Week Eight - Personality Disorders Flashcards
Personality Disorders
Are pervasive and rarely remit without treatment
– Although some do seem to dissipate as the individual
ages
Onset of PD
Generally around adolescence/ early adulthood, but
to diagnose before the age of 18 the symptoms need to be
present for at least 12 months (with the exception of
antisocial personality disorder).
– Antisocial personality disorder can only be diagnosed in individuals who are aged 18 or older
In DSM-5 personality disorders appear in two sections and
they can be coded as
– Categorical (present/absent)
– Dimensional (traits on a continuum)
Dimensional approach
Involves diagnosing a personality disorder based on
pathological personality traits
Personality traits are considered to be a disorder when they are?
– Inflexible
– Maladaptive
– Causes significant distress or impairment in functioning
Dimensional Approach DSM-5 (A)
A. Moderate or greater impairment in personality (self/interpersonal) functioning • Self • Identity • Self direction • Interpersonal • Empathy • Intimacy
B. One or more pathological personality traits There are 5 broad trait domains and 25 specific trait facets including: 1. Negative affectivity 2. Detachment 3. Antagonism 4. Disinhibition 5. Psychoticism
C. The impairments in personality functioning and the individual’s personality trait expression are relatively inflexible and pervasive across a range of personal and social situations
D. The impairments in personality functioning and the individual’s personality trait expression are relatively stable across time, with onset that can be traced back to at least adolescence or early adulthood
E. The impairments are not better explained by another mental disorder
F. The impairments are not solely attributable to the
physiological effects of a substance or another medical condition
G. The impairments are not better understood as normal for an individual’s developmental stage or sociocultural environment
Categorical Approach (3 clusters)
– Cluster A - Odd, eccentric cluster
– Cluster B - Dramatic, emotional, erratic cluster
– Cluster C - Anxious, fearful cluster
Cluster A
Paranoid personality disorder
• Characterized by excessive distrust and suspiciousness
Schizoid personality disorder
• Characterized by severe disinterest in social relationships and restricted range of emotional expression
Schizotypal personality disorder
• Characterized by extreme discomfort in relationships and odd/eccentric behaviour
Cluster B
Antisocial personality disorder
• Characterized by significant disregard for and violation of the rights of others
Borderline personality disorder
• Characterized by extreme impulsivity, unstable sense of self and instability in interpersonal relationships
Histrionic personality disorder
• Characterized by patterns of intense emotionality and attention seeking
Narcissistic personality disorder
• Characterized by grandiosity and need for admiration
Cluster C
Avoidant personality disorder
• Characterized by extreme feelings of inadequacy, hypersensitivity to
negative evaluation and social avoidance
Dependent personality disorder
• Characterized by clingy and submissive behaviour and an excessive need to be taken care of
Obsessive compulsive personality disorder
• Characterized by preoccupation with orderliness, perfectionism and
control
Dimensional advantages and disadvantages
Advantages
- Trait descriptions are more stable over time
- Provides more descriptive information for clinicians
- Avoids patient getting multiple personality disorder diagnoses
Disadvantages
- Not clear when a dimension becomes pathological
Categorical advantages and disadvantages
Advantages
- Used for decades
- Easy transmission of information between clinicians
- Helpful for devising evidence based treatments
Disadvantages
- Diagnoses are not stable
- Do not have great inter-rater reliability
- Stigmatising
Schizotypal Personality Disorder DSM-5 Criteria (A & B)
Criteria A.
A pervasive pattern of social and interpersonal deficits marked by:
- Acute discomfort with, and reduced capacity for, close relationships
- Cognitive or perceptual distortions and eccentricities of behavior,
Indicated by five (or more) of the following:
- Ideas of reference (excluding delusions of reference).
- Odd beliefs of magical thinking
- Superstitiousness, belief in clairvoyance, telepathy, or “sixth sense”
- Unusual perceptual experiences, including bodily illusions Special power to sense events that will occur in the future or sensing that another being might be in the room
- Odd thinking and speech (Vague, circumstantial, metaphorical, overelaborate or stereotyped)
- Suspiciousness or paranoid ideation (People are intentionally out to get them)
- Inappropriate or constricted affect
- Behavior or appearance that is odd, eccentric, or peculiar
- Lack of close friends or confidants other than first degree relatives
- Excessive social anxiety paranoid fears
Criteria B.
Does not occur exclusively during the course of schizophrenia, a bipolar disorder, or depressive disorder with psychotic features, another disorder or autism spectrum disorder.
Treatment for Schizotypal Personality Disorder
Combination of antipsychotic medication, community treatment and therapy including social skills training
• CBT for Psychosis
Social Skills Training?
Social skills training is a structured and therapeutic
approach to teaching clients how to interact with others
It involves teaching clients “the rules” of social interaction thought psychoeducation, modelling, role play and behavioural experiments
Borderline Personality Disorder DSM-5 Criteria
Criteria A.
A pervasive pattern of instability of interpersonal relationships, self image, and affect, and marked impulsivity.
Indicated by five (or more) of the following:
- Frantic efforts to avoid real or imagined abandonment
- A pattern of unstable and intense interpersonal relationships
- Identity disturbance: Markedly and persistently unstable self-image or sense of self
- Impulsivity in at least two areas that are potentially self damaging (e.g. spending, sex, substance use, reckless driving, binge eating)
- Recurrent suicidal behaviour, gestures, or threats, or self mutilating behaviour
- Affective instability due to a marked reactivity in mood (e.g. intense episodic dysphoria, irritability, or anxiety)
- Chronic feelings of emptiness
- Inappropriate, intense anger or difficulty controlling anger (e.g. frequent displays of temper, constant anger, recurrent physical fights)
- Transient, stress-related paranoid ideation or severe dissociative symptoms.
Borderline personality disorder - Etiology
Abuse history
• People with BPD is are likely than individuals with other
PDs to report an abusive history
Linehan’s Diathesis-Stress Theory
• People with BPD have a biological diathesis
• They are then raised in an environment that is invalidating
Treatment for BPD (DBT)
A variant of CBT called dialectical behaviour therapy (DBT)
- DBT involves helping the client regulate emotions and cope with stressors that might trigger self-destructive behaviour.
Involves 4 skills that are taught in a rotating fashion • Mindfulness skills • Interpersonal skills • Emotional regulation • Distress tolerance skills
Avoidant Personality Disorder DSM-5 Criteria
Criteria A.
A pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation.
Indicated by four (or more) of the following:
- Avoids occupational activities that involve significant interpersonal contact because of fears of criticism, disapproval or rejection
- Is unwilling to get involved with people unless certain of being liked
- Shows restraint with intimate relationships because of the fear of being shamed or ridiculed.
- Is preoccupied with being criticized or rejected in social situations
- Is inhibited in new interpersonal situations because of feelings of inadequacy
- Views self as socially inept, personally unappealing, or inferior to others
- Is unusually reluctant to take personal risks or to engage in any new activity because they may prove embarassing
Treatment of APD
Avoidant Personality Disorder has been considered an extreme and pervasive form Social Anxiety Disorder
CBT focusing on behavioural activation, behavioural
experiments and social skills training is indicated
Therapeutic alliance is vital for all clients but is particularly
important for treatment success with this client group
Assessment measure for personality disorders
Structured Clinical Interview for DSM-5-Personality
– Semi structured interview
OVERALL treatment for ALL personality disorders
• Most people with a PD enter treatment for a reason
other than their PD.
• The presence of a PD predicts slower response to
therapy.
• Therapeutic alliance is necessary.
• Multidisciplinary team.
