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.