Week 9 Personality Disorders Flashcards
What is personality?
Global term describing how we cope
with and adapt and respond to a range
of life experiences
Inwardly experienced, outwardly projected
Main features tend to be relatively enduring
Most people evolve through experiences and learn more effective ways of behaving
What are personality disorders?
Fixed, ingrained and unchanging way of dealing with life experience
Enduring patterns of behaviour that deviates
markedly from expectations within the culture
Associated with unusual ways of interpreting events, unpredictable mood swings or impulsive behaviour
Stable patterns of behaving can be traced
back to adolescence or early childhood
Long-standing, pervasive and inflexible
Rarely learn to adapt responses
Ability to learn new responses lacking
Introduce disruption and hardship into lives of others
Frequently cause emotional distress to themselves and those they interact with
Cluster A: Odd or eccentric
Schizotypal:
* Acute discomfort in close relationships
* Cognitive or perceptual distortions
* Eccentricities of beh
Paranoid:
* Distrust
* Suspiciousness
Schizoid:
* Detachment from social relationships
* Restricted range of emotional
expression
Cluster B: Dramatic, Emotional, or Erratic
Antisocial:
* Disregard for rights of others
* Violation of rights of others
Borderline:
* Instability of:
* Interpersonal relationships
* Self-image
* Affects
* Marked impulsivity
Histronic:
* Excessive emotionality
* Attention seeking
Narcissistic:
* Grandiosity
* Need for admiration
* Lack of empathy
Cluster C: Anxious or Fearful
Avoidant:
* Social inhibition
* Feelings of inadequacy
* Hypersensitivity to negative evaluation
Dependent:
* Submissive
* Clingy
* Excessive need to be taken care of
Obsessive-compulsive:
* Preoccupation with:
* Orderliness
* Perfectionism
* Control
Borderline Personality Disorder: Aetiological Considerations
Diverse range of symptoms for a single
theory to encompass – quite often focus
on particular characteristics:
– Risk Factors
– Biological Explanations
* Genetics, neurotransmitters, neuroimaging
– Psychological Theories
* Object relations theory/Splitting
* Diathesis-Stress Theory
Risk factors for BPD
Childhood physical, verbal and sexual abuse
– Herman, Perry & vander Kolk (989); Zanarini et al. (1997)
Childhood neglect or rejection
– Zanarini et al. (2000); Guttman (2002)
Inconsistent or loveless parenting
– Kernberg (1985)
Parental substance and alcohol abuse, promiscuity
– Graybar & Boutilir (2002)
Environmental instability and paternal
psychopathology, academic underachievement, low intelligence and artistic skills
– Helgeland & Torgersen (2004)
Genetic Influence for BPD
- Modest evidence for genetic component
- Appears to run in families (Baron et al.,
1985)
– Twin studies report concordance rates:
* 35% (MZ) and 7% (DZ) twins (Torgersen et al., 2000)
– Traits common in BPD have a strong inherited
component
* E.g., neuroticism, emotional dysregulation (Nigg & Goldsmith, 1994)
Neurotransmitter Activity
Low levels of serotonin
(Norra et al., 2003)
Dysfunction in brain
dopamine activity
(Friedel, 2004)
Explain symptoms e.g., impulsivity/cognition
– Evidence remains circumstantial (Davey,
2008)
Neuroimaging Techniques
Abnormalities in a
number of brain areas:
– Frontal lobe
– Hippocampus
– Amygdala (Juengling et al., 2003; Soloff et al.,
2003)
Cause or consequence ?
(Leib et al., 2004)
Object Relations Theory
- People are motivated to respond to the world through perspectives learnt from important people in their developmental past
Experience: Neglect or abuse in infancy
->
Expectation: Similar behaviour from others
who remind them of the neglectful or abusive person from their past
These images of people and events turn into Objects in the subconscious
Objects carried into adulthood
Used by the subconscious to predict people’s behaviour in their social relationships and interactions
Object Relations Theory cont.
Inadequate or abusive experiences lead
child to develop an insecure ego
– Lack of self-esteem
– Increase dependence
– Fear of separation and rejection
(Bartholomew, Kwong & Hart, 2001; Kernberg,
1985)
Splitting
Weak ego -> Defence mechanism
Evaluations of people, events or things
- The division or polarisation of beliefs, actions, objects, or persons by focusing selectively on their positive or negative attributes
- Diffuses anxiety
- Reinforces sense of self
- Distorted picture of reality
- Restricted range of thoughts and emotions
- Impact on interpersonal relating
Diathesis-Stress Theory (Linehan, M, 1987)
Parenting can amplify
vulnerabilities of some children
– Biological diathesis (possibly genetic) –
difficult in controlling emotions
– Invalidating family
environment
BPD drug treatments
Clients with comorbid AN and DP
– Anxiolytic and antidepressant drugs
Antipsychotic drugs
– Can be effective in reducing symptoms of
Cluster A personality disorders
Atypical antipsychotic drugs
– Used to reduce impulsivity, hostility,
aggressiveness, irritability and rage outbursts
(Walker et al., 2003)
Object Relations Psychotherapy
The self as self developing and
existing within the context of
relationship
Therapist interacts with client, supporting in the resolution of pathological constructs through the active experience of the
real relationship between the therapist and the client
–Opportunity to re-experience relational issues as loss, intimacy, control, dependency, autonomy, trust etc.
Object Relations Psychotherapy cont.
Though interpretation and confrontation may be involved, the primary objective is the
working through original pathological components of the client’s emotional world
Therapist offers a safe, caring
relational environment
–Is aware of the client’s unconscious attempts to involve the therapist in the same patterns of relationship as those that constitute the client’s
distorted dynamic interactions with
significant others
Found to be effective in changing internal representations of relationships with impt
others (Clarkin et al., 2004; Levy et al., 2006)
Dialectical Behaviour Therapy (Marsha Linehan, 1987)
Client-centered empathy
Behavioural problem-solving
Therapist is fully accepting of client
– A dialectical of the goal of bringing about change
Over time, goal is to move client towards
change while maintaining empathic validation
of them
Marsha Linehan (1987)
Behavioural aspect aids in acquiring
– More effective and socially acceptable ways of handling daily living
– Emotion regulation
– Interpersonal effectiveness
– Core mindfulness
– Distress tolerance
Compared to treatment as usual, effective in decreasing self-harm, suicide attempts,
treatment dropout, inpatient hospital days
At 1 year following treatment (Linehan et al., 1991; Linehan, Heard & Armstrong, 1993)
Amanda: conceptualisation and treatment
Lack of direction or goals
->General Equivalency Diploma Examination
Feelings of depression
Mood diary 3 x a day incl. thoughts
– Tendency to make negative predictions about events leading to sadness and
depression
Anxiety-provoking situations
– Worst, best and most likely scenario, compare with actual outcome
Helped control negative thoughts and replace them with more adaptive and realistic ways of thinking based on experience
Cognitive Therapy Example
Amanda held a number of part-time jobs, typically lasted 1-2 months before she quit or was sacked for not turning up to work
‘my supervisors don’t like me and are looking for an excuse to sack me’
->
a small negative interaction at work
->
‘I’m about to be fired’
->
stopped showing up for work
->
self-fulfilling prophecy
Cognitive Therapy Example cont.
Amanda obtained a part-time job in a supermarket
mentally rehearse most likely scenario daily -kept job for 18 months:
Most Likely:
I’m new at work, but everyone else was new at one time, too. Some people may like me, and some may not, but that’s the way it is with everyone. Some conflict with other people is inevitable. I can still do my job even if everyone does not like me. One bad day at work does not mean I have to quit.
Amanda: Conceptualisation and treatment 2
- poor impulse control
- Excessive and poorly controlled anger
*‘Time-delay’ procedures
Impulse
(to use drugs, self-harm, express anger)
Telephone therapist/friend
Go to A&E if not control impulse on own
During waiting period intensity of emotion declines
Amanda: Outcome
Noticeable progress in first few months following therapy
None of the therapeutic interventions had a
lasting impact
Amanda had a poor employment history
– Little evidence she could support herself in the foreseeable future
Concern that she might continue to deteriorate
and end up in hospital on a long-term basis
Section III and Personality Disorder
Impairments in personality FUNCTIONING
Impairments in pathological personality TRAITS
Six specific personality disorder types
– Antisocial
– Avoidant
– Borderline
– Narcissistic
– Obsessive-compulsive
– Schizotypal
