PKG_Krause_2024_Handout
Page 1: Introduction
Topics Covered:
Personality Disorders
Dissociative Disorders
Overview by Annegret Krause-Utz, Clinical Psychology, LUG DUNO, Universiteit Leiden
Page 2: Agenda
Personality Disorders:
Categorical and Dimensional Models
Example: Borderline Personality Disorder (BPD)
Development and Treatment
Dissociative Disorders:
Definitions and Classifications
Development, Models, and Treatment
Page 3: Understanding BPD
Key Concept: Live with BPD, but do not be defined by it.
Encouragement:
Celebrate your uniqueness.
Recognize both good and bad days, embrace emotions as part of life.
Transform negative self-labels into positive affirmations.
Page 4: Concept of Personality
Definition: Personality refers to enduring traits that differentiate individuals.
Traits Listed:
Insecurity, emotional lability, perfectionism, shamefulness, etc.
Relation to Big Five Personality Traits:
Low/High Scores: Neuroticism, Extraversion, Openness, Agreeableness, Conscientiousness
Page 5: Characteristics of Personality Disorders
Understanding:
Stable and pervasive patterns affecting perception, relating, and behavior.
Onset typically in adolescence or early adulthood.
Cultural deviations leading to distress.
Page 6: Personality Disorders Classification
**Clusters:
Cluster A: Odd/Eccentric**
Paranoid, Schizoid, Schizotypal Personality Disorders
Cluster B: Emotional/Dramatic
Antisocial, Histrionic, Borderline, Narcissistic
Cluster C: Anxious/Fearful
Avoidant, Dependent, Obsessive-Compulsive
Page 7: Details on Cluster A
Paranoid Personality Disorder: Suspected pervasive mistrust.
Schizoid Personality Disorder: Reduced interest in interpersonal relationships.
Schizotypal Personality Disorder: Mix of social discomfort, paranoia, and sudden episode symptoms.
Page 8: Details on Cluster B
Antisocial Personality Disorder: Disregard for rights with harmful actions.
Histrionic Personality Disorder: Excessive emotionality; attention-seeking.
Borderline Personality Disorder: Impulsivity and emotional instability.
Narcissistic Personality Disorder: Grandiosity with a lack of empathy.
Page 9: Details on Cluster C
Avoidant Personality Disorder: Extreme social anxiety; fear of criticism.
Dependent Personality Disorder: Reliance on others for emotional needs.
Obsessive-Compulsive Personality Disorder: Focus on perfectionism and control.
Page 10: Dimensional Model of Personality Disorders
Levels of Severity:
0: No Personality Disorder
1: Personality Difficulty
2: Simple Personality Disorder
3: Complex Personality Disorder
4: Severe Personality Disorder
Page 11: ICD-11 Dimensional Model
Focus on Personal Functioning:
Identity and self aspects, interpersonal function, emotional manifestations.
Page 12: Diagnosis of BPD
Former Criteria:
Fear of abandonment, unstable relationships, impulsivity, mood swings, etc.
Page 13: Overview Reevaluation
Review of Agenda Covered for Clarity in Understanding.
Page 14: Etiology of Personality Disorders
Factors:
Genetic predispositions, environmental influences, emotional dysregulation, and negative beliefs.
Page 15: Odds Ratios Following Adverse Childhood Experiences (ACES)
Link Between ACES and Various Disorders:
PTSD, personality disorders, depression, somatic disorders, etc.
Page 16: Brain Development Phases
Sensitive Periods for Brain Development:
Impact of ACEs throughout different life stages, listing MRI volume studies.
Page 17: Effect of ACE on Brain Development
Specific Effects:
DEvelopmental timing and type of ACE influence brain structure and function.
Page 18: Theoretical Perspectives
Stern and Linehan's views:
Combination of biological irregularities and dysfunctional environments contribute to BPD development.
Page 19: Understanding Needs and Responses
Need vs. Response Mismatch:
High processing sensitivity, neurodiversity considerations.
Page 20: Maladaptive Schemas in Self-Perception
Fragmented Self-View:
Negative beliefs about self and mistrust, fear of abandonment, and feelings of defectiveness.
Page 21: Social Withdrawal
Rejection Sensitivity and Its Impact:
Influence of early life experiences on social interactions and maladaptive beliefs.
Page 22: Impulsivity and Suspiciousness
Consequences of Maltreatment:
Development of aggressive behaviors and mistrust based on past experiences.
Page 23: Affect Regulation Problems
Characteristics:
Intense emotions, impulsive actions, and maladaptive strategies.
Page 24: Self-Harm in BPD
Motives for Self-Harm:
Stress reduction, emotional numbing, and regaining a sense of control.
Page 25: Emotion Dysregulation
Summary of Emotional Challenges:
Overwhelming emotions, difficulty focusing attention, and ineffective regulation strategies.
Page 26: Dissociation in Psychiatric Disorders
Meta-Analysis Overview:
Presented data on the prevalence and treatment of dissociative experiences.
Page 27: Common Treatment Goals
Key Goals Include:
Identifying triggers for maladaptive behaviors, enhancing emotion regulation, improving self-esteem.
Page 28: Effective Therapies for BPD
Therapies with Evidence Based Ratings:
DBT, MBT, SFT, TFP, STEPPS and their efficacy regarding treatment of BPD.
Page 29: Reevaluation of Agenda
Confirmation of agenda areas for effective coverage of personality/disorder treatment.
Page 30: Definition of Dissociation
Dissociation Explored:
Disruption in integration of psychological functioning sectors affecting behavior and memory.
Page 31: Continuum of Dissociation
Prevalence among Populations:
Ranges from benign lapses to clinical phenomena affecting general and psychiatric populations.
Page 32: Classification by ICD-11 and DSM-5
Major dissociative disorders listed, including types of depersonalization and amnesia.
Page 33: Symptom Domains of Dissociation
Disruption Patterns:
Memory gaps, derealization, identity distortion descriptions.
Page 34: (Dissociative) Absorption
Description:
Immersive experiences leading to disengagement from immediate surroundings.
Page 35: Maladaptive Daydreaming
Outcome Definitions:
Excessive fantasizing linked to distress and impairment.
Page 36: Normal Detachment Forms
Understanding Everyday Experiences of Detachment.
Page 37: Experiences of Depersonalization/Derealization
Exemplified Experiences:
Descriptions of feeling detached from oneself or one's environment.
Page 38: Distinctions in Experiences
Detailed Understanding of Reality Testing:
Experiences are real but may feel different/strange under duress.
Page 39: Dissociative Flashbacks
Characteristics:
Unwanted intrusions that can occur post-trauma,
Recurring sensory or cognitive disruptions.
Page 40: Dissociative Amnesia Explained
Core Aspects:
Temporary memory loss, distinct from substance/organic causes.
Page 41: Dissociative Identity Disorder
Defining Presence of Multiple Identities:
Amnesia comprehension and personality state variations.
Page 42: Signs and Symptoms of Dissociative Identity Disorder
Indicators of DID:
Sudden shifts in behaviors, appearance, and self-awareness challenges.
Page 43: Conclusion on Dissociation vs. Psychosis
Differentiation and Similarities:
Reality testing and cognitive functioning differences in symptoms.
Page 44: Etiology of Dissociation
Understanding Causative Factors:
Roles of trauma, social-cognitive factors, and neurobiological predispositions.
Page 45: ACES and Trauma Relationships
Impact of Childhood Experiences on Development of Dissociative Disorders.
Page 46: Association with Abuse
Highlight of Interconnected Findings from meta-analysis studies.
Page 47: Developmental Trauma Model
Alteration Across Different Dysregulations Post Traumatization:
Emotional, behavioral, and relational impacts examined.
Page 48: Psychological Factors in Intimate Partner Violence
Study exploring psychological factors linked to interpersonal violence and maltreatment.
Page 49: Study on Childhood Trauma
Risk Factors Discussed:
Higher trauma exposure, dissociation phenomena, and maladaptive coping methods.
Page 50: Socio-Cognitive Models
Analysis of how trauma and dissociation interact within various contexts.
Page 51: Risk Factors for Dissociation
Various factors, including fantasy tendencies and sleep variations, affecting dissociative states.
Page 52: Coping Mechanisms with Dissociation
Negative Impact of Poor Coping Responses:
Association between severity of dissociation and emotional regulation challenges.
Page 53: Neuropsychological Functioning Studies
Mixed Results on Executive Function Deficits:
Explore findings around memory and integration during acute dissociative episodes.
Page 54: Emotional Learning in BPD
Findings on amygdala activity during emotional working memory tasks in dissociative patients.
Page 55: Neurobiological Studies Overview
Influences of Various Brain Areas:
Enhanced activity indicators for pathological dissociation across conditions.
Page 56: Take Home Messages on Dissociation
Key teachings on dissociation such as state vs trait distinctions, and risk factors.
Page 57: Treatment Considerations for Dissociative Disorders
Fundamentals of Individual Psychotherapy:
Integrative methodologies and therapeutic relationships outlined.
Page 58: Guidelines for Treatment
Importance of collaborative, transparent diagnostic processes, especially with traumatic histories.
Page 59: Structured Interviews for Dissociative Disorders
Comprehensive means for accurate diagnosis, including SCID-D assessments highlighted.
Page 60: Factitious Dissociative Disorder Indicators
Potential Red Flags:
Presents contrasting symptoms that necessitate careful evaluation.
Page 61: Goals of Treatment for Dissociation
Establish support frameworks for reconnection and identification of triggers and symptoms.
Page 62: Thematic Analysis in BPD
Representation of prevalent themes from personal narratives of those with BPD.
Page 63: Short-term vs Long-term Effects on Patients
Comparison of perceived benefits and drawbacks results between immediate and subsequent impacts of dissociation.
Page 64: Techniques to Assist with Acute Dissociative States
Activities and interventions aimed at promoting grounding and agency within dissociative episodes.
Page 65: Monitoring Dissociative Functions
Summary of Daily Assessment and Monitoring Tools:
Methods for continued mental health evaluation during treatment.
Page 66: Anti-Dissociation Skills
Defining skills aimed to counter dissociative tendencies in individuals.
Page 67: Trauma-focused Treatment
Summary of effective techniques such as EMDR and CBT for individuals with dissociation.
Page 68: Common Schema Modes in Dissociation
Presentation of schema modes and their role in therapy for emotional integration.
Page 69: Treatment Take Home Messages
Holistic treatment approaches should emphasize flexibility, transparency, and patient engagement.
Page 70: Contributors to Seminar
List of researchers and contributors from associated institutes.
Page 71: Contact Information
For Further Questions:
Contact: a.d.krause@fsw.leidenuniv.nl
Credentials and affiliations of Annegret Krause-Utz, including relevant qualifications.