4a Personality disorders

How were personality disorders originally classified before DSM-5

Axis II

How were personality disorders adjusted to be classified in the DSM-5

as a clinical disorder

What were ‘Axis II’ disorders in DSM-IV?

Personality disorders and intellectual disabilities

Give 3 ‘characteristics’ in defining personality disorder (deviation, nature, consequence), according to DSM systems

enduring patterns of inner experience and behaviour deviating from cultural expectations, are pervasive and inflexible, and cause distress or impairment

Describe the cluster A personality disorders in DSM-5

odd or eccentric disorders

Name 3 personality disorders within cluster A

paranoid, schizoid and schizotypal

Describe cluster B personality disorders in DSM-5

dramatic, emotional, or erratic

Name 4 personality disorders in cluster B

antisocial, borderline, histrionic, narcissistic

Describe cluster C personality disorders in DSM-5

anxious or fearful

Name 3 personality disorders in cluster C

avoidant, dependent, obsessive-compulsive

What does Haslam (2007) note about PD co-occurrence, what does this bring into question?

Co-occurrence of personality disorders is common, diagnostic distinctiveness.

What critique do Lofti et al. (2018) raise about PD diagnostic groups, what might be overlooked?

diagnostic groups show questionable validity and utility, the complexity of PD

5 features of paranoid PD

paranoia, mistrust of others, irrational suspicions

2 behavioural aspects of paranoid PD

pre-occupied with doubts, reluctance to confide

What PD does the behaviour of misinterpreting innocent remarks belong to

paranoid PD

What cluster A PD key feature is a preference for solitude and emotional detachment

schizoid PD

Key 3 features of schizoid PD

detachment from interpersonal relationships, emotional coldness, indifference to praise/criticism of others

2 behavioural traits of schizoid PD

having few friends, choosing solitary activities

Key feature of schizotypal PD

distortions in thinking, feelings and perceptions

3 traits of schizotypal PD

discomfort in social situations, suspicious and paranoia

2 features of antisocial PD

lack of empathy and remorse, disregard for others

3 behavioural traits of antisocial PD

failure to conform to norms/laws, impulsivity and deceitfulness

What cluster B PD key feature is an excess need for approval

histrionic PD

2 behavioural traits of histrionic PD

shallow/over dramatic emotions, sees relationships as more intimate than they are

4 features of narcissistic PD

inflated self-importance, seeks attention from others, low in empathy, envious

3 features of borderline PD

unstable personal relationships, instability of feelings, lack of well-formed identity

2 behavioural traits of borderline PD

frequent suicidal, self-harming

Which cluster B PD involves impulsivity in self-damaging behaviours

borderline PD

Why is Borderline PD often misunderstood, role of media, what does it fail to actually reflect?

Media portrayals sensationalise symptoms, failing to reflect lived personal experiences.

3 features of avoidant PD

low self-worth, fear rejection, feel socially-inept

2 behavioural traits of avoidant PD

avoids/withdraws from social situations, reluctant to engage in new things

2 features of dependent PD

persistent psychological dependence on others, lack confidence to take responsibility

3 behavioural aspects of dependent PD

difficulty doing things alone, tends to agree with others, seeks out new relationships

Feature of obsessive-compulsive PD

preoccupation with orderliness, rules, moral codes and perfectionism

2 behavioural traits of obsessive-compulsive PD

excessive devotion to work, inflexibility

What is the continuity hypothesis, what does this suggest about the line between personality disorders and personality?

The idea that personality disorders reflect extreme versions of normal personality traits, there is no discontinuity between normality and illness

What did Saulsman & Page (2004) meta-analysis examine and demonstrate which can be linked back to the continuity hypothesis?

Links between Big Five traits and personality disorder categories, demonstrating dimensional associations.

Who proposed the Big 5 profile approach to predicting PD tendencies (looks like widget?)

widiger et al

Explain Widiger’s conceptual profiles for PDs

reviewed typical personality trait patterns associated with a PD

What Big 5 trait is obsessive-compulsive PD associated with

high consciousness

What two big 5 traits is avoidant PD associated with, what do these traits reflect in the PD

low extraversion (social inhibition) and high neuroticism

What two big 5 traits are associated with dependent PD, what do these traits reflect in the PD

high neuroticism and high agreeableness (tendency to agree)

What big 5 trait is associated with schizoid PD, what do these traits reflect in the PD

low extraversion (indifference to social connections)

What profile agreement did McCrae et al find (using personality and PD scores)

significant correlations but only modest to moderate

What is the predictive power of personality profiles for PD

indicate risk or characterising a known PD but not a diagnosis

From McCrae’s findings of only modest/moderation correlations between personality and PD, where might the issue lie

in the diagnostic classification system for PD rather than with models of personality

What is the NEO profile – facet scores of personality traits

Three major limitations of DSM-IV PD classification

High comorbidity, low reliability, poor integration with empirical personality models.

What 2 types of reliability are low with PD classifications

temporal and inter-rater

What system did Widiger, Costa & McCrae (2002) propose for DSM-5?

A dimensional PD system (rather than categorical)

What would a dimensional approach to PD diagnosis involve, what are the 4-steps (profile, impairments, significant, match)

1-assess personality facet profile, 2- assess personality-related social/occupational impairments, 3- if dysfunction and distress clinically significant then diagnose PD, 4- determine if profile match with PD category descriptor

What two criteria were introduced in DSM-5 Section III?

severity (criterion A) and style of disorder (criterion b)

What does criterion A – severity – measure

significant impairments in functioning of self and interpersonally

What does criterion B – style – measure

presence of pathological personality trait domains or facets which contribute to disorder

What is the Maladaptive Trait Model

A DSM-5 model describing pathological personality trait domains

What is the significance of emerging measures and models in DSM-5

encourages clinicians to try them out and adopt them

DSM-5 3 criteria for Dissociative identity disorder (DID)

Presence of 2 or more distinct identities or personalities, amnesia for prior/recent events, causes significant distress/functional impairment

What 3 things can DID not be due to

substance use, cultural practice or imaginative play

Is DID considered a personality trait

no

5 ways DID is typically presented, according to Haslam

primary ‘host’ personality (plus alters), alters take turns to control behaviour, distinctive patterns of thinking and behaviour, different names, age etc, and memory loss for experience as other alters

Common history reported in DID patients

Severe childhood trauma (sexual/physical abuse).

What is suggestibility in DID, what is this linked to and what vulnerability?

High openness to influence, linked to memory distortions and vulnerability in therapeutic contexts.

What two clustering of cases has been observed in DID diagnoses

geographically and by therapist

What are the two competing theories of DID

post-traumatic model of DID and the socio-cognitive model of DID

What does the post-traumatic model suggest about why DID develops

as a coping response to trauma, by dissociating from traumatic memories and emotions

What acts as a coping mechanism in the post-traumatic model of DID

dissociation, for future stress

What factor moderates vulnerability to dissociation and DID

suggestibility

What does the socio-cognitive model of DID propose about its development

arises as a product of therapy, rather than being directly caused by trauma

What aspects of therapy are argued to cause DID symptoms

hypnosis and leading questions which cause patients to reinterpret experiences

What symptom is reinterpreted as multiple personalities according to the socio-cognitive model of DID

mood swings

What factor increases a person’s susceptibility to developing DID according to the socio-cognitive model

suggestibility

Which model of DID accounts for the clustering of cases and rise in prevalence and severity

socio-cognitive model

What did Spanos (1994) find about the influence of hypnotic methods in DID development/diagnosis, supporting the socio-cognitive model

can produce “alternate identities” in healthy individuals

what did Paris (2012) highlight in the Sybil case, supporting the socio-cognitive model

Multiple personalities were imposed by therapeutic suggestion, not spontaneously emerging.

What two debates remain around DID

the cause of the disorder and the validity of the disorder as a scientific concept

What does a decline in publication output on DID demonstrate

lacks strong scientific acceptance

What has DSM-5 failed to do when evaluating the existence of DID

the fact it fails to meet criteria for a valid diagnosis

How has neural evidence argued the existence of DID

increasing evidence linking dissociative disorders to trauma and specific neural mechanisms (common in other mental health conditions)