Personality disorders Flashcards
What is the prevalence of PDs?
- 6-9%
*higher in people with other mental disorders
*most PD’d people never come to the attention of MH professionals
What are some of the typical characteristics of people with personality disorders?
- difficulty dealing with others
- inflexible, always right
- POOR insight -> ego syntonic symptoms
- very little beh change
How does the ICD-10 describe PDs?
- disturbances in personality, beh, funtioning
- deviations from normal patterns
- distress
PD symptoms are ….
ego syntonic = feels like a normal part of oneself
When are most PDs recognizable?
And when do they tend to have a lesser effect on individuals?
Adolescence
Middle adulthood (except narcissists)
BPD tends to have what two key characteristics?
- project bad aspects of themselves onto you and make you play that role
- want people to cling to and stay by them
Outline the etiological factors for PDs
Bio:
- abnormalities in certain hormones and neurotransmitters
Psycho social:
- stress and trauma in childhood
- fixation at one stage of psychosocial stage of dev
- attachment issues
- struggle at intimacy vs isolation phases
PD’d people’s personalities are….
largely determined by defense mechanisms
What are the PD clusters and their associated PDs
Cluster A: (weird)
- Odd/eccentric ebeh
- Schizoid, paranoid, schizotypal
Cluster B: (Wild)
- dramatic, emotional, erratic
- anti-soc, BPD, histrionic, narcissistic
Cluster C: (worried)
- anxious, fearful beh
- avoidant, dependant, OCD
Outline the Cluster A PDs
Paranoid
- distrust and suspicion, others motives seen as malevolent
Schizoid
- detached from social relationships, restricted range of emotional expression
Schizotypal
- acute discomfort in close relationships, cog and perceptual distortions, eccentric beh
Outline Paranoid PD presentation
- suspicious of others motives (expects/interprets exploitation)
- appear cold and serious
- refuse responsibility for their own actions
- hostile, angry, irritable
Outline the course and prognosis of paranoid PD
- 0.5% of gen pop
- relatives of those with schizophrenia
- men>women
- lifelong occupational, marital and relationship struggles
Outline the diagnosis for paranoid PD
- unwarranted tendency to interpret others actions as demeaning/threatening
- constant muscular tension
- humorless
- scans environment for clues
- pathologically jealous
Outline treatment for paranoid PD
Psych0theray = trtmnt of choice
- therapist must be straight forward in their dealings w client
- honesty and apology > defensive explanations
- don’t be overly warm w client (struggle w trust and intimacy)
- no group therapy
- deal with delusional reactions realistically and gently
Pharmacotherapy
- anti-anx drugs eg valium
- anti-psychs in small doses can be helpful
Outline schizoid PD presentation
- indifferent to relationships
- aloof, detached
- eccentric, lonely
- missing the “human part”
- 2:1 male : female
Outline the diagnosis of schizoid PD:
- appears ill at ease
- can’t tolerate eye contact
- unsocial, quiet, distant
- can be very attached to animals or things
- lifetime inability to express anger
Outline treatment for Schizoid PD
Psychotherapy:
- may open up in a deep and trusting relationship
Group therapy:
- can be good for providing social contact, but must be protected from aggressive members
Pharmacotherapy:
- small doses of anti-psychs and anti-deps (makes them less sensitive to rejection
Outline Schizotypal PD
- magical thinking (though not psychotic)
- strikingly strange/odd
- 3% of pop
- “distant cousin” of schizophrenia
Outline BPD presentation
- instability in mood/rel/self image
- reckless beh
- deep fear of abandonment
- almost always in crisis
- black and white thinking
Defense mechanism in BPD?
Projection
- intolerable aspects of them are projected onto another, induce other person plays projective role
What are the primary comorbid conditions associated with BPD
- MDD
- Bipolar
- Bulimia
- Subs-use
What are some of the possible causes of BPD?
- genetic/bio links
- history of neglect/abuse/separation
- react strongly to stress
- devalued and invalidated when young
Outline the use of psychotherapy for BPD
- often v difficult for both patient and therapist
- v draining for therapist (a lot to hold)
- problems with transference and c/trans
-DBT to control impulses and angry outbursts
- social skills training
Other than DBT, what are some of the management techniques for BPD?
- psycho-ed programmes
- schema focused therapt (CBT) - reframing the way people view themselves and others
