PYC4802
PYC4802
Psychopathology
Assignment 3
878765
Student Number
########
Due Date
10 July 2019
Prepared By: ?????
1
, PYC4802
TABLE OF CONTENTS
1 INTRODUCTION ...................................................................................................................... 4
2 WHAT ARE PERSONALITY DISORDERS? .......................................................................... 4
2.1 Classification of personality disorders ............................................................................. 5
2.2 Cluster A .......................................................................................................................... 5
2.2.1 Paranoid personality disorder (PPD) ........................................................................ 5
2.2.2 Schizoid personality disorder (SZPD) ...................................................................... 5
2.2.3 Schizotypal personality disorder ............................................................................... 5
2.3 Cluster B........................................................................................................................... 6
2.3.1 Borderline Personality Disorder (BPD) .................................................................... 6
2.3.2 Histrionic personality disorder (HPD) ...................................................................... 6
2.3.3 Antisocial personality disorder (APD)...................................................................... 6
2.3.4 Narcissistic personality disorder (NPD) ................................................................... 6
2.4 Cluster C:.......................................................................................................................... 6
2.4.1 Obsessive-Compulsive personality disorder (OCD) ................................................. 6
2.4.2 Avoidant personality disorder (APD) ....................................................................... 6
2.4.3 Dependent personality disorder (DPD) ..................................................................... 7
3 DSM-5 DIAGNOSTIC CRITERIA FOR PERSONALITY DISORDERS ............................... 7
4 BORDERLINE PERSONALITY DISORDER (BPD) .............................................................. 8
4.1 Description ....................................................................................................................... 8
4.2 Diagnosis .......................................................................................................................... 8
4.3 Treatment ......................................................................................................................... 8
5 DSM-5 DIAGNOSTIC CRITERIA FOR BORDERLINE PERSONALITY DISORDER ...... 9
6 PROBLEMS RELATED TO IDENTIFYING BORDERLINE PERSONALITY DISORDER 9
6.1 Gender Bias ...................................................................................................................... 9
2
, PYC4802
6.2 Stigmatization................................................................................................................. 10
6.3 Difficult Therapeutic Relationship ................................................................................. 11
6.4 Challenges Identifying BPD in Children and Adolescents ............................................ 12
7 PROBLEMS RELATED TO DIAGNOSING BORDERLINE PERSONALITY .......................
DISORDER .............................................................................................................................. 13
7.1 Comorbidity ................................................................................................................... 13
7.2 Diagnostic Issues in Older Age Groups ......................................................................... 13
7.3 Skepticism of the validity of a BPD diagnosis ............................................................... 14
8 CONCLUSION ......................................................................................................................... 15
9 REFERENCE LIST .................................................................................................................. 16
10 PLAGIARISM DECLARATION ............................................................................................ 19
3
, PYC4802
1 INTRODUCTION
Imagine living a life where you constantly feel detached from the world around you. Experiencing
worry and fear daily, hindering you from fulfilling family and work commitments. As a result,
people around you start to label you as ‘odd’, ‘dramatic’ or ‘anxious’. Criticizing your behaviour
and beliefs, resulting in feelings of loneliness and despair. Consequently, your life continues to
spiral downwards, and you don’t understand why. People become concerned that you are a danger
to others, or even yourself. Due to your behaviour you may even find yourself in a psychiatric
hospital or facing legal charges. This describes the life of an individual suffering from a personality
disorder (PD). In the general population of adults in western countries, 12.16% are said to suffer
from a personality disorder. These disorders are often misunderstood, terrifying and impact the
wellbeing of the patient and their family and friends. Thus, with such a high prevalence rate, the
need for understanding these disorders and developing preventative and therapeutic interventions
is crucial (Volkert, Gablonski & Rabung, 2018).
The following discussion will define personality disorders as well as identify the ten different
personality disorders as outlined by the American Psychiatric Association (APA) (2013) in the 5th
edition of the Diagnostic and Statistical Manual for Mental Disorders (DSM-5). Specific attention
will be placed on Borderline personality disorder (BPD), how it presents itself, diagnosis and
treatment thereof. Furthermore, the challenges faced by clinicians in the identification and
diagnosis of BPD will be discussed.
2 WHAT ARE PERSONALITY DISORDERS?
The APA (2013) defines a personality disorder as a stable pattern of behaviour that deviates from
cultural or societal expectations. It begins in adolescence or early adulthood and causes impairment
or suffering. PDs are chronic and since they affect personality they have an impact on every aspect
of an individual’s life (Barlow and Durand, 2012). Von Krosigk, (2014) recognizes difficulties in
self-image, relationships, impulse control and a general understanding of themselves and the world
around them. Interpersonal problems such as difficulty in intimate relationships or maintaining
close relationships can be expected. Furthermore, eating disorders, suicide, anxiety, mood
disorders, sexual issues and substance abuse are common occurrences in PDs (Von Krosigk,,
2014). An individual is often unaware of their PD or of impaired functioning because of the
disorder. In these cases, another person must use their judgment to decide if the suffering
individual needs intervention (Barlow & Durand, 2012). Although many of these symptoms may
4
, PYC4802
be evident in most people, diagnosis of a PD is only valid if behaviours and difficulties are
persistent over a duration of time. Moreover, an individual should meet the general criteria to be
diagnosed (Von Krosigk, 2014).
2.1 Classification of Personality Disorders
The DSM-5 is a classification system used throughout the world to identify psychological
disorders. Personality disorders are included in Axis II of the DSM-5 (Barlow & Durand, 2012).
The personality disorders are further classified into three different clusters based on similarities:
Cluster A (odd-eccentric), Cluster B (dramatic-erratic-emotional) and lastly, Cluster C (anxious-
fearful) (Weiner, 2003).
2.2 Cluster A
2.2.1 Paranoid Personality Disorder (PPD)
According to the APA (2013), an individual suffering from this disorder misinterprets the motives
of others as being malicious or manipulative, resulting in constant mistrust and suspiciousness
towards people. For a diagnosis an individual must display a minimum of four criteria out of the
seven following:
2.2.2 Schizoid Personality Disorder (SZPD)
Barlow and Durand (2012) describe individuals with SZPD as detached or cold, and don’t maintain
close relationships with others. Furthermore, a “restricted range of expression of emotions in
interpersonal settings” is also prevalent (APA,2013, p. 654).
2.2.3 Schizotypal Personality Disorder
“The essential feature of schizotypal personality disorder is a pervasive pattern of social
and interpersonal deficits marked by acute discomfort with, and reduced capacity for,
close relationships as well as by cognitive or perceptual distortions and eccentricities of behavior”
(APA,2013, p. 656). Individuals with this disorder are often regarded as odd due to how they act,
dress and relate with people (Barlow and Durand, 2012).
5
PYC4802
Psychopathology
Assignment 3
878765
Student Number
########
Due Date
10 July 2019
Prepared By: ?????
1
, PYC4802
TABLE OF CONTENTS
1 INTRODUCTION ...................................................................................................................... 4
2 WHAT ARE PERSONALITY DISORDERS? .......................................................................... 4
2.1 Classification of personality disorders ............................................................................. 5
2.2 Cluster A .......................................................................................................................... 5
2.2.1 Paranoid personality disorder (PPD) ........................................................................ 5
2.2.2 Schizoid personality disorder (SZPD) ...................................................................... 5
2.2.3 Schizotypal personality disorder ............................................................................... 5
2.3 Cluster B........................................................................................................................... 6
2.3.1 Borderline Personality Disorder (BPD) .................................................................... 6
2.3.2 Histrionic personality disorder (HPD) ...................................................................... 6
2.3.3 Antisocial personality disorder (APD)...................................................................... 6
2.3.4 Narcissistic personality disorder (NPD) ................................................................... 6
2.4 Cluster C:.......................................................................................................................... 6
2.4.1 Obsessive-Compulsive personality disorder (OCD) ................................................. 6
2.4.2 Avoidant personality disorder (APD) ....................................................................... 6
2.4.3 Dependent personality disorder (DPD) ..................................................................... 7
3 DSM-5 DIAGNOSTIC CRITERIA FOR PERSONALITY DISORDERS ............................... 7
4 BORDERLINE PERSONALITY DISORDER (BPD) .............................................................. 8
4.1 Description ....................................................................................................................... 8
4.2 Diagnosis .......................................................................................................................... 8
4.3 Treatment ......................................................................................................................... 8
5 DSM-5 DIAGNOSTIC CRITERIA FOR BORDERLINE PERSONALITY DISORDER ...... 9
6 PROBLEMS RELATED TO IDENTIFYING BORDERLINE PERSONALITY DISORDER 9
6.1 Gender Bias ...................................................................................................................... 9
2
, PYC4802
6.2 Stigmatization................................................................................................................. 10
6.3 Difficult Therapeutic Relationship ................................................................................. 11
6.4 Challenges Identifying BPD in Children and Adolescents ............................................ 12
7 PROBLEMS RELATED TO DIAGNOSING BORDERLINE PERSONALITY .......................
DISORDER .............................................................................................................................. 13
7.1 Comorbidity ................................................................................................................... 13
7.2 Diagnostic Issues in Older Age Groups ......................................................................... 13
7.3 Skepticism of the validity of a BPD diagnosis ............................................................... 14
8 CONCLUSION ......................................................................................................................... 15
9 REFERENCE LIST .................................................................................................................. 16
10 PLAGIARISM DECLARATION ............................................................................................ 19
3
, PYC4802
1 INTRODUCTION
Imagine living a life where you constantly feel detached from the world around you. Experiencing
worry and fear daily, hindering you from fulfilling family and work commitments. As a result,
people around you start to label you as ‘odd’, ‘dramatic’ or ‘anxious’. Criticizing your behaviour
and beliefs, resulting in feelings of loneliness and despair. Consequently, your life continues to
spiral downwards, and you don’t understand why. People become concerned that you are a danger
to others, or even yourself. Due to your behaviour you may even find yourself in a psychiatric
hospital or facing legal charges. This describes the life of an individual suffering from a personality
disorder (PD). In the general population of adults in western countries, 12.16% are said to suffer
from a personality disorder. These disorders are often misunderstood, terrifying and impact the
wellbeing of the patient and their family and friends. Thus, with such a high prevalence rate, the
need for understanding these disorders and developing preventative and therapeutic interventions
is crucial (Volkert, Gablonski & Rabung, 2018).
The following discussion will define personality disorders as well as identify the ten different
personality disorders as outlined by the American Psychiatric Association (APA) (2013) in the 5th
edition of the Diagnostic and Statistical Manual for Mental Disorders (DSM-5). Specific attention
will be placed on Borderline personality disorder (BPD), how it presents itself, diagnosis and
treatment thereof. Furthermore, the challenges faced by clinicians in the identification and
diagnosis of BPD will be discussed.
2 WHAT ARE PERSONALITY DISORDERS?
The APA (2013) defines a personality disorder as a stable pattern of behaviour that deviates from
cultural or societal expectations. It begins in adolescence or early adulthood and causes impairment
or suffering. PDs are chronic and since they affect personality they have an impact on every aspect
of an individual’s life (Barlow and Durand, 2012). Von Krosigk, (2014) recognizes difficulties in
self-image, relationships, impulse control and a general understanding of themselves and the world
around them. Interpersonal problems such as difficulty in intimate relationships or maintaining
close relationships can be expected. Furthermore, eating disorders, suicide, anxiety, mood
disorders, sexual issues and substance abuse are common occurrences in PDs (Von Krosigk,,
2014). An individual is often unaware of their PD or of impaired functioning because of the
disorder. In these cases, another person must use their judgment to decide if the suffering
individual needs intervention (Barlow & Durand, 2012). Although many of these symptoms may
4
, PYC4802
be evident in most people, diagnosis of a PD is only valid if behaviours and difficulties are
persistent over a duration of time. Moreover, an individual should meet the general criteria to be
diagnosed (Von Krosigk, 2014).
2.1 Classification of Personality Disorders
The DSM-5 is a classification system used throughout the world to identify psychological
disorders. Personality disorders are included in Axis II of the DSM-5 (Barlow & Durand, 2012).
The personality disorders are further classified into three different clusters based on similarities:
Cluster A (odd-eccentric), Cluster B (dramatic-erratic-emotional) and lastly, Cluster C (anxious-
fearful) (Weiner, 2003).
2.2 Cluster A
2.2.1 Paranoid Personality Disorder (PPD)
According to the APA (2013), an individual suffering from this disorder misinterprets the motives
of others as being malicious or manipulative, resulting in constant mistrust and suspiciousness
towards people. For a diagnosis an individual must display a minimum of four criteria out of the
seven following:
2.2.2 Schizoid Personality Disorder (SZPD)
Barlow and Durand (2012) describe individuals with SZPD as detached or cold, and don’t maintain
close relationships with others. Furthermore, a “restricted range of expression of emotions in
interpersonal settings” is also prevalent (APA,2013, p. 654).
2.2.3 Schizotypal Personality Disorder
“The essential feature of schizotypal personality disorder is a pervasive pattern of social
and interpersonal deficits marked by acute discomfort with, and reduced capacity for,
close relationships as well as by cognitive or perceptual distortions and eccentricities of behavior”
(APA,2013, p. 656). Individuals with this disorder are often regarded as odd due to how they act,
dress and relate with people (Barlow and Durand, 2012).
5
