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Flashcards in Task 8 Deck (58)
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1

Personality disorders

extreme level of a personality trait
o Stable and enduring pattern of thought feelings and behaviour, and are pervasive and inflexible across many aspects of one’s life
o Leading to distress and impairment
o Must have negative consequences on well-being of yourself or others

2

Origins of PDs

o Generally the same as for Personality traits
o Traumas (esp. borderline)

3

PDs as a general genetically trait-based construct

o Genes might predispose for PDs (Personality traits are .50 heritable so it suggested that PDs are too)
o Early-life epigenetic variability as a result of early-childhood adversity might account for differential gene expression
o Elements of PD change over lifetime

4

Stability and change

o Weak to moderate individual differences occur between 3 yrs till 18
 No real scientific validation (just assumed based on normal personality traits)
o Highest stability is reached with 30
o Odd or avoidant PDs tend to increase over time
o Features of personality disorder peak at about age 13-14 years and reduce monotonically from age 14 to 28
 Due to decrease in impulsivity, attention seeking and dependency

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´DSM-5 Model

Hybrid model

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Schizoid (DSM-5)

 Extreme degree of detachment from social relationships (isolation) and a very limited expression of emotions in interpersonal settings (emotional detachment)
 They prefer to be alone but even when they are they feel little joy or pleasure

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Schizotypal

 Also detachment form social relationships, but they experience extreme discomfort in such relationships
 They are considered as eccentric and have a tendency to perceive personal meanings in everyday events or objects
 Tend to be highly superstitious or fascinated with the paranormal
 Considered to be extremely odd, peculiar, or eccentric

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Paranoid

 Have an especially strong suspiciousness of others motives, and a sense of being persecuted
 They are quick to take offense or to feel insulted, even in response to innocent actions

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Antisocial

 A tendency to disregard, lying, and to violate the rights of others
 The don’t feel guilt for their actions
 Tend to be aggressive, irresponsible and impulsive and reckless
 Cognitive therapy is most successful

10

Borderline

 Has intense and unstable love/hate relationships with others
 Paired with impulsive behaviours such as drug abuse, eating binges or sexual escapades, often self-harming behaviour
 Tends to be extremely moody and temperamental, has little sense of personal identity or of meaning in life

11

Histrionic

 Exaggerated display of emotions and excessive attention seeking (need to be centre of attention)
 Use physical appearance to draw attention, and have seductive, sexually provocative style
 They tend to be suggestible or easily influenced by other, consider causal relationships as much closer as in reality

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Narcissistic

 Tendency to consider oneself as superior individual who deserves the admiration of others and a selfish lack of concern for others
 Tends to fantasise about having high status and to envy those who are highly successful

13

Avoidant

 Defined by social inhibition and shyness, by feelings of inadequacy and by oversensitivity to possible negative evaluation
 Are unwilling to participate in socially unless certain of being liked
 Low self-esteem along with an extreme sensitivity to embarrassment, criticism and rejection
 The avoidant persons wants social contact but is afraid of rejection

14

Dependent

 Characterized by an excessive need to be taken care of and by submissive, clinging behaviour and fears of separation.
 Need reinsurance for everyday life decisions and feel unable to take care of themselves when alone
 Try to gain support by doing unpleasant things voluntarily or by avoiding expression of disagreement

15

Obsessive compulsive

 Involves preoccupation with orderliness, perfection and control
 Tends to put work ahead of social relationships and to be highly stubborn and inflexible
 Tendency to hoard money and objects unnecessarily
 No repeated behaviour such as handwashing (that is the difference to obsessive compulsive disorder so the PD version)

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Cluster A

odd and eccentric
schizoid, schizotypal and paranoid PD
• Least adaptive and treatable

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Cluster B

Dramatic and erratic
antisocial, borderline, histrionic and narcissistic PD
• Major social adaption difficulties and variable treatability

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Cluster C

anxious fearful
avoidant, dependent and obsessive-compulsive PD

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Problems with DSM-5

 Symptoms of a given disorder do not necessarily go together
• Some symptoms are just about unrelated to each other
• Two persons with the same disorder can have completely different symptoms
 Two disorders may have overlapping symptoms and tend to be diagnosed together
• Comorbidity: joint occurrence of two or more disorder at the same time
• Caused by the fact that some symptoms tend to co-occur despite being listed in different personality disorders
 Clusters of disorder do not match factor analysis results:
 A personality disorder should be seen as a continuum not as a category
• Should not be seen in all or nothing fashion, but as spectrum where you can score high or low on
 Doesn’t consider the development over lifetime

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Dimensional system in DSM-5

divided in those involving self and those that are involving interpersonal impairment

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Identity problems (A DSM-5)

o Does not have a sense of themselves as unique persons or identifies to much or to little (independence) with some other persons
o Highly unstable self-esteem, threated easily by negative experiences, distorted appraisal of own strengths and weaknesses
o Might be unable to regulate and/or recognizes one owns emotions

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Self-direction problems (A DSM-5)

o Might not be able to set realistic or meaningful goals in his or her life
o Lack of internal standards for behaving prosocially
o Might be unable to reflect constructively on his or her own experiences

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Empathy problems (A DSM-5)

o Might be unable to understand experiences or motivations of others
o Might be unable to understand or unwilling to see others perspective
o Might have little understanding how her/his actions affect others

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Intimacy problems

o Lacking in positive sustained relationships
o Unable to engage in close caring relationships
o Might be unable/unwilling to cooperate

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Diagnosing with alternative system of DSM-5

 Structured interview with the client and relatives, might observe behaviour
 Than clinician rates every domain on an 4 point scale
 Impairments have to be stable over time
 Age/culture differences have to be respected
 No effect of substances has to be insured

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ICD 11

No categories
 Negative affective feature: describes the extent to how strong a person reacts negatively (e.g. anxiety) to a relatively minor stressor
 Dissocial factors:
• disregard for social obligations and the rights and feelings of others
• manifested in an overly positive view of the self and a tendency to be manipulative and exploitative of others
 Features of disinhibition: tendency to act impulsively, no long-term effect consideration, as well as irresponsibility and recklessness
 Anankastic features: concerned with controlling behaviour of self and others to conform ones own ideal
• Perfectionism, preservation, orderliness, stubbornness
 Features of detachment: Emotional and interpersonal distance, marked in social withdraw
• Coldness in relation to other people and reduced experience and expression of (mostly positive) emotions

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PD criterion in ICD 11

 A pervasive disturbance in how an individual experiences and thinks about the self, others, and the world, manifested in maladaptive patterns of cognition, emotional experience, emotional expression, and behaviour
 The maladaptive patterns are relatively inflexible and are associated with significant problems in psychosocial functioning that are particularly evident in interpersonal relationships
 The disturbance is manifest across a range of personal and social situations (ie, is not limited to specific relationships or situations)
 The disturbance is relatively stable over time and is of long duration. Most commonly, personality disorder has its first manifestations in childhood and is clearly evident in adolescence

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Mild personality disorder ICD 11

 There are notable problems in many interpersonal relationships and the performance of expected occupational and social roles, but some relationships are maintained and/or some roles carried out
 Mild personality disorder is typically not associated with substantial harm to self or others

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Moderate personality disorder ICD 11

 There are marked problems in most interpersonal relationships and in the performance of expected occupational and social roles across a wide range of situations that are sufficiently extensive that most are compromised to some degree
 Moderate personality disorder often is associated with a past history and future expectation of harm to self or others, but not to a degree that causes long-term damage or has endangered life

30

Severe personality disorder ICD 11

 There are severe problems in interpersonal functioning affecting all areas of life. The individual’s general social dysfunction is profound and the ability and/or willingness to perform expected occupational and social roles is absent or severely compromised
 Severe personality disorder usually is associated with a past history and future expectation of severe harm to self or others that has caused long-term damage or has endangered life