Week 7 Lecture 11 - personality disorders Flashcards

1
Q

In the DSM-IV, what was Axis II –> personality disorders?

A
  • 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
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2
Q

Why in the DSM-IV was personality disorders placed on a separate axis?

A

originally to increase clinical/research attention

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3
Q

In the DSM-V where are personality disorders placed?

A

DSM-V grouped axes I-III (clinical psychological disorders, personality disorders and intellectual disabilities and medical conditions and physical disorders) into a single axis

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4
Q

True or false?

Until recently, categorisation and understanding of personality disorders has been unrelated to empirical personality theories

A

True

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5
Q

How many clusters are personality disorders split into?

A

3

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6
Q

What does Cluster A of personality disorders represent? What disorders are included?

A
  • “odd or eccentric’ disorders
  • paranoid
  • schizoid
  • schizotypal
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7
Q

What does Cluster B of personality disorders represent? What disorders are included?

A
  • ‘dramatic, emotional, or erratic’ disorders
  • antisocial
  • borderline
  • histrionic
  • narcissistic
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8
Q

What does Cluster C of personality disorders represent? What disorders are included?

A
  • ‘anxious or fearful’ disorders
  • avoidant
  • dependent
  • obsessive-compulsive
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9
Q

Is co-occurrence of PDs common?

A
  • yes
  • can occur within and across clusters
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10
Q

What is a criticism of the DSM-V clusters of PDs?

A

highly questionable validity and utility of diagnostic groups

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11
Q

What is paranoid PD?

A
  • Paranoia; mistrust of others; has irrational suspicions.
  • Pre-occupied with doubts; reluctance to confide; misinterprets innocent remarks, and holds grudges against people
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12
Q

How do the PDs in Cluster A differ from a full-blown psychotic disorder?

A
  • greater maintenance of contact with reality
  • narrower, more focussed set of symptoms
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13
Q

What is schizoid PD?

A
  • Detachment from interpersonal relationships; emotional coldness; indifference to praise/criticism of others.
  • Has few friends; chooses solitary activities.
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14
Q

What is Schizotypal PD?

A
  • Distortions in thinking, feelings and perceptions e.g. ideas of reference, magical thinking, perceptual illusions.
  • Discomfort in social situations; suspicions and paranoia.
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15
Q

What is antisocial PD?

A
  • Lack of empathy and remorse; disregard for others.
  • Failure to conform to norms/laws; impulsivity; deceitfulness; irresponsibility, and disregard for safety of self/others
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16
Q

What is histrionic PD?

A
  • Excessive need for approval; need to be centre of attention.
  • Shallow/over-dramatic emotions; sees relationships as more intimate than they are.
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17
Q

What is narcissistic PD?

A
  • 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
18
Q

What is borderline (emotionally unstable) PD?

A
  • 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
19
Q

Is BPD stigmatised?

20
Q

What is Avoidant PD?

A
  • 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
21
Q

What is dependent PD?

A
  • 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.
22
Q

What is obsessive-compulsive PD?

A
  • Preoccupation with orderliness, rules, moral codes, caution and perfectionism; excessive devoted to work; inflexibility and overly-conscientious.
23
Q

What is the continuity hypothesis?

A

there is no discontinuity between normality and illness

24
Q

Are there strong correlations between PDs and the Big 5?

A
  • 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
25
True or false Big 5 facets conceptually associated with PDs
True
26
What is a criticism of the Big 5 Profile Approach?
- profiles may indicate risk (but not diagnosis) of PD
27
What might the Big 5 Profile Approach be useful for?
- May be useful for ruling out a PD, or characterising a known PD
28
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)
29
What are some limitations of DSM-IV PD Classification
- Extensive co-morbidity. - Low temporal/inter-assessor reliability. - Not based on empirical personality modes
30
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)
31
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’)
32
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
33
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.
34
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
35
Is DID a PD?
- no - is a type of dissociative disorder
36
Have cases of DID increased?
yes Up to 1980: Fewer than 200 Current: 10s of thousands
37
Are reported cases of DID becoming more extreme?
yes From 2/3 alters to >100 (including animals) More extreme abuse
38
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
39
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.
40
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
41
What debates remain around DID?
- The causes of the disorder - It’s validity as a scientific concept
42
What are some criticisms of DID?
- described as a fad - diagnosis for DID fails to meet criteria for a valid diagnosis