Personality Disorder Flashcards
Define what is meant by personality disorder [1]
How can you categorise these? [3]
Personality disorder covers a variety of maladaptive personality traits that cause significant psychosocial distress and interfere with functioning
- These traits remain relatively persistent in the person over time and impact their life and relationships.
Personality disorders are characterised by patterns of thought, behaviour and emotion that differ from what is normally expected
There are many different types of personality disorders based on the dominant features. In the DSM-5, they fall into three categories. What are they? [3]
Cluster A – Suspicious
Cluster B – Emotional or impulsive
Cluster C – Anxious
NB
A = Awkward
B = Bold
C = Cautious
A = paranoid, schizoid, schizotypal
B = antisocial, borderline, histrionic, narcissistic
C = OCD, avoidant, dependent
Name and describe the different clusters of personality disorders [+]
Cluster A
* Paranoid - feels like people are out to get them
* Schizoid - avoids people but doesn’t care
* Schizotypal - same as schizoid with odd beliefs (sometimes magical)
Cluster B
* Antisocial - shit people with no emotions for others, usually have illegal tendancies
* Borderline - think they’re shit, believe people think they’re shit, and want to kill themselves
* Histrionic - wants to be THE SHIT
* Narcissistic - thinks they’re THE SHIT
Cluster C
* Obsessive-compulsive - stubborn in their own ways with no leniency
* Avoidant - avoids people but cares
* Dependant - think they’re incapable and always need help
Describe in detail what a paranoid personality disorder is like [5]
Hypersensitivity and an unforgiving attitude when insulted
Unwarranted tendency to questions the loyalty of friends
Reluctance to confide in others
Preoccupation with conspirational beliefs and hidden meaning
Unwarranted tendency to perceive attacks on their character
Describe in detail what a schizoid disorder is like [7]
Indifference to praise and criticism
Preference for solitary activities
Lack of interest in sexual interactions
Lack of desire for companionship
Emotional coldness
Few interests
Few friends or confidants other than family
Describe in detail what a schizotypal disorder is like [7]
Schizotypal
Ideas of reference (differ from delusions in that some insight is retained)
Odd beliefs and magical thinking
Unusual perceptual disturbances
Paranoid ideation and suspiciousness
Odd, eccentric behaviour
Lack of close friends other than family members
Inappropriate affect
Odd speech without being incoherent
Describe what someone with an antisocial personality disorder is like [+]
Failure to conform to social norms with respect to lawful behaviours as indicated by repeatedly performing acts that are grounds for arrest;
More common in men;
Deception, as indicated by repeatedly lying, use of aliases, or conning others for personal profit or pleasure;
Impulsiveness or failure to plan ahead;
Irritability and aggressiveness, as indicated by repeated physical fights or assaults;
Reckless disregard for the safety of self or others;
Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behaviour or honour financial obligations;
Lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another
Describe what someone with a borderline - also known as Emotionally Unstable personality disorder is like [+]
- Efforts to avoid real or imagined abandonment
- Unstable interpersonal relationships which alternate between idealization and devaluation
- Unstable self image
- Impulsivity in potentially self damaging area (e.g. Spending, sex, substance abuse)
- Recurrent suicidal behaviour
- Affective instability
- Chronic feelings of emptiness
- Difficulty controlling temper
- Quasi psychotic thoughts
Describe what someone with a histrionic personality disorder is like [+]
Inappropriate sexual seductiveness
Need to be the centre of attention
Rapidly shifting and shallow expression of emotions
Suggestibility
Physical appearance used for attention seeking purposes
Impressionistic speech lacking detail
Self dramatization
Relationships considered to be more intimate than they are
Describe someone w/ a narcissistic personality disorder [+]
Grandiose sense of self importance
Preoccupation with fantasies of unlimited success, power, or beauty
Sense of entitlement
Taking advantage of others to achieve own needs
Lack of empathy
Excessive need for admiration
Chronic envy
Arrogant and haughty attitude
Describr someone with an avoidant personality disorder [+]
- Avoidance of occupational activities which involve significant interpersonal contact due to fears of criticism, or rejection.
- Unwillingness to be involved unless certain of being liked
- Preoccupied with ideas that they are being criticised or rejected in social situations
- Restraint in intimate relationships due to the fear of being ridiculed
- Reluctance to take personal risks due to fears of embarrassment
- Views self as inept and inferior to others
-
Social isolation accompanied by a craving for social contact
*
Describe someone with a dependent personality disorder [+]
- Difficulty making everyday decisions without excessive reassurance from others
- Need for others to assume responsibility for major areas of their life
- Difficulty in expressing disagreement with others due to fears of losing support
- Lack of initiative
- Unrealistic fears of being left to care for themselves
- Urgent search for another relationship as a source of care and support when a close relationship ends
- Extensive efforts to obtain support from others
- Unrealistic feelings that they cannot care for themselves
What are the causes of personality disorders? [3]
Genetic Factors
- Heritability estimates for personality disorders range from 30% to 60%, indicating a significant genetic component. Twin studies have shown higher concordance rates for personality disorders in monozygotic twins compared to dizygotic twins.
- Specific gene variants associated with neurotransmitter systems (e.g., serotonin, dopamine) have been linked to certain personality disorders. However, no single gene has been identified as a definitive cause; rather, it appears that multiple genes interact in complex ways to increase susceptibility.
Neurobiological Factors
- Neurotransmitter imbalances can also contribute to the development of personality disorders. Serotonin dysregulation is often implicated in impulsive-aggressive behaviour patterns, while dopamine dysregulation may be related to novelty seeking and reward dependence.
Environmental Factors
- Adverse childhood experiences such as abuse, neglect or trauma are strongly associated with the development of personality disorders later in life. These experiences can lead to maladaptive coping mechanisms which persist into adulthood.
Don’t learn - just know that it’s a mix of biological and environmental factors
Describe three types of suspicious personality disorders [3]
Paranoid personality disorder
- features difficulty in trusting or revealing personal information to others.
Schizoid personality disorder
- features a lack of interest or desire to form relationships with others and feelings that this is of no benefit to them.
Schizotypal personality disorder
- features unusual beliefs, thoughts and behaviours, as well as social anxiety that makes forming relationships difficult.
Describe four types of Emotional and Impulsive Personality Disorders [4]
Antisocial personality disorder features reckless and harmful behaviour, with a lack of concern for the consequences or the impact of their behaviour on other people. It often involves criminal misconduct.
Borderline personality disorder features fluctuating strong emotions and difficulties with identity and maintaining healthy relationships.
Histrionic personality disorder involves the need to be the centre of attention and performing for others to maintain that attention.
Narcissistic personality disorder features feelings that they are special and need others to recognise this, or else they get upset. They put themselves first.
Describe three types of Anxious Personality Disorders [3]
Avoidant personality disorder features severe anxiety about rejection or disapproval and avoidance of social situations or relationships.
Dependent personality disorder features a heavy reliance on others to make decisions and take responsibility for their lives, taking a very passive approach.
Obsessive-compulsive personality disorder features unrealistic expectations of how things should be done by themselves and others and catastrophising about what will happen if these expectations are not met.
What are the presenting features of personality disorders? [4]
Presenting Features:
Cognition:
- Individuals with personality disorders may exhibit distorted thinking patterns. This can manifest as suspiciousness or paranoid ideation in Paranoid Personality Disorder;
- magical thinking or odd beliefs in Schizotypal Personality Disorder
- Black-and-white thinking (splitting) in Borderline Personality Disorder.
Affectivity:
- The range, intensity, lability and appropriateness of emotional response is often dysregulated.
- For instance, individuals with Borderline Personality Disorder may experience intense mood swings;
- those with Antisocial Personality Disorder may show a lack of remorse;
- while individuals with Avoidant Personality Disorder may have severe anxiety about being negatively evaluated by others.
Interpersonal Functioning:
- Problems with relationships and empathy are common.
- This could include exploitation as seen in Narcissistic Personality Disorder
- Avoidance of social interaction (Avoidant or Schizoid Personality Disorders)
- Unstable but intense relationships (Borderline Personality Disorder).
Impulse Control:
- Impulsivity is a key feature across many personality disorders.
- It may present as self-damaging behaviours without regard for consequences (as seen in Borderline and Antisocial Personality Disorders)
- Sudden decision making without forethought (Histrionic Personality Disorder)
- Difficulty resisting temptation (Antisocial Personality Disorder).
Describe the management plan for personilty disorders
Psychotherapy:
- Cognitive behavioural therapy (CBT) and dialectical behaviour therapy (DBT) are effective for borderline personality disorder
Pharmacotherapy:
* No medication is licensed specifically for personality disorders in the UK.
Social interventions:
* Community Mental Health Teams (CMHTs) play a vital role in coordinating care, providing psychological therapies, and offering social support.
* Occupational therapy can help improve daily functioning and quality of life.
Crisis management plans:
* A crisis management plan should be developed collaboratively with the patient. This includes identifying triggers, early warning signs of crisis, coping strategies, and emergency contacts.
What are the key features of personality disorders?
Key Features of Personality Disorder (ICD-11)
Persistent Pattern:
- The individual’s patterns of cognition, emotional experience, behaviour, and interpersonal functioning deviate from cultural expectations. These patterns are stable over time and span across various personal and social situations.
Impairment:
The deviation results in significant problems or dysfunctions in the person’s life, especially in relationships, work, or social functioning.
Duration:
- These characteristics are stable over time, beginning in adolescence or early adulthood, and are not transient.
Distress or Dysfunction:
- The impairment may result in distress to the individual or others. These patterns are not explained by another mental disorder, a medical condition, or substance misuse.
How do you manage personality disorders? [2]
Personality disorders are difficult to treat and in the past have been considered ‘untreatable’ by definition.. However, a number of approaches have been shown to help patients, including:
psychological therapies: dialectical behaviour therapy
treatment of any coexisting psychiatric conditions
avoidant personality disorder
Paranoid personality disorder
narcissistic personality disorder
antisocial personality disorder
Borderline personality disorder
histrionic personality disorder
schizoid personality disorder
schizotypal personality disorder
dependent personality disorder
Obsessive-compulsive personality disorder
A 23-year-old female has recently noticed that all of her relationships end in a dramatic fashion. She tells you that she has poor taste in friends and boyfriends and that everyone ends up turning out to be a terrible person.
Which one of the following defence mechanisms is most likely in this patient?
Identification
Dissociation
Sublimation
Reaction formation
Splitting
When you think of borderline personality, you should think of a [] defence mechanism.
Describe what this is [1]
Splitting is a common immature defence mechanism where the patient is unable to reconcile both good and bad traits in a given person, and therefore sees people as either all good or all bad. This patient is prone to explosive relationships, and ultimately driving most close relationships away.
