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3A Psychiatry > Personality disorders > Flashcards

Personality disorders Flashcards

1
Q

What is the definition of a personality disorder?

A

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

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2
Q

What is personality?

A

‘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)

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3
Q

According to ICD 11 - what is a personality disorder?

A

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

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4
Q

What is the pathophysiology of personality disorders>

A

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

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5
Q

RFs for personality disorders?

A

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.

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6
Q

What are the types of Cluster A (Odd/Eccentric) personality types

A

Paranoid
Schizoid

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7
Q

What are the types of Cluster B (Dramatic/emotional) personality types?

A

Emotionally unstable (borderline)
Dissocial (antisocial)
Histrionic

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8
Q

What are the clinical features of borderline pattern?

A
  • Lack of sense of self
  • Unstable self-image
  • Unstable affect
  • Impulsivity
  • Self-Harm
  • Intense unstable relationships
  • Fears and attempts to avoid abandonment
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9
Q

Epidemiology of Emotionally unstable personality disorder (Borderline)

A

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

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10
Q

What are some DDs of Emotionally unstable personality disorder (Borderline)

A

Bipolar affective disorder - Mood changes sustained over weeks, Biological symptoms
Mood congruent psychosis
ADHD / ASD particularly women
Schizophrenia, Schizoaffective disorder
Presence of PTSD symptoms

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11
Q

What is the aetiology: biosocial model for Emotionally unstable personality disorder (Borderline)

A

Emotional sensitivity + Invalidating environment= pervasive emotion dysregulation

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12
Q

WHAT co morbidities are common with emotionally unstable personality disorder?

A

Psychosis
Affective/ anxiety disorders
Alcohol dependence
Hazardous drinking
Substance dependence
Eating Disorders
Functional Disorders, eg chronic pain, non-epileptic seizures

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13
Q

Why is self injury done?

A

Feel concrete pain

Inflict punishment

Reduce anxiety/ despair

Feel in control

Express anger

Feel something when numb

Seek help

Keep away bad memories

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14
Q

What is the prognosis of untreated patients with these issues?

A

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

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15
Q

What are the types of Cluster C (Anxious/fearful) personality types?

A

Dependent
Avoidant (anxious)
Anankastic (obsessional)

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16
Q

Epidemiology of Personality disorders

A

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%).

17
Q

Features of Paranoid Cluster A

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

18
Q

Questions to ask paranoid cluster A personality?

A

‘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?’

19
Q

Features of Schizoid Cluster A

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

20
Q

Questions to ask schizoid personality type?

A

‘Do you work well with others?’, ‘What activities do you enjoy?’, ‘Would you say
you have many close friends?

21
Q

Features of Cluster B emotionally unstable

A

AM SUICIDE
Abandonment feared
Mood instability
Suicidal behaviour
Unstable relationships
Intense relationships
Control of anger poor
Impulsivity
Disturbed sense of self
(identity)
Emptiness (chronic)

22
Q

Questions for emotionally unstable personality type?

A

‘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?

23
Q

Features of Cluster B dissocial (antisocial)

A

CORRUPT
Callous
Others blamed
Reckless disregard for safety
Remorseless (lack of guilt)
Underhanded (deceitful)
Poor planning (impulsive)
Temper/Tendency to
violence

24
Q

Questions for dissocial personality type?

A

‘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?’

25
Q

Features of Cluster B Histrionic personality disorder?

A

PRAISE
Provocative behaviour
Real concern for physical attractiveness
Attention seeking
Influenced easily
Shallow/Seductive inappropriately
Egocentric
(vain)/Exaggerated
emotions

26
Q

Questions for histrionic personality type

A

‘Do you feel that you are easily influenced by your friends?’, ‘Do you like to be the
life and soul of a party?’ (

27
Q

Cluster C Dependent personality features

A

RELIANCE
Reassurance required
Expressing disagreement is
difficult
Lack of self-confidence
Initiating projects is difficult
Abandonment feared
Needs others to assume
responsibility
Companionship sought
Exaggerated fears

28
Q

Questions to ask dependent personality type

A

‘Is there anything you worry about or fear?’, ‘Do you struggle to make an
important decision?’, ‘Place yourself on a scale ranging from very shy to
confident.’

29
Q

Cluster C anxious (avoidant) personality features

A

CRIES
Certainty of being liked
needed before becoming
involved with people
Restriction to lifestyle in
order to maintain security
Inadequacy felt
Embarrassment potential
prevents involvement in
new activities
Social inhibition

30
Q

Questions to ask anxious personality type

A

Tell me about your social circle’, ‘Do you ever take risks or partake in brand new
activities?’, ‘Do you feel contented with yourself?’

31
Q

Cluster C Anankastic (obsessional) personality features

A

LAW FIRMS
Loses point of activity (due to
preoccupation with detail)
Ability to complete tasks
compromised (due to
perfectionism)
Workaholic at the expense of
leisure
Fussy (excessively
concerned with minor
details)
Inflexible
Rigidity
Meticulous attention to
detail
Stubborn

32
Q

Questions to ask anankastic personality type?

A

‘Do you feel that you are a perfectionist?’, ‘Do you spend more time working or
relaxing?’, ‘Do you find you are struggling to meet deadlines at work?’

33
Q

Investigations for personality disorders?

A

‘Do you feel that you are a perfectionist?’, ‘Do you spend more time working or
relaxing?’, ‘Do you find you are struggling to meet deadlines at work?’

34
Q

DDs of personality disorders

A

Mood disorders: Mania, depression.
Psychotic disorders: Schizophrenia, schizoaffective disorder.
Substance misuse.

35
Q

Principles of managing personality disorder

A

Identify and treat co-morbid mental health disorders
Treat any co-existing substance misuse
Help patients to deal with situations that provoke problem behaviours or traits
Provide general support to reduce tensions and anxieties
Give support and reassurance to family and friends

36
Q

What is the biological management for personality disorders?

A
  1. Atypical antipsychotics
    may be used in the
    short term for transient
    psychotic periods in
    certain PDs (e.g.
    paranoid PD).
  2. Mood stabilizers can be
    used in emotionally
    unstable PD for
    symptoms such as
    mood instability and
    aggression.
  3. Small role for
    antidepressants.
37
Q

Psychological management for personality disorders?

A
  1. Cognitive behavioural therapy.
  2. Psychodynamic psychotherapy –
    which may be individual or group.
  3. Dialectical behavioural therapy –
    emphasis placed on developing
    coping strategies to improve
    impulse control and reduce selfharm in emotionally unstable PD.
38
Q

Social management for personality disorders?

A
  1. Support
    groups.
  2. Substance
    misuse
    services.
  3. Assistance
    with social
    problems
    (e.g. housing,
    finance and
    employment).
  4. Help to
    access
    education,
    voluntary
    work,
    meaningful
    occupation
    and work.
39
Q

Management of EUPD

A

Validating Containing Consistant Compassionate services and clinicians

Medication not the mainstay but can help in crises / comorbidities
Psychological therapies
Dialectical Behaviour Therapy, Mentalisation Based Therapy, Structured Clinical Management
Cognitive Analytical Therapy, Cognitive Behaviour Therapy
Trauma processing

EUPD is treatable. Good long-term prognosis with treatment

3A Psychiatry (18 decks)

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