week 8 personality disorders Flashcards
1 describe the characteristic features common to all personality disorders
Began in childhood. Persistent. Causes problems with relationships/ employment and create stress in affected or in those around them. Enduring patterns of thoughts/behaviours.
Sometimes in later life might no longer meet criteria for dx. Sometimes over a lifespan might have 1 personality disorder, and later, another. Most typically however, at least some degree of personality issue remains.
2 critically evaluate the arguments for and against using a categorical system of classification or a dimensional assessment of personality disorder;
Up to 10% of population may have a personality disorder. I think this is too high and therefore more a reflection of normal variance, so would recommend a dimensional assessment as opposed to categorical. Also when discussing personality, is generally considered enduring, thus with time/therapy, a person who no longer meets criteria for a categorical classification of disorder, can still be on a particular dimension of personality disorder, but simply no longer at dysfunctional level. This seems to me more appropriate as opposed to the categorical system.
3 describe the clinical features of each DSM-5 personality disorder;
Defined by CLUSTERS
CLUSTER A (odd/eccentric)
1. PARANOID personality disorder;pervasive, unjustified mistrust of others. May present as argumentative, complain a lot, or might be quiet. Have increased need for autonomy. Increased risk of suicide and violent behaviour.Possibly some genetic influence. Some studies indicate possible increased risk if relative has schizophrenia. Maybe some trauma or upbringing caused mistrust. rarely seek psychologist’s help, unless for some other comorbidity such as eg depression. Getting trusting relationship b/n patient and therapist is vital but difficult. Work on cognitive biases of mistrust etc. However patient rarely stays in therapy long enough to benefit.
2. SCHIZOID personality disorder; neither desires nor enjoys closeness with others. Appear cold and detached. Some will still be sensitive to the opinion of others but be unable to express this. Increased risk of having experienced childhood trauma or neglect. Frequently very shy as child.Tx involves working on social skills, but limited knowledge re effectiveness. Tx is rarely sought. Some overlap b/n schizoid pd and autism.
3 SCHIZOTYPAL pd; displays some schizophrenic or psychotic signs but less severe than schizophrenia. usually no hallucinations, but do have magical thinking, some reduction in social skills and sometimes some cognitive deficits. Thought by some to be a possible precursor to schizophrenia and seem to have close inheritable ties. Some research indicates that men may have experienced childhood abuse, and in women this abuse may have led to ptsd. If clinical help sought, is usually for something else such as depression (are at greater risk of major depressive disorder)
CLUSTER B (dramatic/emotional/erratic)
1.ANTISOCIAL pd: fail to comply with social norms.Irresponsible, deceitful, impulsive. Ruthless social predators without conscience or empathy. Lack of remorse.Synonyms include moral insanity, egopathy, sociopathy, psychopathy. Increased risk of violence and criminality. Many had Conduct disorder diagnosed as children.
2. BORDERLINE pd;one of most common pd’s seen in practice. prevalence 1-2%. Emotional instability. turbulent elationships, often self harm, can go from anger to depression rapidly. Dysfunctional emotions.. Often impulsive. Often comorbid with mood disorders and substance abuse disorders, and bulimia/anorexia. Tend to improve somewhat in their 30’s and 40’s but is lifelong. 90% success rate however with tx.
3. HISTRIONICpd; overly dramatic. May be considered to be “acting” by some. Vain, constantly wanting to be centre of attention. Often flatter excessively. promise much but fail to deliver. Deliberately seductive.Tend to view things globally and as black and white. Impulsive. unable to delay gratification. Tend to pronounce relationships as far more meaningful than are. Tx might involve teaching how short term gains in relationship do not l;ast, and need to work on long term gain. Rewards for appropriate behaviour and punishment for attention seeking behaviours might help.
4. NARCISSISTIC pd;grandiose, believe better than others, lack empathy for others. believe doing job extremely well but is not. Failure at own standards frequently leads to severe depression.Poor at taking criticism. Tx for depression and relaxation techniques, taking criticsm, and how to have sympathy for others. Tx re pd of unknown effectiveness.
CLUSTER C (anxious/fearful)
1. AVOIDANT pd; overly sensitive re opinions of others and prone to assume others’ opinions are negative. desire relationships but extremely anxious and fear rejection. low self esteem. Some link to inheritance of schizophrenia. More likely to report childhood neglect (real or imagined??) Good success with strategies re anxiety and social skills.
2. DEPENDENT pd; very fearful of rejection, allow others to make virtually every decision, do not speak up when disagree, submissive,cling to relationships even if bad. Take care does not become dependent upon therapist.
(some cultures think submission ideal).
3. OBSESSIVE-COMPULSIVE pd;does not have the obsessions or compulsions of ocd but has rigid thinking, obsessed with rules and schedules, task meaning becomes lost in rigid minutiae, relationships suffer for it. fear failure.Unable to delegate.Some studies show some correlation b/n obsessive compulsive pd and serial killers. Genetic influence.Therapy aimed at overcome fear of inadequacy, excessive rumination and cbt as per ocd.tx is effective.
4 discuss issues related to the gender differences in the diagnosis of personality disorders;
Greater number by far males diagnosed with antisocial pd, and females histrionic. Some research has shown that if gender unknown, given symptoms, might classify as either but when gender known, the trend occurs. This may indicate therapist /societal bias. Also, some argue that a histrionic female, is actually the epitomy of feminity. In very general terms, males with a pd more likely to display aggression, self assertion or lack of emotionality whereas women more likely emotional or submissive.
5 discuss the differences in the defining features of antisocial personality disorder and psychopathy
Psychopathy and Antisocial pd are labels for the same thing although they have been defined differently. Psychopathy is technically no longer a recognised dsm 5 dx, but was formerly defined by characteristics of personality such as glibness, grandiosity, manipulative, remorseless etc. Antisocial pd however is defined more along the lines of behaviours such as blatant disregard for rights of others, failure to conform to social norms etc. By having different definitions, they do not 100% capture same patients but I think are so similar as to be considered same.
6 consider the relationship between antisocial personality disorder, psychopathy and criminality
increased criminality amongst them but not a given.Antisocial pd seems to run in families, but so does violence and criminality. Some with antisocial pd have no criminality whatsoever. In general, having lower IQ with antisocial pd, meant criminality far more likely.
7 critically evaluate the genetic, neurobiological, psychosocial, and developmental theories and research as to the causes of antisocial personality disorder;
Possible causes of antisocial pd;
1. genetics. Seems to be a gene/environment interaction
2. Arousal theories;
a) Those with antisocial pd underaroused, therefore cortisol is low, and they seek stimulation with riskier behaviours and this reduction in cortisol also responsible for the antisocial aspect. some studies have shown adolescent predictors of antisocial pd can be seen with lower skin conductance and lower heart rate, which ties in with underarousal theory
b) fearlessness hypothesis states antisocial pd have higher threshold for fear, ie things which others fear and this sufficient to prevent breaking societal norms, doesn’t work for them.
also thought maybe an imbalance b/n bis and bas so bis fear lower and reward system more prominent
8 discuss the treatment and prevention of antisocial personality disorder
environment of upbringing does play a part, so best if this non traumatic/stressful etc. Many children with increased violent tendencies will remain that way, therefore try to reduce with early parental behavioral interventions. Participation in high school sports also seems somewhat helpful. Once reached adulthood, little chance of successfully changing them.
9 discuss the clinical features, causes, and treatment of borderline personality disorder
Genetics, higher incidence in some families. Seems also linked in inheritance with mood disorders.
Thought the emotional reactivity might be associated with dysfn in serotonin system (low level), but unproven. Also possibly issue within limbic system.
They are more accurate than controls in detecting a mood of a morphing screen image of a face.
in a study of those with borderline pd (who were all women), they reprted increased levels of shame and social phobia.
Higher incidence of childhood abuse and trauma.Possible also increased risk when history of a marked change in culture ie immigrant.
higher risk of suicide. More likely to seek therapy than those with mood disorders.
Therapy includes moodstabiisers, and cbt.
Dialectical behaviour therapy is the most successful, initially works on recognising and controlling stress that might trigger suicide attept, then emotional regulation, problem solving, relationship issues etc.Also has trauma re-processing
