Personality Disorders Flashcards
Personality
Pattern of thoughts, feelings, and behavior that makes each of us the individuals that we are.
5 factor model of personality
Openness.
Conscientiousness.
Extraversion.
Agreeableness.
Neuroticism.
Personality Disorder
Evident from early life.
Enduring, stable, inflexible, maladaptive.
Deviates from sociocultural norms/expectations.
Leads to distress and dysfunction.
Not due to other medical conditions/substances/mental disorders.
Not diagnosed before 18.
Not same as mental illness.
Categorical
Unique types of abnormal development that are unrelated to normal personalities.
Dimensional
personality traits are shared amongst general population with excessive dimensions in disordered individuals
DSM 5: PD
Enduring pattern of inner experience & behaviour.
Deviates markedly from expectations of culture.
2 or more of following:
1) Cognition – ways of perceiving & interpreting self, others, events
2) Affectivity – appropriateness of emotional response
3) Interpersonal functioning
4) Impulse control
Inflexible, pervasive, long duration (at least from adolescence/early adulthood).
++ distress / dysfunction.
Not substance / another medical condition / another mental disorder.
DSM 5: PD
Distress, stigma
Long-term care challenging
Common comorbidities: depression, anxiety, substance use disorder, suicidality
High service use; excess medical morbidity
Heritability 30-50%.
Early childhood adversity, incl. abuse, neglect & bullying.
Cluster A
“odd and eccentric”.
Paranoid
Schizoid
Schizotypal
Paranoid PD
Pervasive pattern of mistrust and suspiciousness.
Begins in early adulthood.
Presents in a variety of contexts.
Schizoid PD
Detachment from social relationships.
Restricted range of emotional expressions.
Schizotypical
Odd, eccentric behaviour & thinking.
- Cognitive / perceptual distortions
- Social and interpersonal deficits.
- Risk for schizophrenia.
Cluster B
“Dramatic, emotional, and egocentric”.
Histrionic PD
Narcissistic PD
Antisocial PD
Borderline PD
Historic PD
Excessive emotionality.
Attention-seeking behavior.
Narcissistic PD
-Grandiosity
- Need for admiration
- Extreme jealousy, arrogance & lack of empathy.
Antisocial PD
Disregard for rights of others.
Violation of rights of others.
Lack of remorse for wrongdoing.
Lack of empathy.
Borderline PD
Instability of interpersonal relationships, self-image, and affects.
Marked impulsivity.
Cluster c
“Anxious and fearful”.
Avoidant PD
Dependent PD
Obsessive-compulsive PD
Avoidant PD
Feel socially inhibited & inadequate.
Extremely sensitive to any form of criticism or negative evaluation.
Dependent PD
- Excessive need to be taken care of.
- Submissive behavior.
- Fear of separation.
Obsessive-compulsive PD
- Preoccupation with orderliness and perfectionism.
- Mental and interpersonal control.
- Not same as OCD.
Antisocial more
3-4%
Male:Female = 3:1
Genetic and environmental factors may be contributory
“Absent” fathers and childhood abuse
May “burn out” in later life, particularly if marry a strong partner
DSM 5 antisocial
Pervasive pattern of disregard for, & violation of, rights of others.
Since age 15yrs.
At least 18yrs old.
Evidence of conduct d/o onset before 15 yrs.
Not due to another mental d/o.
DSM 5: Antisocial criteria
- At least 3 of:
Doesn’t conform to social norms re lawful behaviour (eg repeated arrests).
Deceitfulness (eg repeated lying, conning other for profit/pleasure).
Impulsivity or failure to plan.
Irritability & aggression (eg assaults).
Reckless disregard for safety of self/others.
Consistent irresponsibility (eg failure to sustain work).
Lack of remorse (eg indifferent to having mistreated another).
More on: Antisocial PD
- Psychopath: charm; intelligence; egocentric; exploitative; lack remorse.
- Malingering; substance abuse.
- NB! Early identification & intervention
→ parenting skills, problem solving, emotional awareness, improved self-concept, control of arousal and emotions. - Adolescent: Forensic hx? Risk? Need for secure placement??
- Caution: Firm boundaries!
Mx of antisocial PD
Usually don’t seek help.
Risk of poor adherence, substance use disorder.
Evidence for effectiveness of psychological interventions lacking.
NICE guidelines:
- Group based CBT, focused on ↓ offending
- Anger management; violence reduction programmes
Sometimes forensic psych system.
Support & supervision of provider.
Borderline PD
Prevalence: 2%
Male:Female = 1:2
Aetiology is primarily environmental (in vulnerable individuals), up to 80% have a history of abuse or neglect, especially sexual abuse in childhood
Comorbidity: depression, anxiety, self harm, dissociative symptoms, relationship problems, substance abuse
Prognosis: 1/3 “recovered” and 2/3 in stable employment 15y after diagnosis
Suicide Rate: 9%
DSM 5: Borderline PD
Pervasive pattern of instability of interpersonal relationships, self-image and affects
& marked impulsivity
DSM 5: Borderline PD Criteria
Since early adulthood, in various contexts, at least 5 of:
- Dreads abandonment
- Unstable and intense relationships (idealisation vs devaluation)
- Identity disturbance
- Impulsivity
- Recurrent suicidal behaviour
- Affective instability
- Chronic feelings of emptiness
- Inappropriate anger
- Transient paranoia or dissociation under stress (“micropsychotic episodes”)
