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Psychopathology (Medical vs Dimensional Model (Failures of the Categorical…

- - - - If these disorders are unique entities one should not see very much co-occurrence
      - However, many individuals with one personality disorder meet diagnostic criteria for others
      - e.g. sizeable proportion (c. 20%) with antisocial PD also meet diagnosis for narcissistic PD
    - - Each category has “Not otherwise specified”
      - NoS personality disorder is a widely used diagnosis
      - Existing diagnostic categories not sufficient for understanding personality disorders in the clinic
      - If personality disorders are qualitatively distinct, then there’s no problem just adding more to the manual
      - But if they reflect combinations of different personality dimensions then adding more categories just muddies the waters
    - - Blashfield & Intoccia (2000) reviewed the literature
      - Reported that scientific research into several personality disorders had died off
      - Over one-half of the individual personality disorders (e.g., histrionic and passive-aggressive) have either very small literatures or literatures with negative growth rates. Only three personality disorders (i.e., antisocial, borderline, and schizotypal) have modestly growing literatures.”
  - - - FFM
        
        Advantages
        
        Universality – FFM traits are established to be, more or less, crossculturally valid
        
        Better understandings of why disorders co-occur – NB Not specific to the FFM approach
        
        Heterogeneity can be better understood – e.g. OCD features may differ across individuals because of the N and C facet scores – Again, not specific to the FFM; HEXACO etc could provide this benefit
    - - Example: depression
        
        Spectrum Model
        
        Make some intuitive sense
        
        However: – Does it account for episodic depressive episodes? i.e. traits are stable
        
        And what about depression that occurs in people with low levels of N?
        
        So perhaps better as an account of chronic depression than episodic depression?
        
        A depressive diagnosis is simply the most extreme score on a relevant trait (e.g. neuroticism).
        
        Vulnerability Model
        
        Having a higher/lower level of a specific personality trait increases the probability of developing psychopathology.
        
        Example: – Maladaptive personality traits (e.g. Borderline PD) evoke particular responses from others (e.g. ostracism, rejection);
        
        May in turn facilitate the development of depression.
        
        Another example: – An individual who is very low in conscientiousness;
        
        In turn at higher risk for developing conduct disorder because of the lack of inhibition.
        
        Scar Model
        
        If personality traits levels are much higher after the episode has remitted, it would suggest that scarring has occurred.
        
        The scar hypothesis can be evaluated by assessing persons before and after a first depressive episode.
        
        NB what level of analysis has this scarring occurred?
        
        Costa and McCrae would presumably argue that its not at the basic tendency level
- - - - Impairments in interpersonal functioning (a or b):
        
        a. Empathy: Lack of concern for feelings, needs, or suffering of others; lack of remorse after hurting or mistreating another.
        
        b. Intimacy: Incapacity for mutually intimate relationships, as exploitation is a primary means of relating to others, including by deceit and coercion; use of dominance or intimidation to control others.
      - Impairments in self functioning (a or b):
        
        a. Identity: Ego-centrism; self-esteem derived from personal gain, power, or pleasure.
        
        b. Self-direction: Goal-setting based on personal gratification; absence of prosocial internal standards associated with failure to conform to lawful or culturally normative ethical behavior
  - - - Antagonism, characterized by: .
        
        a. Manipulativeness Frequent use of subterfuge to influence or control others; use of seduction, charm, glibness, or ingratiation to achieve one’s ends
        
        b. Deceitfulness Dishonesty and fraudulence; misrepresentation of self; embellishment or fabrication when relating events.
        
        c. Callousness Lack of concern for feelings or problems of others; lack of guilt or remorse about the negative or harmful effects of one’s actions on others; aggression; sadism.
        
        d. Hostility Persistent or frequent angry feelings; anger or irritability in response to minor slights and insults; mean, nasty, or vengeful behavior.
      - Disinhibition, characterized by:
        
        a. Irresponsibility Disregard for – and failure to honor – financial and other obligations or commitments; lack of respect for – and lack of follow through on – agreements and promises.
        
        b. Impulsivity Acting on the spur of the moment in response to immediate stimuli; acting on a momentary basis without a plan or consideration of outcomes; difficulty establishing and following plans.
        
        c. Risk taking Engagement in dangerous, risky, and potentially self-damaging activities, unnecessarily and without regard for consequences; boredom proneness and thoughtless initiation of activities to counter boredom; lack of concern for one’s limitations and denial of the reality of personal danger
- - - - 30% of variance in life event reports over that period was attributale to the level of neuroticism and social disadvantage of the women
      - N scores predict in particular person-dependent stressful life evnts and chronic adversity
      - 6 year longitudinal data
    - - National Brsitish Bithr Cohort of 5000+
      - higher N scores in childhood predicted affective illness at ages 36 & 43
    - - in the presence of high N and/or longterm difficulties at baseline, the depressogenic effect of subsequent stressful life events was substantial whereas it was absent in their counterparts
      - There is also some evidence that high N persons, when depressed, may benefit more from + life change than low N persons
      - 83 ps who developed a major depressive episode in the 5 yrs following baseline were compared with 83 randomy selected controls
    - - found 86 depressed primary care patients who were followed for 3.5 yrs tat N enhances the effect of + life events
      - the capacity of + life event to bring remission forward was 3x stronger for high N individuals
    - - N predicted onset of major depression but it was itself, if measured during an episode, also sig incr compared with pre and post assessments
    - - showed that unipolar depression, phobic disorders, panic disorder, N, and to a lesser extent GAD are too a large extent familial because these disorders share genetic risks
      - collectively these findings support the H1 that N measures habitual level of distress
    - - that N skills measure a persons characteristic level of distress
      - That this individual-specific level of distres is partly stable oer time
      - But also shows differential change over time
- - - - C.The impairments in personality functioning and the individual’s personality trait expression are relatively stable across time and consistent across situations.
        D. The impairments in personality functioning and the individual’s personality trait expression are not better understood as normative for the individual’s developmental stage or socio-cultural environment.
        E. The impairments in personality functioning and the individual’s personality trait expression are not solely due to the direct physiological effects of a substance (e.g., a drug of abuse, medication) or a general medical condition (e.g., severe head trauma).
- - - - Impairments in self functioning (a or b):
        
        a. Identity Sense of self derived predominantly from work or productivity; constricted experience and expression of strong emotions.
        
        b. Self-direction Difficulty completing tasks and realizing goals associated with rigid and unreasonably high and inflexible internal standards of behavior; overly conscientious and moralistic attitudes.
      - Impairments in Interpersonal functioning (a or b):
        
        a. Empathy Difficulty understanding and appreciating the ideas, feelings, or behaviors of others.
        
        b. Intimacy Relationships seen as secondary to work and productivity; rigidity and stubbornness negatively affect relationships with others.
  - - - Compulsivity, characterized by: a. Rigid perfectionism: Rigid insistence on everything being flawless, perfect, without errors or faults, including one's own and others' performance; sacrificing of timeliness to ensure correctness in every detail; believing that there is only one right way to do things; difficulty changing ideas and/or viewpoint; preoccupation with details, organization, and order
      - Negative Affectivity, characterized by: a. Perseveration: Persistence at tasks long after the behavior has ceased to be functional or effective; continuance of the same behavior despite repeated failures
- - - - Impairments in self functioning (a or b):
        
        a. Identity Excessive reference to others for self-definition and self-esteem regulation; exaggerated self-appraisal may be inflated or deflated, or vacillate between extremes; emotional regulation mirrors fluctuations in self-esteem.
        
        b. Self-direction Goal-setting is based on gaining approval from others; personal standards are unreasonably high in order to see oneself as exceptional, or too low based on a sense of entitlement; often unaware of own motivations
      - Impairments in interpersonal functioning (a or b):
        
        a. Empathy Impaired ability to recognize or identify with the feelings and needs of others; excessively attuned to reactions of others, but only if perceived as relevant to self; over- or underestimate of own effect on others.
        
        b. Intimacy Relationships largely superficial and exist to serve self-esteem regulation; mutuality constrained by little genuine interest in others' experiences and predominance of a need for personal gain
    - - Pathological personality traits in the following domain: Antagonism, characterized by:
        
        a. Grandiosity: Feelings of entitlement, either overt or covert; self-centeredness; firmly holding to the belief that one is better than others; condescending toward others.
        
        b. Attention seeking: Excessive attempts to attract and be the focus of the attention of others; admiration seeking.