Personality Disorders Flashcards
What term is used to refer to Ps diagnosed with personality disorder?
Patients with complex emotional difficulties
What is personality?
Collection of characteristics or traits - developed as we grow = shape us in terms of our attitudes, thoughts, feelings and behaviours and our responses to different situations.
What is temperament?
The emotional and behavioural characteristics of children
When is our personality developed by?
Usually by late teens / early 20s
Which is one of the most widely used models to describe personality?
The Big 5 Model
- Openness to experience
- Conscientiousness
- Extraversion - intraversion
- Agreeableness
- Neuroticism
Each of these are a continuum
In what ways is personality formed?
Childhood experiences
Attachment theory
Genetics
Psychoanalytic theories
Name 3 psychiatrists concerned with psychoanalytic theories of personality development.
Freud
Jung
Erikson
Who proposed attachment theory?
Bowlby
What is the basis of attachment theory?
We are born with a drive to form attachments with others - initially with one primary attachment (base for exploring the world) - done as part of survival.
All relationships in our life will be affected by our primary attachment.
When is the critical period for forming attachment?
0-5 years
Name 4 types of attachment styles
Secure
Anxious (Ambivalent)
Avoidant
Disorganised (Fearful)
Which attachment style is this?
Primary caregiver at times appears to the child as frightened and frightening.
Relationships are characterised by features of both anxious and avoidant styles, want but also avoid intimacy.
Disorganised (fearful)
Which attachment style is this?
Less confident in the primary caregiver’s responsiveness.
Relationships are characterised by the belief that other will not reciprocate the wish for intimacy - need for reassurance / validation, fear of abandonment.
Anxious (ambivalent)
Which attachment style is this?
Believes that the primary caregiver will respond to needs.
Relationships are characterised by trust, adaptive response to being abandoned, belief that one is worth of love.
Secure
Which attachment style is this?
Child internalises the belief that they cannot depend on the primary caregiver or any other - perceives them as rejecting / easily angered.
Relationships are characterised by an avoidance of intimacy.
Avoidant
Why is attachment theory felt not to be the only explanation for personality development?
Focuses entirely on the mother (oppressive to women)
Reductionist - children who grow up with abuse can still form loving and stable relationships as adults. Vice versa - children with nurturing and loving caregivers can struggle to form relationships as adults.
Does temperament dictate attachment? I.e. - is there a genetic component too?
Why are personalities between family members often similar?
Social learning
Genetics
What percentage for heritability of personality was determined by twin studies?
35-50%
How does personality change throughout adulthood?
Pretty much set by late 20s, can still undergo changes but at a very slow rate - especially after 30.
How can you assess personality?
Scales and questionnaires (although not often used in clinical practice)
Patients description of their thoughts, feelings and behaviour (How would your friends and family describe you as a person?)
Collateral Hx
Wider picture - nature of relationships with others, usual mood, daily routine, hobbies/activities, substance use, religious beliefs, attitudes towards illness, work, change, family
When is a personality disorder deemed to occur rather than just being a personality trait?
When it causes significant problems with social and personal function.
What is a personality disorder defined as?
Marked disturbance in personality functioning - almost always associated with considerable personal and social disruption.
Enduring.
Manifests across a range of personal and social situations (more than just 1).
What impairments are seen in personality disorder?
Impairment in functioning of aspect of the self (e.g. self-worth, identity, capacity to self-direct)
Impairments in interpersonal relationships (can’t develop or maintain them, can’t understand the perspective of others, problems managing conflict)
Cause maladaptive patterns of cognition, behaviour and emotional expression / experience
Why is there controversy about whether personality disorder is a mental illness?
Because it is persistent and stable throughout life - rather than having a period of illness for which the patient has a definable onset, is treated and recovers.
How is personality disorder classified?
Historically - by categories - involved a checklist of symptoms, often overlapping and based on observations made decades ago. Lacked scientific basis.
Today - is a dimensional approach under ICD11- disorder is defined by overall severity with personality traits grouped in domains.
What type of personality is:
Suspicious, preoccupied with conspiratorial explanations, self-referential, distrust of others, feel easily rejected, tend to hold grudges.
Paranoid
What diagnosis would the following describe? (one diagnosis for all of the following)
- Frantic efforts to avoid real or imagined abandonment.
- A pattern of unstable and intense interpersonal relationships, which may be characterized by vacillations between idealization and devaluation, typically associated with both strong desire for and fear of closeness and intimacy.
- Identity disturbance, manifested in markedly and persistently unstable self-image or sense of self.
- A tendency to act rashly in states of high negative affect, leading to potentially self-damaging behaviours (e.g., risky sexual behaviour, reckless driving, excessive alcohol or substance use, binge eating).
- Recurrent episodes of self-harm (e.g., suicide attempts or gestures, self-mutilation).
- Emotional instability due to marked reactivity of mood. Fluctuations of mood may be triggered either internally (e.g., by one’s own thoughts) or by external events. As a consequence, the individual experiences intense dysphoric mood states, which typically last for a few hours but may last for up to several days.
- Chronic feelings of emptiness.
Inappropriate intense anger or difficulty controlling anger manifested in frequent displays of temper (e.g., yelling or screaming, throwing or breaking things, getting into physical fights).
- Transient dissociative symptoms or psychotic-like features (e.g., brief hallucinations, paranoia) in situations of high affective arousal.
- Other manifestations of Borderline pattern, not all of which may be present in a given individual at a given time, include the following:
- A view of the self as inadequate, bad, guilty, disgusting, and contemptible.
- An experience of the self as profoundly different and isolated from other people; a painful sense of alienation and pervasive loneliness.
- Proneness to rejection hypersensitivity; problems in establishing and maintaining consistent and appropriate levels of trust in interpersonal relationships; frequent misinterpretation of social signals.
Borderline qualifier
