9 & 10. Personality disorders Flashcards
PDs
enduring pattern of inner experience and behaviour that deviates markedly from expectations of individual’s culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time and leads to distress or impairment
General PD
A. Enduring pattern of inner experience and behaviour that deviates markedly from the expectations of the individual’s culture. Pattern manifested in two or more of the following areas: cognition, affectivity, interpersonal functioning, impulse control
B. Enduring pattern is inflexible across a broad range of personal and social situations
C. Enduring pattern leads to clinically significant distress or impairment in social, occupational, or other important areas of functioning
Cluster A
MAD
Individuals often appear odd or eccentric
paranoid, schizoid, schizotypal PD
Cluster B
BAD
Individuals often appear dramatic, emotional or erratic
Antisocial, borderline, histrionic, narcissistic
Cluster C
SAD
Individuals appear anxious or fearful
Avoidant, dependent, obsessive compulsive PD
Comorbidites
frequent cooccurrence of disorders within and across clusters
differential diagnosis
Psychotic disorders- for the 3PDs that may be related to psychotic disorders (paranoid, schizoid, schizotypal), exclusion criteria that pattern of behaviour does not occur exclusively during the course of schizophrenia, a bipolar or depressive disorder with psychotic features, or other psychotic disorder
Anxiety and depressive disorders
PTSD
Substance use disorders
Personality change due to another medical condition
Paranoid PD
Pattern of pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent
assume others will exploit, harm or deceive them even if no evidence exists to support this expectation
More commonly diagnosed in males
Schizoid PD
Pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interersonal settings
reduced experience of pleasure from sensory, bodily or interpersonal experiences
may be oblivious to normal subtleties of social interaction and often not respond appropriately to social cues
difficulties expressing anger- often passive, dificulty responding appropriately to important life events
brief psychotic episodes in response to stress (minutes to hours)
sometimes premorbid antecedent to delusional disorder or schizophrenia
slightly more often in males
Schizotypal PD
pervasive pattern of social and interpersonal deficits marked by acute discomfort with and reduced capacity for close relationships, cognitive and perceptual distortions and eccentricities of behaviour
5 or more of:
ideas of reference (excluding delusions of reference)
odd beliefs or magical thinking that influences behaviour and is inconsistent with subcultural norms
unusual perceptual experiences including bodily illusions
odd thinking and speech
suspiciousness or paranoid ideation
inappropriate or constricted affect
behaviour or appearance odd, eccentric or peculiar
lack of close friends or confidants other than first degree relatives
excessive social anxiety that does not diminish with familiarity and tends to be associated with paranoid fears rather than negative judgements about self
slightly more common in males
may have brief psychotic features but most do not go on to develop a psychotic disorder
Cultural considerations: magical thinking and ‘odd’ beliefs may be culturally appropriate
Schizotypal PD aetiology
genetic risk particularly if first degree relative with schizophrenia or schizotypal
differences in brain structure (increased cortical folding)
greater exposure to stressful life events (trauma, early separation from caregivers, low SES)
Adolescence: bullying and teasing, severe anxiety, mood and suicidal ideation
Schizotypal PD differentials
other psychotic disorders (but PD features must be present in absence of psychosis), NDD, SUD, medical disorders, other PDs
Schizotypal PD comorbidities
mood (depression)
psychotic disorders
Other PDs (cluster A, ASPD, BPD)
SAD
OCD
Antisocial PD
Pervasive pattern of disregards for and violation of the rights of others
deceit and manipulation, collateral information key
more common in males
some remittance can be observed over life course (debatable whether for criminal activities vs personality traits)
BPD
pervasive patterns of instability of interpersonal relationships, self image, affect, marked impulsivity
histrionic PD
pervasive and excessive emotionality and attention seeking behaviour
uncomfortable when not centre of attention
interaction with others often characterised by sexually seductive/provocative behaviour
rapidly shifting and shallow emotional expression
physical appearance to draw attention to self
excessively impressionistic style of speech, lacking in details
self dramatisation, theatricality, exaggerated emotion expression
considers relationships to be more intimate than actual
approximately equal gender distributions
culture considerations regarding appropriate behaviour and dress
histrionic PD comorbidities
BPD
narcissistic
antisocial
dependent
somatic symptoms disorder
conversion disorders
histrionic PD differentials
other PDs
SUD
Histrionic PD aetiology
genetic and biological factors
parenting styles that lack boundaries or are overindulgent
parental modelling of erratic, dramatic, volatile, sexually inappropriate behaviours
childhood trauma
narcissistic PD
pervasive pattern of grandiosity in fantasy or behaviour, need for admiration, lack of empathy that begins in early adulthood and is present in various contexts
more common in males
OCPD
preoccupation with orderliness, perfectionism and mental and interpersonal control at the expense of flexibility, openness and efficiency
more common among males
OCD v OCPD
ego dystonic v ego syntonic
Avoidant PD
pervasive pattern of social inhibition, feelings of inadequacy and hypersensitivity to negative evaluation
equal gender distribution
shyness in childhood that does not abate in adolescence
cultural consideration- consider if effects of acculturation
avoidant PD comorbidities
MDD
bipolar
anxiety disorders, especially SAD
Dependent PD
BPD
Cluster A PDs
Avoidant PD differentials
anxiety disorders, especially SAD and agoraphobia
other PDs
SUD
Dependent PD
pervasive and excessive need to be taken care of that leads to submissive and clinging behaviour and fears of separation, beginning by early adulthood and present in various contexts as indicated by 5 or more of:
difficulty making everyday decisions without excessive advice or reassurance
needs others to assume responsibility for most areas of life
difficulty expressing disagreements because of fear of support or approval loss (unrealistic level)
difficulty initiating projects or doing things on their own (because of lack of self confidence in judgement or abilities rather than lack of motivation or energy)
goes to excessive lengths to obtain nurturance and support from others to the point of volunteering to do things that are unpleasant
feels uncomfortable or helpless when alone because of exaggerated fears of being unable to care for self
urgently seeks relationships when one ends
unrealistically preoccupied with fears of being left to take care of self
gender difference debated
submissiveness deemed appropriate in some cultures
Dependent PD aetiology
early onset but consider age-appropriate dependence in youth
early anxiety experiences and modelling are important predisposing factors
dependent PD differentials
dependency arising from other mental and medical conditions
BPD- DPD reacts to abandonment with increasing submissiveness and appeasement
Histrionic- DPD less overt/extraverted in attempts to seek attention
Avoidant- DPD don’t tend to withdraw re fear of rejection
DPD comorbidities
anxiety
depression
adjustment disorders
other PDs (BPDS, avoidant, histrionic)
