Week 8- Personality Disorders Flashcards
Clients may not present for tx for PD per se, what are some presenting problems that they may seek treatment for?
- interpersonal issues (at work, home, don’t have good friends)
- self harm/suicidal ideation (+ persistent self-harm)
- impulsivity
- criminal behaviour
- couples therapy, family court,
What settings might you find PDs in?
- couples therapy
- family court
- employment settings
- forensic settings
What implications does the fact that most PDs don’t present to tx for PD?
- need to be sensitive with this information
- need to BUILD RAPPORT
- might need to focus on what they presented for first
- be aware that tx might not work for other stuff bc priority is the PD
What is one of the most consistent moderators of treatment effects for other disorders?
- PERSONALITY DISORDERS (implications for treatment planning)
What is the general definition of a personality disorder?
• enduring pattern of inner experience and behaviour that
deviates markedly from the expectations of the individual’s culture manifested in two of: cognition, affectivity, interpersonal functioning, and impulse control
• enduring pattern is inflexible and pervasive
• leads to clinically significant distress or impairment
• stable and of long duration; onset in adolescence or early adulthood
• Not better explained by another mental disorder, substance, or medical condition (e.g., head trauma)
• (may not be considered problematic by the individual)
What are the key features of paranoid PD?
Present in variety of contexts. 4 or more of following:
• Suspects others are EXPLOITING/ DECEIVING THEM
•UNJUSTIFIED DOUBTS about trustworthiness of friends
• RELUCTANT TO CONFIDE in others due to unwarranted fear that INFORMATION USED MALICIOUSLY
• Reads hidden DEMEANING/THREATENING meanings into benign remarks/events
• Persistently bears grudges (unforgiving of insults, injuries, slights)
• Perceives attacks on character/reputation not apparent to others & quick to react angrily or counterattack
• Recurrent suspicion regarding fidelity of spouse/sexual partner
What are the key features of schizoid PD?
- Detachment from social relationships & restricted range of emotional expression in interpersonal settings. Begins by early adulthood. Present in variety of contexts. 4 or more of following:
- NEITHER DESIRES/ENJOYS CLOSE RELATIONSHIPS
- CHOOSES SOLITARY ACTIVITIES
- Little interest in SEXUAL EXPERIENCE WITH ANOTHER
- LITTLE PLEASURE IN ACTIVITIES
- Lacks close friends/confidants
- Indifferent to praise/criticism of others
- Emotional coldness, detachment, flattened affect
What are the key features of schizotypical PD?
Social and interpersonal deficits marked by acute discomfort with & reduced capacity for close relationships as well as cognitive/perceptual distortions/eccentricities of behaviour. Begins by early adulthood. Present in variety contexts. 5 or more of:
• Ideas of reference (excl delusions of reference)
• Odd beliefs/magical thinking that influences behaviour & inconsistent with subcultural norms (e.g., superstitiousness, belief in clairvoyance, telepathy, sixth sense. In child/teen: bizarre fantasies/preoccupations)
• Unusual perceptual experiences incl bodily illusions
• Odd thinking/speech (vague, circumstantial, metaphorical, overelaborate or stereotyped)
• Suspiciousness/paranoid ideation
• Inappropriate or constricted affect
• Behaviour/appearance is odd, eccentric, peculiar
• Lack of close friends or confidants other than immed relatives
• Excessive social anx that doesn’t diminish with familiarity & associated with paranoid fears rather than negative judgements about self
What are the key features of antisocial PD?
Disregard for & violation of rights of others. Since age 15 yrs. 3 or more of:
• Failure to confirm to social norms (lawful behaviour). Repeatedly acts
that are grounds for arrest
• Deceitfulness via repeated lying, use of aliases, conning others for
personal profit/pleasure
• Impulsivity/failure to plan ahead
• Irritability & aggressiveness via repeated physical fights or assults
• Reckless disregard for safety of self/others
• Consistent irresponsibility via repeated failure to sustain consistent work behaviour or honour financial obligations
• Lack of remorse via indifferent to or rationalising having hurt, mistreated or stolen from others
• At least 18 years
• Evidence of conduct disorder with onset prior to 15 years
What are the key features of borderline PD?
Instability of relationships, self-image and affect, & marked impulsivity. Begins by early adulthood. Present in variety of contexts. 5 or more of:
• Frantic efforts to avoid real/imagined abandonment (don’t include suicidal/self- mutilating behav in Crit 5)
• Pattern of unstable/intense relationships characterised by alternating extremes of idealisation and devaluation
• Identity disturbance: markedly & persistently unstable self-image/sense of self
• Impulsivity in 2+ areas that are potentially self-damaging (spending, sex, substance
abuse, reckless driving, binge eating. Not incl suicide/self-mutilating behave in Crit 5)
• Frequent suicidal behav, gestures, threats or self-mutilating behav
• Affective instability due to marked reactive mood (intense episodic dysphoria, irritability, anxiety usually lasting few hours and only rarely more than few days)
• Chronic feelings of emptiness
• Inappropriate intense anger or difficulty controlling anger (freq displays of temper,
constant anger, recurrent physical fights)
• Transient, stress-related paranoid ideation or severe dissociative symptoms
What are the key features of histrionic PD?
• Excessive emotionality and attention seeking. Begins by early adulthood. Present in variety of contexts. 5 or more of:
• Uncomfortable when not centre of attention
• Interactions characterised by inappropriate sexual
seductive or provocative behaviour
• Rapidly shifting and shallow expression of emotions
• Uses physical appearance to draw attn. to self
• Style of speech excessively impressionistic and lacking detail
• Self-dramatization, theatricality, exaggerated expression of emotions
• Suggestible (easily influenced by others or circumstances)
• Considers relationships to be more intimate than they are
What are the key features of avoidant PD?
- Social inhibition, feelings of inadequacy, hypersensitivity to neg eval. Begins by early adulthood. Present in variety of contexts. 4 or more of:
- Avoids occupational activities that involve sig interpersonal contact due to fear of criticism, disapproval, rejection
- Unwilling to get involved with people unless certain of being liked
- Restrain with intimate relationships for fear of shame or ridicule
- Preoccupied with being criticized or rejected in social sitn
- Inhibited in new interpersonal sitn due to feelings of inadequacy
- Views self as socially inept, personally unappealing or inferior to others
- Unusually reluctant to take personal risks or engage in new activities due to fear of embarrassment
What are the key features of dependent PD?
Need to be taken care of that leads to submissive and clinging behavior and fears of separation. Begins by early adulthood. Present in variety of contexts. 5 or more of:
• Difficulty making everyday decisions without excessive advice/reassurance from others
• Needs others to assume responsibility for most major areas of life
• Difficulty expressing disagreement with others because of fear of loss of
support/approval (don’t include realistic fears of retribution)
• Difficulty initiating projects or doing things on own (due to lack of self-
confidence in judgement/ability rather than motivation/energy)
• Excessive lengths to obtain nurturance and support from others to point of
volunteering to do things that are unpleasant
• Feels uncomfortable or helpless when alone due to exaggerated fears of being unable to care for self
• Urgently seeks another relationship as source of care/support when close relationship ends
• Unrealistically preoccupied with fears of being left to take care of self
What are the key features of obsessive- compulsive PD?
• Preoccupation with orderliness, perfectionism, mental and interpersonal control at expense of flexibility, openness, efficiency. Begins by early adulthood. Present in variety of contexts. 4 or more of:
• Preoccupied with details, rules, lists, order, organisation or schedules to extent that major point of activity is lost
• Shows perfectionism that interferes with task completion (unable to complete task because own overly strict standard is not met)
• Excessively devoted to work and productivity at exclusion of leisure activities and friendships (not due to obvious economic necessity)
• Overconscientious, scrupulous, inflexible about matters of morality, ethics, or values (not due to cultural or religious identification)
• Unable to discard worn-out or worthless objects even when no sentimental value
• Reluctant to delegate tasks or work to others unless they submit to exactly his/her
own way of doing things
• Adopts miserly spending style towards self and others, money is viewed as something to be hoarded for future catastrophes
• Shows rigidity and stubbornness
What are the assessment tools used for PD?
STRUCTURED INTERVIEWS:(SCID, International Personality Disorders Exam, Structured Inverview for DSM-IV Personality, Revised Diagnostic Interview for Borderlines)
SELF-REPORT INVENTORIES:
SAPAS (Standardised Assessment of Personality - Abbreviated Scale)
MMPI-2
MSI-BPD
Borderline Personality Questionnaire
- Maclean’s Screener for BDP
