lecture 12 *PDD*

enduring paterns of perciencinf feelings, thinking anout and relationg onself and environemnt

proeminent aspect of personality that is relaively consistent across time and situations

not belonging to self

not alweys active in personality

1. negative emotionality
2. extraversion
3. openess to expirince
4. agreebelenss
5. consciousness

formed around 18 but can change

change until 60 to 65 ( less impulsive )

1. rigid and inflexible patterns
2. dysfuctional
3. ego syntonic

pervasive ( across situations ) inflexible
pathological / problematic ( causes suffering and disyfucntion)
persistent : stable since early adulhood

individual's personality pattern must deviate markedly form expectations of his or her culture as shown in styles of thinking about oneself, other or evens, emotional experiences and expression, interpersonal functioning and or impulse control

- flexible across situations

- stable over time

- onset in adolescence or early adulthood

- significat distress or functional impairment

- under 8 years old must be present for at least one year
- antisoial perosnality disorder cannot be diagnosed before 18

Cluster A : ODD eccentric personality disorders ( eccentric behaviours and thinking )
Cluster B : Dramatic Emotional personality disorders (dramatic , erratic or emotional behaviour and interpersonal relationships )
CLUSTER C : anxious fearful personality disorders ( anxious and fearful emotions and chronic self-doubt)

symptoms similar to schizphrenia , including innaporpriate or flat affect , odd taughts and speech and paranoia. Maintain thier grasp in realitiy however.

1. Paranoid Personality Disorder
2. Schizoid Personality disorder
3. Schizotypal Persoanlity Disoredr

- patter of pervasice distrust and suspiciousness
- hypervigilent for evidence confirming suspicions
- victimised or mistreated by others
- think that someone is actively trying to hurt them
- motives of others are interpreted as malevolent

patter of pervasice distrust and suspiciousness

hypervigilent for evidence confirming suspicions

victimized or mistreated by others

think that someone is actuvely trying to hurt them

motives of others are interpreted as malevolent

sensitive and easily angry to cricitsm

bear grudges

hostile , secretive , hostile and argumentative

0,7 to 5.1 % people in general population

imapired vocational functioning

difficult to get along with and keep up interpesonal relationships

more common in families with schizophrenia

50% heritability

underlying belief that other people are malevicious + low self confidence

impllications of risk factors ( discrimination , SES, chilhood trauma )

contact with clinicians only when they are in crisis

may seek treatment for comorbid disorders

often do not feel need for their paranoia

hard to develop trust in therapeutic relationship

therapist must be calm respectful and cannor directly confront belive

must rely on indirectly mean of raising questions to raise client mind

increase sense of efficacy

decreasing fear and hostility toward others

sometimes just develop coping mechnzism to deal with the fears created by paranoia

pervasive pattern of detachemnt form social relationships

restricted range of emotional expression

indifferent to opportuntiy to develop close relationships

expirince and expression of positive emotins are very low

limited want ot sexual relationships

indiferent to others preose or criticism

pleasure in few activities

0.8 to 1.7 % prevelence

more often man then women

can function in society

low sociability and low warmt suggest that triats are probably inhereted ( indirect )

threapist interpesonal relationship might be percieved as threatening

focus on inceasing person's awerenss of his her own feelings

increasing social skills and social contact

social skills trianing

sometimes group therapy is recoanded

paranoia or souspicousness → percieve others as decietful and hostile

ideas of reference → randomn events have partiuclar meaning just for them

magical thinking → others know what they are thinking

illusions → short hallucinations

other → sheech that is tangential , vague , innapropriate , innaptopriate emotional response or no response

restricted range of emotions

soically isolated

as children : passive, socially unengaged and hypersesitive

they do have contact with reality !

uncomfortable in interpesoanl relatiosnhips

3.9% prevelence

commonly diagnosed in males than females

people of colour more often diagnosed

most well reserched in A cluster

transmitted gentically

81% heritability

more often is fist degree raltive alo have it

more histories of wide range chilhood adevrsities

NMDA receptors system associations

deregulations in dopamine in the brain

abnormally high level of dopamine in some areas of the brain

gray matter reductions in temporal lobe

reductions les in people with schiotypal personality

do not show abnormalities in prefronal areas like schizophrenia

same treatment as schizophrenia

lower doses of haloperidol , thiothixene , olanzapine

relive psychotic like symptooms

antidepreseants sometimes used as well

first establish good relationship with client

they want few close relationships

help client increase social contacts and socially innaporpriate behaviours

sometimes group therapy

crucial to look for objective evidence in environemnt to support their thoughts

Borderline personality disorder

Histrionic perosnlity disorder

Narcissictic perosnlity disorder

out of control emotions that cannot be smoothed

hypersensitivity to abandoment

tendency to cling too tightly to other people

history of hurting onself

fundemntal deficits in self indentity and interpesonal relationships

periods of extreme self doubt alternative with garndiose

need of others to support their self esteem

prone to diasociative states → feel unreal , lose track of time or forget who they are

interpesonal relationships are extremly unstable

switch form idealizing others to despersing them without provocation

feel empty → cling to another person

worry about abandoment

misinterper other people's everyday actions

unstable

severe depression , anxiety or anger

strong tendecy to engage in impulsice self demeging behaviours ( self mutialtion )

frequntly diagnosed with another mental disorder

75% attmept sucicide

10% die form sucide

within 1 or 2 years form diagnosis as they go to therapy only when it gets really really bad

5.9 % could be diagnosed woth borderline personality disorder

often women compared to men

more comonly people of colour and low SES

85% show remisions of symptoms within 10 to 15 years

samll percentage of relpse

grater variability in moods

vrater vulnerability ( especially hostility , fear and sadness )

more negative emoions baseline

more emotional cariability

lower return to their emotional baseline

more negative memories and hyperattentivness to them

unsucesfull attmpts to surperess negative taughts

end up ruminating

childhood marked by instability , neglect and parental psychopathology

sexual abuse during chilhood

become manupalite in attempt to gain support

never develop a fully differentiate view of thmeselves form others

reactive to tohers' opinions of them anad possibility of abandomnet

splitting thinking ( dichotmeous good or bad )
inastability in thei emotions and interpresonal relationships

amygdala and hippocampus smaller in volumr

grater activation of amygdala ( explains difficulty to regulate moods)

abnormalities in preforntal cortex

disorder runs in family

stuctural organisation of hippocamus and amygdala

help have a more realistic and positive sense of self

adaptive skills for solving problems and regulating emotions

correct dichatmous thinking

learn how to control impulsive behaviours

therapy for depresssion and anxiety

group intervention for peple with borderline

combines cognitive techiques, challage irratioanlity and amladaptive behaviours

show grater impovment in negative affect , impulsivity and functioning

develop realisitc and healitr understanding of thmslves and interpesonal relationships

shows reductions in sucidality and impulsivity, agression and anger

difficulty understanding themselves and others due to trauma

need valdation and support

patient and therpais uncover these problems

mood stabilizers

atypical antipychotics

rapidly shifting emotions and intense unsable relationships

behave in order to draw attention to themselves across situations

wants flattering nurturnce and preferintial attention

pursue highly seductive actions ( overly seductive )

1.84 % prevelnece

women are more likey to be diagnoside than man

faliy x enviroment

unclear

uncover repressed emotions and needs

help express emotions

identify clints's assumptions than make them not able to function

hrlp formulate goals

down dramatic evaluation

promote approapiate daily behaviour

rely on inflated self evaluationd and see dependency as weak

thoughts of self importance and fantesies of power and success

feel superior then most others

can be succesful in sociaties that reard self confidence

7.7% prevelence in men and 4,8 % prevelence in women

mostly young people and teens

high rates of comorbidity for substance abuse , depression , anxiety , impulsivity and hohocidal thoughts

maladaptive strategies for managing emotirons ans self views

did not develop realistic positive view of themselves

distess → no adaptive way to hadle stress → relay on prise

indulge in overevaluation

defense agains rejection

1. grandiose narcissim

copes with difficulties in self esteem by viewing self as superior and unique

gradione fantesies

1. vulerable narcissicm

feels intense shame

grandiose fantesies to quell intense shame

avoide treatment uless they have depression

severe interepsonal problems due to eakness

therapy teaches cognitive techiques that can help more realistic expectations

usually not reamin int herapy after they learn basic

Avoidant perosnality disorder

Dependent perosnlity diroder

Obsessive compulsive persoanlity disorder

low self esteem

prone to shame

extremly anxious about being criticized by others → avoid soical interactions

restrained , nervous and hypersensitive for being evaluated or criticized

tend to be depressed and lonely

crave relationships with others

unworthy of these realtionships and isolate themselves

2.4 percent

more women than men

prone to persistent depressive disorder

not stong relationship to sexual or physical abuse

develop dysfunctional belifs about worthleness

result from rejection by important people in early life

discunt feedback as they think people are just nice to them

gradually expose patients to soical settings

social skills trainin

chellenging negative automatic thoughts

increase in frequency and range of soical contacts

decrease in avoidance behaviours

sometimes used to reduce social anxiety

deep need to be cared by others

deny any of their thauhts and feelings that migh end in disagreemnet

difficulty in taking decisions

heavily rely on other peple

do not initiate new activities except in sn effort to please others

high fear of losing relationships

may allow themslevs to be exploited and abused to maintain relationship

0.49% prevelence

more women than men

depressive and anxiety diroders commonly co occur

triggered by interpersonal conflict or realtionship disruption

runs in families

heritability of disorder .81

separation anxiety or chronic phisiacl illnes make the disorder more prone

cognitive → have exagerated and inflexible beliefes regarding their depending needs

frequently seek treatment

show grater insight and self awareness

psychodynmaic → looks at childhood expirnces that lead to dependent behaviours

nondirective and humanistic → helpful in fostering sutonomy and self confidence

increase assertvie behaviours and decrease anxiety

challange clients assumptions about need to rely om otjers

graded exposure to anxiety provoking situations

take decisions by themseves

recognise their competence and challange neagtive thoughts

bases elf esteem on their productivitu and on meeting unreasoble goals

preoccupid , rules , detail , order . perfectionist

difficulty appreciating others and tolerating their quirks

stubborn and follow trict rules

more genral way of interacting with the world than OCD

very anxious if they do not do everything as they palnned

consider it just part of their perosnlity

7.9 prevelentce

most prevelent

prone to depressive anciety and eating disorders

gentic component found such as OCD

sligtly grater history of physical neglect then people with no dosorder

usually do not go to therapy

gradually go out of their rules

anxiety techiques to sooth anxisty provoked by doing such

discuss evidence and replace maladaptive thoughts

help gain more flexibilty

+SSRI

A. 25 pathological personality trits facets organised in 5 domains

B. severity and impairment

C. stability

D. across time

E. not effect of substance or medical condition

F. not being normative for developmental stage

G. not SES

LPFS : Levels of personality Functioning Scale

self functioning and interpersonal functioning

self functioning : identity and self direction

interpersonal fucntioning : empathy and itimacy → impairment on each of the sacales

1. negative affectivity

2. detaichment

3. antagonism

4. disinhibition

5. psychoticism

Step 1 : Asses imapirment in personality functioning

self : identity and self direction

interpesonal : empathy and intimicy

Step 2 : Asses pathological peronality traits

negative affectivity, detachmet, antagonism , dihibition , psychoticism

Step 3a : Apply criteria A and B for specific peronality diorders

antisocial , avoidant , borderline , narcissitic , obbsesive compulsive and schizotypal

Step 3b : Apply crieteria A and B for peronality disorder trait specific

moderate or great imapiremtn ( one or meore pathological perosnality trait )

Step 4 : Apply othwe inclusion and exlusion criteria