What is a personality disorder?
- An enduring pattern of inner experience and behavior that
1. deviates markedly from the expectations of the individuals culture,
2. is pervasive and inflexible,
3. has an onset in adolescence or early adulthood,
4. is stable over time,
5. and leads to distress or impairment
Why are personality disorders categorical?
Personality disorders are separate and distinct from each other
Why are personality traits dimensional?
Personality trait continuum from normal to maladaptive
What disorders are in cluster A of personality disorders?
Paranoid, schizoid. schizotypal
What disorders are in cluster B of personality disorders?
Antisocial, Borderline, Histrionic, and Narcissistic
What disorders are in cluster C of personality disorders?
Avoidant, Dependent, Obsessive-compulsive
What is a paranoid personality disorder?
Pattern of distrust and suspicion. Others’ motives are interpreted as malevolent
What are the diagnostic criteria for paranoid personality disorder?
At least four out of the following:
- suspects that others are exploiting, deceiving or harming them
- Preoccupied with unjustified doubts about the trustworthiness of friends
- Reluctant to confide in others
- Reads hidden/threatening meaning into normal things
- Persistently bears grudges
- Perceives attacks on their character and is quick to counter attack
- Has recurrent suspicions without justification
What is borderline personality disorder?
Pattern of instability in interpersonal relationships, self-image, and affects, and marked impulsivity.
What is dependent personality disorder?
Pattern of submissive and clinging behaviour related to excessive need to be taken care of
Why have personality disorders got to be present in under 18’s for at least a year before diagnosis?
Under 18 patterns must be present for at least a year before diagnosis. Don’t want to stigmatize with a long term diagnosis - Adolescence is a turbulent time where personality is still developing
who coined the big five personality model?
Shiner and Tackett, 2014
What are big five personality categories?
Neuroticism, Extraversion, Agreeableness, Conscientiousness, Intellect
How does disorganized attachment influence our personality?
Participants diagnosed with BPD were 8x more likely to have a disorganized attachment style (Khoury et al., 2019)
What are the methodological issues with diagnosing personality disorders?
In assessing adolescents it is essential for clinicians to assess for personality pathology. Consider the possibility not just in patients that have prototypical obvious features of PD
Why do we aim to diagnose personality disorders so young?
Because if someone young has a personality disorder then evidence shows this will transfer to adulthood and can cause considerable impairment. Personality disorders can be easily treated if caught young with personality change intervention.
what are the principals for addressing a PD?
- Avoid unwarranted assumptions about manifestations or causes of PDs. e.g. abuse/neglect associated, but should not assume as does not hold true for not all cases. Assess for this separately
- Evaluate personality pathology comprehensively to ascertain the possible presence of more than one PD diagnosis
- Consider PD-NOS. Patient has general features but does not meet specific criteria for one PD
- Determine if traits/behaviours are impairing pathological patterns versus normative manifestations of adolescence
- Be attentive to acute symptoms and underlying personality patterns. Newer models suggest current stress contributes to acute symptoms
- Gather information from adolescents and others that know them well
- Assess personality strength as well as difficulty. Most troubled youth have areas of strength as well as difficulty
Name two assessment instruments for personality disorders and who administers them.
- Coolidge personality and neuropsychological inventory for children (CPNI, 1998). Parent informs, 5-17yrs
- Dimensional personality symptom item pool (DIPSI, 2006). Adolescent 11-17yrs or parent 5-17yrs
- Schedule for nonadaptive and adaptive personality – youth version (SNAP-Y, 2003). Adolescent or parent 12-18
What is the modified adult treatment for personality disorders?
- Dialectical behavior therapy (A mix of CBT & Zen mindfulness practices).
- Mindful meditations
- Social skills training
- Self-awareness focused understanding past on present behavior
- Unconscious processes focus in present behavior
Who provided evidence for mentalization based treatment for PD?
Beck et al., 2020
What did Beck et al., 2020 find out about mentalization based treatment for PD?
No differences between the control group and treatment group.
