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Lecture notes 4.2 personality disorders
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Lecture 1Personality Disorders
College 1, 2 and 6 especially important for the exam.
A personality disorder is an enduring pattern of inner experience and behaviour that deviates
markedly from the expectations of the individual’s culture, is pervasive and inflexible, has an
onset in adolescence or early adulthood, is stable over time and leads to distress or
impairment. Its about thinking, feeling and behaviour.
→ this is all of us on a bad day. It’s not like this is something that is very far away from us.
Don’t think of it as abstract, but as extremer bits of what we tend to experience ourselves.
Criteria:
- Enduring pattern of inner experience and behaviour
- Deviates from expectations of the individual’s culture
- Inflexible and pervasive
- Clinically significant distress
- Stable and of long duration
- Not better explained by any other mental disorder, medical condition or drugs
- 3P’s → persistence, pervasive, pathological
If there are other ways to explain someone’s behaviour, we can’t diagnose them with PD.
Aetiology:
We know very little about the aetiology
of personality disorders and how they
come to be. We use a very generic model
for this, the diathesis-stress model. We
assume that in case of personality
pathology there is some kind of
predisposition (Genes, brain), coupled
with different kind of stressors.
When we talk about personality disorders we always talk
about clusters, A, B and C. This shows the prevalence,
which also deals with comorbidity.
,Clusters of PD
Cluster A, atypical
- Paranoid personality disorder
o Pattern of distrust and suspiciousness, no reason to trust others. It is not that you
don’t like everyone, there is just an extreme version of paranoia, which makes you
not spend a lot of time with other people (Stalin). Can be accompanied by
delusions and such, but doesn’t have to be. They expect people to have bad
intentions all of the time, across situations.
- Schizoid personality disorder
o Detachment from social relationship and restricted emotions. People steer clear of
others and are shallow showing emotions (Dexter). Detached from their own
emotions, quite flat in terms of their emotional range. There is a lack of desire,
lack of wanting interpersonal relationships. More observers than participants. Not
very interested in sex or intimacy.
- Schizotypal personality disorder
o Pattern of discomfort around social relationships, eccentric behaviour, everything
is unique and special (Willy Wonka). People are just a little in their own mind,
their own way, they have a unique view on things. Can be accompanied with
delusions etc. closest to schizophrenia. This is not per se linked to psychotic
episodes. Few close relationships, or misinterpret relationships as closer than they
actually are. This is not related to stress, like with schizophrenia, this is more
constant.
Cluster B, boohoo
- Antisocial personality disorder
o Disregard or violation of rights in the way we deal with each other. I don’t care
about rules, I have my own system (Joran van der Sloot). Usually begins in
childhood, you expect stuff to have happened before their 18th. Often lawbreakers,
with difficulties interacting socially. Don’t care about other people, other rules,
others things, anything that’s not me.
- Borderline personality disorder
o Instability in how you see yourself, how you feel and how you relate to others.
Today all is good, tomorrow all is bad. For example when experiencing PMS.
Feeling empty and often very black-and-white (Amy Winehouse & Angelina
Jolie). Often show self harm of self-destructive behaviour.
- Histrionic personality disorder
o Needing attention, attention seeking, need to be the centre of attention. Lots of
drama and emotion, will try to make sure they are the centre of attention (Regina
George), used to be ‘hysteria’ or ‘hysterical neurosis’. More seductive and
sexually provocative in a way of attention seeking.
- Narcissistic personality disorder
o Wanting to be big and important, need for admiration, lack of empathy.
Overwhelming need for admiration (Kim Kardashian, Trump).
, Cluster C, control (of anxiety)
- Avoidant personality disorder
o People steer clear of social interaction, sensitive to rejection. Feelings of
inadequate, super sensitive to rejection. They want to have close friends, but they
always feel like they are failing or not good enough (Michael Jackson, wanting to
live in his own private world). Might be labelled as shy or timid, but they do
actually desire social interaction.
- Dependent personality disorder
o Pattern of submissiveness, need to be taken care of. Please don’t leave me alone, it
feels a lot safer to have someone with you. Fear of being left by yourself, fear of
not being able to handle it themselves. A need to be taken care off in order to be
okay, if you are not there my anxiety will rise.
- Obsessive-compulsive personality disorder
o Pattern of wanting things to be neat, orderly, anxiety from chaos. Perfectionism,
anxiety for chaos and mess. There is often quite a good reason for the order people
want, but it’s also very ‘always and everywhere’ which impacts their relationships
(Steve Jobs). The difference with the ‘regular’ disorder is that the rules don’t just
apply to myself, but also apply to everybody else and if they don’t that is
upsetting.
Critiques of DSM-5:
- Very focused on the western perspective
- Lack of non-psychiatrist input
- Potential bias
- Some controversial disorders
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