week 7 - personality disorder

Question 1

features of a personality disorder -

Answer 1

Pervasive and persistent and include problems with:
forming a stable positive sense of self
sustaining close and constructive relationships
Extreme, maladaptive and inflexible thoughts, emotions and behaviours
impulse control
Although personality disorders are said to be stable/persistent – there can be some change in personality with time and /or with treatment and / or with positive life experiences

Question 2

what are the 3 clusters of personality disorders?

Answer 2

A - odd or eccentric
B - dramatic, emotional, erratic
C - anxious, fearful

Question 3

What disorders are in cluster A?

Answer 3

Paranoid - distrust, suspicious of others

Schizoid - socially withdrawn, lack of emotional expression/ response

Schizotypal - eccentric, odd communication / thinking

Question 4

What disorders are in cluster B?

Answer 4

Antisocial

Borderline

Histrionic - attention seeking, exaggerated / theatrical behaviour

Narcissistic - overestimate abilities, lack of empathy, persuasive need for admiration / reassurance

Question 5

borderline personality disorder - DSM5 criteria

Answer 5

five or more of the following in many context beginning by early adulthood:
- Frantic efforts to avoid abandonment
- Unstable interpersonal relationships (idealised or devalued)
- Unstable sense of self
- Self-damaging, impulsive behaviour
- Recurrent suicidal behaviour
- Mood reactivity
- Feelings of emptiness
- Anger
- Transient paranoid thoughts and dissociative symptoms

Question 6

BPD - studies

Answer 6

Yen et al (2003)

Followed 621 people with BPD over 2 years
20% showed suicidal behaviour (compared to 5.5% in the general population – Lee, 2010)

Zanarini et al (2006)
Found over 10-15 years 75% of people show reduced suicidal behaviour, self harm and impulsiveness

Question 7

BPD - Aetiology (causes)

Answer 7

Neurobiological factors – genes and brain function (pre-frontal cortex and amygdala)

Childhood factors

Interaction (diathesis-stress)

Question 8

BPD - Neurobiological factors

Answer 8

60% of variance in BPD may be due to genes
Evidence from fMRI scans suggests abnormalities in prefrontal cortex and amygdala might relate to problems with emotional inhibition and poor impulse control

Question 9

BPD - childhood factors

Answer 9

experience of abuse in childhood invalidates a childs feelings - linked to symptoms such as dissociation

Question 10

interaction between neurobiological and childhood factors

Answer 10

inherit a tendency to emotional instability + being raised in a family which invalidates these emotions, or being raised in an abusive family which makes the development of a stable sense of self hard to achieve as the child has conflicting messages (“my parent loves me and yet also hurts me”) abusive experiences are also linked to symptoms of dissociation (detachment, depersonalisation).

Question 11

BPD - Treatment – Dialectical Behaviour Therapy (DPT)

Answer 11

Dialectics is a term that means considering opposing points of view to discover the truth.

Dialectical Behaviour Therapy combines Cognitive Behavioural procedures with techniques from Zen Buddhism (e.g. mindfulness meditation) and Humanistic counselling.

Tension between opposites…

Acceptance and change
Good and Bad

Aim of DBT is to achieve balance between these and to validate the person

Dialectical behaviour therapy aims to help people with BPD to find a balance between self-acceptance and change.

Question 12

Evidence for effectiveness of DBT

Answer 12

Kliem et al (2010)
Meta-analysis of 16 studies – moderate positive effects in reducing self-injury and suicidality compared to controls (e.g. general psychiatric management, community therapy)

Question 13

Antisocial personality disorder - DSM5

Answer 13

At least 18 years old
Evidence of conduct disorder before 15
Pervasive pattern of disregard for the rights of others with at least three of:
Repeated law breaking
Deceitfulness, lying
Impulsivity
Irritability and aggressiveness
Reckless disregard for own safety and that of others
Irresponsibility as seen in an unreliable employment of financial history
Lack of remorse
ASPD is associated with a strong desire to maintain control, a feeling of superiority to others and sense of being in competition.

The need to “win” may be linked to a disregard for the needs of others, to risk taking and to lying

There may be a lower capacity for remorse

ASPD is NOT identical to psychopathy, but they may overlap

Question 14

Aetiology of Antisocial personality disorder

Answer 14

Genes - Genes appear to play a larger part in more aggressive forms of APD

Upbringing

Psychological factors

Interaction

(G U P I)

Question 15

APD - genes

Answer 15

45% - 65% of variance in antisocial PD may be due to genes, particularly aggression

Question 16

APD - upbringing

Answer 16

Experience lack of parental warmth, inconsistent and/ or harsh punishment in childhood

Question 17

APD - psychological factors

Answer 17

May be slower to learn from punishment - suggested by experiments with people scoring high in psychopathy where it was harder to condition fear responses to painful stimuli (lower amygdala activity after conditioning)

Question 18

APD - studies

Answer 18

Birbaumer et al (2005)
Compared 10 males identified as psychopaths (offenders) and 10 control participants

A fear response was conditioned by pairing an unconditioned stimulus (painful pressure) repeatedly with unconditioned conditioned stimulus (neutral faces).

Measured activity in the amygdala (fMRI) and skin conductance after conditioning.

Results:The healthy controls showed enhanced differential activation in the limbic-prefrontal circuit (amygdala, orbitofrontal cortex, insula, and anterior cingulate) during the acquisition of fear and successful verbal and autonomic conditioning. The psychopaths displayed no significant activity in this circuit and failed to show conditioned skin conductance and emotional valence ratings, although contingency and arousal ratings were normal.

Conclusion:This dissociation of emotional and cognitive processing may be the neural basis of the lack of anticipation of aversive events in criminal psychopaths.
This suggested that the psychopathic participants had been slower to learn the fear reaction and that people with psychopathy may be less influenced by punishment

Question 19

Example of childhood factors: Attacks in Edlington

Answer 19

In 2010 two boys aged 10 and 11 sadistically attacked two other boys in Edlington, beating, choking and burning the victims. They had a previous history of conduct problems including theft, verbal abuse and damage to property
The case revealed a pattern of severe abuse in the boys’ childhood which was described as “toxic”. They witnessed severe domestic violence, drug use and used cannabis themselves. They were severely neglected and had also been allowed to watch extreme pornography.

Question 20

What disorders are in cluster C?

Answer 20

Avoidant personality disorder - feelings of inadequacy and rejection, hypersensitive to negative evaluation, low self esteem

Dependent personality disorder - excessive need to be taken care of, being submissive and clingy

Obsessive-compulsive personality disorder - perfectionists, a preoccupation with orderliness and control, needing rules