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

Biosocial Theory of BPD

Amygdala: processes emotions

  • Cognitive Dysregulation → information processing problem solving

  • Affective Dysregulation → Physiological arousal attention to emotion

  • Behavioural dysregulation → direct response to emotion attempts to control emotions

  • 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
  • feels invisible and alone

Narcissistic Personality Disorder

  • pattern of grandiosity, need for admiration, lack empathy
  • feels inferior

Antisocial (Dissocial) Personality Disorder

  • pervasive disregard for and violation of the rights of others
  • Finds it difficult to wait, quick to take offence

Avoidant Personality Disorder

  • pattern of social inhibition, feelings of inadequacy, hypersensitivity to negative evaluation
  • Extreme social anxiety, avoids conflict

Dependent Personality Disorder

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

Obsessive Compulsive (Anakastic) Personality Disorder

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

Schizoid Personality Disorder

  • detachment in relationships, restricted range of emotional expression in interpersonal situations
  • Terror of interpersonal closeness

Schizotypal Personality Disorder

  • a pattern of acute discomfort in close relationships and cognitive or perceptual distortions or eccentricities in behaviour
  • Fearful of interpersonal closeness

Paranoid Personality Disorder

  • pervasive distrust and suspiciousness of others who are regarded as malevolent
  • fear of harm from others

Types of Treatments

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