1 / 17

Personality Disorders

Personality Disorders. Hallmarks of Personality Disorders. Stable or persistent maladaptive patterns Problems in at least two areas: Cognition Affectivity Interpersonal functioning Impulse control. Ten Year Stability and Latent Structure of DSM-IV PDS.

erma
Download Presentation

Personality Disorders

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Personality Disorders

  2. Hallmarks of Personality Disorders • Stable or persistent maladaptive patterns • Problems in at least two areas: • Cognition • Affectivity • Interpersonal functioning • Impulse control

  3. Ten Year Stability and Latent Structure of DSM-IV PDS • Examined 4 PDs (schizotypal, borderline, avoidant, and obsessive compulsive) over 7 time points • Baseline, 6 months, 1 year, 2 years, 4 years, 6 years, and 10 years • Latent structure became less differentiated over time • Mean levels of the constructs dropped and stability increased • Higher correlation among the constructs in later years may reflect greater shared base of pathology for chronic PDs

  4. Widiger and Mullins-Sweat • Proposed a five factor model of personality disorder • Dimensional structure • Conceptualize personality disorders as extreme variants of normal personality rather than categorical entities • Generates FFM profiles that may not be represented in the DSM (assesses whether the individual is high or low on each of the five factors

  5. Prevalence of Personality Disorders • 1 in 10 adults has a personality disorder

  6. Cluster A • Odd and Eccentric • Paranoid • Vigilance, overwhelming fear, hostility • High neuroticism, low agreeableness • 2-4% prevalence rates • Schizoid • Disinterested, detached (links with asperger syndrome, autism and pdd) • 1-3%, higher rates in homeless populations • Schizotypal • Odd pecular beliefs or behaviors • Suspicious and apprehensive • Some links with schizophrenic spectrum disorder

  7. Cluster B • Dramatic, Emotional, Erratic • Antisocial • Control or manipulation of others without remorse • Aggressive, controlling, manipulative • 1-4 % prevalence rates • Borderline • Instability in affect and identity accompanied by rejection fears • Impulsive, self damaging, emptiness, anger and reactive to real/perceived abandonment • 2% prevalence rates • 10% complete suicide (primarily with comorbid mdd, antisocial pd and family histories of substance abuse).

  8. Cluster B • Histrionic • High levels of emotinality and attention seeking; view relationships as more intimate than they really are • Prevalence rates of ~2% in the general population • Narcissitic • Use of grandiosity, entitlement or exploitation to maintain self esteem • Arrogance and superiority, anger, shame and envy, lack of empathy • There is a vulnerable conceptualization of NPD in which the indivdual lacks that gradiose features • ~1% in general populations

  9. Cluster C • Anxious and Fearful • Avoidant PD • Shy and guarded, feelings of inadequacy, reticent but longing social inhibition, sensitive to negative evaluation, difficulty with relationship due to fears • 2-5% in general population • Dependent PD Defers excessively and inappropriately, weak and ineffectual, relationships provide protection and support, needs to be taken care of .5-1.5 % prevalence in general population

  10. Cluster C • Anxious and Fearful • Obsessive compulsive PD • Stubbornly pefectionistic, self-critical, inflexible • Focus on orderliness, perfectionism, mental and interpersonal control • ~1% in general population

  11. Clark • Personality Disorders are Dimensional • FFM Neruoticism • Extramversion • Agreeableness • Conscientiousness • Culture/Openness to Experience • Domains of normal and abnormal personalities are overlapping • Used 30 facets of the Revised NEOPI-R for each PD diagnosis • Concerned that the diagnoses themselves do not represent an adequate gold standard • Personality Disorders have both current and longlasting effections on functioning though some of these effects may be associated with the comorbid axis I disorders • Collateral sources assist with providing reliable/valid information

  12. Clark • Comorbidity with Axis I disorders: 50% or greater • More common with earlier age of onset • More severe conditions • More challenging to treat • More resistant to remission • Lower functioning • Greater medical utilization • More suicide attempts and completion • Greater risk of psychopathology in children

  13. Clark • Comorbidity • Pervasive comorbidity of PDs with mood and anxiety disorders (particularly avoidant and dependent PD) • Both pd and axis I disorders predict onset of one another and share genetic variance with each other and with trait neuroticsm/negative affect • In terms of subtypes of comorbidity • BPD, OCPD,, avoidant/depent were more common in unipolar • Narcisstic PD was more common in bipolar though BPD features were characteristic of bipolar disorder (BPD also linked to PTSD)

  14. Clark • Comorbidity • Substance abuse comorbidity is particularly strong in cluster b PDs • Severity of substance disorder moderates comorbidity e.g., antisocial PD increases about twofold (~30-60%) from mild to severe drug abuse/dependence • Comorbidity is associated with pooer outcome • Comorbid presentations have earlier substance use and more legal family problems, greater rates of relapse in the presence of cravings, and greater interpersonal conflict • Broad underlying factor of externalizing characertized by impulsivity may axis I and II disorders.

  15. Clark • Comorbidity • Avoidant PD was associated with all types of eating disorders (AN restricting, AN bingeing, BN, BED • ANR and BED had highest comorbidity with OCPD • Severe ED with bingeing associated with BPD • BN overlapped with antisocial and narcissistic PD • Traits include perfectionism and related OC • State effects of starvation may influence the presentation of the pd

  16. Clark • Stability • Dimensional pds are more stable than diagnostic • Mean level trait change is moderate through adolescence and well into early adulthood with increasingly levels of positive traits (A and C) and decreasingly levels of negative traits (N/NA) • Personality structure is stable as early as adolescence where as individual profile stability is moderate with more change in level and spread than shape (i.e., more quantitative change than qualitative) • Personality is set like ‘plaster’ after the age of 50

  17. Clark • Stability • Criteria that are more changeable are odd behvior and constricted affect (schizotypal PD), self injury and abandonment avoidance behaviors (BPD), avoiding inerpersonal jobs and potentially embarrassing situations (avoidant pd), miserly and strict moral behaviors (OCPD) • More stable criteria paranoid ideation (schizotypal), affective instability and anger (BPD), feeling inadequate and socially inept (avoidant PD), and rigidity and difficulty delegating (OCPD).

More Related