Personality disorders Flashcards
What is the definition of a personality disorder?
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
What is personality?
‘Sum of actions and reactions’
‘Essential character of a person’
‘Personal Identity’
‘Organised pattern of behavioural characteristics’
‘Characteristic lifestyle and mode of relating to themselves and others’ (ICD – International Classification of Diagnosis)
According to ICD 11 - what is a personality disorder?
Pervasive and inflexible across different situations
Impairments in relating to self and/or others
Isn’t developmentally appropriate
Deviates from cultural expectations or due to socio-political conflict
Stable over time (2 years or more)
Not due to a medication, substance ot other diagnosis
Associated with distress & functional impairment
What is the pathophysiology 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.
PDs can be classified into three clusters assigned A, B and C based on symptoms
RFs for personality disorders?
Society Both 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
childhood
This includes physical, sexual (particularly linked to emotionally
unstable PD) and emotional abuse, as well as neglect.
What are the types of Cluster A (Odd/Eccentric) personality types
Paranoid
Schizoid
What are the types of Cluster B (Dramatic/emotional) personality types?
Emotionally unstable (borderline)
Dissocial (antisocial)
Histrionic
What are the clinical features of borderline pattern?
- Lack of sense of self
- Unstable self-image
- Unstable affect
- Impulsivity
- Self-Harm
- Intense unstable relationships
- Fears and attempts to avoid abandonment
Epidemiology of Emotionally unstable personality disorder (Borderline)
Prevalence (NICE 2007)
0.7-2% general population
10-30% psychiatric outpatient
75% diagnosed people are women
Heritability
35% genetic; 35% shared environment (Torgerson 2000, 2008)
14% in first degree relatives (Gunderson 2011)
Attachment problems and trauma common
What are some DDs of Emotionally unstable personality disorder (Borderline)
Bipolar affective disorder - Mood changes sustained over weeks, Biological symptoms
Mood congruent psychosis
ADHD / ASD particularly women
Schizophrenia, Schizoaffective disorder
Presence of PTSD symptoms
What is the aetiology: biosocial model for Emotionally unstable personality disorder (Borderline)
Emotional sensitivity + Invalidating environment= pervasive emotion dysregulation
WHAT co morbidities are common with emotionally unstable personality disorder?
Psychosis
Affective/ anxiety disorders
Alcohol dependence
Hazardous drinking
Substance dependence
Eating Disorders
Functional Disorders, eg chronic pain, non-epileptic seizures
Why is self injury done?
Feel concrete pain
Inflict punishment
Reduce anxiety/ despair
Feel in control
Express anger
Feel something when numb
Seek help
Keep away bad memories
What is the prognosis of untreated patients with these issues?
Poor Quality of Life
Increased substance use
Difficulty keeping jobs
45% unemployed
Increased risk of being victim of violence
Self-injurious behaviour
Up to 10% complete suicide
Poor physical health outcomes
20-year reduction in life expectancy
What are the types of Cluster C (Anxious/fearful) personality types?
Dependent
Avoidant (anxious)
Anankastic (obsessional)
Epidemiology of 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.
The most prevalent PD is dissocial (3%) followed by histrionic (2–3%) and paranoid (0.5–
2.5%).
Features of Paranoid Cluster A
SUSPECTS
Suspicious of others
Unforgiving (bears grudges)
Spouse fidelity questioned
Perceives attack
Envious (jealous)
Criticism not liked/Cold
affect
Trust in others reduced
Self-reference
Questions to ask paranoid cluster A personality?
‘Are you ever concerned about other people in your life?’, ‘Can you rely on friends
and family?’, ‘How do you view your relationship with family?’
Features of Schizoid Cluster A
DISTANT
Detached (flattened) affect
Indifferent to praise or
criticism
Sexual drive reduced
Tasks done alone
Absence of close friends
No emotion (cold)
Takes pleasure in few
activities
Questions to ask schizoid personality type?
‘Do you work well with others?’, ‘What activities do you enjoy?’, ‘Would you say
you have many close friends?
Features of Cluster B emotionally unstable
AM SUICIDE
Abandonment feared
Mood instability
Suicidal behaviour
Unstable relationships
Intense relationships
Control of anger poor
Impulsivity
Disturbed sense of self
(identity)
Emptiness (chronic)
Questions for emotionally unstable personality type?
‘How would you describe your relationships with the people in your life?’, ‘Do
other people ever say you have a temper?’, ‘Do you ever feel life is not worth
living?’, ‘Do you have any worries about being alone?
Features of Cluster B dissocial (antisocial)
CORRUPT
Callous
Others blamed
Reckless disregard for safety
Remorseless (lack of guilt)
Underhanded (deceitful)
Poor planning (impulsive)
Temper/Tendency to
violence
Questions for dissocial personality type?
‘Have you ever got into serious trouble, for instance with the police? If so, was it
your fault?’, ‘Do people ever tell you that you have a temper?’, ‘Do you like to
think things through properly before carrying out an act?’
