Samenvatting
Samenvatting Literatuur Persoonlijkheidsstoornissen deel 2
- Instelling
- Universiteit Van Amsterdam (UvA)
Dit is de samenvatting van de literatuur voor het tweede deeltentamen van persoonlijkheidsstoornissen. Succes!
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Door: elisedegroot1 • 4 jaar geleden
Door: lexanneweggemans • 4 jaar geleden
Voorbeeld van de inhoud
Persoonlijkheidsstoornissen deel 2Hi! Dankjewel voor het kopen van mijn samenvatting!
Ik was aan het twijfelen of ik deze er nog op ging zetten, maar ik kreeg 3(!) berichtjes of
ik dat wel wilde doen! Heel erg bedankt daarvoor, dat geeft me motivatie haha.
Ik ga proberen om ook de aantekeningen van de hoorcolleges er nog op te zetten deze
week. Gelukkig staan ze allemaal online dus kan je ze ook zelf terugkijken.
Voor deze samenvatting geld weer: gebruik het als ondersteuning bij het leren, niet als
enige leermiddel.
Succes! Liefs!
Inhoudsopgave
Dependent personality disorder p. 2
Avoidant personality disorder p. 5
Obsessive-compulsive personality disorder p. 9
Paranoid personality disorder p. 12
Schizoid personality disorder p. 15
Schizotypal personality disorder p. 17
Beck H1 p. 20
Beck H5 p. 22
DBT p. 28
Nieuwe ontwikkelingen in TFP p. 33
TFP p. 35
MBT p. 39
Theoretisch model: schema’s, copingstrategieën en modi p. 43
1
, Widiger H23: Dependent personality disorder
Dependent personality Disorder (DPD) is one of the oldest and most intriguing forms of
personality pathology. DPD is associated with an array of negative outcomes in clinical
settings and in vivo. It is also associated, however, with increased adaptation in a
variety of areas.
The evolution of dependent personality disorder
Virtually every culture has recognized and describer highly independent individuals and
speculated regarding the origins of dependent personality traits. The writings of
Kraepelin and Schneider on DPD helped reify the notion that high levels of dependency
are invariably associated with deficit and dysfunction. It has also helped set the stage for
early psychoanalytic writings on dependency.
In classic psychoanalytic theory, dependency is linked to events that occur during the
first months of life – the oral stage of development. There is not a lot of evidence for this
theory. The core component of pathological dependency is: a perception as oneself as
weak, couples with the belief that potential caregivers – if properly appeased – will offer
needed protection and support. A dominating parent does indeed play a role in the
etiology of DPD.
PDP in the DSM-I was characterized as “helplessness, indecisiveness, and a tendency to
cling to others as a dependent child to a supporting parent.” It received less attention in
the DSM-II. In the DSM-III, three symptoms were included:
1. Passivity in interpersonal relationships.
2. A tendency to subordinate one’s needs to those of others.
3. Lack of self-confidence.
The symptoms in the DSM-III-R were far more detailed. These were also listed in the
DSM-IV. Here, the overlap between other Axis-II disorders was reduced. The essential
feature was: “a pervasive and excessive need to be taken care of that leads to
submissive and clinging behavior and fears of separation beginning in early adulthood
and present in a variety of contexts”. Empirical evidence regarding the symptoms in the
DSM-IV was mixed.
In the PDM, DPD is described as “the tendency to define themselves mainly in relation to
others and seek security and satisfaction predominantly in interpersonal contexts”. The
PDM is primarily descriptive rather than prescriptive. Individuals think: “I am
inadequate, others are powerful.” Two other common symptoms are: possessiveness
and projective identification.
DPD assessment methods
It typically involves questionnaires and/or structured interviews. There are no specific
questionnaires for this PD. The most used questionnaire is the Millon Clinical Multitaxial
Inventory. Also commonly used are the SCID, the IPDE and the SIDP-R. To measure the
trait dependency, the Interpersonal Dependency Inventory or the Rorschach Oral
Dependency are commonly used.
Epidemiology, differential diagnosis, and comorbidity
2
,The prevalence of DPD is between 5% and 15% in psychiatric inpatient units, and 0% to
10% in outpatient clinics. The prevalence in the general population is between 1% and
2%. Women are about 40% more likely than men to receive a PDP diagnosis. PDP shows
substantial comorbidity with a variety of Axis I and Axis II disorders. It is associated
with: eating disorders, anxiety disorder, depression, substance dependence, and the
majority of personality disorders.
Contemporary theoretical perspectives
About one-third of the variability in adult dependency is attributable to genetic factors. It
seems like the earliest precursors of dependency are certain temperament variables.
Several contemporary viewpoints have been influential in explaining the etiology of DPD.
The psychoanalytic perspective
Dependent personality traits result from the internalization of a mental representation of
the self as vulnerable and weak. A representation of the self as helpless and in need of
support and guidance from others may be associated with exaggerated dependency
needs in a variety of participant groups.
Behavioral and cognitive models
People exhibit dependent behaviors because those behaviors are rewarded, were
rewarded, or – at the very least – are perceived by the individual as likely to elicit
rewards. Dependency was initially conceptualized as an acquired drive, for the reduction
of basic, primary drives. This framework emphasized the role of the self-concept, beliefs
regarding other people, and expectations regarding self-other interactions in the etiology
and dynamics of dependency and DPD.
Trait models
Leary’s two-dimensional (love-hate, dominance-submission) matrix classified personality
disorder. Dependency was thought to occupy the love-submission quadrant. The Five-
Factor Model classifies personality traits along five broad dimensions or factors:
neuroticism, extraversion, openness to experience, agreeableness, and
conscientiousness. The FFM provides and overarching framework for examining stability
in personality structure over time, and change in response to treatment. Dependency
was related to openness and neuroticism. It is suggested that dependency is
characterized by high levels of anxiety and insecurity and low levels of risk taking and
sensation seeking.
The humanistic existential perspective
A key tenet of the humanistic perspective on dependency is that various familial and
societal factors can cause the developing person to construct a “false” self. Parental
authoritarianism plays a role in the etiology of dependency.
An integrated model
The etiology of DPD lies in two areas: overprotective, authoritarian parenting and gender
role socialization. Overprotective, authoritarian parenting prevents the child from
developing a sense of autonomy and mastery following successful learning experiences.
Gender-role socialization teaches girls a development of a dependent self-concept. This
model also posits that while the dependent person’s core beliefs and motives remain
stable over time and across context, the dependent individual’s behavior varies
predictably from situation to situation.
3
, Treatment strategies
Psychodynamic approaches
This approach has a core assumption that many features of conscious experience are
rooted in unconscious conflicts. The aim of psychoanalytic therapy with dependent
patients is not to ameliorate these conflicts but to make them accessible to
consciousness, where they can be examined critically and acted upon mindfully. Thus,
the primary goal is insight. The first task is to build a collaborative working relationship
through empathic communication on the part of the therapist. The therapist may fear
that the patient’s dependency will become increasingly intense over time. One way to
prevent this is to explore the patient’s transference reaction and the therapist’s
countertransference response.
Behavioral approaches
Dependency is conceptualized as a set of responses aimed at obtaining help and support,
which are acquired and maintained through a combination of conditioning and learning
processes. Behavioral principles may be particularly useful for understanding the
persistence of dependent behavior. Four techniques are useful in altering the
contingencies that maintain this pattern.
1. Extinguishing the problematic dependency.
2. Replacing dependency with autonomy.
3. Using desensitization to facilitate behavior change.
4. Maintaining behavior change post treatment.
Cognitive approaches
Cognitive approaches share an emphasis on effecting behavior change by altering the
patient’s characteristic manner of thinking about, perceiving, and interpreting the world.
It focuses on the patient’s maladaptive schemas. A primary goal of therapy is cognitive
restructuring – altering dysfunctional thought patterns that foster self-defeating
dependent behavior. There is a four-stage model for this:
1. Active guidance from the therapist.
2. Enhancement of the self-esteem of the patient.
3. Promotion of autonomy of the patient.
4. Relapse prevention.
Conclusion
Pathological dependency is increasingly viewed as stemming from a perception of the
self as weak, couples with a belief that others are comparatively competent and
confident. Continued research on the etiology and dynamics of DPD is important.
4
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