Personality Disorders

Question 1

Definition (TIDE)

Answer 1

Umbrella term that covers a number of variations of maladaptive personality traits that cause significant psychosocial distress and interfere with everyday functioning.
- Traits become: INFLEXIBLE, DISABLING, EXTREME

Question 2

Characterised by

Answer 2

Patterns of THOUGHT, BEHAVIOUR and EMOTIONS that differ from what is normally expected by society. It leads to difficult relationships, reduced quality of life and poor physical health.

Question 3

Aetiology

Answer 3

Genetic and environmental factors.
- Often a history of childhood trauma

Question 4

Presentation

Answer 4

• Strong, intense emotions
• Emotional instability
• Anger
• Low self esteem
• Impulsive behaviour
• Substance abuse
• Poor sense of identity
• Difficulty maintaining relationships
• Risky behaviour, such as risky sex
• Violence and aggression
• Self harm
• Suicide attempts

Question 5

Types of personality disorders (DSM-5)

Answer 5

The classification is based on the dominant features. They fall under three main categories:
- CLUSTER A: Anxious
- CLUSTER B: Suspicious
- CLUSTER C: Emotional or impulsive

Question 6

Anxious personality disorders (Dead On Arrival)

Answer 6

• Dependent personality disorder = heavy reliance on others to make decisions and take responsibility for their lives, taking a very passive approach
• Obsessive compulsive personality disorder: unrealistic expectations of how things should be done by themselves and others and catastrophising about what will happen if these expectations are not met.
• Avoidant personality disorder = severe anxiety about rejection or disapproval + avoidance of social situations or relationships

Question 7

Suspicious personality disorders (PaSS)

Answer 7

• Paranoid personality disorder = difficulty in trusting or revealing personal information to others.
• Schizoid personality disorder: A lack of interest or desire to form relationships with others and feelings that this is of no benefit to them.
• Schizotypal personality disorder: unusual beliefs, thoughts and behaviours, as well as social anxiety that makes forming relationships difficult.

Question 8

Emotional Impulsive personality disorders (BAHNned)

Answer 8

• Borderline personality disorder: fluctuating strong emotions and difficulties with identity and maintaining healthy relationship
• Antisocial personality disorder: reckless and harmful behaviour with lack of concern of the consequences or the impact of their behaviour on other people. Involves criminal conduct
• Historic personality disorder: features the need to be at the centre of attention and having to perform for others to maintain that attention
• Narcissistic personality disorder: feelings that they are special and need others to recognise this or else they get upset. They put themselves first.

Question 9

Management

Answer 9

Mx difficult: The patterns of thinking and behaviours are deeply ingrained and are difficult to change.
- Patient and carer education is very important to help them understand the condition.
- Cognitive behavioural therapy (CBT) and psychotherapy
- Supportive care can be provided during crises to help keep the patient safe.
- No medical treatments recommended for personality disorders.
- Personality disorders can co-exist with other psychiatric problems (e.g. depression) where medications may be beneficial.