Personality Disorder Flashcards
What are central traits?
- Openness - appreciation of a variety of experiences
- Conscientiousness - planning ahead rather than being spontaneous
- Extroversion - sociable, energetic and talkative
- Agreeable - kind, sympathetic and happy to help
- Neuroticism - worry, vulnerable, temperamental
How are personality disorders diagnosed?
Generally diagnosed by long lasting inflexible, pervasive traits, behaviours and thoughts which cause serious problems and impairment to the functioning of those affected. PDs are seen as traits that deviate from the expectations of the culture of the individual. Diagnosis takes time and gathering lots of history.
What are the ICD-10 diagnostic guidelines for personality disorder?
Conditions not directly attributable to gross brain damage or disease or to another psychiatric disorder, meeting the following criteria:
- Markedly disharmonious attitudes and behaviour involving usually several areas of functioning e.g. affectivity, arousal, impulse control, ways of perceiving/thinking/style relating to others
- Abnormal behaviour pattern is enduring of long standing and not limited to episodes of mental illness
- Abnormal behaviour pattern is pervasive and clearly maladaptive to a broad range of personal and social situations
- The above manifestations always appear during childhood or adolescence and continue to adult
- Disorder leads to considerable personal distress but may only become apparent late in its course
- Disorder is usually, but not invariably, associated with significant problems in social and occupational settings
What are the types of EUPD?
- Impulsive type
- Borderline type
What are the causes of PD?
- Classic case of complex biological/psychological social factors
- Nature and nurture (epigenetics)
- Genetic predisposition
- Parents often have development disturbances, so patients are exposed to substance misuse, erratic parenting, marital discord, abuse
- Childhood trauma
- Possible brain injury/cognitive dysfunction
What is the treatment for PD?
- Biological: treat co-morbidities
- Psychological: DBT (CBT + unstructured psychodynamic therapies) + balint groups (reflection groups for key workers)
- Social: support, structure and crisis management
What is Dialectical Behavioural Therapy (DBT)?
- Developed for difficulties with treatment of PD e.g. EUPD
- DBT is not suicide prevention, it is trying to balance acceptance with change and build a life for yourself
- Promoting behavioural change
- Common initial targets include: thinking of suicide/SH, restricting meals, binging/purging, drug/alcohol abuse, risky sexual behaviour, reckless driving, physical aggression, shoplifting
- 3-4hr/week
What is the WEIRD type of PD?
‘odd’ ‘eccentric’
- Paranoid (distrust, suspicious)
- Schizoid (detached emotionally, relationships)
- Schizotypal (magic, odd beliefs)
What is the WILD type of PD?
‘dramatic’ ‘emotional’ ‘erratic’
- Antisocial (inconsiderate, legal issues)
- Borderline (unstable relationships/emotions, self-image, impulsive)
- Histronic (attention seeking/display lots of emotion)
- Narcissistic (big ego, need admiration, can’t handle criticism)
What is the WORRIED type of PD?
‘anxious’ ‘fearful’
- Avoidant (inhibited, avoid situations, dependent, submissive, clingy)
- Obsessive Compulsive Personality Disorder (order, perfectionist, in control)
What are the primitive defence mechanisms?
- Denial
- Regression (reversion to earlier stage of development)
- Acting out
- Projection
- Splitting (when person cannot tolerate that there are positive and negative aspects to everyone)
- Identification
- Projective identification
What are less primitive defence mechanisms?
- Intellectualisation: overemphasis on thinking when confronted with unbearable emotion e.g. parents of terminal child seeking all possible fruitless medical procedures
- Rationalisation: e.g. after not getting into school you want saying “It was rubbish school anyway”
- Undoing: the attempt to take back an unconscious thought that is unacceptable e.g. after having lustful thoughts about someone, telling partner you love them
What are mature defence mechanisms?
- Sublimation: channeling of unacceptable impulses, thoughts and emotions into more acceptable ones e.g. sport, humour, fantasy
- Compensation: understanding that you may not be good at one thing but are good at something else
- Assertiveness: respectfully expressing thoughts and emotions without being passive or aggressive
How is psychotherapy used with defence mechanisms?
It aims to provide a safe, supportive but challenging relationship (attachment) in which people can learn to be more aware of when they are using less constructive mechanisms and develop mature ones.
What aspects need to be covered in an overdose history?
- Intro, empathise with patient, reassure, confidentiality
- Explore events leading to overdose
- Exploration of signs and symptoms
- Exploration of alcohol use/symptoms of dependency
- Return to exploration of signs and symptoms
- Exploration of self-harm and overdose act
- RISK ASSESSMENT
- Exploration of psychotic symptoms
