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Summary 4.2 Personality Disorders week 2
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4.2 PDs week 2 literature
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WEEK 2 LITERATURELECTURE 3
o To identify key aspects of the construct validity of PD
o To identify and distinguish between different alternative models of PD, incl.:
o FFM (NEOCA)
o AMPD
o And to link and apply this to the PD framework
o To reflect on PD assessment and the why, what and hows
o To identify and distinguish the different domains of psychodiagnostics, incl.:
o Domain aims
o Instruments to use
o Pro/cons of the instruments
o To apply knowledge of PD assessment to clinical examples
EMMELKAMP CHAPTER 2 DIAGNOSIS AND ASSESSMENT
Validity of the concept of PD
- two main approaches: standardized medical approach known from the PD model
from DSM-4 and an alternative model using a more dimensional approach instead of
a categorical approach
- DSM-5: includes the old categorical version but has the alternative model in the
research section
- what distinguishes normal and abnormal personality variation?
- how can different levels of functioning personality be standardized to make a model
which can be generalized in clinical practice?
- does the used model need to be clinically relevant or more research driven?
- construct validity of PDs?
Different approaches to abnormality
- DSM5 lost the axis approach
- all-or-none categorical formulation implies there should be an identifiable cut-off
point of where normal ends and abnormal begins
- taxometrics investigates whether latent structures of PDs are categorical (taxonic) or
dimensional
o direct empirical tests of underlying structure for most PDs is missing
o some taxometric evidence for cluster C, paranoid PD and borderline PD
o review suggests little evidence for the categorical approach for PDs other than
schizotypal PD
- cluster and factor analytic techniques have also been used
o mixed results
- define pathology by nature and associated domains of impaired functioning:
o 3 step criteria: functional inflexibility, self-defeating circles, and tenuous
stability under stress
- tripartite criterion for pathology:
, o a) failure of the self-system to establish stable and integrated representation
of the self
o b) maladaptive functioning in interpersonal relationships
o c) failure to develop and maintain prosocial and cooperative relationships
o this resembles more a dimensional approach
DSM-5 PDs
- categorical representation is easier to define, are convenient, and guide clinical
decision making easily
- to diagnose PD:
o 1. does the person meet the general criteria for a PD
o 2. look at more specific criteria with dynamics of PDs, symptoms and cut-off
numbers
The DSM criteria
- personality pathology is dichotomous (either there or not)
- each criterion is weighed equally for diagnosis and no criterion is necessary for
diagnosis
- it’s not possible to capture the full range thus, other specified/unspecified categories
for when presentation is less homogenous
- polythetic criteria of equal weight: there is no single criterion required/essential to
the disorder, but there are alternative definers, with a certain critical min. number to
be present
o possibility to capture a wide range of psychopathology, heterogeneity
o meeting 5 or more out of nine criteria in borderline PD gives 246 variations
o some criticism for not weighing importance on some criterion
o there is evidence that some criteria are more essential as they differ in their
sensitivity and specificity (if a criterion has high specificity and high sensitivity
then it’s prototypical of that disorder)
- symptoms vs traits: disorders are a mixture of symptoms, behavioral expression of
traits and traits themselves
o some disorders have emphasis on symptoms and behavioral expressions (e.g.
borderline PD) and some disorders have emphasis on traits (e.g. paranoid PD)
o advantage to behavioral criteria is minimal inference from rater
o but we favor behavioral expressions at the expense of characteristic patterns
of inner experiences (motivation, cognitive style, affect etc.)
- comorbidity: people with PDs usually have multiple PDs and can also have syndrome
disorders
o often people come in for complaints other than their PD
- most objections are not specific to PDs but other clinical syndromes too
Differential diagnostics
- motivation for behavior is very important in current classification e.g. schizoid vs
avoidant social isolation motivation
- structure to diagnostic process:
o 1. self-report instruments to narrow down range of potential PDs
o 2. info used to select relevant parts of a structured interview
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