Psychopathology Ch.10 4/10 Personality Disorders

Personality

• personality characteristcs across:

  1. time

  2. contexts

• 5 Factor Model of personality

  • OCEAN (openness to experience, conscientiousness, extroversion, agreeableness, and neuroticism)

Why do PDs (personality disorders) exist

• extremes on various personality traits that lead to clinically significant distress or impairment

• most psychiatric disorders are episodic (they come and go in episodes)

• many only need to be there for a little while to be diagnosed

• in diagnosing, we ask questions like, “when was the last time you felt like your normal self”

• for some people, nearly their entire lives have been marked by a pattern that is distressing, deviant and dysfunctional

• PDs may predispose ppl to episodic disorders as well

• among most controversial and least understood disorders in DSM

DSM Personality Disorder

• A Personality Disorder is an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual's culture.

• this pattern is manifested in 2+ of the following ares

  • cognition (e.g., interpretations of events)

  • affect (i.e. emotional response — in terms of range, intensity, liability and appropriateness)

  • interpersonal functioning

  • impulse control

• this pattern is inflexible, pervasive across a broad range of situations and stable

• traced back to at least adolescence/early adulthood, but must be currently 18+

• clinically significant distress OR impairment

prevalence PD

• PDs have a point prevalence ~1.5% (not very common)

• psychologists are reluctant to diagnose someone bc the diagnosis might make other providers think they’re harder to treat (which is true, harder to treat, but want to be sure bc will make other providers reluctant to treat)

Clusters PDs

• don’t need to know every symptom of every PD, but be able to distinguish btwn them

• 10 personality disorders

• Divided into 3 clusters (don’t need to worry too much abt them)

  • Cluster A (odd, eccentric)

  • Cluster B (dramatic, emotional, or erratic)

  • Cluster C (anxious, fearful)

Cluster A

• paranoid

• schizoid

• schizotypal

DSM Paranoid Personality Disorder

• a pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent, beginning by early adulthood and present in a variety of contexts (this is present across all PDs)

• 4+ of the following

  • suspects without sufficient basis that others are exploiting, harming or deceiving him or her

  • is preoccupied with unjustified doubts about the loyalty or trustworthiness of friends or associates

  • is reluctant to confide in others because of unwarranted fear that the information will be used maliciously against them

  • reads hidden demeaning or threatening means into benign remarks or events

  • persistently bears grudges (i.e., is unforgiving of insults, injuries or slights)

  • perceives attacks on their character or reputation that are not apparent to others and is quick to react angrily or counterattack

  • has recurrent suspicions, without justification, regarding fidelity of spouse or sexual partner

5 Factor - Paranoid PD

• low agreeableness

• High neuroticism

  • angry-hostility

Schizophrenia vs Paranoid PD

• paranoid PD

  • no psychosis, in touch w reality

  • no hallucinations, beliefs are paranoid but not as unrealistic as delusions

  • persistent throughout life (whereas schizophrenia has a sudden onset/increase)

• schizophrenia

  • psychotic, loss of touch w reality

  • delusions are unrealistic and often extreme

Schizoid PD

• pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings

• 4+ of the following

• batman

Schizoid PD - 5 Traits

• low extraversion

• low openness to experience

  • low on feelings aspect (openness to new feelings)

Schizoid PD Vs SAD (Social Anxiety Disorder)

• schizoid

  • doesn’t want relationships

  • not concerned about what others think of them

• SAD (social anxiety disorder)

  • wants relationships

  • overly concerned about what others think of them

Schizotypal PD

• pervasive pattern of social and interpersonal deficits marked by acute discomfort with, and reduced capacity for, close relationships as well as by cognitive or perceptual distortions and eccentricities of behavior

• 5+ of the following

  • ideas of reference (excluding delusions of reference)

  • odd beliefs or magical thinking that influences behavior (e.g., superstitiousness)

  • unusual perceptual experiences, including bodily illusions

  • odd thinking and speech (e.g., vauge, circumstantial)

  • suspi * CHECK SLIDES

• Luna Lovegood

Schizotypal 5 Factors

• low extraversion

• high openness

  • actions

  • ideas

• high neuroticism

  • anxiety

  • self-consciousness

• Psychoticism - unusual beliefs, eccentricities, cognitive and perceptual dysregulation

Schizotypal vs Schizophrenia

• schizotypal

  • CHECK SLIDES

• many features in common w schizophrenia, but less severe

• similar biological and cogntiic features

• increased risk for developming schizophrenia CHECK SLIDES

Cluster B PDs

Histronic PD DSM

• pervasive pattern of excessive emotionality and attention seeking

• 5+ of the following

  • is uncomfortable in situations in which they are not the center of attention

  • interaction with others is often characterized by sexually provocative or seductive behavior

  • consistently uses physical appearance to draw attention to the self

  • displays rapidly shifting and shallow expressions of emotion

  • style of speech tht is exces

• Regina George/Zoolander

Big 5 - histrionic

• high extraversion

• high openness to experience

• high neuroticism

  • depression

  • self-consciousness

  • need for attention to validate self-worth

Narcissistic PD DSM

• pervasive pattern of grandiosity, need for admiration and lack of empathy… (fill in this from all PDs)

• 5 + of the following

  • has a grandiose sense of self-importance (e.g., exaggerates achievements, expects to be recongized as superior)

  • is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love

  • believes they are “special” and unique and can only be understood by or associate with

5 Factor - Narcissistic PD

• Low agreeablenss

• high neuroticism

  • anger-hostility

  • sometimes self-consciousness

Grandiose vs. Vulnerable Narcissist

Grandiose

• DSM description: grandiosity, aggression, dominance

• Low neuroticism

• less personal distress — impacts others

Vulneralbe

• fragile/unstable self-esteem, shame, hypersensitive to criticism, fear of rejection

• high negative affect nerutoicsm

• more personal distress

Histrionic vs Narcissistic PD

• Histrionic

  • ex CHECK SLIDES

BPD DSM

• pervasive pattern of instability of interpersonal relationships, self-image and affects and marked impulsivity…

• 5+ of the following

  • frantic efforts to avoid real or imagined abandonment

  • pattern of unstable or intense interpersonal relationships characterized between extremes of idealization or devaluation

  • identity disturbance: marked and persistently unstable self-image or sense of self

  • impulsivity in 2 areas that are potentially self damaging (e.g., spending, substance abuse)

  • recurrent suicidal behavior, gestures or threats, or self-mutilating behavior (35% of diagnosed attempt, 8-10% of those complete)

  • affective instability due to marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety for a few hrs)

  • chronic feelings of emptiness

  • inappropriate, intense anger or difficulty controlling anger

  • transient stress-related paranoid ideation or severe dissociative symptoms

5 Factor - BPD

• low agreeableness

• high neuroticism

Antisoscial PD DSM

• pervasive pattern of disregard for and violation of the rights of others, occurring since age 15

• 3+ of the following

  • fialure to conform to social norms with respect to lawful behaviors, as indicated by repeatdly performing acts that are grounds for arrest

  • deceitful as indicated by repeated lying, use of aliases or conning others for personal profit or pleasure

  • impulsivity or failure to plan ahead

  • irritability or aggressiveness

• Barry

• need evidence of conduct disorder w onset before age 15

Conduct Disorder DSM (Childhood Disorder)

• repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate society norms or rules are violated 3 + of the following the past 12 months

  • often bullies, threatens, intimidates others

  • often initiates physical fights

  • has used a serious weapon (e.g., gun, bat or brick)

  • has been physically curel to people

  • has been physically curel to animals

  • has stolen while confronting someone (e.g., mugging)

  • has forced someone into sexual activity

  • has set fires to cause damage

  • has destroyed others’

  • CHECK SLIDES

Developmental Perspective

• add image CHECK SLIDES

Conduct Disorder → Antisocial PD

• onset of Conduct Disorder matters

• early onset. (before age ~13)

• CHECK SLIDES

Antisocial PD vs Criminality vs Psychopathy

• common in prison populations (also used as critique of this diagnosis)

  • 47% of incarcerated men

  • 21% of incarcerated women

• some similar features but not the same as psychopathy

  • psychopathy is not in DSM, more focus on superficial charm, lack of empathy, and manipulativeness than antisocial PD

  • conduct disorder + limited prosocial emotion as risk factor

5 Factor- ASPD - antioscioal PD

• low agreeableness

• low conscientiousness

Etiological Factors ASPD

• genetics - moderate to large heritability

• poverty

• adverse childhood experiences

• CHECK SLIDES - add graph

• interactive model

Cluster C

• anxious or fearful

DSM Avoidant PD

• pervasive pattern of social inhibition, inadequacy and hypersensitivity to negative evaluation…

• 4+

  • avoids occupational activities that involve significant interpersonal contact becacuse of fear of criticism, disapproval, or rejection

  • is unwilling to get involved with people unless sure of

  • CHECK SLIDES

5 factors Avoidant PD

• low extraversion

• high neuroticism

Dependent PD DSM

• a pervasive and excessive need to be taken care of leads to submissive and clinging behavior and fears of separation

• 5+ of the following

  • has difficulty

• CHECK SLIDES

5 Factors - Dependent PD

• high agreeableness

• high neuroticism

OCPD - DSM - Obsessive Compulsive Personality Disorder

• pervasive pattern of preoccupation with orderliens, perfectionism and mental and interpersonal control — at the expense of flexiblity, openness and efficiency

OCPD vs OCD

• OCPD no intrusive obssessions or inappropriate intrusive obsessions

• no compulsive behavior to solve intrusive obsessions CHECK SLIDES

OCPD 5 factors

• high l

• CHECK SLIDES

Treatment PDs

• difficult to treat

  • long-standing patterns

  • interpersonal difficulties (e.g., splitting - working w two diff providers - telling them two diff things to create conflict)

  • don’t believe need to change

• little research on evidence-based treatments

• medications

  • schizotypal - low doses antipsychotics

DBT - dialectical behavior therapy

• problem solving

• lots of validation - accepting where they’re at and emotional difficulties experiencing

• CBT adapted for BPD

• multi-modal: individual, group, phone coaching

• efficacy? (does it work)

  • good evidence for BPD: more effective than control conditions (treatment as usual) helps with self-harm and psychosc

• CHECK SLIDES

DBT Skills

• group component of DBT

• mindfulness

• distress tolerance (e.g., splash water on face when angry)

• emotional regulation (e.g., get enough sleep, avoid drugs)

• interpersonal effectiveness (i.e., deal with interpersonal situations - DEAR MAN - Describe, Express, Assert, Reinforce, stay Mindful, Appear confident, Negotiate)