Week 7 Lecture 11 - personality disorders Flashcards
In the DSM-IV, what was Axis II –> personality disorders?
- enduring pattern of inner experience and behaviour
- deviate from cultural expectations
- are pervasive and inflexible
- cause distress and impairment
- not due to another disorder, drugs, intoxication etc.
- in past largely seen as untreatable
Why in the DSM-IV was personality disorders placed on a separate axis?
originally to increase clinical/research attention
In the DSM-V where are personality disorders placed?
DSM-V grouped axes I-III (clinical psychological disorders, personality disorders and intellectual disabilities and medical conditions and physical disorders) into a single axis
True or false?
Until recently, categorisation and understanding of personality disorders has been unrelated to empirical personality theories
True
How many clusters are personality disorders split into?
3
What does Cluster A of personality disorders represent? What disorders are included?
- “odd or eccentric’ disorders
- paranoid
- schizoid
- schizotypal
What does Cluster B of personality disorders represent? What disorders are included?
- ‘dramatic, emotional, or erratic’ disorders
- antisocial
- borderline
- histrionic
- narcissistic
What does Cluster C of personality disorders represent? What disorders are included?
- ‘anxious or fearful’ disorders
- avoidant
- dependent
- obsessive-compulsive
Is co-occurrence of PDs common?
- yes
- can occur within and across clusters
What is a criticism of the DSM-V clusters of PDs?
highly questionable validity and utility of diagnostic groups
What is paranoid PD?
- Paranoia; mistrust of others; has irrational suspicions.
- Pre-occupied with doubts; reluctance to confide; misinterprets innocent remarks, and holds grudges against people
How do the PDs in Cluster A differ from a full-blown psychotic disorder?
- greater maintenance of contact with reality
- narrower, more focussed set of symptoms
What is schizoid PD?
- Detachment from interpersonal relationships; emotional coldness; indifference to praise/criticism of others.
- Has few friends; chooses solitary activities.
What is Schizotypal PD?
- Distortions in thinking, feelings and perceptions e.g. ideas of reference, magical thinking, perceptual illusions.
- Discomfort in social situations; suspicions and paranoia.
What is antisocial PD?
- Lack of empathy and remorse; disregard for others.
- Failure to conform to norms/laws; impulsivity; deceitfulness; irresponsibility, and disregard for safety of self/others
What is histrionic PD?
- Excessive need for approval; need to be centre of attention.
- Shallow/over-dramatic emotions; sees relationships as more intimate than they are.
What is narcissistic PD?
- Inflated self-importance and sense of entitlement; belief they are special; seeks attention and admiration from others.
- Fantasises of success; arrogance; envy of others; low in empathy
What is borderline (emotionally unstable) PD?
- Unstable personal relationships; frantic attempts to avoid real/imagined abandonment; lack of well-formed identity; feelings of emptiness/ worthlessness; Instability of feelings
- Frequent suicidal, self-harming, self-mutilating behaviours; Impulsivity in self-damaging behaviours
Is BPD stigmatised?
yes
What is Avoidant PD?
- Social inhibition; avoids and withdraws from social situations.
- Low self-worth; fear rejection, disapproval and criticism; feel socially-inept; reluctant to engage in new things for fear of embarrassment
What is dependent PD?
- Persistent psychological dependence on others; lack confidence in ability to take responsibility; has difficulty doing things alone.
- Tends to agree with others; seeks out new relationships.
What is obsessive-compulsive PD?
- Preoccupation with orderliness, rules, moral codes, caution and perfectionism; excessive devoted to work; inflexibility and overly-conscientious.
What is the continuity hypothesis?
there is no discontinuity between normality and illness
Are there strong correlations between PDs and the Big 5?
- no
- while there are significant correlations they are all fairly weak
- suggests that we need to look at personality at a facet level rather than trait level when determining the relationship between PD and personality
True or false
Big 5 facets conceptually associated with PDs
True
What is a criticism of the Big 5 Profile Approach?
- profiles may indicate risk (but not diagnosis) of PD
What might the Big 5 Profile Approach be useful for?
- May be useful for ruling out a PD, or characterising a known PD
McCrae et al (2001) had 1926 patients from psychiatric hospitals complete:
- Personality Disorder Interview
- Personality Disorder Questionnaire (PDQ)
- NEO-PI-R
They then calculated ‘profile agreement’ scores for each patient
What was found? What are the implications of this?
- Significant correlations – but only “modest to moderate”
- Potential need to revise the current diagnostic classification system for personality disorders (DSM-IV)
What are some limitations of DSM-IV PD Classification
- Extensive co-morbidity.
- Low temporal/inter-assessor reliability.
- Not based on empirical personality modes
What are some suggestions that were made for the DSM-V for PDs?
- dimensional rather than categorical approach
- Assess personality facet profile (NEO-PI-R).
- Assess personality-related social/ occupational impairments and distress.
- If dysfunction & distress clinically significant – diagnose PD.
- (determine if the profile matches with PD category descriptor)
Suggestions were made to improve PDs in the DSM-V, what happened when the DSM-V was published?
- Retention of all 10 PDs and Clusters in main DSM-5
- But: additional ‘emerging measures and models’ section
DSM-5: Section III (Emerging Measures and Models)
Criterion A: Severity
- Significant impairments in functioning of
self (identity or self-direction)
- Interpersonal (empathy or intimacy)
Criterion B: Style
- One or more pathological personality trait domains or facets (measured with ‘Maladaptive Trait Model’)
In the emerging measures and models section of the DSM-V, how many PDs are listed?
- 6 + trait specified
- borderline PD
- obsessive-compulsive PD
- avoidant PD
- schizotypal PD
- antisocial PD
- narcissistic PD
- PD - trait specified
What does the DSM define DID as?
- A mental disorder defined by the presence of two or more distinct identities or personalities.
- Amnesia for prior or recent events.
- Cause distress and/or functional impairment.
- Not due to e.g. substance use, cultural practice or imaginative play.
According to Haslam (2007) what are the typically features of DID?
- Primary ‘host’ personality plus one or more alters.
- Alters take turns to control behaviour.
- Distinctive patterns of thinking and behaving.
- Different names, ages, genders etc.
- Memory loss for experiences as other alters.
- Reports of severe childhood sexual/ physical abuse common.
- Patients high in ‘suggestibility’.
Clustering of cases –> Geographically, by therapist
Is DID a PD?
- no
- is a type of dissociative disorder
Have cases of DID increased?
yes
Up to 1980: Fewer than 200
Current: 10s of thousands
Are reported cases of DID becoming more extreme?
yes
From 2/3 alters to >100 (including animals)
More extreme abuse
What is the Post-Traumatic Model of DID?
Primitive response to trauma:
- Dissociation of consciousness to escape initial trauma.
- Dissociation becomes response mechanism for future stress
- Suggestibility pre-disposes to dissociation
What is the Socio-Cognitive Model of DID?
Symptoms emerge as a product of therapy
- Hypnosis and leading questions cause patient to reinterpret experiences.
- Mood swings expressed as multiple personalities.
- A culture-bound phenomenon (not ‘faking’).
- Suggestibility increases susceptibility .
- Accounts for clustering of cases and rise in prevalence and severity.
What evidence support the Socio-Cognitive Model of DID?
Spanos (1994):
- Experimental, hypnotic manipulations can ‘reveal’ apparent hidden self or past life identities in psychologically healthy individuals.
Paris (2012):
- Transcripts of ‘Sybil’’s therapy sessions show that the multiple personality narrative was imposed upon her
What debates remain around DID?
- The causes of the disorder
- It’s validity as a scientific concept
What are some criticisms of DID?
- described as a fad
- diagnosis for DID fails to meet criteria for a valid diagnosis
