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Chapter 12

Chapter 12 + lecture

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University of Toronto St. George
Martha Mc Kay

Chapter 12 Personality Disorders Personality- is all the ways we have of acting, thinking, believing, and feeling that make each of us unique, and a trait is a complex pattern of behaviour, thought, and feeling that is stable across time and across many situations Dening and Diagnosing Personality Disorders A Personality Disorder is a long standing pattern of maladaptive behaviours, thoughts and feelings - In order to to be diagnosed, the symptoms must have been around since childhood, and be harmful to everyday life causing signicant distress - These disorders are controversial because of the conceptualization of the disorder and the assessment - The DSM gives it special treatment because it is on Axis II and not on Axis I, like many other psychotic disorders such as schizophrenia and major depression - People often with a personality disorder often experience one or more acute disorders such as major depression or substance abuse - People with personality disorders do not usually seek treatment unless it is for something else like depression or because their substance abuse has landed them in prison - The criteria for assessing these disorders are a lot vaguer than other disorders so, there is more room for error - The pervasive nature makes it a lifelong pattern thats why it is on Axis II The DSM Enduring pattern of behaviour that is pervasive and inexible, as well as, stable and of long duration Causes clinically signicant distress or impairment in functioning Manifests in at least 2 of the following: cognition, affectivity, interpersonal functioning or impulse control Must show symptoms since adolescence or early adulthood Problems with DSM 1. Symptoms are treated as if they are discrete categories when they are often only extreme versions of otherwise normal traits. Whats abnormal? So it doesnt take into account the dimensionality of the trait 2. Overlap in the diagnostic criteria and the majority of people who are diagnosed with one disorder tend to meet the diagnostic criteria for at least one other personality disorder. What is the category for two or more criteria? 3. Diagnosing a personality disorder often requires information that is hard for a clinician to obtain. They might not be able to provide the history, so its not reliable 4. Conceptualized as stable characteristics, yet they vary, so individuals go in and out of the diagnosis, e.g when a person is suffering from an Axis I disorder such as major depression, it may seem as if they are suffering from personality disorder, so when they get treatment and their Axis I disorder seems to diminish, so does their personality disorder This may also make it difcult to diagnose and be reliable, and difcult to do research www.notesolution.com Gender and ethnic Biases Differences in frequencies with which men and women and individuals of minority groups are diagnosed with different personality disorders does this reect bias and an application of negative stereotypes? Lack of recognition that the expressions of symptoms of a disorder may vary between women and men. Lack of recognition that the expressions of symptoms of a disorder may vary between groups. sometimes more men are diagnosed with one disorder than women and vice versa, so is this a true distinction or just a bias? Personality disorder maybe seen as being an extreme version of female personality and clinicians are quick to diagnose but males face the same situation with antisocial personality, paranoia, and OCD and males are quick to be diagnosed with this disorder It maybe that symptoms may naturally vary b/w genders and races (European > other) Or it may just be that different genders express it differently based on different roles taken in society, such as a male showing his symptoms against society, or female against her kids Another possibility is because of the DSM downplays masculine ways of expressing which contributes to it being under diagnosed, as the DSM sees male expression of personality disorder as acting macho and bragging about athletic skills, so clinicians may be too quick to see histrionic, dependent, and borderline personality disorders in women and anti-personality in men, in fact a study showing that when the profile of someone exhibiting these symptoms, say of histrionic disorder than, the person is more likely to be described as female than male Critics of personality disorder say that structured interviews rather than unstructured interviews should be used to asses because it makes it more fair, and show less gender biases, but yet even still more women are diagnosed with certain personality disorders, (e.g histrionic) over others Structured interviews and self-reports produce similar diagnoses among ethnic groups, so the clinicians do not just show bias Some argue that criteria should be balanced to include equal numbers of symptoms and diagnoses that are pathological variants of male and female, and the DSM should do a better job of balancing male and female Subtypes of Personality Disorders Cluster A: Odd-Eccentric Personality Symptoms similar to those for Disorders schizophrenia, including inappropriate or at affect, odd thought and speech patterns, paranoia. People with these disorders maintain their grasp on reality, however. There is still a general grasp of reality, unlike schizophrenia where there is an lack of touch with reality www.notesolution.com Cluster B: Dramatic-Erratic Personality Manipulative, volatile, and uncaring in Disorders social relationships. Impulsive, sometimes violent behaviour that show little regard for their own safety or the safety or needs of others, such as histrionic, narcissistic Cluster C: Anxious-Fearful Personality Extremely concerned about being criticized Disorders or abandoned by others and thus have dysfunctional relationships with them. Avoidance, dependent, OCPD The Odd-Eccentric Three main types : 5. Paranoid personality disorder Chronic and pervasive mistrust and suspicion of other people that is unwarranted and maladaptive. - it has a weak relationship with schizophrenia - Believe people are chronically trying to deceive or exploit them for conrming evidence of suspicions - Misinterpret or Overinterpret situations in line with their suspicions e.g. wifes cheerfulness = shes having an affair - Resistant to rationale arguments against their suspicions - Withdrawal from others in order to protect themselves - Prevalence estimates are between .5 -5% - Males > Females - Acute psychological problems: major depression, anxiety, substance use DSM I) Evidence of pervasive distrust or suspiciousness of others present in at least 4 of the following ways: a.Pervasive suspiciousness of being deceived, harmed, or exploited b.Unjustied doubts about loyalty or trustworthiness of friends or associates, or ppl not close to them c.Reluctance to conde in others because of doubts of loyalty or trustworthiness d.Hidden demeaning or threatening meanings read into benign remarks or events e. Bears grudges; does not forgive insults, injuries, or slights f. Angry reactions to perceived attacks on his or her character or reputation g.Recurrent suspicions regarding delity of spouse or sexual partner II) Does not occur exclusively during course of Schizophrenia, Mood Disorder with Psychotic Features, or other psychotic disorder www.notesolution.com Theories and Treatment Family: more commonly to occur in families with Schizophrenia, so this may be a part of the spectrum of Schizophrenia No twin or adoption studies done, so no conclusions Cognitive: This disorder is the result of an underlying belief that other people are malevolent and deceptive + a lack of self-condence about defending themselves Vigilant against signs of others deceit or criticism Quick to act against others These people usually only seek help when in a crisis and usually come for something else like depression or anxiety Patients may misinterpret beliefs that the therapist may challenge,e.g this is all a hoax Therapists dont expect clients to achieve full insight, but some degree may be achieved Schizoid Personality Disorder Lack desire to form interpersonal relationships; emotionally cold Described as aloof, reclusive, detached, humorless View interpersonal relationships as unrewarding, messy, intrusive Rare - .4-1.7% Males > Females, 3:1 Function well in occupations that do not require interpersonal interactions Twin studies suggest some heritability of personality features such as low sociability and low warmth Insecure attachment patterns linked to disorder DSM Evidence of pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings shown in at least 4 of the following ways: 6. Neither desires nor enjoys close relationships 7. Almost always chooses solitary activities 8. Has little if any interest in sexual experiences with another person 9. Takes pleasure in few if any activities 10.Lacks clos
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