week 12 - personality disorders Flashcards
Personality Disorders: Key Characteristics
3 of em
(1) Functional Inflexibility:
Inability to adapt to changing contexts
Rigidly applying same patterns of responding across time & situations
—Even when the response is clearly inappropriate or ineffective
(2) Self-Defeating Patterns of Behaviour
Response patterns that actually worsen the situation
Patterns that are damaging to the person involved
Limited capacity to learn from these experiences
(3) Unstable functioning in the face of stress
Mood instability, cognitive & behavioural difficulties
General Criteria of PD (DSM)
Enduring pattern of inner experience & behavior that deviates markedly from the expectations of the individual’s culture
Pattern is manifested in 2 (or more) of the following areas: Cognition Affectivity Interpersonal functioning Impulse control
Pattern is inflexible & pervasive across a broad range of personal & social situations
Leads to clinically significant distress or impairment in social, occupational, or other important areas of functioning
Pattern is stable & of long duration
–onset can be traced back at least to adolescence or early adulthood.
The Impact of Diagnosis
As in all forms of psychopathology, a diagnosis can carry serious consequences for the individual.
This is particularly important for PD
- -Perception of poor prognosis
- -Perception of ‘difficulty’
- -Aversion of clinicians to working with PD
Particularly important given diagnostic unreliability
Misuse of the Diagnosis
A diagnosis of Personality Disorder can sometimes be made for the wrong reasons
- For a client that the therapist is not having success in treating
- For a client who challenges the expertise or opinion of the therapist
- “Resistant” clients
Criticisms of the PD Concept
DSM Personality Disorders…
Are mostly atheoretical
Show poor inter-rater reliability of diagnosis.
Show poor reliability with factor analytic studies of symptoms/criteria
Vary across culture and over time
Show considerable comorbidity
–When one PD is diagnosed, it is more common to have another PD than not
–90% of narcissistic, paranoid, borderline patients receive another PD diagnosis
Arguments for a dimensional vs categorical approach
Comorbidity
Personality disorders show high levels of comorbidity with mood disorders
Mood Disorder: 61.3% at a single timepoint
Depression: 39% at a single timepoint
Depression: 74% lifetime prevalence
Substance Abuse
Anxiety Disorders
Some features can tap into features of other disorders
–BPD: shares dissociation/unstable sense of self with DID
–Social anxiety vs Avoidant PD?
Possible Indications of a PD
Does the presenting problem include aspects that are not typical of the presentation of other disorders?
Are there previous multiple inconsistent psychiatric or psychological diagnoses?
Is the person chaotic or excessively emotionally responsive?
Does the person have problems in relationships with others?
Does the person not respond to effective treatments for presenting problems?
How does the therapist react to being with the person?
Personality Disorder Clusters
VERY IMPORTANT TO KNOW
Cluster A: Odd, Eccentric paranoid PD schizoid PD schizotypal PD
Cluster B - Dramatic Emotional erratic Antisocail PD Borderline PD Histrionic Pd Narcissistic PD
CLuster C = anxious & fearful
Avoidant PD
Dependent PD
Obsessive-Compulsive PD
Cluster A:
Odd, Eccentric
paranoid PD
schizoid PD
schizotypal PD
Cluster B - Dramatic Emotional erratic
Antisocial PD
Borderline PD
Histrionic Pd
Narcissistic PD
CLuster C = anxious & fearful
Avoidant PD
Dependent PD
Obsessive-Compulsive PD
Paranoid Personality Disorder
Pervasive distrust & suspiciousness of others such that their motives are interpreted as malevolent
4 or more of:
suspects, without sufficient basis, that others are exploiting, harming, or deceiving them
preoccupied with unjustified doubts about the loyalty or trustworthiness of friends or associates
reluctant to confide in others because of unwarranted fear that the info will be used maliciously against them
reads hidden demeaning or threatening meanings into benign remarks or events
persistently bears grudges, i.e., is unforgiving of insults, injuries, or slights
perceives attacks on character or reputation that are not apparent to others & is quick to react angrily or to counterattack
has recurrent suspicions, without justification, regarding fidelity of spouse or sexual partner
Paranoid Personality Disorder
cog themes and Ip strategyies and beliefs
cognitive Theme: people as potential adversaries
Interpersonal Strategy: wariness
Typical Beliefs:
> I cannot trust or confide in other people.
>Other people have hidden motives
I have to be on guard at all times
people will take advantage of me if i give them the chance
other people will deliberately try to demean me
I will be in serious trouble if I let other people think they can get away with mistreating me
If other people find out things about me, they will use them against me
Schizoid Personality Disorder
Pattern of detachment from social relationships
Restricted range of expression of emotions in interpersonal settings
4 (or more) of the following:
neither desires nor enjoys close relationships, including being part of a family
almost always chooses solitary activities
has little, if any, interest in having sexual experiences with another person
takes pleasure in few, if any, activities
lacks close friends or confidants other than first-degree relatives
appears indifferent to the praise or criticism of others
shows emotional coldness, detachment, or flattened affectivity
Schizoid Personality Disorder
cog theme, beliefs, ips
CT: i need plenty of space
IPS: Isolation
Typical Beliefs
Relationships are problematic.
Life is less complicated without other people.
I am empty inside.
It is better for me to keep my distance and maintain a low profile.
I am a social misfit.
Life is bland and unfulfilling.
Schizotypal Personality Disorder
Social & interpersonal deficits marked by acute discomfort with, & reduced capacity for, close relationships
Cognitive or perceptual distortions & eccentricities of behavior
5 (or more) of the following:
ideas of reference (excluding delusions of reference)
odd beliefs or magical thinking that influences behavior; inconsistent with subcultural norms
unusual perceptual experiences, including bodily illusions
odd thinking & speech (e.g., vague, circumstantial, metaphorical, overelaborate, or stereotyped)
suspiciousness or paranoid ideation
inappropriate or constricted affect
Behaviour/appearance is odd, eccentric, or peculiar
lack of close friends or confidants other than 1st-degree relatives
excessive social anxiety that does not diminish with familiarity and tends to be associated with paranoid fears rather than negative judgments about self
(e.g., superstitiousness, belief in clairvoyance, telepathy, or “sixth sense”; in children and adolescents, bizarre fantasies or preoccupations)
Schizotypal Personality Disorder
CT, IPS, beliefs
CT: I need to consider my own views, I must not be influenced by anyone
IPS: eccentric thinking
Typical Beliefs
I feel like an alien in a frightening environment.
Since the world is dangerous, you have to watch out for yourself at all times.
There are reasons for everything. Things don’t happen by chance.
Sometimes my inner feelings are an indication of what is going to happen.
Relationships are threatening.
I am defective.
Cluster B Personality Disorders
Antisocial Personality Disorder
Pervasive pattern of disregard for & violation of the rights of others
Occurring since 15 yrs of age
3 (or more) of the following:
failure to conform to social norms with respect to lawful behaviors repeatedly performing acts that are grounds for arrest
Deceitfulness repeated lying, use of aliases, or conning others for personal profit/pleasure
impulsivity or failure to plan ahead
irritability & aggressiveness repeated physical fights or assaults
reckless disregard for safety of self or others
consistent irresponsibility repeated failure to sustain consistent work behavior or honour financial obligations
lack of remorse being indifferent to or rationalising having hurt, mistreated, or stolen from another
Antisocial Personality Disorder
CT, IPS, typical beliefs
CT: People are there to be taken
IPS: ATtack
Typical Beliefs
Force or cunning is the best way to get things done.
We live in a jungle and the strong person is the one who survives.
People will get at me if I don’t get them first.
It is not important to keep promises or honor debts.
Lying and cheating are OK as long as you don’t get caught.
I have been unfairly treated and am entitled to get my fair share by whatever means I can.
If people can’t take care of themselves, that’s their problem.
Can be associated with Gambling Disorder (use of drug treatment unclear because of high drop out rates, short follow-up times, different measures)
Borderline Personality Disorder
Pattern of instability of interpersonal relationships, self-image & affects
Marked impulsivity
Beginning by early adulthood & present in a variety of contexts
5 (or more) of the following:
frantic efforts to avoid real or imagined abandonment.
pattern of unstable & intense interpersonal r’ships characterised by alternating between extremes of idealization & devaluation
identity disturbance: markedly & persistently unstable self-image or sense of self
impulsivity in at least 2 areas that are potentially self-damaging
recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior
affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours & only rarely more than a few days)
chronic feelings of emptiness
inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights)
transient, stress-related paranoid ideation or severe dissociative symptoms
BPD - CT, IPS and beleifs
CT: I am vulnerable to rejection
IPT: Subjugation, protest
Typical Beliefs
I can’t cope on my own
I need someone to rely on
I cannot bear unpleasant feelings
If I rely on someone, I’ll be mistreated, found wanting, abandoned
The worst possible thing would be to be abandoned
It is impossible for me to control myself
I deserve to be punished
Histrionic Personality Disorder
Pattern of excessive emotionality & attention seeking
Beginning by early adulthood & present in a variety of contexts
5 (or more) of the following:
uncomfortable in situations when not the centre of attention
interaction with others is often characterised by inappropriate sexually seductive or provocative behavior
displays rapidly shifting & shallow expression of emotions
consistently uses physical appearance to draw attention to self
has a style of speech that is excessively impressionistic & lacking in detail
shows self-dramatization, theatricality, & exaggerated expression of emotion
is suggestible, i.e., easily influenced by others or circumstances
considers relationships to be more intimate than they actually are
Histrionic - CT, IPS, TBs
CT: I need to impress
IPs: dramatics
Typical Beliefs
In order to be happy I need other people to pay attention to me.
Unless I entertain or impress people, I am nothing.
If I don’t keep others engaged with me, they won’t like me.
The way to get what I want is to dazzle or amuse people.
It is awful for people to ignore me.
I should be the centre of attention.
If I entertain people, they will not notice my weaknesses.
People will pay attention only if I act in extreme ways.
Narcissistic Personality Disorder
Pervasive pattern of grandiosity (in fantasy or behavior)
Need for admiration
Lack of empathy
5 or more:
Grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognised as superior without commensurate achievements)
Preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love
believes that he or she is “special” & unique & can only be understood by, or should associate with, other special or high-status people (or institutions)
requires excessive admiration
has a sense of entitlement
is interpersonally exploitative
lacks empathy: is unwilling to recognize or identify with the feelings and needs of others
is often envious of others or believes that others are envious of them
shows arrogant, haughty behaviors or attitudes
