personality disorders
- Characterized by rigid, inflexible thoughts, feelings, actions and impulse regulation.
- Originates in early development
- Present since late adolescence/early adulthood
- Dysfunctional - Sometimes only experienced by others
- Part of our character/who we are - egosyntone
egosyntone
Consistent with self-image, aligns with goals, values and self-view. Seen as ”normal”, cannot imagine otherwise
egodystone
Not consistent with self-image or part of the self. Causes conflict and distress
what are normal personality and traits
- habitual ways of thinking, feeling and acting
- consistent across sitiuations
- mostly stable across time
which 2 big 5 traits decrease as ppl age
extraversion and openness
-* conscientiousness also but less*
why does our personality change as we age
- biological matturation
- envioronmental influences
- increased responsibility
- corrective experiences like feedback from the envioronment (conditioning)
how to distinguish PDs from other pathologies
PDs are
- presistent
- pervasive
- problematic
prevalence of min 1 PD
general population 9 - 13%
out patient - 30 - 50%
inpatient care - 50 - 70 %
higghest in prison samples
what is the life expectancy of PD
18 years shorter than average
higherst risk before 44
childhood taruma
emotioanl abuse is an importaint predictor
specific corelations
BPD - corelated with sexual, physical abuse and emotioanl neglect
antisocial is correlated with physical abuse
cluster c is corelated with emotional abuse
is pharmacotherapy useful for treatmnet of PDs
NO
treatment of OCPD
no widely accepted empiricaly based treatment
T/F
OCPD is one of the most prevalent PDs
OCPD is one os the most impairing PDs
its more common in men
there is a significant overlap between OCD, OCPD and HD
T
F
F
T - perfectionism
according to freud the obbsesive personality type is stuck in which phase
anal
OCPD is related to high or low parental care and higl or low parental overprotection
low care high overprotection
what are the differences between OCD and OCPD
OCD
- focal obsessions and irrationaly relared compulsions
- ego dystoninc/distressing
- inshight that the symptoms are irrational
- seeks help becasue symproms are bothersome
- low capacity to delay reward
OCPD
- pervasive patterns of obsessional thoughts and behaviors
- not distressed/ ego-syntonic
- little insight,
- seeks help becasue of secondary symptoms
- greater capacity to delay reward
what are the 2 opposing views of the difference of AVPD and SAD
- AVPD and SAD are different becasue one is a personality disorder and the other is a symptom disorder
- AVPD is on a spectrum of severity between SAD and AVPD on the more severe end
what is the optimal diagnostic criterion for AVPD
avoidance of occupational activitivities that involve significant interpersonal contact for fear of criticism, disapproval or rejection
bological case conceptualisation of APD
mix of biological and environmental factors
- overreactive symapthetic nervous system and low treshold for automomic arousal
- parental oand or peer group rejection
interpersonal case conceptualisation of APD
relentless parental control aimed at creating a social image leads to humiliation and emberasment over visible flaws
cognitive case conceptualisation of APD
maldaptive schemas about the self and others
core belief of rejection
integrative case conceptualisation of APD
biology - hyperirritable, fearful… overreactive symapthetic nervous system
psychology - unjust worldviews, self views - i am inadequate and scared of being rejected
socially - parental ridicule and rejection
Treatment guidelines
- Specialized Psychotherapy (e.g., DBT or ST)
* Determine what should be treated first in case of comorbidity
* Additional treatment can be effective (e.g., PTSD, phobias)
* Integrated treatment for syndrome disorders - Social psychiatric treatment (if first choice is not possible, lack of motivation)
- Pharmacotherapy is not useful for treatment personality disorders, only dampens symptoms
* Possible for comorbid disorder or specific symptoms
* For support psychotherapy, but should not interfere (too much sedation)
* Prevent polypharmacy
Assessment
- Usually the SCID – 5 is used for assessment
- Diagnosis based on clinical expertise has low reliability
- Stereotypes
- Premature closure
- Confirmation bias - Interviews force disconfirmation
