S2W9 ID: personality orders

S2W9 ID: personality orders

1. Circumplex Theory of Affect

   • Watson & Tellegen, 1985 key paper in theoretical understanding of mood. Propose mood compromised of two dimensions: Positive Affect and Negative Affect. So the two dimensions in essence are comprised of combinations of different moods and states of being
   • Positive Affect Negative Affect Schedule (PANAS) – Watson et al., 1988)
     • Freely available measure that has been validated/shown to be reliable . Can measure “State” or “Trait” affect. However, mainly used as a short-term subjective rating of well-being

2. Concept and definition of personality disorders in relation to trait models.

   • Biopsychosocial model:
     • Additive effects of genes, personality and environmental risk factors
   • Diathesis-stress model
     • Maladaptive personality traits (inherited or formed in early experience) might form a diathesis Life stress could tip over the edge into disorder High IQ or social support might be protective factors (Cohen et al., 2005)

3. Treatment/coping of personality disorders

   • Issues in PD Diagnosis
     • Treatment rarely sought for PD itself but for resulting impairment or distress PDs overlap and difficult to distinguish – leads to high comorbidity  Validity? Reliability?
       • Many permutations of symptoms for each PD ‘Not Otherwise Specified’ common diagnosis Forces categorical distinction onto naturally dimensional individual differences
   • There are at least 18 alternative dimensional models of PDs! O’Connor et al. (2002): same factors emerge in clinical/non-clinical samples for both clinical/non-clinical measures
     • Livesley et al. (1989); validated by Kushner et al. (2011) Factor analysis of PD symptoms  18 facets, 5 higher-order factors DAPP (Dimensional Assessment of Personality Pathology) Q’re
   • Are PD’s related to the Big Five?
     • Continuity Hypothesis: PDs are just extreme combinations of normal personality traits
       • Widiger & Trull (2007): Five-Factor Model can be used to assess PDs Identify extreme facet scores Identify likely resulting impairments Assess global functioning
         • Most PDs related to high N, low E, low A, and low C Facets can help distinguish different PDs or clusters (Samuel & Widiger, 2008)
   • Issues in predicting PDs with FFM
     • FFM doesn’t capture extremes (e.g., of disagreeableness) found in PDs – ceiling effects (Clark et al., 2002) e.g., ‘I feel little concern for others’
       • FFM doesn’t cover relevant PD dimensions (Tromp & Koot, 2010) e.g., cognitive distortions, self-harm
         • FFM based on lay concepts of personality - doesn’t reflect complexity of clinical cases (Shedler & Westen, 2004) e.g., NPD = inflated self-worth + inadequacy
   • DSM-5: Alternative hybrid model
     • Extensively debated but included in Section III (further study) (A) Long-term, stable, pervasive impairment of functioning (self/interpersonal) PLUS (B) High score on 1/5 pathological trait domains (negative affectivity, detachment, antagonism, disinhibition vs. compulsivity, psychoticism) (25 facets) PD type diagnosis if match specific patterns of impairments and traits (avoidant, antisocial, borderline, narcissistic, obsessive-compulsive, schizotypal) Otherwise, Personality Disorder—Trait Specified
       • Evaluating: Would remove comorbidity and ‘not otherwise specified’ Can also be used to describe pathological personality of non-PD clients 4/5 traits are unipolar and do not map on perfectly to FFM (or other theoretical models) How useful?
   • Are PDs treatable?
     • Medical: Medication used to treat Axis I (other disorder) problems
     • Psychodynamic: -Some evidence that achieving insight into problems is helpful (Svartberg et al., 2004) .
     • Behavioural: Dialectical Behaviour Therapy (Linehan, 1987) Accept and understand maladaptive behaviours, replace with more helpful ones Learn alternative emotional/coping skills Effective for reducing BPD behaviours but not identity/emotions (Robins & Chapman, 2004)
       • Cognitive-Behavioural
         • CBT: identify dysfunctional cognitions Adapted to help client trust therapist, avoid direct ‘challenges’ Schema therapy: identify origins of early maladaptive schemas, accept/manage associated emotions, reduce belief in schemas Preliminary RCT evidence for BPD (Giesen-Bloo et al., 2006) 3 years schema therapy vs. psychodynamic therapy

4. Psychopathology as an individual difference

   • Psychopathology is:
     • Deviant (statistically or socially): but “abnormal” just means unusual Maladaptive: impaired ability to function Distress: to individual and/or others Not merely expected response to event. Patterns are common – only illness if causes distress and impaired functioning
   • Personality disorders
     • Personality trait: enduring yet flexible Personality disorder (PD): enduring inflexible and pervasive patterns differs from social expectation in at least two of: Cognition Affectivity Interpersonal functioning Impulse control clinically significant distress or impaired functioning long-standing, stable – intrinsic part of someone’s personality and identity
     • Prevalence: 10-15% Unclear – many people do not seek treatment Onset: usually recognisable from adolescence
       • Assessment: self-report questionnaires (e.g., PDQ-IV; reliable, efficient, use validity scales BUT requires insight) semi-structured interview (e.g., SCID-II; good inter-rater reliability, validity BUT potential bias, time-consuming) Often comorbid with Axis I (non-personality) disorders (especially depression and anxiety) - make those disorders harder to treat
     • Antisocial PD
       • (A) Disregard and violate others’ rights/feelings: 3 or more of… repeated unlawful behaviour deceitfulness impulsivity aggression and physical fights reckless disregard for safety consistent irresponsibility (e.g., job, money) lack of remorse (B-C) Over 18 but evidence of conduct disorder before age 15
         • Previously called psychopathic/sociopathic, but now emphasises behaviours, not underlying psychology Overlaps with, but not same as, subclinical psychopathy
       • Aeitiology:
         • More prevalent in men than women Genetics: 41% heritable (meta-analysis; Rhee et al., 2002) Biology: smaller brain (Barkataki et al., 2006) lack of response to distress and punishment (Birbaumer et al., 2005; Blair et al., 1997) Impaired prefrontal cortex functioning (Dinn & Harris, 2000) Environment: low SES, family conflict, physical abuse, inconsistent parenting (father APD?) (Cohen et al., 2005) Childhood conduct problems (just APD showing already?) Difficult to study: don’t seek help, if “successful” not caught!
     • Histrionic PD:
       • Excessive emotionality + attention-seeking, 5 or more of: Needs to be centre of attention; concerned with appearance; theatrical exaggeration; sexually provocative Shallow and rapidly shifting emotions; impressionistic speech; suggestible Considers relationships more intimate than they are
         • Genetics: 67% heritable (Torgersen et al., 2000) Environment: Psychodynamic theories: parental coldness or attitudes to sex, but little evidence Evidence for maternal over involvement (Cohen et al., 2005)
     • Narcissistic PD
       • Grandiosity, need for admiration and lack of empathy, 5 or more: Grandiose, self-importance, Fantasies of unlimited success etc. , Believes self is special/unique, Requires admiration, Sense of entitlement, Exploitative , Lacks empathy , Envy (self or others) , Arrogant
         • Aietiology:
           • More prevalent among men than women Genetics: significant heritable component (up to 79%; Torgersen et al., 2000) Psychodynamic approach: permissive or rejecting parenting can result in self not developing in healthy way Environmental risk factors: parental verbal abuse (Cohen et al., 2005) but little research Most research on subclinical narcissism (overlaps with NPD but related to better psych health; Miller & Campbell, 2008)
     • Boderline PD
       • Pervasive instability and impulsivity, 5 or more of: Frantic effort to avoid abandonment V. unstable relationships (idealised devalued) V. unstable self-image Impulsive in at least 2 damaging areas Recurrent self-harm or suicidal behaviour/threats Extremely reactive mood Chronic empty feelings Intense, inappropriate or uncontrolled anger Stress-related paranoia OR severe dissociative symptoms Comorbid with depression, anxiety, and addiction disorders
       • Aetiology:
         • More women than men present for treatment Genetics: 42-69% heritable in both sexes (Distel et al., 2008; Torgersen et al., 2000) Biology: Frontal lobe  impulse control Amygdala functioning  emotion regulation.
         • Environmental risk factors (Cohen et al., 2005): Childhood verbal, emotional, or sexual abuse (60-90%) Extended separations from mother before age 5 Inconsistent parenting
           • Anxious or disorganised attachment? (Steele & Siever, 2010) Role of emotion regulation and negative model of self BPD correlates with attachment anxiety in non-clinical samples (Nickell et al., 2002) BPD patients report preoccupied or fearful attachment (Levy et al., 2005)

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