CT 8 - Personality Disorders Flashcards
What is personality
Collection of traits that we have developed as we have grown up which make us an individual. Includes how we think, feel and behave
How does personality develop
Nature - inherited tendencies
Nurture - influenced by the environment you are raised in
Which kind of mental health conditions have some sort of genetic influence
Cluster B
Schizotypal
Schizophrenia (in twins there is a 50% increased risk in the other twin)
Affective disorders like major depressive disorder, anxiety disorders, bipolar disorder
Eating disorders
OCD
ADHD and autism
Most personality disorders have a link to an individuals childhood
Starts from intrauterine period all the way to adulthood. Any adversities, neglect, abuse etc can impact on the devlopement of the child and increases risk of personality disorder in adulthood
What physiological things might contribute to personality disorder
Low levels of 5HT /serotonin
Or imaging of amygdala might show decreased activity in those with psychopathy/apathy -lack of neuronal connections
What is the psychodynamic theory of how personality is developed
Freud:
Mind can be split into 3:
- Id - primitive part of the mind which focuses on pleasure, desires and needs.
- ego - rational part of the mind which mediates between a balance between ID and superego and finds ways to satisfy needs in a manner which is socially acceptable
- superego - moral component to the mind which judges actions and strives to be perfect according to societies standards
Levels of consciousness:
- conscious,
- preconscious
- unconscious* (largest and most influential part with repressed memories + desires )
Oral stage 0-1
Anal stage 1-3
Phallic stage 3-6 focus shifts to genitals
Latency 6- puberty (sexual impulses are repressed + social skills develop)
Genital stage puberty onwards (maturation of sexual interests and mature relationships occur)
Ego employs defence mechanisms to manage conflicts like repression, denial, projection etc
Which region in the brain specialises in threat detection, fear conditioning and harm avoidance
Amygdala
Living in an unfriendly environment in childhood sensitises the amygdala + lowers the threshold for triggering defensive reactions later on life
Where is the reward centre of the brain
Nucleus accumbens/ located in the basal forebrain
Messages are sent to this area in the brain + dopamine is the primary NT
Density of receptors for dopamine and oxytocin in the nucleus depends on how well the person was parented
What kind of PDs are more common in males
Emotionally unstable borderline personality
Antisocial
Schizotypal
What kind of PDs are more prevalent in women
Borderline
Histrionic
Dependent
What % of the general population have PD
5-10%
What are specific personality disorders:
Severe disturbances in the personality and behavioural tendencies of the individual not directly resulting from disease, damage or insult to brain or from another psychiatric disorder
What is emotionally unstable PD:
Marked tendency to act impulsively and mood instability. Have anger outbursts which may be easily precipitated when impulsive acts are criticised by others
Two types of this disorder exist:
- impulsive type (struggle more with impulsivity and feelings of anger)
- borderline type ( overdoses and self harm, chronic feelings of emptiness, unstable +intense relationships uncertainty about self-image and sexuality), do a lot to avoid abandonment, polarised thinking (all or nothing, good or bad etc black or white)
Borderline subtype struggle more with relationships, feelings of emptiness and self harm
What is dissocial PD
Irresponsible + callous unconcern for others
Don’t care about social norms + rules
Can’t MAINTAIN relationships
Very low tolerance to frustration
Can’t feel guilt
Blame others or offer rationalisations for behaviour
Dissocial PD: CORRUPT and FIGHTS
Cannot conform to law
Obligations ignored
Reckless
Remorseless
Underhanded (deceitful)
Planning insufficient (impulsive)
Temper
Forms relationships but can’t maintain
Irresponsible
Guiltless
Heartless
Temper easily lost
Someone else’s fault
- note this is not conduct disorder as that is diagnosed in childhood or adolescence. Dissocial PD diagnosed in >18yrs
Paranoid PD : suspect
Suspicious
Unforgiving
Sensitive about setbacks
Possessive
Excessive self importance
Conspiracy theories
Tenacious sense of rights
- not delisonal disorder
Not schizophrenia
Schizotypal PD: ME PECULIAR
Magical thinking
Experiences unusual perceptions
Paranoid ideation
Eccentric behaviour or appearance
Constricted or innapriate affect
Unusual thinking or speech
Lacks close friends
Ideas of reference
Anxiety in social situations
Rule out psychotic
May progress to schizophrenia or if observing retrospectively maybe prodromal phase of schizophrenia
Schizoid PD: DISTANT
Detached - flattened affect
Indifferent to criticism or praise
Sexual experience of little interest
Tasks done alone
Absence of close friends
No desire for enjoyment
Takes pleasure in few activities
Not - Asperger’s or schizophrenia
Avoidant personality disorder : CRINGES
Criticism and fear of social rejection
Restraint in relationships due to fear of shame
Inhibited in new relationships
Needs to be sure of being liked before engaging
Gets around occupational activities with little need for interpersonal contact
Embarrassment prevents doing new things
Self view as unappealing or inferior
Depedent PD : reliance
Reassurance needed
Expressing disagreement is difficult
Life responsibilities assumed by others
Initiating projects difficult
Alone
Nurturance (goes to excessive lengths to get)
Companionship sought uregcntly as soon as one ends
Exaggerated fear of being left on own
Narcissistic PD: GRANDIOSE
Grandiose
Require attention
Arrogant
Need to be special
Dream of success and power
Interpersonally exploitative
Others disregarded
Sense of entitlement
Envious
SPECIAL :
Superiority
Preoccupied with fantasies
Entitled
Criticism sensitive
Interpersonal exploitation
Arrogant
Lack empathy
Histrionic PD:
Care about their appearance a lot, seek attention, shallow, theatrical, seductive behaviour
PRAISE:
Provocative/seductive
Racked with concern over appearance
Attention
Impressionable/easily influenced
Shallow and labile affect
Exaggerated expressions of emotion
What is dialectical behavioural therapy
Based on CBT but adapted to help people who experience emotions very intensely
Occurs as group therapy where therapists teach skills like
1) mindfulness (help patient to focus on present rather than worries)
2) distress tolerance (teaching to deal with distress in other ways than self harm)
3) interpersonal effectiveness (teaching how to ask for things or how to say no)
4) emotion regulation (awareness and control over emotions)
what is cognitive analytic therapy
CAT - Looks at the way a person thinks, feels and acts and the events and relationships that underlie these experiences (eg from childhood)
CBT focuses on the practical effects of a problem rather than its meaning and the reasons behind it
