complex emotional + relational needs

what is another term for personality disorders

complex emotional + relational needs → now the standard terminology

why is gaining the POVs of people with CERN important for research

• there is a large diversity of experience across individuals → no one standard of presentation/experience

• integral for the movement away from stigmatising representations, e.g. ‘dangerous’ or ‘self-obsessed’

• the prevalence of personality diagnoses is high

what are 2 common experiences in CERN

• emotional + interpersonal sensitivity → negative attributional style + experience of despair/shame despite rational thinking

• difficulty with interpersonal relationships + lack of trust → often born out of past experiences + maintained by current behaviours

how can diagnosis be a paradoxical experience for people with CERN

• may feel like being written off something being inherently wrong with you, e.g. being a ‘problem person’/having no prospect of change

• may also feel like an enormous relief due to recognition that there is a problem + access to therapy

personality definition

our tendency towards patterns of behaviour, emotion, cognition + interaction that show through regardless of the situation we are in

• traits held over time rather than temporary states

what is the issue of context when considering when personality becomes a problem

personality can have positive implications if it fits the demands of the world/environment that they are in, but they can have negative influence if they don’t fit the rules/social expectations of society

• e.g. aggression in boxing is appropriate, but would be problematic if persisting outside of this context

what are the issues of sociopolitical conceptualisations of personality disorders

conception of personality disorders usually involves sociopolitical perspectives → these involve sentiments of:

• this person is weird/not acceptable, or not within social bounds → these views are not agreed upon, and can change depending on social climate

• early conceptualisations were based in relation to being non-diagnosable forms of other disorders → e.g. BPD used to be considered the ‘borderline’ of experiencing psychosis

• medico-legal perspectives → how people in society are treated on the basis of whether they are likely to offend, rather than whether they have

what are 2 issues of categories vs dimensions when considering personality disorders

personality traits vary along dimensions, e.g. the big 5 personality traits

• the issue is if personality disorders are extremes on these dimensions, how do we establish a cut-off, especially if what is considered a ‘problem’ is subjective

  • e.g. the top 0.5% of impulsivity would not be considered qualitatively different to the top 1%

• another issue = whether personality disorders are distinct ‘clumps’ at either extreme of trait distribution (e.g. being 2/3 SD from average in confidence), or only at one end of the dimension

  • e.g. extreme neuroticism would be seen as a problem, but not extreme stability

what was the DSM-IV definition of personality disorders (1994)

an enduring pattern of inner experience + behaviour that deviates markedly from the expectations of the individual’s culture

what were 2 main issue with the DSM-IV definition of personality disorder

• definition is very vague + broad → it encompasses many things e.g. belief systems that are unusual in the current context, but may have been more regular at different points in history/in different societies

• the issue of strictly using the method of categorisation

what is the DSM-V definition of personality disorders (2013)

the essential features of a personality disorder = impairments in personality (self + interpersonal) functioning + the presence of pathological personality traits

what 5 criteria does the diagnosis of a personality disorder require in the DSM-V (2013)

• significant impairments in self (identity/self-direction) + interpersonal (empathy or intimacy) functioning

• one or more ‘pathological’ personality trait domains/facets

• impairments in personality functioning + treat expression are relatively stable across time + across situations (persisting)

• impairments are not better understood as normative for the individual’s developmental stage/sociocultural environment

• impairments are not solely due to the direct physiological effects of a substance (e.g. drug abuse/medication) or general medical condition (e.g. head trauma)

how have definitions of personality changed between the DSM-IV and DSM-V

DSM-V maintains diagnostic criteria + the same 10 personality disorders as the DSM-IV, but uses a more dimensional approach to diagnosis (accounting for variability in traits) + encourages further research on these than the DSM-IV, which was much more categorical

what 3 research proposals did the DSM-V include to allow future potential change in diagnosis of personality disorders

• levels of personality functioning

• personality trait domains + facets

• personality disorder types

what are 3 key issues with reaching a personality disorder diagnosis

• long-term presentations → traits must be persisting

• must be independent of biological factors, e.g. drug use, starvation, actual threat

• diagnosis cannot be made at a single clinical meeting → due to necessity of long-term effects + ruling out contextual factors, it should be judged over a number of weeks

however, a lot of clinicians do not adhere to this criteria, meaning some diagnoses may not be as accurate

what is Tyrer (2022)’s argument for diagnosing PDs in adolescents + what are issues with this

argues that some young people present personality functions are so disturbed that they cross the threshold of personality disorders

• this is an incredibly stigmatising mindset to have → demonises personality disorders + enhances stereotypes of PD

• incredibly inappropriate to diagnosed PDs at this age due to the wealth of changes adolescents go through in terms of identity → traits are not always stable/persistent at this age

what are the 3 clusters of personality disorders

• cluster A → odd/eccentric

• cluster B → dramatic/erratic

• cluster C → anxious/fearful

what are cluster A personality disorders overall + what are the 3 types

PDs with schizophrenia-like features, while lacking in some positive symptoms e.g. hallucinations. includes:

• paranoid PD

• schizoid PD

• schizotypal PD

what is paranoid PD

pattern of distrust/suspiciousness + resistant to challenge by others

what is schizoid PD

pattern of separation from social relationships, limited emotional expression + experience (affective flattening)

what is schizotypal PD

pattern of eccentric ideas + magical thinking (believing thoughts are reality)

what are cluster B personality disorders overall + what are the 4 types

PDs characterised by impulsive/erratic or self-centred behaviours, emotions + thinking. includes:

• antisocial PD

• borderline PD

• narcissistic PD

• histrionic PD

what is antisocial PD

presents pattern of disregard for other’s rights, selfishness + lack of empathy. strong links to conduct disorders + criminality

what is borderline PD

also known as emotionally unstable PD in ICD → pattern of unstable relationships, mood + behaviour, with efforts to control emotion (often using maladaptive coping mechanisms e.g. drinking/self-harm) + avoid rejection, as it is thought of as incredibly distressing

what is narcissistic PD

presents as a pattern of overestimation of one’s own abilities + accomplishments, with a pervasive need for admiration while not caring about others

• fragility of self-esteem results in compensation + anger when not recognised for their ‘special’ nature

what is histrionic PD

presents with attention-seeking, dramatic behaviour → needing to be the centre of attention resulting in undue emotional expression + exaggerated presentation

what are cluster C personality disorders overall + what are the 3 types

PDs characterised by anxiety that is lifelong + not related to any specific trigger. includes:

• avoidant PD

• dependent PD

• obsessive-compulsive PD

what is avoidant PD

presents with pattern of social avoidance → includes feelings of inadequacy + sensitivity to others’ views of them

what is dependent PD

presents with a pattern of dependence on other’s care → submissive, clinging + seeking others approval/support in order to elicit care from others

what is OCPD

presents as excessive perfectionism, need for order, patterns + control

• often focus on completing a task results in forgetting the goal

is there much overlap across clusters + diagnoses

yes → it is rare for people to only meet 1 personality disorder criteria

• if having one diagnosis, someone with a PD is expected to meet 4.5 criteria on average, demonstrating a huge amount of comorbidity

is prevalence or incidence used when measuring epidemiology of PDs + what is its estimated rate

prevalence (tota number of existing cases), as most of the time PDs have no clear onset (so number of new cases cannot be determined)

• estimated rate = 10-15% for all PDs, with most common being borderline, schizotypal, antisocial + OC

in what 2 main ways are studies assessing prevalence of PDs often limited

depends on how thorough the assessment is:

• many studies use weak measures + overestimate prevalence based on these

• potential gender bias in diagnosis may misrepresent actual prevalence → women more likely to be diagnosed with B + C, men with A

what 7 conditions do PDs tend to be highly comorbid with

• depression

• substance misuse

• panic disorder

• PTSD → e.g. BPD often results from trauma

• social phobia

• eating disorders

• neurodiversity e.g. autism

what does the high rate of comorbidity between PDs potentially suggest

raises questions as to whether diagnostic categories are as separate as they are depicted in the DSM, e.g. BPD + DPD both contain intense fear of abandonment

what are the old + current viewpoints as to whether PDs are lifelong

• old view → they were considered untreatable + lifelong until around the age of 40 (typically fade after this time)

• current view → they are not lifelong, as a large number of cases are not diagnosable a few years later (as symptoms can be transient over time), and are also treatable in some cases

what is the psychosocial model of the aetiology of PDs

when considering specific personality disorders, both biological/neurological factors + environmental factors contribute to its onset

what are 4 biological/neurological factors underpinning cluster A PDs

• genetics

• enlarged ventricles

• enhanced startle response

• cognitive deficits → lack of link to specific PDs means there isn’t too much specificity as to which

what are 3 environmental factors underpinning cluster A PDs

• parental relationships → often due to trauma from caregivers

• rejection

• abuse

what are 4 biological/neurological factors underpinning APD

• childhood conduct disorder

• genetics

• low anxiety

• weak fear conditioning

what are 2 biological/neurological factors underpinning BPD

• genetics

• limbic system dysfunction

what is an environmental factor underpinning APD

modelling → some suggest modelling from harsh/inconsistent caregivers can contribute to experience driving an angry + impulsive schema development

what is an environmental factors underpinning BPD

trauma + emotional invalidation from close interpersonal relationships (e.g. caregivers, romantic relationships) → drives negative interpersonal schema development

what is an environmental factor underpinning NPD

potentially doting parents, though there is weaker evidence for this → may contribute to experience driving narcissistic schema development

what are 2 biological/neurological factors underpinning cluster C PDs

physiological predisposition to anxiety

• genetics may specifically contribute to avoidant PD

what is an environmental factor underpinning avoidant PD

negative childhood experiences → drives negative schema development about interpersonal relationships

what is an environmental factor underpinning DPD

fear of rejection from previous experience driving negative schema development

which personality disorder are treatments usually limited to

BPD, due to being the most common

give 5 examples of treatments for personality disorder + approaches they take

all evidence accumulated is for psychological interventions rather than neurological:

• CBT for personality disorders, based on Beck’s approach to depression

• schema therapy (Young; Arntz) → takes broader approach to understanding PDs by drawing on + integrating CBT, Bowlby’s theory of attachment + other forms of psychotherapy to understand how one’s schemas form from experience

• cognitive analytic therapy (Ryle) → integrates psychoanalysis into treatment lasting 16-20 sessions (though has limited evidence of efficacy)

• mentalisation-based treatment (Bateman + Fonagy) → teaches to improve awareness of mental states by enhancing capacity to understand how others + themselves feel (has some evidence of efficacy)

• structured clinical management (Bateman + Fonagy) → generalist approach similar to mentalisation-based treatment

what did Oud et al. (2018)’s meta-analysis on efficacy of specialist therapy for treating BPD find

using 20 studies (N = 1375), found a medium effect size of specialist therapeutic approaches on reducing BPD severity, with DBT also having a small-medium effect on self-injury

• overall moderate evidence that specialist psychotherapies are more beneficial than generalised approaches

which approach to BPD treatment has the best evidence + what is its approach

Schema therapy (Young, 1990) → an integrative model that includes cognitive, behavioural, gestalt, attachment theory + object relation approaches. believes we have 3 ways of changing schemas:

• behavioural

• experiential (feeling)

• cognitive (thinking)

what 3 techniques does schema therapy (Young, 1990) focus on

• therapeutic relationship (rapport with clinician)

• using mental imagery techniques to work through past life experiences + reattribute negative thoughts/feelings from them

• using chair-work in therapy

what did Taylor et al. (2017)’s meta-analysis on the efficacy of schema therapy confirm

schema change and disorder-specific symptom change was found in 11 of the 12 studies that were eligible → provides some evidence for efficacy in the treatment of PDs, but less so on other disorders

what did Arntz et al. (2022) assess the efficacy of + what were the results

assessed effectiveness of schema therapy in groups (PGST → twice-weekly sessions + limited individual therapy) + combined individual and group (IGST → weekly individual + group ST)

• found IGST had significantly reduced BPD trait scores after 3 years of treatment, with PGST yielding no significant effect

• large trial → better methodology

what did Crawford et al. (2026) assess the efficacy of + what were the results

brief psychological support for people with a probable personality disorder → took a brief 10-session approach

• treatment had no effect on social functioning, no evidence of cost-effectiveness + no difference in primary outcomes

• shows importance of longer therapeutic approaches → abrupt cut-off for treatment was highly unsuitable for people with PDs

what is an example of a BPD treatment with good evidence supporting it + what approach does it take

dialectical behavioural therapy (Linehan, 1993) → behaviourally-based programme (less focus on changing cognitions) that aims to manage impulsive behaviours + thought processes in BPD to aid emotional regulation

• contains elements of contingency management (what to do if a negative situation arises + how to cope adaptively), operant conditioning + mindfulness, often using suicidal ideation as a DV

• very resource-intensive → involves out-of-session contact with therapist if distressed to recap strategies

what does evidence from analysing efficacy of DBT suggest

it is an effective treatment of BPD + reduces suicide risk substantially → 75% of people no longer fit diagnostic criteria after one year

which approach has better efficacy → schema therapy or DBT

not sure yet → trial is ongoing (get fucked)

what factor is the stronger contributor to PD aetiology

causes are much more consistently about developmental experiences (e.g. trauma + emotional invalidation) than neurological factors

how does personality disorder differ from mental illness (Gask et al., 2013)

PD is more persistent throughout adult life, whether mental illness results from a morbid process + has more recognisable onset time/course

• remission more common in personality disorders + takes longer

what is the difference between the DSM-V + ICD-11 classification of personality disorders (Gask et al., 2013)

• DSM-V, while suggesting revisions, still uses a categorical approach

• ICD-11 proposes more dimensional approach using 4 levels of severity → personality difficulty, personality disorder, complex PD + severe PD, with description of 4 domains

what is the range of heritability between personality disorders (Gask et al., 2013)

between 30-60% → moderate heritability

what additional kind of therapy does Gask et al. (2013) propose as effective for BPD

transference-focused therapy → adaptation of psychodynamic psychotherapy, which describes contradictory internalised representation of self + others

• focuses on therapeutic relationship + involves integrating split-off aspects of the personality

what are recommended treatments for APD (Gask et al., 2013)

research is currently lacking, but current suggestions include treatments for any comorbid conditions as usual, with knowledge that patient is less likely to adhere to it/misuse drug treatments

• group-based cognitive + behavioural interventions that focus on reduction of offending + other antisocial behaviour