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PSYB32 - Lecture 09 Notes.docx

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Konstantine Zakzanis

PSYB32 – Lecture 09 WebOption – Summer 2013 (Chapter 13: Personality Disorders) + (Chapter 12: Substance-related Disorders) Chapter 13: Personality Disorders ** I’ll be using PD instead of typing out Personality Disorders all the time  When reading about Personality Disorders, it’s really easy to self-diagnose because we’re talking about traits that are common to all of us  However, it’s not until they cause distress and disability that they become a concern Slide 3 – Personality Disorders  Textbook states that they’re a heterogeneous group of disorders, but that’s a little contradictory since there is overlap between the different PDs o There’s some degree of comorbidity, so if you have one personality disorder there’s a chance that you may also have another  They are longstanding, pervasive, and inflexible patterns of behaviour and inner experience o Meaning that they are very difficult to treat o Even more so than Axis I disorders (Personality disorders are on Axis II)  First time we’re talking about Axis II disorders  They deviate from the expectations of a person’s culture o So their level of “abnormality” depends on what culture the patient is in o For example, in some parts of the world Avoidant PD may be viewed as completely normal Slide 4 – Personality Disorder Clusters  PDs are extremes of several traits that we all have  May develop in early adulthood/teen years, but interestingly they begin to disappear in the late stages of life, rather than worsen o One reason is that the acute symptoms begin to fade at this stage o ie the suicidal tendencies of a person with Borderline personality disorder will dissipate with age  One of the main reasons why people with PDs don’t seek treatment for PDs is because they’re ego dystonic o They’re unaware of the fact that they have a PD o So even though they may be distressed or disabled, they don’t recognize that it’s due to an impairment of their personality  PDs tend to be diagnosed by clusters (listed on slide) Slide 5 – Assessment and Diagnosis  Diagnostic issues to be aware of when it comes to PDS:  Test-retest reliability o The Personality Disorders that are most reliably diagnosed (most easily identifiable by diagnosticians) are Narcissistic PD and Avoidant PD. It’s easy to know when someone has these, hard to miss o The PDs with the worst reliability (multiple clinicians looking at the same patient are least likely to come to a consensus on what they have) are Dependent PD and Obsessive-Compulsive PD  Because in Dependent PD, the person often looks depressed and may be misdiagnosed as depression, and OCD because it appears like an anxiety disorder o Antisocial PD is the most stable – once a criminal always a criminal. Hard to rehabilitate these individuals o Schizotypal PD is the least stable – it can easily evolve into a fullblown psychotic state such as Schizophrenia, so a person rarely has Schizotypal PD for very long. Also, Dependent PD is quite unstable Slide 6 – Odd/Eccentric Cluster (Cluster A) Disorders Paranoid Personality Disorder (PPD)  One of the more common PDs  People who expect to be mistreated, exploited by others, and therefore they’re very secretive, on the lookout for possible signs of trickery or abuse, may often misread or misinterpret the simplest things, and they’re extremely jealous  Most often diagnosed in men; comorbid with Schizotypal PD, Borderline PD, and Avoidant PD Schizoid Personality Disorder  Does not desire or enjoy social relationships  This person is dull, bland, aloof (don’t display many emotions), but they also don’t experience strong emotions, for ex they’ll often report never having felt very very happy  They have no interest in sex, are often anhedonic (don’t find pleasure in pleasurable things), are indifferent to praise, and described as loners  Prevalence of 1%, more common in men, typically comorbid with Schizotypal, Avoidant and Paranoid PDs Schizotypal Personality Disorder  Patients with this have the characteristic signs of Schizoid PD, but also eccentric types of thoughts described as odd beliefs or magical thinking o For ex if you’re in a room with them they’ll say something like “it feels like there’s a dead person in here with us”  Keep in mind that this isn’t a hallucination because they don’t claim to SEE a dead person o Will also have the flat affect of a person with schizoid PD o Also believe that they can read the thoughts of others  Described by psychologists as an attenuated (milder) form of Schizophrenia o It’s usually through the absence of psychotic symptoms related to schizophrenia but the presence of these other symptoms that the clinician will end up diagnosing someone with Schizotypal Slide 7 – Dramatic/Erratic Cluster (Cluster B) Borderline Personality Disorder  Described as someone who has rapid shifts in emotions in very short periods of time o ie within minutes the patient can go from loving someone and thinking the world of them to hating their guts without any real reason  Irritable, sarcastic, quick to take offense, hard to live with, unpredictable and impulsive in their behaviour o ie they may engage in gambling to the point that it puts them into financial difficulties  May engage in discriminate sexual activities (promiscuity), they cannot bare to be alone, demand attention  Chronic depression (dysthymia), suicidal  1-2% of the population (more common in women)  People with Borderline PD are most likely to have an Axis I disorder in comparison to those with another PD o For ex, there may be a period in a Borderline patient’s life where they develop a full blown major depressive disorder, anxiety disorder, etc  Comorbidity is very high, and substance abuse, PTSD and eating disorders aren’t uncommon in them either Slide 9 - Dramatic/Erratic Cluster (Cluster B) continued  Again even though personality disorders are considered to be heterogeneous, there is a great deal of overlap  However, while the next two may sound highly similar, there is a distinguishing feature that separates them Histrionic Personality Disorder  Overly dramatic and attention seeking. Constantly attempting to draw attention to themselves o Whether it be through how they dress or act; anything they can do to be the centre of attention  They are uncomfortable when they aren’t the centre of attention o Easily influenced by others  They display emotions extravagantly (ie “I LOVE YOU MORE THAN ANYTHING), but behind that strong wording is an emotionally shallow person  Even though they may make it seem like you come first, they typically prioritize themselves over anybody else  They state very strong opinion, but very little rationale or support for the opinions they express o This is to draw attention so they can be the biggest personality in the room  2-3% prevalence (more common in women – surprise surprise)  Comorbid with: depression, borderline PD  *What distinguishes this from Narcissistic Personality Disorder is that the Histrionic person does not think much of themselves o Even though they put on this type of presentation, they don’t actually think that they’re the shit Narcissistic Personality Disorder  They have an overwhelming grandiose view of their uniqueness and their abilities  Preoccupied with fantasies of great success. Self-centred. Require constant attention and excessive admiration  Lack empathy, very arrogant and they have a great sense of entitlement  1% prevalence. Comorbid with: Histrionic and Borderline PD (Borderline is highly comorbid with all of the PDs)  This disorder is a good bridge to the next disorder… Slide 10 – Dramatic/Erratic (Cluster B) continued Antisocial Personality Disorder  When you have someone who displays signs of Narcissistic PD, but is also anti-social  *Only personality disorder that requires a previous diagnosis to be present o To be diagnosed with Antisocial PD, the patient would have HAD to be diagnosed with a Conduct disorder prior to the age of 15  ie if as a kid/early teen they set animals or property on fire, dismembering animals and enjoying it  They are irresponsible in terms of their social conduct, they’re irritable, they break laws, physically aggressive, wreckless  Key characteristics: highly impulsive, fail to plan ahead, show no remorse o These are executive functioning deficits, which makes sense as patients with Antisocial PD show deficits in their frontal lobes  Paul Bernardo – the Scarborough rapist, had this  Distinct from Psychopathy which often gets confused with Antisocial PD o Difference is that in Psychopathy, then emphasis is on the emotions. There’s an overwhelming lack of emotional expression and remorse Slide 12 – Anxiety/Fearful Cluster (Cluster C) Avoidant Personality Disorder  Sensitive to the possibility of criticism, rejection, or disapproval which is why they avoid relationships or situations where they may be a chance of this happening (most situations then) unless they are assured that they can be liked  Very low self-esteem; see themselves as incompetent, feel inferior to others, reluctant to take any risks  Highly comorbid with Dependent Personality Disorder  *The ONLY difference b/t the two is that Avoidant patients have great difficulty approaching and initiating social relationships  Like all personality disorders it must
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