Personality Disorders Flashcards
Explain the general criteria for a personality disorder? (6)
- Enduring patterns of behavior that manifest themselves as inflexible responses to a broad range or personal and social situations
- Has to be pervasive (i.e. not just in certain situations)
- Has to be inflexible, maladaptive or dysfunctional
- Has to cause personal distress and/or have an adverse impact on the social environment
- They are developmental conditions that appear in childhood or adolescence and continue into adult life
- Cannot be explained as a manifestation or consequence of other adult mental disorders (although they are more common in those with other mental health disorders)
ICD 10 vs 11 vs DSM for personality disorders?
narcissistic and histrionic only exist in DSM
In ICD schizotypal is a paranoid psychosis, in DSM it is a personality disorder
In ICD 11 there are no longer subtypes due to recognised overlap simply that personality disorders can be classed as mild moderate or severe but there are trait domain specifiers you can use with borderline as an additional descriptor
What are the 5 trait domain specifiers you can use in ICD 11?
- Negative affectivity
- Detachment
- Dissociality
- Disinhibition
- Anakastia
And additionally – borderline pattern can be added as a descriptor
List the cluster A, B, C PDs?
Cluster A – the odd and eccentric
* Paranoid – very suspicious, misconstrues friendly actions, questions fidelity of partners
* Schizoid – cold and detached, insensitivity to societal/ cultural norms
* Schizotypal – odd beliefs and thinking, ideas of reference, odd appearance and behaviour
Cluster B – the dramatic and emotional
* Dissocial
* Emotionally unstable impulsive – impulsive actions and quarrelsome behaviour
* Emotionally unstable borderline
* Histrionic – self dramatization, wants to be centre of attention
* Narcissistic – egotistical and wanting of admiration, oppressive of others
Cluster C – the anxious and avoidant
* Dependent – depends on someone, can’t make decisions without them and puts their person above their own needs
* Anxious – socially anxious, restricts lifestyle to feel secure
* Anankastic – perfectionistic traits that interfere with task completion, can’t let others do things
What is meant by emotionally unstable borderline personality disorder?
- Type of personality disorder
- The borderline refers to how the patient sits on the borderline between neurotic and psychotic symptoms
- They have anxiety symptoms that can be pushed to psychotic symptoms
Criteria for emotionally unstable borderline personality disorder?
2 from impulsive list:
1. Tendency to act unexpectedly without consideration of consequences
2. Quarrelsome behaviour and conflicts with others especially when impulsive acts are thwarted/ criticized
3. Liability to outbursts of anger or violence
4. Difficulty in maintaining any course of action that offers no immediate reward
5. Unstable mood
Plus 2 from borderline specific list:
1. Disturbances in an uncertainty about self image, aims and internal preferences (including sexual)
2. Intense and unstable relationships often leading to emotional crisis (form and end quickly)
3. Excessive efforts to avoid abandonment
4. Recurrent threats or acts of self harm
5. Chronic feelings of emptiness
What are the treatment challenges in EUBPD?
- They may often present to A and E after self-harming or suicide attempts
- These may occur after the end of a relationship
- Often form relationship with anti-social PD as these can appear very charming on surface so draws them in, then get resulting abuse and turbulent relationship
- Evidence for admission to hospital with EUBPD is not good
- Patients enjoy the safety of hospital and the relationships they form with staff and don’t want to leave
- When get close to discharge they tend to get very distressed and then express strong suicidal intent in order to avoid discharge
- This can be combatted with only offering time limited admissions e.g. for crisis management
- Can still be difficult and sometimes have to send them home when expressing suicidal intent – most do not follow through
What personality disorders tend to present to psychiatric services the most?
EUBPD and antisocial/ dis social
Management of EUBPD?
- DBT (dialectical behavioural therapy) is proven to work, it is a form of CBT designed to focus on tolerating distressing emotions and ultimately learning how to regulate them
- There are no medicines specifically licensed
- However, in crisis and very high distress could use short course of benzodiazepines
- If specific symptoms that are verging on psychotic with intrusive thoughts etc. then could use low dose quetiapine
Treatment of personality disorders?
- Generally, there isn’t good evidence to guide the treatment for most personality disorders
- Treatment of co-morbidity e.g. depression, anxiety is effective and should be the focus of the treatment
- In general, pharmacological treatment isn’t recommended by NICE but can be used to reduce individual symptoms e.g. antipsychotics, SSRIs
- Benzodiazepines or hypnotics can be used short term as sedatives as part of a larger care plan during a crisis
- The personality disorder with the best evidence for treatment is borderline personality disorder, a special type of CBT has been developed called dialectical behavior therapy
EUBPD is more common in ______ and antisocial/ dissocial is more common in _____
females for eubpd
males for antisocial/ dissocial
What proportion of patients with Emotionally Unstable Personality Disorder will improve to the point of not having the disorder for 2 years or more with appropriate treatment when followed up over a long period?
> 90%
