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Chapter 13

PSY240 Chapter 13

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Hywel Morgan

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Chapter 13: Personality Disorder  Mary’s Case: Borderline Personality  Personality Disorders (PDs): A heterogeneous group of disorders that are coded on Axis II of the DSM; regarded as long-standing, pervasive and inflexible patterns of behaviour and inner experience. (some cause emotional distress) 13.1 Classifying Personality Disorders: Clusters, Categories, and Problems  The diagnoses has improved because: 1. The publication of specific diagnostic criteria 2. The development of structured interviews specially designed for assessing PDs  High Inter-Rater Reliability but low Test-Retest reliability (only anti-social has high test-retest reliability)  Data show that compares patients who have a specific personality disorder with some control group; are the groups (clusters) actually exist?  Personality disorders can be construed as the extremes of characteristics we all possess  Personality disorder is a failure or inability to come up with adaptive solution to life tasks.  Failing the following three tasks would cause personality disorders: 1. to form stable, integrated and coherent representations of self and others 2. to develop the capacity for intimacy and positive affiliations with others 3. to function adaptively in society by engaging in prosocial and co-operative behaviours 13.2 Assessing Personality Disorders  A significant challenge is that many disorders are egosyntonic; the clients are not aware of the problems  Another challenge: Personality disorder not otherwise specified has a substantial proportion according to structured interviews  Often rely on self-report measures when assessing (MMPI-2)  PSY-5: five dimensions, which consist negative emotionality/neuroticism, lack of positive emotionality, aggressiveness, lack of constraint, and psychoticism  MCMI-III: the most widely used measure of personality disorder symptoms  Personalized Therapy: In order to be more effective and meaningful for individuals, therapies need to be modified to recognize each person’s unique needs and personality styles. 13.3 Personality Disorder Clusters  DSM-IV-TR criteria: 1. Individuals in Cluster A (paranoid, schizoid, and schizotypal) seem off or eccentric. (Oddness and avoidance of social contact) 2. Those in Cluster B (Borderline, histrionic, narcissistic, and anti-social) seem dramatic, emotional, or erratic. Behaviours are extrapunitive and hostile. 3. Those in Cluster C (avoidant, dependent, and obsessive-compulsive) appear fearful.  Tyrer et al., 2007 suggests: Cluster D: Splitting the obsessive-compulsive features into a separate category reflecting the themes of obsession and inhibition. 13.4 Odd/Eccentric Cluster Paranoid Personality Disorder The individual with PPD is suspicious of others  Preoccupied with unjustified doubts about the trustworthiness or loyalty of others  Occurs most frequently in men and co-occurs most frequently with schizotypal, borderline and avoidant personality disorders Schizoid Personality Disorder  Do not appear to desire or enjoy social relationships and usually have no close friends, no interest in sex and experience few pleasurable activities  Appear dull, bland, and aloof without warm tender feelings for others  Have solitary interests (differentiate to Asperger’s: age onset)  Prevalence is less than 1% Schizotypal Personality Disorder  Grew out of Danish studies of the adopted children of schizophrenic parents  Some of the children develop schizophrenia; some develop an attenuated form of schizophrenia  Have interpersonal difficulties of the schizoid personality and excessive social anxiety that does not diminish as they get to know others  Eccentric symptoms that are similar to the prodromal and residual phases of schizophrenia occur in schizotypal personality disorder  Comorbid with borderline, avoidant, paranoid and narcissistic personality disorder  Higher comorbidity with Axis I disorders than any other personality disorders Etiology of the Odd/eccentric Cluster  The disorders are genetically linked to schizophrenia, perhaps as less severe variants of Axis I disorder  Enlarged ventricles and less temporal-love grey matter 13.5 Dramatic/Erratic Cluster Borderline Personality Disorder  The core features of it are impulsivity and instability in relationships, mood, and self-image  The unpredictable and impulsive behaviour of people with BPD include gambling, spending, indiscriminate sexual activity and eating sprees  Onset: early adulthood  Prevalence rate is 1 to 2%  More women than men  Less likely to have an Axis I mood disorder, and their parents are more likely to have other kinds of psychopathologies  Comorbid with substance abuses, PTSD, eating disorders and odd/eccentric cluster personality disorder.  Even if the treatment is apparent, the social ability in BPD patients is still poor Etiology of Borderline Personality Disorder  Object-Relations Theory  Concerning the way children incorporate the values and images of important people  Importance of attachment styles (210)  Dichotomizing: defence mechanism that makes the clients see everything in black and white.  Biological Factors  Runs in families, which has a genetic component  Low glucose metabolism in the frontal lobes  Low levels of serotonin (impulsivity)  Linehan’s Diathesis-Stress Theory  Biological genetic component + raised in a family environment that is invalidating  The person’s wants and feelings are discounted and disrespected, and efforts to communicate one’s feelings are disregarded or even punished  The two main hypothesiz
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