Personality Disorders - PSY2003

Issues in indentifying Personality Disorders

Poor COnceptual clarity

Dimensional vs Categorical

Stigma and Bias

Poor conceptual clarity

Personality disorders (PDs) lack universally accepted definitions. The DSM-5 acknowledges difficulty distinguishing between normative personality traits and disorder.

Dimensional vs categorical

PDs may lie on a spectrum (e.g., extreme introversion or neuroticism). Categorical cut-offs are arbitrary and do not always reflect underlying traits.

Stigma and Bias

Labels carry heavy stigma

Diagnosis often used inconsistently - especially across gender

Diagnosis challenges

Symptoms are long term, often co-occur and resist simple classification

Diagnosis often made without considering developmental stage, trauma history of substance use

Clinicians may diagnose prematurely or innaccurately due to lack of objective tests

DSM-5 Definition (2013) - PD involves:

Significant impairments in self (identity/self-direction) and interpersonal functioning (empathy/intimacy)

Presence of pathological personality traits

Traits must be stable over time and not due to substances or medical conditions

Cluster A

odd/eccentric

paranoid, schizoid, schizotypal

Cluster A traits

Social withdrawal, cognitive/perceptual distortions

Cluster B

dramatic, erratic

antisocial, borderline, histrionic, narcissistic

Cluster B traits

Impulsivity, affective instability, self-centredness

Cluster C

Anxious, fearful

avoidant, dependent, obsessive compulsive

Cluster C traits

Anicety-driven behaviours

Dependency

Prevalance

Varies depending on the diagnostic method used

Reliable estimates: 10-15% of general population have a diagnosable PD

Most common: Borderline, Antisocial, Obsessive-Compulsive, Schizotypal

Comorbidity

Very high within and between clusters (average person meets criteria for ~4.5 PDs)

Course of PDs

Contrary to older beliefs, PDs are not always lifelong.

Longitudinal studies (e.g., Zanarini et al., 2012) show symptom remission is common over time

Factors for Cluster A

BIO: Genetics, Cognitive deficits, Enlarged ventricles

Env: Rejection, abuse, poor attachment

Factors for Cluster B

BIO: Low anxiety, weak fear conditioning, lymbic dysfunction

ENV: Childhood trauma, emotional invalidation, modeling

Factors for Cluster C

BIO: Genetic predisposition to anxiety

ENV: Childhood neglect, fear of abandonment

General causes

Genetics

Brain dysfunction - Limbic dysfunction, poor fear conditioning

Early environment - trauma neglect

Current evidence regarding effective treatment

Evidence strongest for Borderline Personality Disorder (BPD)

Most effective interventions are psychological, not pharmacological

Treatments focus on symptom management and interpersonal skills

Dialectical Behaviour Therapy

Behaviour-based programme for emotional dysregulation and self-harm

Effective at reducing suicidality (Linehan, 1993)

Schema Therapy (ST)

Integrative therapy combining CBT, attachment theory, gestalt

Strong evidence for BPD and Cluster C PDs

Mentalisation-Based Treatment

Helps patients understand their own and others' mental states

Effective for BPD

Cognitive Analytic Therapy

Integrates cognitive and psychodynamic approaches

Promising clinical support