Lecture 22

Youth personality and somatic symptom disorder

Cluster A - odd/eccentric	Paranoid, schizoid, schizotypal
Cluster B - dramatic/emotional/erratic	Antisocial, borderline, histrionic, narcissistic
Cluster C - anxious/fearful	Avoidant, dependent, OCD

What are the 3 clusters for personality disorders?

11%

The prevalence of personality disorders in youth is of ___% and stable

distinct

• comorbidity

• heterogeneity

• Arbitrary

• Stigma

Personality disorders ate sometimes seen as categorical, meaning that they are _____ syndromes

→ Problems:

• Inter-category _______

• Intra-category _______

• ______ diagnostic thresholds

• ______ associated with rigid categories

spectrum

• multi

• Reduces

• setting

Personality disorders are sometimes seen as dimensional, meaning that they are on a ______

→ Advantages:

• Emphasizes the _____-dimensionality of personality disorders

• ______ stigma

• Eases goal-______ in treatment

• differently

• pathological

• multi

Having a dimensional view of personality disorders is important because:

• Psychopathology manifests _____ in youth

• Normative behaviour at one age can be _____ at another

• There are discrepancies caused by ______-informant reports

Dimensional-categorical

The alternative model to diagnose personality disorders in youth uses which view?

• 6

• • functioning

  • pathological

In the dimensional-categorical model:

• There are ___ diagnoses types

• There are 2 criteria:

  • Criteria A: level of personality _____

  • Criteria B: ______ personality traits

• Self-functioning → identity, self-direction

• Interpersonal functioning → intimacy, empathy

What are the 2 dimensions in criteria A - level of personality functioning?

• Neuroticism

• Extraversion

• Consciousness

• Agreeableness

• Openness

What are the 5 traits in criteria B - pathological personality traits?

• valid

• harm, risk

• control

• identity

Borderline personality disorder in youth:

• Has a reliable and ______ diagnosis, like in adults

Borderline personality disorder in adolescents:

• Main markers: self-____ and ____-taking

• Poorer impulse ______

• Some ______ problems

26%

BPD’s prevalence in youth is common, ranging from 0% to ___%

• 66%

• abuse, sexual

BPD etiology:

• There is a genetic psychopathology propensity with a ___% variance genetic

• Are more likely to have experiences childhood ______ or neglect, including _____ abuse

Linehan’s biosocial theory	Being in an invalidating environment → think that your feelings don’t matter → not able to recognize and label emotion → difficulties in experiencing and regulating emotions later on
Fonagy’s mentalization model	Disrupted attachments → more vulnerable to emotional distress → hyper-responsive of attachment systems → deficits in mentalizing (how you think others see you) → poor development of the self

2 important theories:

Linehan’s biosocial theory
Fonagy’s mentalization model

• temperament

• internalizing/externalizing

• maturation

• individuation

• traits

Course of BPD:

• Childhood extremes in ______ and personality

• Early ______/______ problems

• Lack of ______

• Difficulties in developing ______ and dealing with relationships

• Early onset BPD or _____ in adolescence

• Some remission maybe…?

limited

→ risky, severe

There is ______ availability of BPD treatment

→ Solution: stepped care approach (CDP that targets adolescent ______ behaviours for everyone, DBT-A that targets the psychopathological pathway for more _____ cases)

ACE

Personality disorders are not just a response to trauma because 30% of adults diagnosed have no ______s

how

→ efficay

The problem with the stigma associated with personality disorders is not whether the diagnosis is communicated but ____

→ It can enable adolescents’ self-_____

• physical

• mental

• 17%

• dysfunctional

Somatic symptoms in youth:

• Includes _____ symptoms like headaches, stomachaches, fatigue, nausea, musculoskeletal pain

• Severe ______ consequences

• Between 6%-___%

• Greater rates in ______ families