Personality Disorders

Personality Disorders are associated with risk

• high rates self-harm   * inc. self-harm by ingestion
• multiple suicide attempts
• 50% abuse drugs and/or alcohol
• unprotected sex
• violence
• increased risk of harm/attack
• poor compliance with medical recommendations
• poor self-care/self-neglect

What is personality disorder?

• Livesley, 2003 → ‘failure to achieve adaptive solutions to life tasks’
• The overall goal in treating personality disorder is to improve adaptations

Life tasks

• integrated representations of self and others
• capacity for intimacy
• capacity for affiliation
• adaptive social functioning   * prosocial behaviour   * cooperative relationships

Dimension or categorical

• APA (1994) → Personality traits are enduring patterns of perceiving, relating to, and thinking about the environment an oneself, that are exhibited in a wide range of social and personal contexts. Only when personality traits are inflexible and maladaptive and cause significant functional impairment or subjective distress do they constitute Personality Disorders
• PD are long lasting patterns, enduring since adolescence, and independent of social context
• PD is ego-syntonic
• The symptoms are often transient (i.e. eating disorders, psychosis, dissociative disorders)
• Personality shaped by innate (hereditary) temperament reacting to:   * parental style,   * cultural influences,   * social environment,   * intelligence,   * events [trauma]
• The P factor of general psychopathology → Refers to a general latent dimension that is derived from a wide range of items measuring adult psychiatric symptoms
• Resilience → Resilience can generally be defined as ‘the capacity of a dynamic system to withstand or recover from significant challenges that threaten its stability, viability, or development’   * it is a dynamic process that leads to successful individual adjustment in the face of adversity (Guillen et al, 2021)
• Epistemic Trust → an individual's willingness to consider new knowledge as trustworthy and relevant, and therefore worth integrating into their lives.   * In contrast, epistemic mistrust is characterised by inflexible thinking patterns and a difficulty to learn from the social environment

Prevalence

• 1 in 20 in the ^^general population^^
• 50 % ^^substance misusing^^
• 15-95% ^^mental health settings^^
• 35% ^^prison population^^ (maybe higher)
• high in ^^eating disorde^^r settings
• high in ^^trauma clinics^^
• different presentations different settings

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Biosocial Theory of BPD

• Cognitive Dysregulation → information processing problem solving
• Affective Dysregulation → Physiological arousal attention to emotion
• Behavioural dysregulation → direct response to emotion attempts to control emotions

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• Failure to label emotions accurately
• Ease of solving life’s problems
• Lack of skills to manage emotions

Histrionic Personality Disorder

• pattern of excessive emotionality and attention seeking
• $<em>feels invisible and alone</em>$

Narcissistic Personality Disorder

• pattern of grandiosity, need for admiration, lack empathy
• $<em>feels inferior</em>$

Antisocial (Dissocial) Personality Disorder

• pervasive disregard for and violation of the rights of others
• $<em>Finds it difficult to wait, quick to take offence</em>$

Avoidant Personality Disorder

• pattern of social inhibition, feelings of inadequacy, hypersensitivity to negative evaluation
• $<em>Extreme social anxiety, avoids conflict</em>$

Dependent Personality Disorder

• pattern of excessive need to be taken care of that leads to submissive behaviours and fears of separation
• $<em>Extreme generalized anxiety, fearful of making mistakes</em>$

Obsessive Compulsive (Anakastic) Personality Disorder

• pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control at the expense of flexibility, openness and efficiency
• $<em>Fears being out of control</em>$

Schizoid Personality Disorder

• detachment in relationships, restricted range of emotional expression in interpersonal situations
• $<em>Terror of interpersonal closeness</em>$

Schizotypal Personality Disorder

• a pattern of acute discomfort in close relationships and cognitive or perceptual distortions or eccentricities in behaviour
• $<em>Fearful of interpersonal closeness</em>$

Paranoid Personality Disorder

• pervasive distrust and suspiciousness of others who are regarded as malevolent
• $<em>fear of harm from others</em>$

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Types of Treatments

• Dialectical Behavioural Therapy
• Mentalization Based Therapy
• Cognitive Behaviour Therapy
• Schema Focussed cognitive Therapy
• Cognitive Analytic Therapy
• Transference Focussed Psychotherapy

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