Personality Disorders Flashcards
What is a personality disorder?
Ingrained pattern of inner experiences and behaviour that deviates from the individuals culture, leading to distress and impairment
Stable from its onset in early adulthood - can’t diagnose in childhood
What are the main risk factors associated with developing a personality disorder?
Family history
Bad parenting and behaviour reinforcement
Abuse
Low socioeconomic status
What differentials would you consider for personality disorders?
Mania/depression
Schizophrenia - ask about hallucinations and delusions
Substance misuse
What personality disorders are in cluster A?
Paranoid
Schizoid
Schizotypal
What personality disorders are in cluster B?
Borderline
Antisocial
Histrionic
Narcissistic
What personality disorders are in cluster C?
Dependent
Anxious/ avoidant
Anankastic/obsessional
How would someone with a paranoid personality disorder appear?
overly sensitive to insults
questions peoples loyalty
doesn’t confide in others
How would a schizoid personality appear?
emotionally cold
isolated
low libido
How would a schizotypal personality appear?
odd and magical beliefs and behaviours
odd (although coherent) speech
eccentric behaviour
no close friends
How would a borderline personality disorder present?
frequent self-harm/suicide
intense relationships
impulsivity around drugs and sex
can’t control temper
How would an antisocial personality disorder present?
most common in men don't obey the law no remorse irritable and aggressive no regard for own or others safety
How does histrionic personality disorder present?
centre of attention
use appearance to get attention
sexually inappropriate
self dramatization
How does narcissistic personality disorder present?
Arrogant
entitled
grandiose sense of self importance
fantasise about unlimited success
How does dependent personality disorder present?
Unable to make decisions alone
Fear of being left alone to care for oneself
Fear losing support
How does anxious personality disorder present?
Fear of social situations that could lead to criticism or embarrassment
Socially isolated but craves interaction
Views self as inept
How does obsessive compulsive personality disorder present?
Meticulous and rigidity surrounding rules, morals, ethics
Perfectionism that prevents reaching goals
Lists, organisation, rules
How can the clusters of personality disorders be remembered?
WWW
Cluster A - weird
Cluster B - Wild
Cluster C - worriers
What are the features of Cluster A - paranoid?
SUSPECTS
Suspicious of others
Unforgiving
Spouse infidelity questioned
Perceives attack
Envious
Criticism not liked
Trust in others reduced
Self reference
What are the features of Cluster A - schizoid?
DISTANT
Detached Indifferent to praise or criticism Sexual drive reduced Tasks done alone Absence of close friends No emotion Takes pleasure in few things
What are the features of emotionally unstable/borderline?
AM SUICIDE
Abandonment feared
Mood instability
Suicidal behaviour Unstable relationships Intense relationships Control of anger poor Impulsivity Disturbed sense of self Emptiness - chronic
What are the features of dissocial/antisocial personality disorder?
CORRUPT
Callous Others blamed Reckless Remorseless - lack of guilt Underhanded Poor planning Temper/tendency to violence
What are the features of histrionic personality disorder?
PRAISE
Provocative behaviour Real concern for physical attractiveness Attention seeking Influenced easily Shallow/seductive Egocentric, vain, exaggerated
What are the features of dependent personality disorder?
RELIANCE
Reassurance required Expressing disagreement difficult Lack of self confidence Initiating projects difficult Abandonment feared Needs others to assume responsibility Companionship sought Exaggerated fears
What are the features of anxious personality disorder?
CRIES
Certainty of being liked needed before becoming involved
Restriction to lifestyle to maintain security
Inadequacy felt
Embarrassment potential prevents in engagement in new activities
Social inhibition
What are the features of anankastic personality disorder?
LAW FIRMS
Loses point of activity due to preoccupation with detail Ability to complete tasks compromised - perfectionism Workaholic at expense of leisure Fussy Inflexible Rigidity Meticulous attention to detaio Stubborn
How can Cluster A PDs be differentiated from psychotic disorders?
Hallucinations and true delusions are absent in Cluster A PDs.
What is the 3 Ps personality mnemonic?
Personality disorder problems are persistent, problematic and pervasive - noticable in every part of a thing or place.
What can be enquired in a history for PDs?
How other people would describe the personality
Concerned about others in life, relationship with others, close friends
Ever got into serious trouble, have a bad temper, do you think things through before you do them
Worry about anything, fear anything, struggle to make important decisions
Perfectionist, more time working than relaxing
Do patients with PDs have good insight?
No
What investigations can be done for PDs?
Questionnaires e.g. Personality Diagnostic Questionnaire, Eysenck Personality Questionnaire
Pyschological testing - Minnesota Multiphasic Personality Inventory MMPI
CT head/MRI to rule out organic causes of personality change e.g. frontal lobe tumours, intracranial bleeds
What are the differentials for PDs?
Mood disorders e.g. mania, depression
Psychotic disorders e.g. schizophrenia, schizoaffective disorder
Substance misuse
What is the general management of personality disorders?
Identify and treat co-morbid mental health disorders
Treat any co-existing substance misuse
Help patients to deal with situations that provoke problem behaviours or traits
Provide general support to reduce tension and anxieties
Give support and reassurance to family and friends
Risk assessment
Pharmacological management can help to control symptoms
Written crisis plan
What is the management of PDs under the bio-psychosocial model?
BIOLOGICAL
Atypical antipsychotics
Mood stabilisers
Small role for antidepressants
PSYCHOLOGICAL
CBT
Psychodynamic psychotherapy
Dialectical behaviour therapy - emphasis placed on developing coping strategies to improve control and reduce self harm
SOCIAL
Support groups
Substance misuse services
Assistance with social problems e.g. housing finance and employment
Help to access education, voluntary work, meaningful occupation and work
