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Personality & Psychopathy (Antisocial (Significant impairments in…
Personality & Psychopathy
DSM
Diagnostic & Statistical Manual of Mental Disorders
DSM-IV
Axis 1: Depression, anxiety, schizophrenia etc.
All categories except mental retardation and personality disorders
Axis 2: Personality Disorders
Borderline, obsessive-compulsive, narcissistic PD etc.
DSM V
Now grouped on a
single axis
Disorders: Antisocial, borderline, dependent, narcissistic, paranoid etc.
^ No reason to separate PD's from axis 1
Antisocial
Significant impairments in personality functioning by:
Impairments in
self functioning
(a or b)
a) Identity, b) Self-direction
AND 2. Impairments in
interpersonal functioning
(a or b)
a)Empathy, b) Intimacy
Lack empathy and struggle with relationships
Attacking someone is antisocial but not enough to be diagnosable
No remorse - think someone is out to get them
Patient should not be labelled until over 18 y/o -> stigmatisation
They want approval from others
Unaware of motivations - some people use others to inflate ego
Narcissistic
Notion that they are better than others
Think they will be famous one day
Autistics are often narcissistic
In some sub-cultures (gangs) you have to be narcissistic
Do gangs breed nar. people or do nar. people get into gangs?
Obsessive Compulsive
Everything must be flawless
They carry on long after the behaviour has become functional/effective
Medical vs. Dimensional Model
Medical:
Diagnosis implies dichotomous distinction
Either you have the disorder or you don't
Similar to the diagnosis of an infectious disease
Dimensional perspective
suggests that psych. disorder may be at the extreme end of the normal personality distribution
Think of a SD graph (most people in the middle - less people at either end
Failures of the Categorical Model
Excessive co-occurance
If these disorders are unique entities - there shouldn't be much co-occurance
^However, many people with one PD meet the diagnostic criteria for another
E.g. sizeable proportion with antisocial PD also meet diagnosis for narcissistic PD
Inadequate Coverage
Each category has 'not otherwise specified' (NoS)
NoS = widely used diagnosis
Existing diagnostic categories not sufficient for understanding PD
If each PD is distinct, then there isn't a problem with adding more to the DSM
^BUT if they reflect combinations of different dimensions then adding more categories muddies the waters
Heterogeneity among people with the same diagnosis
Symptoms are fairly common across cases
E.g. two people can receive OC PD diagnosis but share few of the clinical features
Unstable Boundaries
How does one know when a clinical feature has been sufficiently met?
E.g. Rigid Perfectionist - sometimes this is needed for work - when is this detrimental and needs treating
Inadequate Scientific Base
Blashfield & Intoccia
: Reviewed literature - research into several PDs that had stopped
Psychiatrists often aren't doing DSM research - do they really understand the PDs without the research?
Use complex stats to ask questions -> do disorders cluster into discrete bands?
By using stat approach, all disorders are
dimensional
(less or more than others - NOT that they have it or they don't)
Models
Advantages
Universality: Traits generally cross-culturally valid
Better understanding of why disorders co-occur
Heterogeneity can be better understood: E.g. OCD features may differ across individuals because of the N & C facet scores
Spectrum
A depressive diagnosis is the most
extreme
score on a relevant trait (e.g. neuroticism)
Doesn't account for depressive episodes - traits aren't stable
Major life events -> Depression
E.g. death in the family, job loss etc.
Scar Model
If trait levels are higher after episode -> suggests scarring (assess before and after episode)
Vulnerability Model
Having higher/lower personality level increases the probability of developing psychopathology
E.g. maladaptive personality traits (borderline PD) evoke particular responses form others (rejection) --> Depression
Kendler et al.:
Neuroticism = first major onset of depression
The models are NOT mutually exclusive - possible to experience them all
Difficulties with Adopting a Dimensional Approach
Clinical Utility
Helpful to have a firm diagnosis -> aids communication
May be needed for insurance purposes - private healthcare
Psychiatrists do not conduct research - may be an issue when learning something new
Many different dimensional models (B-5, HEXACO etc.)