Persoanlity Disorders Flashcards
What is a personality disorder?
Which three are most common?
A deeply ingrained pattern of inner experience and behaviour, deviates from persons culture, it is inflexible and pervasive. Onset is during adolescence or early adulthood, leading to distress or impairment, where this stabilises over time.
Most common is emotionally unstable (borderline PD).
Also anxious avoidant and antisocial.
What is the pathophysiology of personality disorders?
Genetics Neurodevelopment Difficult childhood experiences I.e. abuse (physical, sexual, emotional, neglect) Low socioeconomic status Parental deprivation Poor parenting
What are the clusters of personality disorder?
Cluster A- Weird (odd/eccentric)
Paranoid
Schizoid
Cluster B Wild (emotional/dramatic)
Emotionally unstable (borderline)
Dissocial (antisocial)
Histrionic
Cluster C Worry (anxious/fearful)
Dependent
Avoidant (anxious)
Anankastic (obsessional)
What are the clinical features of paranoid PD?
SUSPECTS Suspicious of others Unforgiving (grudges) Spouse fidelity questioned Perceives attack Envious Criticism not liked/cold affect Trust in others reduced Self-reference
What are the clinical features of schizoid PD?
DISTANT Detached affect Indifferent to praise or criticism Sexual drive reduced Tasks done alone Absence of close friends No emotion (cold) Takes pleasure in few activities
What are the clinical features of emotionally unstable PD?
AM SUICIDE
Abandonment feared
Mood instability
Suicidal behaviour Unstable relationships Intense relationships Control of anger is poor Impulsivity Disturbed sense of self (identity) Emptiness (chronic)
What are the clinical features of dissocial PD?
CORRUPT Callous Others blamed Reckless disregard for safety Remorselessness Underhanded (deceitful) Poor planning (impulsive) Temper/tendency to violence
What are the clinical features of histrionic PD?
PRAISE Proactive behaviour Real concern for physical attractiveness Attention seeking Influenced easily Shallow/seductive inappropriately Egocentric (vain)/exaggerated emotions
What are the clinical feature of dependent PD?
RELIANCE Reassurance required Expressing disagreement is difficult Lack of self confidence Initiating projects is difficult Abandonment feared Needs others to assume responsibility Companionship sought Exaggerated fears
What are the clinical features of anxious (avoidant) PD?
CRIES
Certainty of being liked before becoming involved with people
Restricted lifestyle to maintain security
Inadequacy felt
Embarrassment potential prevents involvement in new social activities
Social inhibition
What are the clinical features of anankastic PD?
LAW FIRMS
Loses point of activity (preoccupied with detail)
Ability to complete tasks compromised (due to perfectionism)
Workaholic at expense of leisure
Fussy (concerned with minor detail) Inflexible Rigidity Meticulous attention to detail Stubborn
What are the differences between cluster A disorders and psychosis?
Although they present similar, cluster A have an absence of true delusions or hallucinations.
How are personality disorders investigated?
Hx-
How would your friends/family describe your personality?
Are you ever concerned about other people in your life? Can you rely on friends/ family? (Paranoid)
Do you work well with others? Would you say you have many close friends? (Schizoid’
How would you describe your relationship with others in your life? Do you ever feel life is not worth living? Would people say you have a temper? (EU)
Have you ever got into serious trouble I.e. with police? Was it your fault? Do you like to think things through before carrying out an act? (Dissocial)
Do you feel you are easily influenced by your friends? Do you like to be the soul of the party? (Histrionic)
Is there anything you worry about/fear? Place yourself on a scale of confidence and shyness. Do you struggle to make important decisions? (Dependent)
Tell me about your social circle. Do you ever take part in new activities? (Anxious)
Do you feel you are a perfectionist? Do you spend more time working or relaxing? Do you struggle to meet deadlines? (Anankastic)
Need a reliable collateral too.
Investigations-
Questionnaires- personality diagnostic questionnaire.
Psychological testing- Minnesota multphasic personality inventory (MMPI)
CT/MRI head- to rule out organic cause I.e. frontal lobe tumour, intracranial bleed.
What are the differentials for PD?
Mania Depression Schizophrenia Schizoaffective disorders Substance misuse
How are personality disorders managed?
Co morbid psychiatric illness and substance misuse are common so recognise and treat these.
Carry out risk assessment (especially in EUPD), find potential stressors which could induce crisis and reduce these. Create a written crisis plan to refer to at the time of crisis. If there is a suicide risk or the patient is dangerous/violent then consider detaining under MHA and crisis team resolution.
Biopsychosocial-
Biological-
Atypical antipsychotics- short term for transient psychosis I.e. in paranoid PD.
Mood stabilisers in EUPD,with aggression.
Anti-depressants
Psychological-
CBT
Psychodynamic psychotherapy- individual/group
Dialectical behavioural therapy- developing coping strategies to improve impulse control and self harm tendencies in EUPD.
Social-
Support group for patient and family
Substance misuse services
Assistance with social problems I.e. housing, finance, employment
Help accessing education, voluntary work, occupation etc.
