Personality disorder Flashcards
What is the aetiology of personality disorder?
Genetics
Childhood temperament (attachment problems, conduct disorders)
Childhood experience (neglect, trauma, abuse)
Neurochemical imbalance
What is the epidemiology of personality disorder?
Epidemiological community survey 10% Primary care- 20% C Psychiatric outpatients- 30% B Psychiatric inpatients- 40% B Prison- 50% B
What are common comorbid conditions with personality disorder?
Anxiety Disorder (especially Cluster C personality disorder)
Depression (particularly difficult to spot in emotionally unstable patients where it can easily be mistaken for emotional lability or ignored because mood problems are assumed to be a consequence of emotional lability. Good history taking is essential in such cases)
PTSD
Substance Misuse & alcoholism
Adjustment Disorder/ Stress Reaction
What is the classification for personality disorder?
Cluster A: odd and eccentric Schizoid Paranoid Schizotypal Cluster B: dramatic and emotional Antisocial Histrionic Borderline Narcissistic Cluster C: anxious and fearful Obsessive compulsive Anxious Dependent
What is the ICD-10 classification for types of personality?
Paranoid Schizoid Schizotypal Dissocial Borderline Narcissistic (DSM) Anakastic Anxious (avoidant) Dependent
What is paranoid personality disorder? (SUSPECT)
Sensitive Unforgiving Suspicious Possessive and jealous of partners Excessive self-importance Conspiracy theories Tenacious sense of rights
What is schizoid personality disorder? (ALL ALONE)
Anhedonic Limited emotional range Little sexual interest Apparent indifference to praise or criticism Lack of close relationships One-player activities Normal social conventions ignored Exessive fantasy world
What is is dissocial personality disorder? (FIGHTS)
Forms but cannot maintain relationships Irresponsible Guiltless Heartless Temper easily lost Someone else’s fault
What is emotionally unstable (borderline) personality disorder? (SCARS)
Self-image unclear Chronic “empty” feelings Abandonment fears Relationships are intense and unstable Suicide attempts and self-harm Occasionally experience fleeting psychotic features (pseudohallucinations)
What is emotionally unstable (impulsive) personality disorder? (LOSE IT)
Lacks impulse control Outbursts or threats of violence Sensitivity to being criticised or let down Emotional instability Inability to plan ahead Thoughtless of consequences
What are common features for both types of emotionally unstable personality disorders?
Affective instability Explosive behaviours Impulsive Outbursts of anger Unable to plan or consider consequences
What is histrionic personality disorder? (ACTORS)
Attention Seeking Concerned with own appearance Theatrical Open to suggestion Racy and seductive Shallow affect
What is anankastic personality disorder? (DETAILED)
Doubtful Excessive detail Tasks not completed Adheres to rules Inflexible Likes own way Excludes pleasure and relationships Dominated by intrusive thoughts
What is anxious/avoidant personality? (AFRAID)
Avoids social contact Fears rejection / criticism Restricted lifestyle Apprehensive Inferiority Doesn't get involved unless sure of acceptance
What is dependent personality disorder? (SUFFER)
Subordinate Undemanding Feels helpless when alone Fears abandonment Encourages others to take decisions Reassurance needed
What is the short term management for those with personality disorders?
Risk assessment- self harm, suicide, substance abuse
Consider comorbidity
What is the long term management for those with personality disorders?
Cognitive Behavioural Therapy (CBT)
Dialectical Behavioural Therapy (DBT)
Cognitive Analytical Therapy (CAT)
Therapeutic communities
Which medications are used for personality disorders?
NICE do not recommend pharmacological treatment for either emotionally unstable or dissocial personality disorder.
May be a need to treat complicating comorbid problems (psychosis, ADHD)
Antipsychotics: for transient psychotic experiences, reduction of impulsivity and agitation
Antidepressants for comorbid illness such as anxiety and depression
Mood stabilisers for mood instability
What is the prognosis for personality disorder?
Linked with a higher rate of suicide, especially cluster B disorders
cluster B disorders seem to be less common with increasing age
What is splitting?
Defence mechanism seen in borderline personality disorder
Patient is unable to reconcile both good and bad traits in a given person, assess people as either all good ir all bad
