modern day personality types when combined

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3
Q

What are the 4 types of personality? (Theophrastus)

A
  1. Suspicious man = someone who was paranoid and detached from reality compared to normal (similar to paranoid personality disorder)
  2. Reckless man = bold/impudent individual undeterred by criticism/disgrace, offensive and frivolous and disreputable activities, eg. theft, gambling, neglectful
  3. Shameless man = greed and boldness, disregard for decency and reputation, seeking loads from defrauded, demanded free goods
  4. Superstitious - engages in rituals, washing in sacred fountain, carrying a laurel lead, avoiding serpents, purifying his house
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4
Q

What PD is the “superstitious man” similar to?

A

similar to OCPD and schizoid PD

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4
Q

What PD the “Suspicious man” similar to?

A

paranoid personality disorder

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5
Q

Did early psychoanalysis directly address PDs?

A

No = it tended to use ‘character’ over personality and focused on sustained issues with mood and mania, not directly related to personality disorder

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5
Q

What PD is the “shameless” and “reckless” man similar to?

A

similar to ASPD

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6
Q

First person to discuss psychopathy?

A

Emil Kraepelin first talked about psychopathy in personality disorders, eg. impulsive insanity and compulsive insanity, similar to modern-day psychopathy

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7
Q

Who first coined ‘psychobiology’ out of concern for PD labels? (1900s)

A

Adolf Meyer (1900s) was concerned with diagnostic label would inhibit further enquiry and lead to stigma/biases from others

  1. psychobiology’ incorporates biological social and psychological factors to understand someone’s situation and symptom presentation

also wanted to separate personality from other forms of psychopathology in diagnostic manuals, that personality needs to be considered equally in someone’s presentation

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7
Q

How did Freud introduce ideas on PD development?

A

Freud talked about fixations with stages that result in character flaws from psychosexual stages (not personality/temperament)

  1. Oral stage causes oral fixation to develop an oral-receptive type = envious and hypercritical) or
  2. Anal-receptive = passive character
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8
Q

How were PDs in the 1st DSM defined?

A
  1. “Patterns of behaviour resistant to change but not connected to anxiety or personal distress on part of the patient”
  2. Needed to characteristic prolonged and treatment resistant patterns of behaviour compared to short term distress
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9
Q

What edition of the DSM first included distinct PDs?

A

2nd edition (1968)

Included clinical useful personality syndromes including paranoid, cyclothymic, schizoid, explosive, obsessive compulsive, hysterical, asthenic, antisocial, inadequate and passive aggressive personality disorders”

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10
Q

How were PDs in the 2nd DSM defined?

A

“deeply ingrained maladaptive patterns of behaviour that are perceptibly different in quality from psychotic and neurotic symptoms”

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11
Q

Outline the 3 groupings of personality disorders in the early DSM:

A

Section 1 = cardinal personality; therapy unchangeable

Section 2 = personality trait disturbances independence / personality maldevelopment

Section 3 - Sociopathic personality disturbances: lack of social conformity
Antisocial behaviours, chronically in trouble and do not seem to change from experience/punishment OR sexual deviation: homosexuality, transvestism, pedophilia, fetisism, and sexual sadism

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12
Q

What was an example of a cardinal / unchangeable personality disorder in the early DSM?

A

Inadequate personality

  • inadequate responses to intellectual, social, emotional and physical demands of environment with an inflexibility and lack of judgement
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13
Q

What was a PD example of “personality trait maldevelopment and disturbances”?

A
  1. Passive aggressive personality with three subtypes:
  2. passive -dependent type who are helpless/over dependent and indecisive
  3. passive-aggressive type = aggressiveness passively through pouting, procrastination and intentional inefficient,
  4. aggressive subtype = irritability, temp and destructive behaviours
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14
Q

What might be a PD example of “sociopathic personality disturbances”?

A
  1. ASPD
  2. Schizoid PD
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15
Q

How was the DSM-III (1980) a huge change for PDs?

Outline the 3 major changes to PDs in the DSM-III

A
  1. A catalyst of changing from a psychoanalytic to a behavioural perspective, PD had its own category and was distinct from other disorders
  2. Axis II was reserved for personality disorders and some types of childhood problems
  3. Polythetic = Patient had to meet a specified minimum number of criteria, ie., no single criterion was considered to be essential / sine qua non
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16
Q

What has changed between DSM-III and DSM-5?

A

Very little!

  1. The same 10 PDs have been kept since the 1980s with some more additions
  2. Appendix was used to place diagnostic labels/systems for new revisions/adaptations
  3. DSM-5 has suggested a hybrid approach to personality disorders
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17
Q

What are the 3 main groupings for categorising PDs in the DSM?

A

A. Odd / eccentric

B. Dramatic / erratic

C. Anxious / fearful

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18
Q

What is the current definition of a personality disorder?

A
  1. “Persistent maladaptive or culturally infrequent thoughts, feelings and behaviour including
  • Patterns of cognitions, affects and types of interpersonal relationships
  • Behaviour is maladaptive, inflexible and pervasive across situations
  • Causes significant distress or impairment to life
  • Often traced back to adolescence
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19
Q

What is a controversial aspect of the PD definition?

A
  • Whether the sufferer recognises or not (controversial, as sometimes the patient believes other people are the problem or doesn’t see any problems with their behaviour, eg. narcissism or antisocial PD, must be careful)
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20
Q

What’s the prevalence rate of PDs in gender and comorbidity

A
  1. The prevalence of a diagnosis can vary between 0.3-3%, and varies between gender, eg. ASPD is more common in men
  2. People with PD experience additional mental health disorders and are prevalent in ED and inpatient units
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21
Q

What 3 PDs make up Cluster A? (Odd / eccentric)

A
  1. Paranoid PD = pattern of distrust and suspiciousness whereby other’s motives are interpreted as malevolent
  2. Schizoid PD = pattern of detachment from social relationships and restricted range of emotional expression
  3. Schizotypal PD = similar to schizoid PD, pattern of acute discomfort in close relationships, cognitive or perceptual distortions and eccentricities, closer to schizophrenia behaviours
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22
Q

In what 5 ways are the DSM and ICD definitions of PD similar?

A
  1. Aspects of the self
  2. Causes interpersonal dysfunction
  3. Persistent over extended periods of time and personal/social situations
  4. Not better explained by social/cultural factors including socio political conflict
  5. Causes substantial distress or significant impairment in areas of life
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23
Q

What 4 PDs make up Cluster B (Dramatic / erratic)

A
  1. Histrionic PD = pattern of excessive emotionality and attention seeking, feel anxious without attention
  2. Narcissistic PD = pattern of grandiosity, need for admiration and entitlement, lack of empathy
  3. Antisocial PD = pattern of disgrace for and violation of, the rights of others
  4. Borderline PD = a pattern of instability in interpersonal relationships, self-image and affects, impulsivity, struggling with ER
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24
Q

What 3 PDs make up Cluster C? (Anxious / fearful)

A
  1. Avoidant PD = pattern of social inhibition, feelings of inadequacy and hypersensitivity to negative evaluation
  2. Dependent PD = pattern of submissive and clinging behaviour related to an excessive need to be taken care of
  3. Obsessive-compulsive PD = pattern of preoccupation with orderliness, perfectionism and control pre- occupation with control/orderliness in all aspects of everyday life)
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25
Q

Where do personality disorders come from?

What questions can we ask to determine how someone has come to have a personality disorder

A
  1. from ATTACHMENT styles (learnt behaviours of relating to others, which can be understandable ways of seeing the world from upbringing)

Q. How does this individual see others and how have they learnt to see people in their childhood?

Q. Are people reliable, dependable, trustworthy or dangerous?

Q. How does this person interact with others?

Q. Are they aggressive, submissive, withdrawn/avoidant or do they idealise or demand things from others?

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26
Q

How might someone with avoidant attachment view others?

A

see people as dangerous/unreliable and are withdrawn/avoidant, eg. schizoid PD

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27
Q

How might someone with disorganised attachment view others?

A

see people as unsafe/dangerous, eg. BPD

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28
Q

Why is it useful to use an attachment style point of view to understand personality disorders?

A

Using an attachment style approach, can find underlying factors and give more empathy

eg. ask why do narcissists need so much attention? It’s because they feel inherently inadequate and thus go over the top)

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29
Q

What are 4 developmental/risk factors for PDs? (from community studies)

A
  1. Early adversity: abuse/neglect
  2. Social stress (bullying, financial, social isolation)
  3. Dysfunctional families/parent breakdowns
  4. Ineffective or adverse parenting styles (harsh/punitive or invalidating)
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30
Q

Whats the amount of genetic variance found in PDs?

A

Twin studies suggest MODERATE heritability of PDs, explaining about 30.33% / ⅓ of genetic variance of PDs

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31
Q

Why do we differentiate cause vs. risk factors in PDs? Why do we not attribute causality to developmental factors for PDs? (4)

A
  1. Many people with PD report experiences in their past and it is difficult to prove that these factors are causally involved in the development of their personality disorder
  2. The onset of PDs tend to develop in adolescence and become stable by adulthood
  3. Callous/unemotional traits tend to be observed earlier in life / primary school
  4. On average, PDs tend to burn out over time, the severity of symptoms tends to reduce
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32
Q

What are the 3 major types of PD treatments?

A
  1. Dialectical behaviour therapy (DBT, Linehan)
  2. Mentalisation based therapy
  3. Systems Training for Emotional Predictability & Problem Solving (STEPPS)
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33
Q

What is Dialectical behaviour therapy?

A
  1. leading treatment for BPD by Linehan who had it herself
  2. Module based approach with specific modules focusing on specific skills, ER and interpersonal skills
  3. Therapy has overarching themes like developing a life of purpose, being respectful, being present, connecting over withdrawing from people
  4. High structured routine for inpatients, everyone goes through in the same order, eg. wake up at 9am, practice mindfulness, individual therapy in afternoon
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34
Q

What is Mentalisation based therapy?

A
  1. An intensive framework with psychoanalytic underpinning focused on mentalisation

Mentalisation = the way we connect with others and share our emotions and understand their feelings in our relationships, eg. type of METACOGNITION

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35
Q

What is the STEPPS Program (Systems Training for Emotional Predictability & Problem Solving)?

A

A program that helps BPD people manage emotions and involves 20 structured group sessions with experience with CBT and problem solving techniques

36
Q

What’s the main issue with PD treatments?

A
  1. The individual’s willingness to engage in therapy, eg. self-stigma and perceived stigma from others
37
Q

What is the underlying logic of the dimensional model of PDs?

A

“ What differentiates individuals with personality disorders is not the presence of these traits but rather the severity to which they occur”

38
Q

What are the 4 broad criticisms of the categorical approach to PDs?

A
  1. No evidence of demarcation between presence/absence of PDs
  2. Appear to fall of the same continuum, differentiating in severity and NOT nature
  3. DSM Criteria appear to be arbitrary, eg. 5 / 9 symptoms required for diagnosis is simply must be 50% of symptoms
  4. Sub-threshold is often overlooked for treatment, research and funding
39
Q

What is the Comorbidity Problem and how does it defeat the idea of discrete categories in PDs?

A
  1. “people with more than one mental disorder is often the rule rather than an exception”
  2. The comorbidity problem defeats the idea of discrete categories of PDs, as the odds ratio is 2.8-4.6x in favour of co-occurrence of having more than one personality disorder
40
Q

Why is cormorbid PDs difficult?

A
  1. Multiple PTs are hard to distinguish in clinical practice
41
Q

What is the criticism of Temporal instability & inaccurate Tx efficacy in categorical approach to PDs?

A
  1. Many patients move from PD to no PD classification within 6 months to 1 year, eg. might move from 5 to 4 symptoms out of 9, and no longer meet criteria
  2. Treatment outcomes are determined if someone is “no longer meeting criteria” = very misleading
42
Q

What’s the issue of PDNOS in dimensional/categorical approaches to PDs?

A

There is a large amount of people with PD NOS rate (40%) who don’t find into any one category / labels don’t fit

43
Q

How is the structural validity of the PD categorical approach?

A

it has POOR structural validity

44
Q

How is the clinical utility of the PD categorical approach?

A
  1. Quite poor, 74% of professional PD societies said most diagnostic approaches were not effective
    80% believed a dimensional approach is better
45
Q

What is the issue of Within Category heterogeneity in PDs?

A
  1. As you need to fulfil 5 out of any 9 symptoms, there are 256 DIFFERENT PRESENTATIONS OF A PD DIAGNOSIS

(2 people can be diagnosed with BPD with only one overlapping symptom)

  1. Most clinicians make diagnoses based on mapping the clients’ internalised archetypes (do NOT solely rely on external categorical criteria), such that 2 different clinicians might diagnose BPD in a different way (eg. poor structural validity)
46
Q

Is the Big 5 a valid/reliable measure for personality?

A

Arguable so, it shows relatively stable, cross-cultural, neurologically based and understandable findings for these traits)

47
Q

Can the Big 5 explain / capture all dimensions of PDs?

A

Lower level facets of the Big 5 can further explain aspects of PDs

48
Q

What PD’s might HIGH and LOW caution be attributed to?

A
  1. High caution = highly distrusting, eg. schizotypal
  2. Little/no caution: = highly impulsive, histrionic or BPD?
49
Q

What PD’s might HIGH and LOW spontaneity be attributed to?

A
  1. High spontaneity = recklessness characteristic of ASPD
  2. Low spontaneity = uncomfortable doing anything new, eg. OCPD?
50
Q

What PD’s might HIGH and LOW hypervigilance be attributed to?

A
  1. High Hypervigilance = paranoid PD,
  2. Low hypervigilance = schizoid PD
51
Q

How can we use Big 5 narrow traits to replicate the symptoms of categorical disorders in PDs?

A
  1. Use trait combinations as diagnosis

Example = Paranoid PD might be = high caution + low spontaneity + high hypervigilance

52
Q

ASPD could consist of what 2 narrow traits?

A

low caution + high confidence

53
Q

What are the 4 strengths of using Big 5 traits to capture PDs?

A
  1. By using trait combinations as diagnosis along a continuum, means you don’t have to be extreme, but from 0-100 (different expressions of mental health disorders)
  2. Treats everyone on the same continuum and sees people as granular

3.. Can describe all possible combinations of PDs, gets rid of PDNOS and comorbidity issues

  1. Genetic and clinical support = involvement with five factor model shows same model with personality disorders, HIGH VADILITY
54
Q

FFM: What is meant by “With an increase in specificity in traits, comes decreased genetic differentiation”?

A
  1. Genetics tend to show that the more BROAD categories of personality have a STRONGER personality contribution, eg. internalising vs. externalising problems predict lots of different behaviours
  2. Moving down the levels of differentiation and increased specificity, there is LESS genetic contribution to behaviour in lower-level traits
  • eg. certain aspects of negative affect only influence certain behaviour
55
Q

What is an alternate term for conscientiousness?

A

grit / anankastia (in ICD-11)

56
Q

What are the 3 STRENGTHS of the continuum/severity based approach?

A
  1. Our current models emphasise SEVERITY in DSM-5, ICD-11
  2. Does allow for finding subthreshold individuals
  3. Still retains current nostology of PD
57
Q

What are the 4 LIMITATIONS of the continuum/severity based approach?

A
  1. Still problems with diagnostic overlap / comorbidity in disorders
  2. Issues with PDNOS (not otherwise specified)
  3. Still issues with replication/identification across cultures and arbitrary thresholds
  4. Keeps boundary between those disordered vs. non disordered
58
Q

What are the 3 LIMITATIONS of the trait based approach?

A
  1. Increased efforts for PD communication, requires new learning and adoption
  2. Requires new allocation of health care resources
  3. No clear demarcation between having vs. not having PDs, thus more VAGUE treatment outcomes
59
Q

What is “Criterion A” of the DSM-5 Section III Model (alternative hybrid model of diagnosing PDs)?

A
  1. Criterion A
    Significant impairments in both:
    • Self functioning (goal-directed behaviour) including
      identity: integration) OR
      Self-direction (of behaviour in a productive manner)
      AND
    • Interpersonal functioning (connection & appropriate attachment with others) including
      Empathy OR
      Intimacy
60
Q

What is “Criterion B” of the DSM-5 Section III Model (alternative hybrid model of diagnosing PDs)?

5 Traits - NA, D, A, D, P

A

INCLUDES 5 TRAIT FACETS FOCUSING ON DISTRESS:
1. Negative affectivity (similar to neuroticism): issues with anxiousness, hostility, suspiciousness, depressivity, emotional lability

  1. Detachment (similar to introversion): anhedonia, depressivity, withdrawal, intimacy avoidance
  2. Antagonism (opposite of agreeableness) = manipulativeness, deceitfulness, callousness, attention seeking
  3. Disinhibition (opposite of conscientiousness) = lack of rigid perfectionism, impulsivity, distractibility, risk taking
  4. Psychoticism (similar to openness to experience) = perceptual dysregulation, eccentricity and unusual beliefs
61
Q

How is genus and species a good metaphor for the alternative PD model in the DSM?

A
  1. Distress/genus = criteria A (significant impairments in something
  2. Flavour/species = nature of that distress
62
Q

How does the trait based approach to PD clarify disorder and reduce PDNOS?

A
  1. Someone with high levels of risk taking and impulsive behaviour could meet threshold for ASPD or BPD

Which do they meet best? Do they get one or both or is it better described as PDNOS?

Solution: using the trait based approach, it does not need to distinguish between these two possible disorder, but rather describe the symptoms as “problems with elevated antagonism and disinhibition and have issues with identity and intimacy” - no demarcation for labels

63
Q

What is a possible middle ground for categorical and dimensional approach?

A

a hybrid diagnosis:
To try to recapture categorical labels using traits, if categories are meaningful you can represent them using dimensional perspectives

6/10 PDs retained: antisocial, avoidant, borderline, narcissistic, OCPD and schizotypal

64
Q

What is an Example of a hybrid classification of BPD using the DSM-5 Section III Model?

A

Criterion A = Impairment on self and interpersonal functioning, self-harm, identity disturbance and inability to form stable relationships

Criterion B = Pathological personality traits in the following:
* Negative affectivity
* Disinhibition (impulsiveness)
* Antagonism (hostility)

65
Q

What’s the issue with the hybrid approach?

A

it still retains the issue with elevations in continuum, assumes these personality labels are meaningful and homogenous ways of capturing people’s symptoms

The cost of that is that there are 256 different presentations of BPD - so reducing personality dimensions into labels we lose ability to detect it

66
Q

How many different possible presentations of BPD?

A

256

67
Q

What is the primary task of the clinician using the ICD-11?

A

The only task from a clinician is to allocate the severity of the disturbance, everything else is secondary, including the traits

68
Q

How do you get a diagnosis of personality disorder in the ICD-11?

Why is severity prioritised here?

A

You only need to characterise/explain the severity of disturbance or dysfunction

Findings suggest severity of a PD over the type of PD is a BETTER and PREDICTOR of positive outcomes for long-term severity and prognosis

69
Q

What is the continuum of PDs?

A
  1. There exists a continuum of dysfunction in personality disorders from 0-100
    • 0 = no signs of dysfunction
    • 100 = severe breakdown in intrapersonal and interpersonal functioning
70
Q

What is the hybrid label exception kept in the ICD-11?

Why is it controversial?

A

The ICD-11 kept a hybrid label: the “borderline pattern qualifier”

Highly controversial, argued that borderline is an meaningful label and can help organise treatment and provide understanding

Criticised for having no statistical evidence, BPD behaviours are very common in many PDs, and is stigmatising

71
Q

What are the 4 reasons why the DSM placed dimensional approaches into the appendix? / appendix is like Siberia

A

The APA has failed to support the new dimensional system:

  1. Unfamiliar to clinicians
  2. It lacks clinical utility
  3. Lack of quality science
  4. Harmful effects for BPD diagnosis
72
Q

What did a meta-analysis of 10 studies by Bornstein and Natoli find on clinician attitudes?

A
  1. Many clinicians favoured the dimensional models for BETTER COMMUNICATION with patients, describing personalities and making interventions
  2. But many clinicians said the categorical and dimensional systems were similarly easy to use with communications with professional and treatment
73
Q

Which is ranked higher by clinicians, DSM-5 or ICD-11?

A

The ICD-11 continuum based model was ranked higher in:

  1. Describing personality issues
  2. Making treatments
  3. Communication with patients
74
Q

What are the pros and cons reported by clinicians in using the dimension or trait approach?

A

Pros =
think it would be better for conversation and more detailed ideas, better uniformity for treatment

Cons =
More frustrating, need to provide a real diagnosis
How do you provide treatment for this?

75
Q

Why do some people think we should get rid of personality disorders completely? (4)

A
  1. ARGUED that PDs instead call them interpersonal disorders, as interpersonal dysfunction is the main characteristic for diagnosing PDs
  2. Provides a clear model for distinguishing different kinds of PD problems
  3. Individuals get placed in a quadrant circle that describes different interpersonal problems and dysfunction
  4. Interpersonal dysfunction is not seen as an extreme, but acknowledges that PDs are a dynamic pattern of interacting with others and your social environment
76
Q

Textbook: what are the 2 essential characteristics of personality disorders?

A
  1. unusually extreme in a way that general entails a distortion of reality
  2. cause problems for the self and others
77
Q

Are PDs somewhat social and stable?

A
  1. Yes
  2. some are ego-syntonic, so the person with the PD does not experience their PD as a problem
78
Q

How does Aaron Beck et al conceptualise PDs?

A
  1. PDs are defined as incorrect beliefs or problematic ways of thinking which result in maladaptive patterns of behaviour
78
Q

What are the “Bad 5” traits involved in personality disorders in the DSM-5 (analogous to Big 5 traits)?

A
  1. Negative affectivity
  2. Detachment
  3. Antagonism
  4. Disinhibition
  5. Psychoticism
78
Q

What are the 6 personality disorders recognised by the DSM-5 to be “scientifically sound”?

A
  1. Schizotypal (A)
  2. Narcissistic (B)
  3. Antisocial (B)
  4. Borderline (B)
  5. Avoidant (C)
  6. Obsessive compulsive (C)
78
Q

What are the 3 steps for diagnosing PDs in the new DSM-5 approach?

A
  1. assess degree of client’s function
  2. assess whether one of 6 recognised disorders is present
  3. assess the degree to which client has “Bad Five” traits
79
Q

Why might it be better to adopt a trait-based or hybrid approach for PDs compared to normal personalities?

A

because some personality disorders can be seen as exaggerations of traits that, in moderation, are desirable

79
Q

Personality affects —— health as well as —— health:

A
  1. physical
  2. mental
79
Q

How is personality and health outcomes measured?

A
  1. mostly using S-data
  2. L-data can be used to include medical records
79
Q

How precisely does personality impact physical health?

A

Personality may have DIRECT, biological associations with health, but

a more IMPORTANT pathway is probably the way personality affects BEHAVIOURS that affect health, eg. smoking

80
Q

Is the Type A personality valid?

A

Not really, but chronic hostility does appear to have some negative health consequences

80
Q

What is the Type A Personality characterised by? (EARLY RESEARCH)

A

a pattern of nervous and compulsive seeking for achievement, combined with hostility, that promoted heart disease

81
Q

How is positive and negative emotion linked to health?

A
  1. negative emotions seem to be more of a consequence of poor health than a cause
  2. positive emotions do not directly lead to better health, but might benefit people wanting to improve their health
82
Q

What is the link between conscientiousness and health?

A
  1. conscientious people tend to be healthier and live longer because their behaviours promote their health
    - eg. stop smoking, drive carefully
83
Q

What is the healthy personality defined as (both mentally physically)?

A
  1. someone who is capable of love and work

Personality Psychology (10 decks)

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