Personality Disorders Flashcards
Identify the components of DIALECTIC BEHAVIOURAL THERAPY (DBT).
- mindfulness
- interpersonal skills –> developing skills to help navigate personal relationships
- emotional regulation skills –> developing positive skills to replace maladaptive coping mechanisms for overwhelming / extreme emotions
- distress tolerance skills –> developing positive skills for dealing with stressful life situations / environments
Describe the principles of management of personality disorders.
Psychotherapy is the first-line management for personality disorders. This can be challenging as many personality disorders are egosytoric (meaning they do not cause the patient any distress), hence, it can be difficult to motivate the patient to engage in any type of change.
Psychotherapy may take the form of:
✔️ dialectic behavioural therapy (DBT)
✔️ psychoanalytical therapy
There is little place for pharmacotherapy in the management of personality disorders. Minimal evidence suggests that mood stabilising agents, antipsychotics, anti epileptics and antidepressants may have some effect, depending on the individual patient.
Benzodiazepines should be avoided at all costs, for risk of overdose.
Outline the diagnostic criteria for BORDERLINE PERSONALITY DISORDER.
D - disturbance of identity E - emotionally labile S - suicidal / self harm behaviour P - paranoid behaviour A - abandonment (fear of) I - impulsive behaviour R - relationships unstable E - emptiness (feelings of extreme) R - rage (inappropriate for given situation)
The patient must demonstrate at least FIVE of the above nine features.
Define SPLITTING.
Splitting is a primitive defence mechanism seen commonly in BPD. This involves the person being unable to hold opposing emotions / thoughts at the same time, and only being able to see things in “black and white” (eg. love or hate).
Splitting is the polarisation of good and bad feelings. This is a coping mechanism to deal with internal stress / trauma.
Define PROJECTION.
Projection is when an individual attributes qualities that they find unacceptable within themselves onto another person.
Define DISASSOCIATION.
Disassociation is a mental process that enables an individual to be completely disconnected from their thoughts, feelings and sense of identity. It is usually a consequence of trauma.
Define DEFENCE MECHANISMS and identify the most common mechanisms seen in BPD.
Defence mechanisms can be classified as primitive, less primitive or mature. They are coping strategies adopted by an individual to exist in the content of past trauma or stressors around them.
Some common defence mechanisms include:
✔️ splitting
✔️ projection
✔️ disassociation
Define PERSONALITY.
Personality refers to the autonomic behaviours, emotions and thought patterns portrayed by an individual. Personality is related to the way in which individuals react to the world around the.
The “innate” component of personality is temperament. This is believed to be mostly genetic and pre-determined.
Define PERSONALITY DISORDERS.
“Personality disorders” are a group of conditions characterised by persistent / lifelong maladaptive coping mechanisms, inconsistent with societal “norms,” with manifestation in at least TWO of the following areas:
- cognition
- affect
- interpersonal functioning
- impulse control
There are TEN personality disorders which can be categorised into three clusters:
✔️ Cluster A –> mad
✔️ Cluster B –> bad
✔️ Cluster C –> sad
All personality disorders share the following traits in common:
✔️ manifest in early adulthood
✔️ mainstay treatment is interpersonal / psychotherapy
✔️ minimal role for pharmacotherapy
✔️ do NOT occur in the context of schizophrenia, schizoaffective disorder, major depression or anxiety / stress related conditions
For CLUSTER A personality disorders, outline: ✔️ outward appearance ✔️ familial predisposition ✔️ defence mechanisms ✔️ individual conditions
OUTWARD APPEARANCE: bizarre, odd, eccentric
FAMILILAL PREDISPOSITION: psychotic conditions
DEFENCE MECHANISMS: magical thinking, intellectualisation, projection
INDIVIDUAL CONDITIONS:
- paranoid personality disorder
- schizoid personality disorder
- schizotypical personality disorder
For CLUSTER B personality disorders, outline: ✔️ outward appearance ✔️ familial predisposition ✔️ defence mechanisms ✔️ individual conditions
OUTWARD APPEARANCE: emotional, unstable, mean / nasty, inconsistent
FAMILILAL PREDISPOSITION: mood disorders
DEFENCE MECHANISMS: splitting, projection, disassociation, acting out
INDIVIDUAL CONDITIONS:
- borderline personality disorder
- narcissistic personality disorder
- antisocial personality disorder
- histrionic personality disorder
For CLUSTER C personality disorders, outline: ✔️ outward appearance ✔️ familial predisposition ✔️ defence mechanisms ✔️ individual conditions
OUTWARD APPEARANCE: anxious, fearful
FAMILILAL PREDISPOSITION: anxiety disorders
DEFENCE MECHANISMS: isolation, avoidance
INDIVIDUAL CONDITIONS:
- avoidant personality disorder
- dependent personality disorder
- obsessive compulsive personality disorder
Describe the aetiology of BPD.
✔️75% of patients with BPD have a history of trauma / abuse (e.g. sexual, physical, emotional)
✔️ inconsistent parenting styles can lead to insecure adult attachment –> craves intimacy
✔️ painful rejection (combined with the above features) leads to maladaptive coping mechanisms demonstrated in BPD
Common traits for PARANOID PERSONALITY DISORDER.
Suspicious and paranoid about everything
Ruminates on partner infidelity
Common traits for SCHIZOID PERSONALITY DISORDER.
Prefers to be alone
Struggles to form close relationships
Performs everything in solitude
