personality disorders final

Pritchard (1835)

moral insanity -> psychopathy (ASPD)

Schneider (1923)

-psychopathic personalities

-only and issue if causing great distress to self and/or others

psychopathy characteristics

- culturally deviant?

- maladaptive? (thoughts cause them problems)

- self destructive? (or cause distress or threaten others?)

- discomfort/concern to others, impairing social relationships?

- duration and interference are important

Pros of DSM

- atheoretical stance

- stronger empirical foundations

- more specific and reliable criteria

- first to include PDs (dsm5)

cons to DSM

- arbitrary cutoffs

- extensive within category heterogeneity

- frequency of comorbidity

- does not help with treatment recommendations

- those with PDs symptoms often do not meet criteria (large about in unspecified category)

major changes to DSM 5

removal of axis system

axis 1 - mental health and substance use

axis 2 - PDs and mental retardation/developmental disorders (lifelong)

axis 3 - medical conditions

alternative models

criterion A: level of personality functioning

criterion B: maladaptive traits (opposite of big 5)

ultimately a failure

HiTOP model

focuses on how symptoms and syndromes co-occur, using data available from studies with thousands of patients

general PD prevalence

10-15% in general pop, 50% in psychiatrist settings

cluster A

odd, eccentric

cluster B

dramatic, emotional, erratic

cluster C

anxious, fearful

main characteristics: paranoid

- distrust

- suspicion of others

- others motives are malevolent

how many are needed to diagnose paranoid?

4 or more

associated features: paranoid

- excessive suspiciousness that may manifest differently (anger, complaining, quiet aloofness, RBF)

- may appear cold in affect but that does not reflect inner feelings

- want control and autonomy

prevalence: paranoid

2.3-4.4%

more common in males and relatives of schizophrenia spectrum

main characteristics: schizoid

- detachment from social relationships

(fewer and shallower rel., restricted emotional expression, lack of desire, lack of pleasure from sensory experiences)

how many are needed to diagnose schizoid?

4 or more

associated features: schizoid

- difficulty expressing anger

- appears their life is directionless

- lack of social desire

prevalence: schizoid

3.1-4.9%

-more common in males and relatives of schizophrenia spectrum

main characteristics: schizotypal

- cognitive or perceptual distortions

- discomfort in close relationships

- eccentricity

how many are needed to diagnose schizotypal?

5 or more

associated features: schizotypal

- often seek treatment for anxiety or depression than their PD symptoms

- also common to have schizoid, paranoid, avoidant, and BPD dx as well

prevalence: schizotypal

0.6-4.6%

- slightly more common in males

- more common in relatives of schizophrenia spectrum

main characteristics: antisocial

- disregard for the rights of others

- violation of the rights of others

how many are needed to diagnose antisocial?

3 or more + evidence of conduct disorder before 15, at least 18 yrs old

associated features: antisocial

- lack of empathy

- inflated self appraisal

- superficial charm

prevalence: antisocial

0.2-3.3%

mostly in males, alcohol use dx and in forensic settings

main characteristics: histrionic

- excessive emotionality

- attention seeking behaviors

how many are needed to diagnose histrionic?

5 or more

associated features: histrionic

- interpersonal difficulties with romantic partners

- interpersonal difficulties with friends

prevalence: histrionic

0.4-1.8%

similar in males and females

main characteristics: narcissistic

- grandiosity

- need for admiration

- lack of empathy

how many are needed to diagnose narcissistic?

5 or more

associated features: narcissistic

- very sensitive to criticism

- leads to social and occupational impairment

prevalence: narcissistic

0-6.2%

much more common in males (50-75%)

main characteristics: borderline

- instability in interpersonal relationships

- marked impulsivity

how many are needed to diagnose BPD?

5 or more

associated features: borderline

- instability in multiple aspects of life

- ACEs

- several co-morbid disorders (mood, substance use, ED (bulimia), ADHD, PTSD, other PD features)

-5x risk in 1st degree relatives of those with BPD

prevalence: borderline

1.6-5.9% in general pop.

- 10% in outpatient, 20% inpatient

- 75% dx are women

main characteristics: OCPD

- orderliness

- perfectionism

- control

how many are needed to diagnose with OCPD?

4 or more

associated features: OCPD

- prone to negative emotions when they lack control

- difficulty expressing affection despite feeling it

prevalence: OCPD

2.1-7.9%

-2x dx in men

main characteristics: dependent

- submissive and clingy behavior

how may are needed to diagnose dependent?

5 or more

associated characteristics: dependent

- pessimism and self doubt

- impaired occupational functioning

- social relations limited to those whom they are dependent on

prevalence: dependent

-0.49-0.6%

-more common in females

- not dx in children

main characteristics: avoidant

- social inhibition

- feelings of inadequacy

- hypersensitivity to negative evaluation

how many needed to diagnose avoidant?

4 or more

associated features: avoidant

- desire for affection and acceptance

- described as very shy, timid, isolated

- negatively impact social and occupational functioning

prevalence: avoidant

2.5%

-men and women equal

origins of DBT

Marsha Linehan, developed for chronically suicidal women

three foundational principles of DBT

- behavior training

- overarching dialectical philosophy

- zen buddhism

4 components of DBT

- mindfulness

- interpersonal effectiveness

- emotional regulation

- distress tolerance

4 stages of DBT

pretreatment: orient to philosophy and set goal

- stage 1: behavioral dyscontrol -> control

stage 2: quiet desperation -> non-traumatic emotional experiencing

stage 3: problems in living to ordinary happiness and unhappiness

stage 4: incompleteness to freedom and capacity for joy

origins of CBT

- Aaron Beck

-originally for depression, now EST for several disorders

schemas

beliefs about self, others, and future that are typically negative in those with depression

automatic negative thoughts

pattern of negative thinking that is more or less habitual and may occur without conscious awareness, includes overgeneralization, all-or-none thinking, and mind reading

CBT triangle

thoughts, behaviors, and emotions all affect each other

cognitive restructuring

combat dysfunctional thoughts with evidence that proves they are untrue

thought record

A way of recording thoughts, feelings, and behaviors so as to explore negative/irrational thought patterns and introduce a more balanced perspective

key components of CBT

- present focused

- time limited

- structured