Personality Disorders Flashcards
What are personality disorders?
A deeply ingrained and enduring pattern of inner experience and behaviour that deviates markedly from expectations in the individual’s culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time and leads to distress or impairment.
Briefly describe the pathophysiology/ aetiology of personality disorders
The cause of personality disorders (PD) involves both biological and environmental factors.
Biological factors can be genetic and neurodevelopmental (abnormal cerebral maturation).
Environmental factors encompass both adverse social circumstances and difficult childhood experiences such as abuse.
Briefly describe the 3 different clusters of personality disorders
PDs can be classified into three clusters assigned A, B and C based on symptoms:
What are the risk factors for personality disorders?
Society: low socioeconomic status and social reinforcement of abnormal behaviour are linked to PDs.
Genetics: monozygotic twin studies show a higher concordance rate for PD than dizygotic studies. Incidence is higher in those with a positive family history of PD.
Dysfunctional family: poor parenting and parental deprivation are risks for the development of PD.
Abuse during childhoos: this includes physical, sexual (particularly linked to emotionally unstable PD) and emotional abuse, as well as neglect.
How common are personality disorders?
4– 13% of the adult population has a PD of at least mild severity.
20% of GP attendees who are adults suffer from a PD.
What are the most common types of personality disorders?
The most prevalent PD is dissocial (3%) followed by histrionic (2– 3%) and paranoid (0.5– 2.5%).
Briefly describe the ICD-10 Classification of emotionally unstable borderline personality disorder
Note: AM SUICIDE
- Abandonment feared
- Mood instability
- Suicidal behaviour
- Unstable relationships
- Intense relationships
- Control of anger poor
- Impulsivity
- Disturbed sense of self (identity)
- Emptiness (chronic)
Briefly describe the ICD-10 Classification of dissosocial (antisocial) personality disorder
Note: CORRUPT
- Callous
- Others blamed
- Reckless disregard for safety
- Remorseless (lack of guilt)
- Underhanded (deceitful)
- Poor planning (impulsive)
- Temper
- Tendency to violence
Briefly differentiate between cluster A personality disorders and psychotic disorders
‘Cluster A’ PDs (paranoid and schizoid) may present with similar features to psychotic disorders e.g. schizophrenia, for instance with suspiciousness, odd beliefs and social withdrawal. The differentiating factor is that hallucinations and true delusions are absent in ‘Cluster A’ PDs.
Do patients with personality disorders have insight?
Patients with PDs often have no insight into their psychiatric disorder. It is almost impossible to make a diagnosis of personality disorder without taking a reliable collateral history to elicit the pervasiveness and stability of the presentation. You need to complete a detailed personal and social history to understand the impact of the disorder on relationships, friendships and occupation.
What investigations should be ordered for personality disorders?
Questionnaires: e.g. Personality Diagnostic Questionnaire, Eysenck Personality Questionnaire.
Psychological testing: Minnesota Multiphasic Personality Inventory (MMPI).
CT head/MRI: to rule out organic causes of personality change such as frontal lobe tumours and intracranial bleeds.
What are the principles in managing personality disorders?
- Identify and treat co-morbid mental health disorders
- Treat any co-existing substance misuse
- Help patient 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
Why is risk assessment important in personality disorders?
Risk assessment is crucial, particularly in cases of emotionally unstable PD, where patients may be suicidal. Potential stressors that induce crises should be identified and reduced.
What is the role of pharmacological management in treating personality disorders?
Pharmacological management will not resolve the PD, but may be used to control symptoms.
Low-dose antipsychotics for ideas of reference, impulsivity and intense anger.
Antidepressants may be useful in emotionally unstable personality disorder.
Mood stabilizers can also be given.
All of these are off-licence indications for prescribing.
What is a written crisis plan?
Give the patient a written crisis plan. At times of crisis, if dangerous and violent or if there is a suicide risk consider the Crisis Resolution Team and detention under the Mental Health Act.
