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Chapter 12

Psychology 2310A/B - Chapter 12: The Personality Disorders

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Psychology 2310A/B
Rod Martin

Psychology 2310A – Textbook Notes Final Exam Chapter 12: The Personality Disorders Concept of Personality Disorder - Traits: cross-situationally consistent/persistent features - Combination of traits forms personality - Personality disorders: patterns of highly maladaptive personality traits - DSM-IV-TR definition; personality traits are “enduring paterns of perceiving, relating to, and thinking about environment and oneself that are exhibited in wide range of social and personal contexts” - Common feature of ppl with PDs; personality is rigid/inflexible than most, highly inapprop beh - Personality disorders include conditions that cause distress primarily for other people - DSM-IV-TR diagnosis: o Criterion A – pattern of beh must be manifested in at least 2 of: cognition, emotion, interpersonal functioning, or impulse control o Criterion B – enduring pattern of beh be rigid and consistent across broad range of personal and social situations o Criterion C – beh should lead to clinically significant distress o Criterion D – stability and long duration of symptoms, w onset in adolescence or earlier o Criterion E – beh cannot be accounted for by another mental disorder - DSM-IV-TR 3 clusters: o Cluster A – odd and eccentric – paranoid, schizoid, schizotypal o Cluster B – dramatic, emotional, erractic – anti-social, borderline, histrionic, narcissistic o Cluster C – anxious and fearful – avoidant, dependent, obsessive-compulsive - DSM-5 o Suggested PDNOS moved to personality disorder trait specified to account for disorders being removed (PDNOS) - Personality disorders can disrupt alliance between therapist and client - Wrong diagnosis could lead to wrong treatment plan and/or wrong meds - Prevalence varies considerably - Generally, prevalence higher among inpatient psychiatric patients than outpatients - Personality disorders distinct from other forms of psychopathology and appear on AXIS II NOT AXIS I - Egosyntonic: they do not view their behaviour as problematic Diagnostic Issues - More diagnostic problems than Axis I disorders - Two indices important: o Inter-rater reliability o Test-retest reliability - Gender and Cultural Issues Psychology 2310A – Textbook Notes Final Exam o Clinicians can misdiagnose certain cultural differences in personality as PD as population becomes increasingly diverse o Similar concerns for gender; sex role stereotype may influence diagnosis o Gender bias presented in DSM criteria for disorders o Grilo (2003)  compared distribution of BPD, STPD, AVPD and OCPD across White, Black and Asian  higher rates of BPD in Asian than White and Black and higher rates of STPD in Black than White - Reliability of Diagnosis o More recent studies suggest PD diagnoses may be becoming more reliable o Goal of research? Determine stability of personality disorders over time - Comorbidity and Diagnostic Overlap o Comorbidity: co-occurrence in same person of 2+ disorders o Overlap: similarity of symptoms in two or more different disorders o Research indicates problems w overlap b/w specific disorders o Patients diagnosed w BP have commonly found to have schizotypal features and considerable overlap found between BP diagnosis and other PDs o Scizotypal PD associated with both BPD and NPD o Psychopathic individuals w Anti social PD show overlapping symptoms w schizoid PD and NPD Historical Perspective - Historically, greater attention to what we call APD - Niccolo Machiavelli (1469-1527) o Advocated for use of unscrupulous manipulative amoral and deceptive beh in achieving power in politics in society o Machiavellianism, subclinical narcissism, subclinical psychopathy = Dark Triad - Pinel (1809) o Manie sans delire: madness w/out delirium o Observed profound deficits in emotion but no apparent reasoning/intellectual dysfunction Etiology - Psychodynamic View o Psychoanalysts see personality disorder as resulting from disturbances in parent-child relationship o Process by which child learns that he or she is an individual separate from mother/father o Difficulties in this process result in either inadequate sense of self or problems in dealing w other people o Clear evidence that PD adults far more likely than others to have had disrupted childhoods Psychology 2310A – Textbook Notes Final Exam - Attachment Theory o Children learn how to relate to others by the way in which their parents relate to them o When attachment to parents is positive, child will develop skills and confidence necessary for later relationships o If parent-child attachment is poor, child will typically develop adult relationship styles that are characterized by ambivalence, fear, avoidance o Patients w PDs typically described parents as uncaring and/or unprotective - Cognitive-Behavioural Perspectives o Schemas said to develop early in life, and in PD ppl they become more rigid/inflexible o Form early in life as result of damaging experiences, believed that schemas are comfortable/familiar o Parents may model inapprop schemas during childhood of people with PDs and/or inapprop reward or punish behaviour and expression of attitudes - Biological Factors o Either brain dysfunction or genetic/hormonal imbalance o Some support for biological factors; strongest support comes from research with APD o Prefrontal cortex important The Specific Disorders Cluster A: Odd and Eccentric Disorders - Paranoid Personality Disorder o Pervasive suspiciousness concerning motives of other people and tendency to interpret what others say and do as personally meaningful in –ve way o Consistently misread innocent actions/comments of others o Hypervigilant o Other people intend to hurt them/are against them o Genetic link with schizophrenia proposed ... “cousins” o In PPD individuals paranoia is non-bizarre o Significant diagnostic overlap b/w paranoid personality and both avoidant and BPD - Schizoid Personality Disorder o Seem completely uninterested in having any sort of intimate involvement with others, and they display little in the way of emotional responsiveness o Rarely experience intense emotions and may be puzzled by the passions of others o Loners; cold, indifferent toward others o Seem to not enjoy relationships of any type; apparently prefer being alone o Avoid social activities and do not seek/seem to desire sexual relations o May not be included in DSM-5 - Schizotypal Personality Disorder o Eccentricity of thought and behaviour; extremely supersticious; may believe in magic o Ideation and beh are peculiar, tend to turn people away leaving them socially isolated o Similarities w schizophrenia Psychology 2310A – Textbook Notes Final Exam o Overlap b/w schiotypal and Cluster A disorders considerable o Low doses of antipsychotic drugs relieve cognitive problems and social anxiety apparent in these patients and antidepressant meds also produce +ve effects o Most likely be included in DSM-% Cluster B: Dramatic, Emotional, or Erratic Disorders - Do not seem to have much
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