Personality disorders Flashcards
What is conduct disorder? Epidemiology:
Conduct disorder is a diagnosis given to patients under the age of 18 years old who show behaviour and attitudes that continuously disrespect and violate the rights of other people. It is more common in males.
Common symptoms of conduct disorder:
-physical agression (repetitive & persistent)
-destructive (dissocial, aggressive, defiant) behaviour
-stealing
-lying
-bullying others
-temper tantrums
-fighting
-fire-setting
-cruelty to animals
Prognosis of conduct disorder:
The prognosis of conduct disorder is generally poor:
- Around 50% of children with conduct disorder develop antisocial personality disorder
-Around 50% develop substance misuse issues
-Around 40% become recurring young offenders
A 54-year-old man presents to A&E after breaking up with his long-term partner, stating that he needs to be admitted to hospital or he will harm himself. While awaiting psychiatric assessment, the nursing shift ends. The patient becomes increasingly agitated, telling the nurse that she cannot leave because no one else will know how to take care of him. In an attempt to calm him down, the catering team offer him a sandwich. This however seems to make him more distressed, stating that he does not know which one to choose as his partner used to ‘deal with all of my food’.
What type of personality disorder is this patient most likely to have?
A. Class C – Emotionally unstable personality disorder
B. Class B – emotionally unstable personality disorder
C. Class C – dependent
D. Class B – dependent
E. Class A – schizoid
Class C-dependent:
This patient is most likely to have dependent personality disorder. Dependent personality disorder is characterised by an intense psychological need to be cared for by others. This patient has recently broken up with a romantic partner, and therefore feels the need to seek out a new source of care and support. This is also demonstrated by his distress at the nursing staff changeover, as he is again experiencing the loss of a source of care.
Those with dependent personality disorder can also lack initiative and struggle to make decisions independently. This could underlie his increased distress at being required to make a decision regarding the sandwiches.
Not A: Class C – Emotionally unstable personality disorder
Emotionally unstable personality disorder (also known as borderline personality disorder) is a class B personality disorder. It is characterised by abrupt mood swings and unstable relationships with others. Patients may demonstrate splitting, whereby relationships alternate between idealisation and devaluation.
Although this patient has had a recent break-up with his partner, it is notable that this was previously a long-term relationship, with no evidence of instability. He also did not demonstrate any mood swings. Although it can be argued the patient idealised the nurse taking care of him, his distress at her leaving was not driven by devaluation of the next nurse coming on shift, but by a loss of his current source of care.
what are class C personality disorders:
Cluster C personality disorders are the “anxious or fearful” disorders. They include:
- Avoidant personality disorder
Involves strong feelings of inadequacy and fear of social situations where they may be criticised
Patients are extremely sensitive to criticism
Often self impose isolation while craving acceptance and social contact - Dependent personality disorder
Characterised by an intense psychological need to be cared for by others
Lack initiative and need others to make decisions on their behalf
Urgently search for new relationships as soon as one ends to provide care and support - Obsessive-compulsive personality disorder
Preoccupied by rules, details and organization to the detriment of other aspects of their life
Perfectionist, often eliminating leisure activities to ensure work is completed
In contrast to Obsessive-compulsive disorder, these activities are seen as pleasurable and desirable, rather than distressing and anxiety inducing.
Criteria for personality disorder (mnemonic):
REPORT
- Relationships affected
- Enduring
- Pervasive
- Onset in childhood or adolescence
- Results in distress
- Trouble in occupational/social performance
A 23-year-old woman presents to the Emergency Department with a paracetamol overdose. She discloses she took 50 paracetamol tablets after having an argument with her boyfriend. Her boyfriend wants to end this relationship, as she is constantly checking on him. She explains that she is doing this to prevent her boyfriend from having an affair. She initially just wanted to threaten her boyfriend, but she eventually took an overdose because she was distressed by her boyfriend’s ignorance. She has multiple previous attempted suicides, mostly due to relationship problems. She is living with her boyfriend, having left home when she was 18, as she says that her family is too controlling.
What is the most likely psychiatric diagnosis?
A. Histrionic personality disorder
B. Emotionally unstable personality disorder
C. Paranoid personality disorder
D. Avoidant personality disorder
E. Dependent personality disorder
B. Emotionally unstable personality disorder
This woman has traits of emotionally unstable personality disorder – unstable relationships, mood instability and multiple suicidal behaviours. There is evidence of the persistent and pervasive nature of these traits since early adulthood, given the outcomes of her previous romantic relationships and her family relationships.
Not C: paranoid PD
Although this woman is worried about the possibility of her boyfriend having an affair, she has no other prominent traits of paranoid personality disorder, eg. reduced trust in others, jealousy or tendency to hold grudges.
Not A: Histrionic PD
Multiple suicidal attempts are more a sign of impulsivity and emotional instability as seen in emotionally unstable personality disorder, rather than a sign of attention seeking seen in histrionic personality disorder. The reason she eventually decides to take the overdose is due to her poor control of emotions and actions. She also has no traits of histrionic personality disorder, eg. overly concerned about physical attractiveness, shallow affect or exaggerated emotions.
Not E: Dependent PD
There is no evidence that this woman has strong feelings of needing her boyfriend or family to take care of herself or is being clingy to her boyfriend. She also has no other traits of dependent personality disorder, eg. lack of self-confidence, difficulty in initiating projects or needing others to make most decisions for her.
Not D: Avoidant PD
She has no traits of avoidant personality disorder, eg. avoiding social interactions, a sense of inadequacy, feeling the need to be liked or being extremely sensitive to criticisms.
What are class B personality disorders?
Definition: Cluster B personality disorders are categorized as the “dramatic, emotional or erratic disorders”. They include:
- Antisocial personality disorder
-Characterised by a patterns of disregard and violation of the rights of other’s. Individuals lack empathy and are often manipulative and impulsive.
-Aggressive and unremorseful
-Consistently irresponsible with failure to obey laws and social norms - Borderline personality disorder (emotionally unstable)
-Pattern of abrupt mood swings, unstable relationships and instability in self-image
-Self harm is common
-Relationships alternate between idealization and devaluation (splitting)
-Inability to control temper and general affect - Histrionic personality disorder
-Characterised by attention seeking behaviours and excessive displays of emotions
-Often sexually inappropriate
-Shallow and self-dramatising
-Relationships are considered to be more intimate than they really are - Narcissistic personality disorder
-Involves a pattern of grandiosity, need for admiration of others and a lack of empathy
-Has a sense of entitlement and will take advantages of others to achieve their own wants
-Arrogant and preoccupied by their own fantasies and desires
