4A. Personality Disorders

What are Axis II personality disorders?

enduring pattern of inner experience and behaviour that: deviate from cultural expectations, are pervasive and inflexible, cause distress or impairment, not due to another disorder, drugs or intoxication

What are separate axis for?

to increase clinical research or attention, categorisation and understanding have been unrelated to empirical personality theories

What does cluster A involve?

'odd or eccentric' disorders including paranoid, schizoid, schizotypal personality disorders

What does cluster B involve?

'dramatic, emotional or erratic' disorders including antisocial, borderline, histrionic and narcissistic personality disorders

What does cluster C involve?

'anxious or fearful' disorders including avoidance, dependent, obsessive-compulsive personality disorders

What did Lofti et al (2018) find about diagnostic groups?

highly questionable validity and utility of diagnostic groups

What is paranoid personality disorder in cluster A?

paranoia, mistrust of others, has irrational suspicions - preoccupied with doubts, reluctance to confide, misinterprets innocent remarks and holds grudges against people

What is schizoid PD in cluster A?

detachment from interpersonal relationships, emotional coldness, indifference to praise/criticism of others - has few friends, chooses solitary activities

What is schizotypal PD in cluster A?

distortions in thinking, feelings and perceptions e/g magical thinking, perceptual illusions - discomfort in social situations, suspicions and paranoia

What is antisocial PD in cluster B?

lack of empathy and remorse, disregard for others - failure to conform to norms/laws, impulsivity, deceitfulness, irresponsibility, and disregard to safety of others

What is histrionic PD in cluster B?

excessive need for approval, need to be centre of attention - shallow/over dramatic emotions, sees relationships as more intimate then they are

What is narcissistic PD in cluster B?

inflated self importance and sense of entitlement, belief they are special, seeks attention and admiration from others - fantasises of success; arrogance; envy of others; low in empathy

What is borderline (emotionally unstable) PD in cluster B?

unstable interpersonal relationships, frantic attempts to avoid real/imagined abandonment; lack of well-formed identity, feelings of worthlessness, instability of feelings - frequent suicidal, self-harming, self-mutilating behaviours, impulsivity in self damaging behaviours

What are examples of sensationalised media portrayal?

Glenn Close in 'Fatal Attraction' and Winona Ryder in 'Girl Interrupted'

What is avoidant PD in cluster C?

social inhibition, avoids and withdraws from social situations - low self worth, fear rejection, disapproval and criticism, feel socially inept, reluctant to engage in new things for fear of embarrassment

What is dependent PD in cluster C?

persistent psychological dependence on others; lack confidence in ability to take responsibility, has difficulty doing things alone - tend to agree with others, seeks out new relationships

What is obsessive-compulsive PD in cluster C?

preoccupation with orderliness, rules, moral codes, caution and perfectionism, excessive devoted work, inflexibly and overly conscientious

What is the continuity hypothesis?

there is not discontinuity between normality and illness

Describe the meta analysis on the level of correspondence between personality disorders and the big 5 traits (Saulsman & Page, 2004)

each disorder has some correlation with one or more personality traits, the three cluster A disorders are all associated with low levels of extraversion which fits with clinical profile of symptoms, magnitude of these correlations is not huge especially for some disorders (obsessive compulsive PD strongest relationship is .23), suggests we need to look a little more finely then this trait level description

What are conceptual profiles?

profiles that describe how strong each facet or trait will be expected to correlate with each personality disorder on the base of the diagnostic criteria

When are high (>70%) or low scores (<30%) assigned in conceptual profiles?

for any facets that were directly related to diagnostic criteria for a personality disorder

When are moderate scores (40-60%) assigned in conceptual profiles?

for facets that related to associated features of each disorder and then any less related facet gave even more moderate scores (50%)

What did McCrae et al (2001) find about conceptual profiles usefulness?

profiles may indicate risk (but not diagnosis) of PD. May be useful for ruling out a PD, or characterising a known PD

Describe McCrae et al. (2001) study on testing the big 5 approach?

1926 patients from psychiatric hospitals (personality disorder interview, PD questionnaire, NEO-PI-R) and calculated profile agreement scores for each patient. found significant correlations but only modest to moderate so potential need to revise the current diagnostic classification system for personality disorders

What are limitations of the DSM 5 classification of personality disorders?

extensive comorbidity, low temporal/inter-assessor reliability, not based on empirical personality models

What are the suggestions for DSM 5?

dimension rather than categorical approach (1) assess personality facet profile (NEO-PI-R) (2) assess personality related social/occupational impairments and distress (3) if dysfunctional & distress clinically significant - diagnose PD (4) determine if profile matches with PD category descriptor

What does DSM Section III involve?

emerging measures and models, criterion A (severity) and criterion B (style)

What is dissociative identity disorder (DID)?

A mental disorder defined by the presence of two or more distinct identities or personalities. involves: amnesia for prior/recent events, cause distress and/or functional impairment, not due to e/g/ substance abuse

What are examples of the dissociative disorders in the DSM-5?

dissociative identity disorder, dissociative amnesia, depersonalisation/ derealisation disorder, other specified/ unspecified dissociative disorder

What did Haslam (2007) find that were typical features of dissociative disorders?

primary 'host' personality plus one or more alters, alters take turns to control behaviour, distinctive patterns of thinking and behaving, different names, ages, genders, memory loss for experience as others alters

What are features and observations (Haslam, 2007)?

reports of severe childhood sexual/physical abuse is common, patients high in suggestibility, clustering of cases (geographically, by therapist), increase in cases (1980: <200, now: 10s of thousands), reports becoming more extreme (more extreme abuse)

What is the post-traumatic model of DID?

primitive response to trauma: dissociation of consciousness to escape initial trauma, dissociation becomes response mechanism for future stress. suggestibility pre-disposes to dissociation

What is the socio-cognitive model of DID?

symptoms emerge as a product of therapy: hypnosis and leading questions cause patient to reinterpret experiences, mood swings expressed as multiple personalities, a culture bound phenomenon. suggestibility increases susceptibility - accounts for clustering of cases and rise in prevalence and severity

What were the conclusions of dissociative identity disorder?

debates remain around: the cause of the disorder, its validity as a scientific concept