Please enable JavaScript.
Coggle requires JavaScript to display documents.
Personality disorders (General info (Gutierrez 2012: How do traits evolve…
Personality disorders
General info
-
Paunonen 2006: Maladaptive and adaptive traits of PD
- can good leaders be identified based on their personality ?
Do narcocists make good leaders ?
- bright side = self confidence + charisma
- dark side = manipulative + impression management
--> authors think that those displaying bright side = best leaders
How:
- 199 military cadets (12platoons)
- during training they all lead their platoon once hence every one has been a leader
- big 5 questionaire
- impression management
- egotism + manipulation (SPI questionnaire)
- peer rating questionnaire
Results:
- leaders with good rating correlated moderately (0.3) with bright side of narcism (egotism + self esteem)
- no correlation found for dark side
- big 5 for good leader = extroverted, conscientious and emotionally stable
Arntz 2009 : Are PD categorical or dimensional?
- --> look dimensional ofc haha xD
PD = dimensional
- only 2 out of 78 analysis 1 for paranoid and one for BPD showed equal support for both
- there were like 3 analysis for each disorder so for BPD 1 o f those 3 was shewed equal support etc
-
Limitations/caution:
- just cause dimensional doesnt mean big 5 can describe them accurately as based on nonclinical sample
- nonclinical sample doesn't represent important PD features
- big 5 items too superficial and doesn't asses these important characteristics
--> thus big5 might only be able to detect PD if the symptoms are extremely high in the person being assessed which can lead to misdiagnosis etc
How:
- SCID interviews taken of 1400 people
- only 40% of which had a PD
- then analyzed to model which system fits best (cat or dimensional)
-
Cluster B
Borderline personality
- Instability in self-image, emotion, and relationships
- impulsivity
- Transient dissociative states
- Highly reactive to real or imagined abandonment
treatment
Dialect Behaviour therapy
- focuses heavily on emotion dysregulation
- they think its what underlies BPD
- basically 5 components to it
Chain analysis
- step by step what lead up to the behavior
- thought to work on exposure
Mindfulness
- behavioural exposure
- improves attentional control
opposite action
- reevaluating emotion + blocking automatic response
- behavior exposure + cognitive modification
Validation
- accepting themselves as they are , product of their learning
- reduces emotional arousing
- enhances learning
Emotional dysregulation
How to tell BDP and ASPD apart / Movie paradigm
- emotion dysregulation in BPD and ASP so wants differntiating the two
How ?
- N=145 (half borderline half antisocial)
- SCID + Trauma interview
- direct measure
- POMS + Schema mode inventory
- indirect measure
- physiological measurements
- implicit association test
- neutral movie , m , abuse movie, m , happy movie, m
Results:
BPD
- more self report negative affect
- More maladaptive less adaptive schema modes
- higher physiological measures
- higher heartrate
- higher skin conductance
- higher systolic blood pressure
- shows there is emotion dysregulation in BPD!
APD
- same implicit measures as BPD
- else everything different
BPD can be distinguished from APD by these measures
- ALSO BPD is Sexual abuse and Emotional englect Trauma
- Whereas APD is physical abuse !! #
Emotional reactivity review
- conflicting evidence between self report and behavior measures
Studies with self report show:
- more emotion intensity
- more negative affect
- emotion dysregulation
---> HOWEVER !! behavioral exp and physiological measurements dont find it!!
CLEAR limitation of self report !!
- schema therapy comparing Schema therapy to tau and clarification therapy
- schema therapy better if SCID interview used
- when self report measures used no significant differences
- Clearly shows that self report not sensitive enough to detect differences especially cause Schma modes might fuck things up for people filling in self report !!
- previously shown that people have difficulties recognizing their own emotions and schema modes !!
Imaging studies show:
- reduced hippocampus
- reduced orbitofrontal
- reduced amygdala
- increased amaydala activity to emotional stimuli
BUT too much heterogeneity and findings not replicated so inconclusive
- year long medication use influence brain structure
- some medication = affects emotional reactivity etc
Thin slice paradigm :D!!
- schemas cause emotion deregulation + interpersonal problems by biasing environmental stimuli
How ?
- BPD vs depressive vs controls
- 51 BPD, 23 depressive, 45 controls
- depression might have been underpowered!!
- 6 silent clips 10 sec each, after every video:
- judge people on big 5 sub scales and adjective scale
- interpersonal style assessed too
results:
- BPD vs healthy:
- rated less positive, more negative and more aggressive traits
- BPD vs depression
- more aggressive traits chosen in BPD
- interpersonal problems
- way more negative sub scales than both others
Yes there is emotion dysregulation and more interpersonal problems in BPD than in depression and healthy controls
Emotion inhibition
--> emotion hyperactivity and deficient emotion regulation lead to dysfunction emotion inhibition
- ---> not really supported lol they faked so much here
How:
- 30 BPD vs 30 healthy controls
- 3 tasks
- beck depression
- PANAS
- state trait anxiety
- state trait anger
-
- emotional negative priming
only one significant lol !!
- shown list of negative words
- then told not relevant forget them
- then irrelevant list shown
- then asked to remember all the words they've been shown
- --> they remembered more negative words form before lol
-
Limitations:
- small sample size
- only females
- no counterbalancing of tests
- likely exhaustion on some
- p-value fixing
Splitting vs dichotomous thinking
- only dichotomous thinking found !
How:
- BPD vs Cluster C vs healthy controls
- 3 minute phone interview where they described a problematic situation they had to interviewer
- interviewer either neutral, accepting, rejecting
- participants had to rate them on a VAS scales and in an open interview
- splitting and dichtomus thinking scores were derived :D!!
Results:
- BPD rated ONLY !! rejecting interviewer more negative
- other than that could not be differentiated from cluster c or healthy controls
- Only evidence for dichotomous thinking higher in BPD!!
- they rated them more on the polar ends of the VAS scales and little variation in between
--> might be relevant target for treatment !
Antisocial personality
- Disregard for, and violation of the rights of others
- Criminal, impulsive, deceitful, or callous behaviour
- Lack of remorse
Psychopathy
- lack of empathy + remorse
- impulsivity
- criminal behavior (violence)
DSM SUCKS or APSD VS psycho (PCL-R)
- APD is mostly behavioural effects (antisocial + lifestyle )
- :!!: very weak associations ith affective and interpersonal
- psychopathy has behavioural effects (antisocial + lifestyle ) + affective ones (remorse, guilt, empathy)
DSM mostly takes behavioural part into account (antisocial + lifestyle) and only 3 parts of affective domain!
But fails to account for the affective domain of psychopathy
- (interpersonal + affective) so no remorse and empathy
- all factors that can influence the behavioural domain!
APD often found in criminals 50%
BUT psychopathy only 30% of the time
:!!:---> most psychopaths meet criteria for APD but most APD cases are no psychopaths
-
Psychopaths know right form wrong but dont care lol
- completely flawed study
- all groups judged moral dilemmas same
- only measured cortisol and not even during task
- psychopaths no stress response
HOW
- 30 healthy, 14 psycho and 23 nonpsycho
- too small psychopath group
- PCL-R diagnosis
- trier social stress cortisol measure
- 7 impersonal and 14 personal moral dilemmas
- biased cause imbalance lol
--> asked to rate what they would do
- checked which personal or impersonal is less bad
RESULT
- all rated impersonal dilemmas as less bad
- all took the same dilemma action
- psychopaths had no elevated cortisol stress response in trier social stress task
- However they did this task unrelated before anything happened so its not even task related and doesn't say anything about whether they care or not low --> trash study !!
Antisocial and deceit FMRI
- lying core feature of ASPD but what about neural correlates ?
- didn't look at I"inverse" condition
- did not report statistical correction bonferroni !! etc
HOW
- 3 groups (10 each ) of APD based on deceit strength
- 0 = no liar, 1 = mild, 2 = severe
-
those were displayed during scanning
- either had to be:
- honest (press yes for yes and no for no)
- opposite (press no for yes and yes for no)
- lie (press no for yes and yes for no )
2 sequences
- each 6 bloks of 2 of each above instructions above
- each block = 6 images
RESULTS
- DLPFC
- MPFC
- ACC
- left inferior parietal
--> activity decreases
--> also mild lying and strong lying different from no lying
Histrionic personality
- Excessive emotionality and attention seeking
- Dramatic, seductive, or provocative behaviour
- Suggestible
- Shallow emotional expression and relationships
Narcicistic personality
- Grandiosity, need for admiration, and lack of empathy
- Entitled, arrogant, and exploitative attitudes/behaviour
- manipulative (impression management :3!!)
- Increased rates of physical and sexual aggression, impulsivity, homicidal thoughts, and suicidal behaviours #
Narcicists switch between grandiose and vulnerable ?
- they say yes but this study was really shitty haha xD
- say did it cause no longitudinal study indetified it lol
HOW
- survey send out to psychologists
- send them vignette of grandiose and then vulnerable narcocist
- then asked them to rate them on 14 traits of first grandiose then vunurble or vulnerable and then grandiose depending on which vignette they got
- also asked to rate short big 5 the person
RESULTS
- said there is fluctuation especially when they got vignette of grandiose narcism first (which means they filled in criteria for grandiosee first and the vulnerable ... no counterbalancing AND highly subjective = trash!!)
- the short big 5 the same people filled out apparently matched their subjective case description lol traaaash haha
LIMITATIONS
- no counterbalancing
- highly subjective and no control condition
- given them exactly what you wanted them to say or know
- person who rated person on traits also was the person filling out the big 5
- one point in time only no actual recording of fluctuations lol !! study suuuucks :D!!!
Cluster A
- symptoms should not be cause active psychosis orsubstanceabuse
Shizoid
- strong detachment
- avoids physical closeness
- no joy in close relationships
- nothing phases them (praise/criticism)
- finds joy only in few activities
paranoid
- suspicious + mistrust of others
- think others will take advantage of them
- persistance cause they convinced of this
- mostly centred against others and if others try to dispute this convinces them even more
- makes therapy hard cause also think therapist is against them
Shizotypal
- strong detachment
- avoids closeness to avoid criticism
- believe random arbitrary events are about them (magical thinking)
- often in special supernatural way
- lifestyle in line with these believes
- hallucinations
- isolated = avoid others cause they don*t believe the same thing + negative reaction to their believes
General characteristics
- avoid social contact / lonely
- report uncommon experience
not shared by others
- see world out of joint rather than them being out of sync #
- leads to difficulty in relationship
-
-
Psychosis model
Genetic risk + Childhood trauma
- lead to. -->
- Caregiver often the person causing the trauma thus likely results in insecure attachment style !!
attachment style
Secure attachment = protective factor :D!!
- associated with good normal mentalizing / ToM :3!! #
Insecure = risk factor
- Caregiver often the person causing the trauma thus likely results in insecure attachment style !!
- 5 pathways to psychosis from here
1. HPA-hyperreactivity
- elevated cortisol
- structural changes brain
- like density and receptors
- PFC, hippocampus + amygdala
- leads to low oxytocin --> hyper dopa
2. dopamine dysfunction
- too much dopa in striatum (Basal ganglia)
3. low oxytocin
- cause lots of cortisol
- might amplify dopa hyperactivity #
4. Neuroinflammation
- inflammatory cytosine release
- related to state psychosis
- influences prior believe certainty
#
5. Oxidative stress
- reduced antioxidant control #
- related to trait psychosis
- influences sensory affective certainty / gating
-
-
Is cluster A treatable ?
- pharmacological well known little known about psychological intervention
- shows that cluster A treatable with therapy
- inpatient vs hospital vs outpatient
1. How:
- N=57 from clinics recruited
- inpatients
- hospital
- outpatients
- SCID
- Brief symptom scale = main outcome scale
- quality of life
Results:
- Inpatient + hospital = improved
- less global severity index
- better quality of life
- better interpersonal functioning
- outpatients not improved
Cluster C
Avoidant
- Social inhibition, feelings of inadequacy, and fear of being criticized
- lead to avoidance of social interactions and nervousness
difference between avoidant and social anxiety
- high coorcurance
- do they have different genetic and environmental risk studies ?
HOW:
- over 1700 twin study 10 year follow- up
RESULTS:
- Both equally stable across time (singly)
- co-occurance increased cause environmental factors
- comorbid SAD = highly influenced by environmental factors
- wave 1 = 31% of APD had SAD --> at follow up over 50% !!
- no such influence of SAD with comorbid APD
- wave 1 = 21 % SAD had APD --> at flow up 22%!!
- also genetic risk factor for SAD increases with age
- risk factors were different for each disorder but correlated highly
- two factor model with low crossloadings
Dependant
- Submissive and clinging behaviour
- Excessive need to be taken care of
Functional vs emotional dependency
- if one the other domain can be completely untouched
- this has treatment implications
Functional dependncy
- thinks has to rely on other strong person cause not good enough in functional sense
- lacks self confidence and autonomy
- caused by overprotective + authoritarian parents
==> treatment focus on increasing self confidence
Emotional dependency
- need someone to be secure attached to
- clingy and abandonment fears
- linked to insecure attachment style
==> treatment focus on correcting insecure attachment through modelling (se limited reparenting schema therapy :D!!)
Currently DSM mainly focused on functional !!
- only 3 items check for emotional !
==> IMPORTANT cause different treatment indices!!
-
Obsessive compulsive
- Preoccupation with orderliness, extreme perfectionism, and control
- Anxiety about even minor disruptions in one’s routines
- lead to emotional problems and problems with activities and relationships
Visual attention in OCPD :D!! big H and L
- ppl with OCPD focus on small things
- histrionic focus on global things
---> hence task to delineate the two and see if that's actually true or not-
HOW
- 89 uni students
- SNAP inventory fo histrionic and OCPD
RESULTS
- local interference in people with OCPD
- they took longe to correctly indetify the global big letters cause they got distracted by the smaller letters
- calculated by global inconsistent - global neutral
- so Name the global letter (while its made up of opposing tiny letters) - name global letter while its made up of blocks (control)
no effect found for histrionic ppl
- thought maybe global interference there as they are supposed to focus on little letters
- calculated local inconsistency - localneutral
- so name local letter while the big letter is different from the small letters its made out off - the global letter is a 0 (control)
Shame in cluster C
Shame proness (TOSCA)
- in how many situations likely to experience some
Shame aversion (SHARQ)
- how painful and undesirably they perceive shame
Implicit association task (go/nogo)
- shame - pain (implicit SHARQ) measure
-
RESULTS !!
- shame aversion = predicted all cluster C disorders
- shame proness = predicted APD and DPD
- aversion *proness interaction = predicted whole cluster C better than individually
- shame proness predicted APD DPD and OCPD ONLY when shame aversion was high !! (not when it was low)
- Implicit association task associated with DPD if aversion and proness = high
Schema therapy
Schema vs Tau vs clarification therapy
- in cluster C + paranoid + histrionic + narcissism
- they only included these cause others need more training and time to be effective
1. Results:
- Schema therapy =
- higherst recovery
- least dropout
- only when interviews used self report no difference!!
- strongest if administered by ppl trained by exercise rather than lectures
- no difference between tau and clarification
Important to note that changes were only detected in SCID and not in self report interview
--> self report not sensitive enough probs
1. How:
- in cluster C + paranoid + histrionic + narcissism
- 323 ppl assigned to either
- schema threapy
- TAU
- clarification therapy
- interview and self report taken every 6 months for 3 years
- schema therapy therapist training:
- by lecture
- by exercise (best one)
Schema therapy in forensics
- preliminary study shows trend towards significance
- mainly cluster B + paranoid
how:
- N=30 cluster B + paranoid ppl
- high psychopathy in the sample
- 3 years of schema therapy or TAU
- outcome measures
- reoffend risk battery
- personality disorder symptoms
- reintegration into community
- can it lower reoffend risk and PD better than TaU ? #
Results:
- EVERYTHING just a trend no significant differences!
- Schema therapy:
- reached supervised and unsupervised leave 137 days earlier
- Reached reduced risk to reoffend quicker as well with more reduction than tau
results show that even psychopaths scoring high on risk to reoffend can be treated !
- before believe was that treatment might make the risk to reoffend worse actually which is not the case (different paper by silva!!
- specifically they all had strong flaws like no control groups, no reproducibility high heterogeneity etc etc and didn't control for intention to treat !!
How it works
Schemas
Schema modes
- transient emotional states
- dominate their thoughts and behavior
- goal to weaken maladaptive schema modes and strengthen adaptive healthy adult mode :D!!
Early maladaptive schemas
- unmeet emotional need (trust, safet, love) during childhood forms them
- three coping styles
- surrender
- avoidance
- over-compensation
surrender
- if abandoned child schema triggered respond with schema mode abandoned child
Avoidance
- abandoned child schema triggered = avoid it = detached protector schema mode triggered
Overcompensation
- abandoned child schema triggered = overshadow it with angry child
techniques
- goal to weaken maladaptive schema modes and strengthen adaptive healthy adult mode :D!!
limited reparenting
- therapists meets early developmental needs of patient
Empathic confrontation
- therapists confronts maladaptive behavior in direct but empathic way
Other treatments
Is cluster A treatable ?
- pharmacological well known little known about psychological intervention
- shows that cluster A treatable with therapy
- inpatient vs hospital vs outpatient
Results:
- Inpatient + hospital = improved
- less global severity index
- better quality of life
- better interpersonal functioning
- outpatients not improved
1. How:
- N=57 from clinics recruited
- inpatients
- hospital
- outpatients
- SCID
- Brief symptom scale = main outcome scale
- quality of life
Dialect Behaviour therapy
- focuses heavily on emotion dysregulation
- they think its what underlies BPD
- basically 5 components to it
Chain analysis
- step by step what lead up to the behavior
- thought to work on exposure
Mindfulness
- behavioural exposure
- improves attentional control
opposite action
- reevaluating emotion + blocking automatic response
- behavior exposure + cognitive modification
Validation/selfacceptance
- accepting themselves as they are , product of their learning
- reduces emotional arousing
- enhances learning
Embodied Mentalizing / theory of mind # # # #
- detect + identify + regulate signals and sensory experiences from own mind
- EM = associated with remission = associated with secure attachment :D!!
- lack of EM = associated with psychosis
- mentalizing = basically same as theory of mind
- understanding everyone is different with different motivations thoughts etc
State psychosis
- IF Prior believes (cognitive) too strong top down discards sensory input and only uses prior believes = state psychosis (magical thinking)
--> makes perfect sense !!! also that they think their beliefs = reality and thus everyone else = out of line rather then they being theones out of synch :D!! :D!!! awesome :D!!!
Trait psychosis
- IF sensory experience not regulated by top down prior believes = trait psychosis (hallucinations) !!
- weak prior believes can be caused by trauma :D!! lawl
Wish I had read that for the debate haha xD !! #
Borderline = both sexual and emotional # #
Mention difference to full blown OCD !!
--> lack of thought action fusion!! #
Failure of top down prior beliefs (experience is internal) to modulate actual sensory experience (perceived as being external experience)
well explained in debanne 2016 article all the way at the end above author contributions lol # #
Again limitation of self report and big 5 at that in BPD hmm most likely why they found significant results ! #