Understanding Cluster B Personality Disorders: Risk Factors, Interventions, & Case Studies, Lecture notes of Psychology

Download Understanding Cluster B Personality Disorders: Risk Factors, Interventions, & Case Studies and more Lecture notes Psychology in PDF only on Docsity! Cluster B Personalities Pathways and Interventions Syed Aftab Shah Forensic Psychologist & Advocate BPS, APA, SBC, KBA Workshop: Wellness from a Forensic Perspective Outline of the talk • Cluster B personalities • Risk factors • Therapeutic interventions • Forensic implications • Case studies Risk Factors • Five times more likely for you to develop BPD if your first degree relative (biological) has it. • Familial risk for: 1. substance use disorder, 2. ASPD 3. MDD 4. Bipolar disorder. • Childhood Trauma (flight-fight state) Cluster B personalities • Disorders in this cluster are very socially interpersonally-focused and to some degree exploitive. • Cluster B personality disorders experience a lack of empathy and unpredictable behaviors and may seem aggressive and narcissistic. Older adults with Cluster B personality disorders may have unstable relationships and desire to be the center of attention. • ASPD, NPD, NPD, HPD ASPD • The key features ofantisocial personality disorder are repetitive unlawful acts, socially irresponsible behaviors, and a pervasive disregard for the rights of others.  • Antisocial behaviors develop early in adolescence, before age 15. These individuals are so unconcerned with the feelings and rights of others that they are morally bankrupt and lack a sense of remorse. • Such people seem completely unable to project themselves into the feelings of others and they are bereft of empathy. Superficially, they can be charming and engaging, yet beneath the facade lie individuals who live in a world filled with illegal activity, deceit, promiscuity, substance abuse, and assaultive behavior. Because patients with this disorder are so indifferent to how their actions affect others, antisocial personality disorder is the personality disorder most resistant to treatment. •  Bipolar mania can be difficult to separate from antisocial personality disorder, because patients with antisocial personalities can also have co-morbid bipolar disorders. • For the most part, however, patients with bipolar disorder lack a significant degree of childhood conduct problems, and the antisocial behavior is usually limited to manic episodes. Patients with psychotic disorders may also perform criminal acts, but these acts are usually in response to delusions or hallucinations. • Substance abuse disorders can be especially difficult to differentiate from antisocial personality disorder, because patients with antisocial personality disorder almost invariably engage in substance use. However, criminal behaviors associated with substance abuse disorders generally center around using and obtaining the drugs. HISTRIONIC PERSONALITY DISORDER • The most notable features of histrionic personality disorder (HPD) are excessive emotionality and an almost insatiable need for attention. • These individuals are overly concerned with their physical appearance, they have poor frustration tolerance (with emotional outbursts), and their speech is impressionistic and vague. • They view physical attractiveness as the core of their existence, and as such, are often provocative in dress, flamboyant in mannerisms, and inappropriately seductive in behavior. While they appear superficially charming, others tend to view them as vain and lacking in genuineness. Histrionic and N arcissistic personality disorders are closely associated. DD • The differential diagnosis for HPD includes other cluster B personality disorders and somatization disorder. • BPD differs from HPD in that the borderline patient displays more despair and suicidal/parasuicidal behaviors. • The narcissistic patient is more preoccupied with grandiosity and envy than is the histrionic individual. The person with dependent personality disorder, while sharing the need for acceptance and reassurance, lacks the degree of emotionality seen in histrionic individuals. • Somatization disorder can co-exist with HPD, but it is distinguished by the greater emphasis on physical complaints. • Substance Use Disorder • Further support for the importance of BPD is found in a study by Bulik et al. (1997), where they compared Bulimia Nervosa patients with and without alcohol dependence and found substantial differences between these groups. The co-morbid group had higher rates of suicide attempts, anxiety disorders, conduct disorder, and problems with other substances as well as higher rates of personality disorders, particularly borderline and histrionic personality disorder. This study also replicated the earlier finding by Bulik et al. (1994) that women with ED and alcohol abuse score higher on measures of novelty seeking.  • Borderline PD is common in forensic samples, and is the second most common disorder found in men and often the first in women (Esbec & Echeburúa, 2010). For women, self-harm may be a greater risk and this is not only common in forensic samples, but also in clinical sample (Paris, 2005). Suicide and suicidal ideation is in fact one of the diagnostic criteria, discussed later.  • While individuals with BPD are often characterized by self-harm, they can display externalized aggression  • BPD shares many features with posttraumatic stress disorder, which is an anxiety disorder caused by major physical or emotional trauma(Martin, 2015). The relationship between the two disorders is well established, where it has been found to be common but not ubiquitous (Zanarini et al., 1998), with posttraumatic stress disorder (PTSD) being twice as likely to be found in borderline patients (Golier et al., 2003). NPD • Grandiose sense of Self-importance – overestimating their abilities or conflating their accomplishments • Preoccupied with fantasies of unlimited success, power, brilliance, beauty or ideal love • Expectation that they be recognized by people and society for being unique, special and superior • Require excessive admiration – self esteem being fragile. • Sense of entitlement – unreasonable expectation of special treatment • Lack of sensistivity and an entitled nature leads them to easily exploit others Alternative DSM-5 Model for Personality Disorders – Personality Impairment • PID-5 Short Version (25 questions) • PID-5 Long Version (220 questions) • Main domains of Personality 1. Negative Affect 2. Detachment 3. Antagonism 4. Disinhibition 5. Psychoticism The Alternative DSM model for diagnosis complements HiTOP. The Hierarchical Taxonomy of Psychopathology (HiTOP) • HiTOP is a data-driven, hierarchically based alternative to traditional classifications that conceptualizes psychopathology Level 5 Spectrum Psychopathology Level 4 Broad Spectra Internalization/externaliztion pathology, psychosis spectrum disorders Level 3 Syndromes/Disorders Nested within Broad Spectra Level 2 Maladaptive traits Nested within Syndromes/Disorder Level 1 Symptoms/signs Nested within maladaptive traits Super spectrum Spectra HiTOP Detachment traits Symptom Maladaptive components een Social Romantic “Avedon . . een withdrawal disinterest oss ee ‘ Avoidant DSM Forensic Implication: Criminal behavior and Cluster B Personality Disorders Case Study • Jeffrey Dahmer Ted Bundy