5 - Personality Disorders Flashcards
When doing a psychiatric exam what is important to think about?
Why has this person got this disorder at this time?
Positive AND Negative symptoms
Could this be organic?
What hallucinations can LSD give people?
Visual!! Think organic cause or LSD if visual hallucinations
What is a personality and what shapes a personality?
Individual differences in characteristics thinking, feeling and behaving
What is a personality disorder?
An individual differs significantly from the average person in terms of how they think, feel, perceive and relate to others
Maladaptive pattens of behaviour, cognition and inner experience exhibited across a wide range of contexts and deviated largely from those accepted by the individual’s culture
They develop early, are persistent and cause significant distress
What are some of the aetiologies of personality disorders?
- Childhood development – insecure childhood attachments, childhood trauma, inconsistent parenting
- Genetic
- Psychodynamic theories – maladaptive or primitive defence mechanisms
- Cognitive-behavioural theories – development of maladaptive core beliefs derived from early experiences
What are some characteristics of having a personality disorder? (3 P’s)
1 Markedly disharmonious attitudes and behaviour, involving usually several areas of functioning, eg affectivity, arousal, impulse control, relationships
2 Prevailing, chronic, abnormal behaviour patterns, not limited to discrete episodes
3 Present in a broad range of personal and social situations
4 Start before 18 years old and continue into adulthood
5 Personal distress caused by these patterns of behaviour
6 Associated with significant problems in occupational and social performance
People have traits of a personality disorder, when does this become a ‘disorder’?
When it interferes with normal everyday functioning
What are the three clusters of personality disorder?
Mad, Bad and Sad
Group A: Odd or Eccentric (Paranoid, Schizoid, Schizotypal)
Group B: Dramatic or Emotional (Dissocial, Emotionally Unstable, Narcissistic, Histrionic)
Group C: Anxious or Avoidant (Anankastic, Anxious, Dependent)
What are Group A personality disorders and how do they present?
Paranoid
- Irrational suspicion and mistrust of others (no delusions)
- Hypersensitive to criticism
- Reluctant to confide and preoccupied with perceived conspiracies against themselves
Schizoid
- Lack of interest in others, apathy and a lack emotional breadth
- Have few friends, do not form relationships, prefer solitary activities
Schizotypal
- Eccentric odd behaviours
- Unconventional beliefs
- Can go on to develop Schizophrenia
Emotionally stable is a Group B personality disorder. What are the two types and the characteristics of these?
More common in females
Often outburst of emotion and inability to control these emotions
Borderline: Feeling of ‘emptiness’, unclear identity, intense and unstable relationships, unpredictable affect, threats or acts of self-harm/suicide, impulsivity, pseudohallucinations, fear of abandonment
Impulsive: Inability to control anger or plan, unpredictable affect and behaviour
Dissocial (Antisocial) is another Group B personality disorder. How does it present?
- Disregard for social obligations, and unconcern for the feelings of others
- Behaviour not readily by adverse experience, including punishment
- Low tolerance to frustration and discharge of aggression, including violence
- Tendency to blame others or offer plausible rationalizations for the behaviour
Apart from Emotionally stable (Borderline) and Antisocial, what are the other personality disorders in Group B and how do they present?
Narcissistic:
- Grandiose, need for admiration of others and a lack of empathy
- Has sense of entitlement and will take advantage of others to achieve own wants
- Arrogant and preoccupied by their own fantasies and desires
Histrionic:
- Over-dramatize
- Self-centred
- Shallow affect/Superficial emotionality
- Labile mood
- Seeks attention and excitement
- Manipulative behaviour
- Seductive
What are Group C personality disorders and how do they present?
Anankastic (Obsessive Compulsive)
- No intrusive thoughts or ritual, obsessions are pleasurable
- Rigid, stubborn, perfectionism
- Preoccupied with rules
Anxious (Avoidant)
- Persistent anxiety self-conscious, insecure
- Fearful of negative evaluation by others
- Desires to be liked
Dependent
- Feels helpless when not in relationship
- Fear of abandonment
- Need for reassurance
- Need others to make decisions for them
What is the ICD-10 diagnostic criteria for dissocial personality disorders?
Needs 3 of:
- callous unconcern for the feelings of others
- gross and persistent attitude of irresponsibility and disregard for social rules
- incapacity to maintain relationships, though no difficulty in establishing them
- very low tolerance to frustration and aggression
- incapacity to experience guilt and to profit from experience, particularly punishment
- marked proneness to blame others, or to offer plausible rationalizations, for the behaviour
What is the prognosis with personality disorders?
- Risk of suicide
- Issues with interpersonal relationships
- May switch from one disorder to another e.g B to C
- Prevalence declines with age as older adults tend to be less impulsive and aggressive or may get better at hiding traits