Personality and Personality Disorders Flashcards by saskia stander

Define Personality

“Enduring patterns of perceiving, relating to, and thinking about the environment and oneself, which are exhibited in a wide range of important social and personal contexts.
totality of emotional and behavioral traits
relatively stable and predictable

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Aetiology of personality

Nature: genes
Nurture: family; peers; upbringing; trauma; culture; values; beliefs
Interactive model: nature provides the template that life experience modifies
Evolutionary model: “life experience” of the species has modified the genome
“ontogeny recapitulates phylogeny”

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List Erikson’s Stages of the Life Cycle

0-1: Basic trust vs. basic mistrust
1-3: Autonomy vs. shame and doubt
3-5: Initiative vs. guilt
6-11: Industry vs. inferiority
11-20: Identity vs. role confusion
21-40: Intimacy vs. isolation
40-65: Generativity vs. stagnation
65+: Integrity vs. despair

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Describe the categorical vs Dimensional approach to Personality Disorders

Categorical: personality disorders unique types of abnormal development that are unrelated to “normal” personalities
Dimensional: personality traits are shared amongst general population with excessive dimensions in disordered individuals
Traits: particular characteristics associated with a PD

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Describe the Dimensional Approach: The five factor model

Extraversion vs. introversion
Agreeableness vs. antagonism
Conscientiousness
Emotional instability (neuroticism)
Unconventionality

Lexical approach
Each factor breaks down into more specific facets, eg. Agreeableness: trust, altruism, compliance, modesty, tender-mindedness

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Define personality disorder

Patterns of inflexible and maladaptive traits that cause subjective distress or significant impairment in social or occupational functioning or both.
Foster vicious cycles
Deviate markedly from cultural norms
DSM4 Axis II - not used anymore
Generally safer to talk about “traits” than a personality disorder

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Describe a paranoid personality disorder

A pervasive mistrust and suspiciousness of others such that their motives are interpreted as malevolent.
Suspects others are exploiting them.
Doubts the loyalty of friends.
Reluctant to confide in others.
Bears grudges
Feels attacked by others and reacts to this
Suspects partner of deceit/disloyalty/unfaithfulness.

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Management of paranoid PD

Low dose antipsychotic may be helpful
Possible role for CBT
NB to establish a trusting and non-threatening relationship.

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Describe Schizoid PD

A pervasive pattern of detachment from social relationships and a restricted range of expression of emotion in interpersonal settings.
Neither desires nor enjoys close relationships (including family)
Chooses solitary activities
Little sexual interest
Few close friends
flattened affectivity
Indifferent

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Prevalence of paranoid PD

0.5-2.5%

M : F = 1 : 1

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Prevalence of Schizoid PD

7.5%, possibly much less

M:f = 1:1

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Aetiology of Schizoid PD

Primarily genetic aetiology

Often schizophrenia probands

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Describe schizotypal PD

A pervasive pattern of social and interpersonal deficits marked by acute discomfort with close relationships as well as by cognitive or perceptual distortions or eccentricities of behaviour
Ideas of reference
Odd beliefs
Odd thinking, speech and affect paranoid ideation
Eccentric behaviour or aappearance
No close relationships except family
Social anxiety

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Prevalence of Schizotypal PD

M : F = 1 : 1

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Aetiology of Schizotypal PD

primarily genetic aetiology

Often schizophrenia probands but seem to have preserved frontal lobes and less striatal activity

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Management of schizotypal

Low dose neuroleptics may be helpful
Differentiate from schizophrenia
Relatives may need advice and reassurance

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Describe antisocial PD

A pervasive pattern of disregard for and violation of the rights of others.
Since age 15
Repeated acts that are grounds for arrest
Deceitful, impulsive, irritable and aggressive
Reckless
Irresponsible
Lack remorse
Conduct disorder before age 15

Prevalence of antisocial PD

3-4%

M:F = 3:1

Aetiology of antisocial PD

Genetic and environmental factors may be contributory
“Absent” fathers and childhood abuse
May “burn out” in later life, particularly if marry a strong partner
“Psychopath”: charm; intelligence; egocentric; exploitative; lack remorse
Malingering; substance abuse

Describe borderline PD

A pervasive pattern of instability of interpersonal relationships, self-image and affects, and marked impulsivity
Abandonment issues
Unstable and intense relationships
Identity disturbance
Impulsivity
Suicidal behavior
Affective instability
Chronic feelings of emptiness
Inappropriate anger
Transient paranoia or dissociation under stress (“micropsychotic episodes”)
ICD10: “emotionally unstable personality disorder”

Prevalence of borderline PD

M:F = 1:2

Aetiology of borderline PD

Aetiology primarily environmental (in vulnerable individuals), up to 80% have a history of abuse or neglect
High incidence of depression, anxiety, self harm, relationship problems

Prognosis of borderline PD

9% suicide rate

1/3 “recovered” and2/3 in stable employment 15y after diagnosis

Management of borderline PD

Know what you are dealing with, avoid “red herrings”eg. “depression” “voices in the head”
Be honest,consistent and non-judgmental
Firm boundaries, beware of idealization, be realistic about treatment targets as well as risks and side effects.
Treat presenting pathology
SSRI’s, mood stabilizers and low dose antipsychotics may be helpful
Psychotherapy, counseling and regular long term support.

Describe histrionic PD

A pervasive pattern of excessive emotionality and attention seeking Needs to be the center of attention Sexually seductive or provocative Rapidly shifting, shallow expressed emotions Uses physical appearance to draw attention to self Impressionistic style of speech Exaggerates emotions, prone to self –dramatization Suggestible Exaggerates intimacy of relationships

Prevalence of histrionic PD

2-3% | M:F = 1:2

Management of histrionic PD

Treat presenting illness Long term psychotherapy may be helpful Long term, consistent support. NB depression & substance abuse when relationships end or social support lost

Narcissistic PD

``` A pervasive pattern of grandiosity, need for admiration and lack of empathy. Self important Fantasies of unlimited success Believes is special Requires excessive admiration Sense of entitlement Arrogant and exploitative Lacks empathy ```

Prevalence of narcissistic PD

1% M:F = 2:1 High incidence in Doctors

Progression of narcissistic PD

Relationship problems Substance abuse Mid-later life crises when no longer able to satisfy inflated sense of self; depression and suicide

Management if narcissistic PD

Psychotherapy may be helpful but “need to be ready”

Management if narcissistic PD

Psychotherapy may be helpful but “need to be ready”

Describe dependent PD

Apervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation Need excessive advice and reassurance Needs others to take responsibility Struggles to disagree Lack of initiative Goes to great lengths for support/nurturance Uncomfortable alone Urgently seeks to replace ended relationship with new one Preoccupied with fears of being left alone Vulnerable to abusive relationships Common pathology in stalkers

Prevalence of dependent PD

1-3% | M:F = 1:1

Which diseases are commonly present in people with dependent PD

Anxiety disorders and depression common, especially after separation

Management of dependent PD

Need long term support and structure | CBT

Describe avoidant PD

A pervasive pattern of social inhibition, feelings of inadequacy,and hypersensitivity to negative evaluation, beginning by early adulthood and present in a variety of contexts Avoids occupations involving contact with people Unwilling to get involved with people unless sure of being liked Restrained in relationships for fear of shame Preoccupied with social rejection and ridicule Feels inadequate Views self as inept, unappealing or inferior Avoids personal risk for fear of embarrassment

Prevalence of avoidant PD

1-10% | Probably on a spectrum with social phobia.

Management of avoidant PD

CBT useful | Imipramine, SSRI’s and RIMA’s may be useful.

Describe obsessive compulsive PD

A pervasive pattern of preoccupation with orderliness, perfectionism and control at the expense of flexibility, openness and efficiency Preoccupied with rules and lists Perfectionism interferes with task completion Excessively devoted to work Scrupulous and inflexible morality, ethics and values. Cannot discard objects. Miserly, saving for future catastrophe Rigid and stubborn. Differentiate from obsessive-compulsive disorder

Prevalence of OCPD

5-10%

Name the DSM clusters of PD

A. “odd and eccentric”- Paranoid; Schizoid; Schizotypal B. “dramatic; emotional and egocentric”- Antisocial; Borderline; Histrionic; Narcissistic C. “anxious and fearful”- Avoidant; Dependant; Obsessive-Compulsive