Personality Disorders Flashcards
What are personality disorders?
A series of maladaptive personality traits that interfere with normal function in life
A type of mental health disorder that affects a persons pattern of thinking, feeling and behaving
They must be:
- Pervasive: occurs in all/most areas of life
- Persistent: evident (starts) in adolescence and continues through adulthood
- Pathological: causes distress to self or others, impairs function
What are the OCEAN personality traits?
5 big personality traits / five factor model
(O) = Openness to experience
- HIGH = imaginative, curious, appreciate of art / travel
- LOW = more conventional, value practicality and perseverance over new experiences
(C) =Conscientiousness
- HIGH = following rules, being orderly, ability to plan and be self-disciplined to achieve goals
- LOW = spontaneous, free-spirited, risk being impulsive / unreliable
(E) = Extraversion
- HIGH = predisposition to experience positive social events / be around other people
- LOW = introversion, mental energy drained by being around others, prefer being alone
(A) = Agreeableness
- HIGH = tendency to cooperate, be trusting and kind, prone to peer pressure
- LOW = less interested in social harmony, less time/effort into helping others, may view others motives with scepticism
(N) = Neuroticism
- HIGH = predisposition to negative emotions, thinking of mistakes from the past / worrying about the future
- LOW = less emotionally reactive, tend to become upset less often
How are personality disorders categorised?
Cluster A - WEIRD - (PaSS)
- Paranoid
- Schizoid
- Schizotypal
Cluster B - WILD - (BANHed)
- Borderline (Emotionally Unstable)
- Antisocial / Dissocial
- Narcissistic
- Histrionic
Cluster C - WORRIED - (DOA)
- Dependent
- Obsessive-Compulsive / anankastic
- Anxious-Avoidant
What is the gender epidemiology of personality disorders?
- M > F in cluster A, anankastic, dissocial, narcissistic
- F > M in histrionic, emotionally unstable
What is the aetiology for personality disorders?
Biological
- Strong association to genetics and FHx
- Neurotransmitter theories – lower 5-HT levels in dissocial (cluster B) personality types
Psychosocial
- Childhood temperament – difficult temperament (≥3yo)
- Childhood experiences – insecure attachment, traumatic upbringing
- Cognitive theories – confirmation bias perpetuation (i.e. if you’re negative, you spark ‘negativity’ in others, confirming your thoughts)
- Psychological defences – overly reliant on psychological defences such as ‘acting out’, ‘splitting’, ‘projection’, ‘fantasising’, etc.
What are the investigations for personality disorders?
- Second interview (and collateral history)
- Check for REPORT criteria
- List personality traits and match to cluster criteria (≥3, and REPORT required)
- Use… questionnaires, specific instruments for each cluster, etc.
- MRI may be indicated if organic causes of personality change are suspected, e.g. frontal lobe tumour, subdural haematoma
What is the prognosis for personality disorders?
- Personality disorders disrupt relationships, education and employment
- Although they are persistent, they may change in severity over time (i.e. Cluster B often burn out as you age)
- Long-term risk is 10% suicide rate (however, admission can be counter-productive, fostering dependence)
What is the difference between schizoid and schizotypal?
Schizotypal (some positive schizophrenia symptoms):
- Eccentricity and eccentric thoughts/ideas (this is the main difference between this and schizoid)
- Paranoid or bizarre idea
- Social withdrawal
- Cold/inappropriate affect
- > > Believe in ‘magic’ and ‘fairies’
Schizoid (just negative schizophrenia symptoms)
Describe paranoid personality disorder
FEAR, MISTRUST & SUSPICIOUSNESS OF PEOPLE
> Low agreeableness
(S) Sensitive (e.g. unwarranted tendency to perceive attacks on their character)
(U) Unforgiving (e.g. unforgiving attitude when insulted / bear grudges)
(S) Suspicious (e.g. unwarranted tendency to questions the loyalty of friends / reluctance to confide in others)
(P) Possessive and jealous of partners
(E) Excessive self-importance
(C) Conspiracy theories (e.g. preoccupation with conspirational beliefs and hidden meaning)
(T) Tenacious sense of rights (e.g. stubborn sense of personal rights)
E.g. Reuben suspected that his colleagues at the Post Office were getting preferential treatment, despite his certainty that he was the best worker there. When he was offered overtime, it was ‘only the shifts that no-one else wanted’. This confirmed his suspicion, and so he resigned, feeling insulted. Five years later he is still convinced that his boss was corrupt.
DDx: schizophrenia, delusional disorder
Reuben suspected that his colleagues at the Post Office were getting preferential treatment, despite his certainty that he was the best worker there. When he was offered overtime, it was ‘only the shifts that no-one else wanted’. This confirmed his suspicion, and so he resigned, feeling insulted. Five years later he is still convinced that his boss was corrupt.
Paranoid PD
Describe schizoid personality disorder
CONSISTENT LACK OF INTEREST IN SOCIAL RELATIONSHIPS
> Low extroversion
(A) Anhedonic
(L) Limited emotional range (e.g. emotional coldness)
(L) Little sexual interest / lack of desire for companionship
(A) Apparent indifference to praise / criticism
(L) Lacks close relationships
(O) One-player activities
(N) Normal social conventions ignored
(E) Excessive fantasy world
E.g. Masson was a night security guard, content with solitude and daydreaming his shift away. His manager passed on complaints from the day staff that he left a ‘body odour smell’ in the office, but he didn’t try to wash. Although people thought he was odd, he really didn’t care. He wasn’t interested in having friends or a sexual partner, preferring his own company. He was neither happy nor sad about this; that was just life.
DDx: depression, autism spectrum, psychosis, phobia
Masson was a night security guard, content with solitude and daydreaming his shift away. His manager passed on complaints from the day staff that he left a ‘body odour smell’ in the office, but he didn’t try to wash. Although people thought he was odd, he really didn’t care. He wasn’t interested in having friends or a sexual partner, preferring his own company. He was neither happy nor sad about this; that was just life.
Schizoid PD
Believing in paranormal activity or hearing name called in empty room / loneliness, isolation - avoidance out of fear that others will judge them for their odd ways
Schizotypal PD
Describe schizotypal personality disorder
PRESENCE OF ODD BELIEFS AND DIFFICULTY IN RELATING TO OTHER PEOPLE
- E.g. believing in paranormal activity or hearing name called in empty room
- Loneliness, isolation - avoidance out of fear that others will judge them for their odd ways
Describe histrionic personality disorder
PATTERN OF EXCESSIVE/EXAGGERATIVE BEHAVIOURS INTENDED TO BECOME THE CENTRE OF ATTENTION / GAIN APPROVAL OF OTHERS
(A) Attention-seeking / seeks excitement
(C) Concerned with appearance
(T) Theatrical
(O) Open to suggestion
(R) Racy and seductive (e.g. inappropriate seductiveness)
(S) Shallow affect (e.g. rapidly shifting and shallow expression of emotions)
E.g. Paige met her boyfriend for lunch. He suggested a bottle of wine, so she ordered champagne! Tottering on her pink stilettos, she fell into his lap as she got out of her chair. Everyone stared but Paige shrieked with laughter! She became bored and flirted with the waiter, but when he ignored her, she left, announcing loudly, ‘I’ll never eat here again!
DDx: BPAD (manic/hypomanic), substance
