personality disorders Flashcards
timing of personality disorders
something that is persistent across the lifespan, in different settings
in a way that isn’t better explained by another disorder
what are the cluster A disorders
what are their general features
basic mistrust of others, tend towards a withdrawal from ordinary sociality
paranoid personality disorder
schizoid personality disorder
schizotypal personality disorder (not in ICD-10 as personality disorder)
what is paranoid personality disorder
general distrust of others that markedly gets in the way of any ordinary relating
can be seen directly as distrust or by its effect e.g. tendency to anger and to feel slighted
rarely of clinical concern, pts don’t seek treatment
suffers may have important reasons to feel like their boundaries are at threat - incl those relating to their bodily integrity; often because they have been in the past
what is schizoid personality disorder
indifference to social contact with others
pts often are strikingly unbothered by their lackof sociality
often a rich fantasy life - may have a deep yearning for relatedness
small number of pts who recognise they have a problem and want to change probably can improve in long term psychodynamic therapy
what is schizotypal personality disorder
considered as a sz-spectrum condition
come across as markedly odd - beyond eccentric
often have psychotic like experiences - intuitions, magical thoughts etc
not a good prognostic sign for work in psychotherapy
what are the cluster B disorders and what characterises them
serious problems of behaviour and impulse control
borderline personality disorder (emotionally unstable personality disorder)
narcissistic personality disorder - not in ICD-10
antisocial personality disorder (dissocial personality disorder)
histrionic personality disorder
features of borderline personality disorder
distress when relationships are strained
difficult behaviours to try and manage strong feelings
frantic efforts to avoid abandonment
stormy sense of their emotions, below which they can often feel quite empty
tendency to be unsure about one’s identity
why is there controversy surrounding borderline personality disorder
suggestion that it pathologises responses to the abuse that often has been part of the hx of people w/ the diagnosis
concern is applied to a higher degree to women
management and natural hx of borderline personality disorder
people whose main problem is BPD often find that simple treatments (e.g. antidepressants) don’t improve things
if people want and can engage w/ meaningful therapy and are in a good place to use it - things can change
natural hx - improvement over time, 60% of people no longer met criteria at 6yrs after diagnosis
mentalisation based treatment for BPD - what are the aims
aims to help people improve their ability to think about their feelings at times they feel more distressed
aims to help them make better sense of other’s intensions
what are the aims of dialectical behaviour therapy for BPD and benefits
different set of aims to mentalisation based treatment
people often find their skills for distress tolerance can be improved by it
medication for BPD
not favoured in guidelines but is sometimes used
sometimes use off-label medication symptomatically in BPD
avoid polypharmacy, use medications as trials w/ clear goals and review timetables
only ever used as an adjunct rather than definitive treatment
self harm in BPD
high rate (one of the criteria for BPD is self harm)
self-injury/suicidal thoughts or communication of suicidal intent may be complicated in terms of their meaning
what is narcissistic personality disorder
outwardly have a very high opinion of themselves and very little sense of what matters to others
in fact have a deep sense of their inadequacy that is very painful for them to get close to so they deny it
not of particular clinical concern
in some offending pts, narcissistic traits can be relevant to the formulation of their offending behaviour and way of approaching treatment - rarely meet DSM-5 criteria for NPD
what is antisocial personality disorder
of clinical interest
characterised by persistent criminal conduct and a tendency to be remorselessness about those affected by it
spectrum of behaviour
psychotherapeutic treatment for ASPD
high degree of callousness, enjoyment of violence, little capacity to experience anxiety, manipulative and charming - not amenable to psychotherapeutic treatment
antisocial, low degree of callous unemotionality - can in rare cases so well in therapy w/ specialists after careful assessment
what is psychopathy
psychological construct rather than psychiatric diagnosis
used to describe people w/ high degree of callous-unemotionality and a high degree of antisocial acting
what is histrionic personality disorder
rarely of clinical interest
small no of pts have a tendency to dramatic displays of emotion that seem to ring hollow
may be openly flirtatious and continuously seeking appreciation
cluster C disorders
characterised by a constitutional difficulty in the way anxiety is managed
esp anxiety relating to ordinary social roles and responsibilities
obsessive compulsive personality disorder (anankastic personality disorder)
dependent personality disorder
avoidant personality disorder (anxious [avoidant] personality disorder)
what is OCPD
different from OCD
tendency towards obstinateness, rigidity and significant anxiety about anything that is disorderly
not often directly a PC - presentation may be w/ the associated anxiety, lifelong rather than episodic
can improve on psychodynamic psychotherapy - rarely that someone has single OCPD diagnosis (usually have had something happen that lead to symptomatic anxiety disorder)
what is dependent personality disorder
marked difficulty in assuming appropriate adult responsibilities
defers to others in all areas, rarely seeing any way in which they can manage things themselves
not of significant clinical concern
what is avoidant personality disorder
tend not to allow conflict
tend to put off their problems
rarely off the degree that leads to clinically-significant impairment as a single diagnosis
treatment of personality disorder
need a formulation that makes sense - provide a rationale for the treatment that suggests it has a chance of being helpful
good assessment is helpful for you and the patient - understanding of what the difficulty is, how it has developed, particular form, co-occuring disorders
what is personality
those characteristic aspects of a person that distinguishes them, that allows them to be known by others and by themselves
in psychiatry - often thought of as the baseline, with an assumption of illness as an aberration or break from it
what are the 5 factors in the five factor theory
openness-rigidity recklessness-conscientiousness introversion-extraversion agreeableness-difficulty neuroticism-psychoticism
what impacts on the development of personality in early life
psychological and social life of the family before the infant arrives
innate temperament of the infant
early soothing and the early environment
exploring the environment in early life - how does it affect our development
from a secure base, exploration - attachment behaviour
recapitulation in adolescence
continual developmental process/conflict and continues lifelong
development of an internal working model
general personality disorder
- examples
- features
dysfunction or harmful dysfunction is what characterises personality disorders
marked deviation
what is a personality disorder
problems in functioning of aspects of the self and/or interpersonal dysfunction that have persisted over an extended period of time
disturbance manifests in patterns of cognition, emotional experience/expression and behaviour that are maladaptive and present across a range of personal and social situations
patterns of behaviour aren’t developmentally appropriate and cannot be explained by social/cultural factors
disturbance is associated w/ substantial distress/significant impairment in important areas of functioning (personal, family, social, educational, occupational)
features of borderline personality disorder
marked instability in affect, interpersonal relations and other functioning
proneness to feeling abandoned, w/ often frantic efforts to avoid it
disorder of attachment trauma (but not always)
frequently has self-injury and suicidal behaviour
fMRI and BPD
changes related to aberrant functional connectivity between ACC and other frontal regions
mentalisation and BPD
good progress in last decade w/ ideas from mentalisation
loss of mentalising ability in attachment situations
tactics for working w/ people having these difficulties
treatment of BPD
therapy
- good clinical care
- psychotherapeutic treatment
- social treatment
- psychopharmacological treatment - management of co-morbid illness but otherwise isn’t particularly helpful
- inpatient care
what is antisocial personality disorder
features
concept of psychopathy
antisocial behaviour, risk taking, inability to profit from prior experience incl punishment
biological features of ASPD
F-HIAA metabolite and psychophysiological differences
treatment of ASPD
little evidence for good treatment
consistent and firm boundaries about what’s expected and what’s not expected
