personality disorder by K88Gve

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									   Personality
Normal & Abnormal
               Personality
•   Normal – what do you know so far?
•   Approaches?
•   Theories?
•   ??
History of Personality Disorders
• Pinel (1809) “manie sans delire”
• Pritchard “moral insanity”
What are personality disorders?
• “an enduring pattern of inner
  experience and behaviour that deviates
  markedly from the expectations of the
  individual’s culture, is pervasive and
  inflexible, has onset in adolescence or
  early adulthood, is stable over time and
  leads to distress.”
                 DSM-IV
• Persistence of personality disorders
  – Do not relapse
  – Do not remit
  – Treatment?
   How are personality disorders
            defined?
• What are personality disorders?
• What do you think of the categorical
  system?
• How does this compare to the trait
  approach?
• Any problems with the approach taken to
  define personality disorders?
• Treatment – biological basis?
                    Three clusters
• A = odd/eccentric
   – Paranoid
   – Schizoid
   – Schizotypal
• B = dramatic/emotional
   –   Antisocial
   –   Borderline
   –   Histrionic
   –   Narcisstic
• C = fearful/anxious
   –   Avoidant
   –   Dependent
   –   Obsessive Compulsive
   –   Passive Aggressive
                    Cluster A
Paranoid
• Prevalence in clinical setting found between 1%-20%.
  Among non-clinical adult samples the prevalence is
  about 3% or less.
• Only about 25% of people with paranoid personality
  disorder do NOT receive a further concurrent personality
  disorder diagnosis — i.e. lots of overlap.
Schizoid
• Non-patient samples prevalence rates between 0.5%
  and 7% Clinical samples found between 1% and 16%.
Schizotypal
• Overlap with schizophrenia and major depressive
  disorder. Similar biological abnormalities seen in
  relatives of people with schizophrenia
  Paranoid personality disorder
• Sensitive to setbacks
• Suspiciousness
• Tendency to self-importance, manifest in a
  persistent self-referential attitude
• Tendency to bear grudges – refusal to
  forgive insults or slights.
  Schizoid personality disorder
• Emotional coldness, detachment or
  flattened affectivity
• Limited capacity to express either warm,
  tender feelings or anger towards others
• Invariable preference for solitary activities
• Marked insensitivity to social norms and
  conventions
                             Cluster B
Antisocial
• In prisons often over 50% and can be as high as 70-80%. Among
  normal populations 2.1%-3.7%.
Borderline
• More common in women — 2%-4% of general population.
• 10% of outpatients.
• Has considerable co-morbidity.
• catch phrase here is “identity diffusion.” ICD 10 splits into two types:
    – emotionally unstable
    – impulsive.
Histrionic
• male = female, about 2-3% in general population.
• Substantial overlap with other types.
Narcissistic
• 1 % of general population.
  Dissocial personality disorder
• Very low Tolerance to frustration and a
  low threshold for discharge of aggression
• Proneness to Heap blame on others
• Callous Unconcern for the feelings of
  others
• Incapacity to experience Guilt
• Persistent irresponsibility and disregard for
  Social norms
  Emotionally unstable personality
              disorder
• Impulsive type – emotional instability
  and lack of impulse control

• Borderline type – emotional instability
  and disturbance of patient’s own self-
  image, aims and internal preferences.
  Chronic feeling of emptiness. Excessive
  efforts to self-harm or self-poison
    Histrionic personality disorder
•   Self-dramatization
•   Suggestibility
•   Shallow and labile affectivity
•   Continually seeking excitement
•   Inappropriate seductiveness
•   Over-concern with physical attractiveness
                     Cluster C
Avoidant
• 0.5-1% of general population.
Dependent
• 5% to 55% in mental health settings.
Obsessive / compulsive
• 1% of general population
• 3-10% of psychiatric populations.
• This is the anal type — fastidious, lists, cannot throw
  anything away, tends to postpone decisions, and is rigid
  in interpersonal relationships.
• As expected some studies report considerable overlap
  with OCD up to 50% in some studies.
Anankastic personality disorder
• Preoccupation with details, rules and lists
• Perfectionism interfering with task
  completion
• Excessive conscientiousness to the
  exclusion of pleasure
• Excessive pedantry
• Rigidity and stubbornness
• Intrusion of unwelcome thoughts
   Anxious [ avoidant] personality
              disorder
• Persistent feelings of tension and
  apprehension
• Beliefs of social ineptness, or inferiority
• Preoccupation with criticism or social
  rejection
• Avoidance of social activities fearing
  criticism, disapproval or rejection
Dependent personality disorder
• Encouraging or allowing others to make most
  of one’s important life decisions
• Subordination of one’s own needs to those of
  others on whom one is dependent
• Feeling uncomfortable or helpless when alone
• Limited capacity to make everyday decisions
  without excessive amount of advice from
  others
Awright, mate, so ye dinnae what "Trainspotting" gadge ye are, aye? Take the loupin quiz tae find oot, likesay. Nae
                                    git ootay here, ye plukey-faced wanker!
You could be described as:

Honest.
Underage.
Angry.
High.
Quirky.
One sick fuck.

A bit of random information about you:

You're a vegetarian.
You're still in school.
You're homophobic.
You've got a pornography video of you and your significant other.
You're obsessed with films.
You've made a mess of your significant other's kitchen.

On your free time, you:

See Iggy Pop concerts.
Go to clubs.
Watch football.
Obsess over Sean Connery.
Pick fights.
Shoplift.
Your view on drugs:

They're shite, man!
I'm quitting. Well, after my last hit.
Yes, please.
I used to be against them...
I'd never do anything hardcore. That's just too dangerous.
You haven't got any speed, have you?
You've once said:

"Anyone in my way gets it, fucking gets it. Everybody hear that? Everybody happy?"
"Well, what's wrong, boy? Cat got your tongue?"
"Face it, it could have been wonderful."
"I love people. All people. Even people that no one else loves, I think they're
   OK, you know."
"Doesn't it make you proud to be Scottish?"
"I'm getting on with life. What are you doing?"
Which would you rather listen to?

New Order.
Iggy Pop.
You know, whatever, like.
Fuck off, you doss cunt!
David Bowie.
Lou Reed.
• What are you obsessed with?
  Sean Connery.
  Heroin.
  Getting shagged.
  Music, films, football...whatever.
  Mark Renton.
  Ah'm no a fuckin' poof, ye ken? Piss off!
  In the end, you:
  Run away.
  Find a boyfriend.
  Die.
  Get angry.
  Get screwed (metaphorically).
  Get money.
         Criteria for measures
• For a measure to be valid what criteria must it
  adhere to?
• It must be reliable and valid
• However one individual may be diagnosed with
  a number of different personality disorders
• And – there are correlations between scores on
  scales,
• And conceptual overlap of diagnostic criteria for
  different personality disorders
• Which aspect of validity is not adhered to?
        Discriminant Validity
• Discriminant / divergent validity – that the
  measure discriminate between other
  measures and constructs.
• In this case – that one personality disorder
  is overlaps with another – the categories
  do not discriminate from one another.
        Convergent Validity
• Convergent – the construct can be
  assessed using a number of different
  methods
• Consistent diagnoses are not given using
  different scales
Other problems with the diagnostic
            categories
• Test-retest
• Inter-rater
                  Issues
• Theoretical basis of personality disorders?
• Is there an underlying biological basis?
• Does treatment affect personality
  disorders
• However meant to be enduring
• Treatment may help
• Clusters lack conceptual consistency
• Is there a better way????
 Personality disorders and normal
           personality?
• Four A’s
• Mulder and Joyce (1997)
  –   Antisocial
  –   Asocial
  –   Asthenic
  –   Anankastic
• Others
  –   Emotional Disregulation
  –   Dissocial behaviour
  –   Inhibition
  –   Compulsivity
   Problems with the categorical
 approach to abnormal personality
1) different patterns used for the different types –
  for example, Borderline PD describes people in
  very broad non-specific terms of identity,
  affectivity and impulsiveness, whereas Avoidant
  is much narrower looking only at people in terms
  of specific behaviours
2) Classification is a hotch-potch of historical
  descriptions and (very) pseudo-scientific
  approaches.
            The Future?
• Normal seems okay – why not look at
  abnormal in the same way?
• Could we use the same dimensional
  approach? Could we apply normal terms
  to the abnormal?
        Where are we now?
• Schroeder & Livesley (1991) looked at the
  79 terms used to cover the 11 DSM PDs.
  They distilled them down to between 15
  and 18 primary personality traits – with
  further factor analysis they came up with
  their BIG FOUR!
           Four more big four
•   Psychopathic entitlement
•   Dependent emotionality
•   Social Avoidance
•   Compulsiveness
              Aetiology
• Genetic (XYY)?
• Sociocultural factors
• Temperament (Thomas & Chess)
• Deviant Children Grown Up (Conduct
  disorders and ADHD
• Negative childhood experiences
               Treatments
•   Bio/psycho/social
•   DBT
•   CBT
•   Psychodynamic
•   Behavioural
•   TCs
•   Pharmacological
               Prognosis
• With Borderline personality disorder
• 10% suicide
• 60% clinical maturation (10-25 year follow-
  up)

								
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