Personality Disorders Flashcards
Diagnosis of a personality disorder
-general criteria
2 years consistent in a range of situations with moderate impacts without other causes or cultural explanation
Persistent marked deviation from culturally expected and accepted range of inner experience and behaviour in 1+
- cognition, perception of events and actions
- range, intensity, appropriateness of affect
- impulse control and gratification of needs
- interpersonal interactions
- inflexible, maladaptive behaviours in personal, social situations
- adverse impact on social environment
Childhood, teen => stable, long duration
Behaviour cannot be explained by any other diagnosis
-no organic cause
Types of emotionally unstable personality disorders
Impulse type
Borderline type
Diagnosis of impulsive personality disorder
3+ of
- Acts impulsively
- Frequent conflict with others
- Outburst of anger, violence which cannot be controlled
- Difficulty maintaining actions without immediate rewards
Diagnosis of borderline personality disorder
Can present like depression
- premorbid personality, more persistent symptoms with PD
- PD can be more labile than depression
- reduced response to antidepressants in PD
3+ of
- Disturbance in self image and personal goals
- Intense, unstable relationships => excess efforts to avoid abandonment
- Recurrent threats and acts of self harm
- Chronic emptiness
Other aspects of the history that may contribute to emotionally unstable personality disorder
Broken, poor relationships in early years
Abandonment, poor parental history
Physical, sexual, emotional abuse
Management of emotionally unstable personality disorder
- medication
- psychotherapeutic
- behavioural
Minimise medication use
Restrict use of addictive medication - sleeping tablets, BZ
Treat any underlying psychiatric problems - depression, psychosis
Dialectical behavioural therapy
Mentalisation based treatment
Therapeutic community
Behavioural management
How to promote engagement between the
- clinician
- patient
Engagement
- develop rapport
- establish boundaries
- manage expectations
- crisis/chaos management
Clinician
- consistent treatment plan and management
- minimise staff changes => reduce feelings of abandonment
- clear boundaries and goals
Patient
- encouraged to take responsibility for actions and behaviour
- clear management plan for crisis
- hospital admissions to be reserved for crises involving risk of significant harm to self and others
Describe dialectical behavioural therapy
-how does this differ from CBT
Based on CBT but adapted for people who feel emotions very intensely
Aims to help you
- understand and accept your difficult feelings
- learn skills to manage them so you don’t have to turn to harmful behaviours
- make positive changes in your life
Describe mentalisation based treatment
Views BPD as a developmental disturbance in attachment => reduced ability to understand your mental state and of others
Intervention focuses on increasing self reflection
Describe therapeutic community treatment
Group based approach where interpersonal, emotional issues are openly discussed
-mutual feedback helps develop an awareness of interpersonal actions and problems
What are the 3 clusters of personality disorder
Cluster A - odd or eccentric disorders
- paranoid PD
- schizoid PD
- schizotypal PD
Cluster B - dramatic, erratic, emotional
- dissocial/amtisocial PD
- emotionally unstable PD (BPD type or impulsive type)
- histrionic PD
Cluster C - anxious or fearful
- obsessive/anankastic PD
- anxious/avoidant PD
- dependent PD
Describe
- paranoid PD
- schizoid PD
- schizotypal PD
Paranoid - delusional/paranoid
- paranoia, distrusting of others
- easily offended
Schizoid - social withdrawal
- uninterested in others or activities
- emotionally detached, cold to others
- difficulty forming relationships
Schizotypal - distorted reality
- odd ideas, eccentricities
- interpersonal difficulties, social anxiety
Describe
- dissocial/antisocial PD
- narcissistic PD
- histrionic PD
Antisocial -
- lack of remorse, empathy, guilt
- disregard for social norms
- difficulty sustaining relationships
- prone to blaming others
- low tolerance for frustration => aggression
Narcissistic - grandiosity
- belief of unlimited success and entitlement, admiration
- take advantage of others to achieve own goals
- chronic envy
- lack empathy
Histrionic
- preoccupation with attractiveness, dressing/behaving provocatively to stay at the center of attention
- easily influenced
- labile affects
Describe
- anankastic PD
- avoidant PD
- dependent PD
Anankastic - rigid, needs order
- needs rules, organisation
- perfectionism
Avoidant - inhibited
- belief that they are socially inept
- avoid social situations due to fear of embarrassment
- low self esteem
Dependent - insecure
- indecision, clingy
- require constant reassurance
- fears being alone
How to promote stabilisation of the patient
Team management of risk
- awareness of toxic communication
- triage when to admit for risky behaviour
Use of structured psychotherapies and medications to manage symptoms if needed.
Communicating with the patient
Containment - develop rapport with clear boundaries that can tolerate disturbance, difficult thoughts and feelings => patient becomes confident in trying alternative strategies
Listen and believe in them
Acknowledge and validate experiences of symptoms and system
-talk to them about the positives despite the negatives
Emphasise the struggle
What is the theory of developmental processes
Infant starts life with innate potentials
Our relationships with our primary caregiver shapes our mind, personality and ability to cope
Baby changes behaviour => mother reacts => baby learns
What are the characteristics of a mature individual
Coherent and stable sense of self Perceives other as separate own mind Capacity to manage one's emotional state Enjoy intimate relationships Tolerates being separate and alone Able to be productive and creative
What does treatment aim to achieve
Psychosocial treatment to help people develop a healthy sense of self
How else could you classify personality disorders
ICD11, DSM 5 - severity or impariment of functioning
- no PD
- personality difficulty - in certain situations only
- mild - definite well demarcated problems in a range of situations
- moderate - definite problems covering several domains
- severe - affects all areas of their life
ICD11, DSM 5 - traits
- negative affect - broad range of negative emotions out of proportion and frequency too situation
- detachment - socially and emotionally
- disinhibition - act rashly based on immediate stimuli without thought to consequences
- dissociality - disregard of rights and feelings of others, lack of empathy, self centeredness
- anakastia - rigid focus on perfection, right and wrong, controlling own and others’ behaviours and situations to maintain conformity
