Personality disorders Flashcards
What are PDs
A group of mental health conditions characterised by persistent patterns of thinking, feeling, and behaving that are significantly different from cultural expectations.
What distinguishes a PD from just a trait?
The 3Ps:
- Pervasive: occurs in many areas of life
- Persistent: present all the time
- Pathological: causes distress to others/impairs functioning
Who can PDs not be diagnosed in?
Anyone under 18
What are the 3 clusters of PDs
A - mad (odd/eccentric)
B - bad (dramatic/erratic/emotional)
C - sad (anxious/fearful)
What are the cluster A PDs
- Schizoid
- Schizotypal
- Paranoid
What PDs are more common on men/women
Overall M>F except histrionic and EUPD which are more common in women
What are the cluster B PDs
- Histrionic
- EUPD/BPD
- Antisocial
- Narcissistic
What are the cluster C PDs
- Dependent
- Avoidant
- Obsessive compulsive (Anankastic)
What is one of the accepted aetiologies for PDs
Disrupted attachment/ developmental trauma –> specific adaptive responses. You develop the traits needed to meet your psychological/basic needs.
What are the features of paranoid personality disorder
- Pervasive and enduring pattern of irrational suspicion and mistrust of others
- Hypersensitivity to criticism and potential slights
- Reluctance to confide in others due to fear of information being used maliciously against them
- Preoccupied with unfounded beliefs about perceived conspiracies against themselves
What are the traits of schizoid PD
- Characterised by an enduring pattern of detachment from social relationships and a restricted range of emotional expression
- Displays a pervasive lack of interest in or desire for interpersonal relationships, often preferring solitary activities
- Shows an emotional coldness, detachment, or flattened affectivity
- Often has few, if any, close relationships outside of immediate family
What are the features of schizotypal PD
- Characterised by a chronic pattern of impaired social interactions, distorted cognitions and perceptions, and eccentric behaviours
- Demonstrates inappropriate or constricted affect, and peculiar, eccentric or bizarre behaviour
- Displays odd thinking and speech, such as magical thinking, peculiar ideas, paranoid ideation, and belief in the influence of external forces
- Shares certain cognitive or perceptual distortions with schizophrenia, but maintains a more intact grasp on reality
What are ideas of reference
Where someone believes that seemingly random or unrelated events in their environment have special meaning or significance specifically directed towards them
What are the features of antisocial PD
FIGHTs:
- Forms but can’t maintain relationships
- Irresponsible
- Guiltless
- Heartless
- Temper easily lost
- Someone else’s fault (behaviour not easily modified)
What are the features of narcissistic PD
- Characterised by a persistent pattern of grandiosity, a strong need for the admiration of others, and a marked lack of empathy.
- Individuals with this disorder often display a sense of entitlement and will exploit others to fulfil their own desires.
- Tendency to be arrogant and preoccupied with personal fantasies and desires, often at the cost of disregarding others’ feelings and needs.
What are the features of histrionic PD
ACTORS:
- Attention seeking
- Concerned with their own appearance
- Theatrical
- Open to suggestion
- Racy and seductive
- Shallow affect
What are the features of EUPD (both subtypes)
AEIOU
- Affective instability
- Explosive behaviour
- Impulsive
- Outbursts of anger
- Unable to plan or consider consequences
What are the subtypes of EUPD
Borderline (disturbance in the way they view themselves) and impulsive type
What are the features of borderline personality disorder subtype
SCARS
- Self image issues
- Chronic empty feelings
- Abandonment issues
- Relationships unstable
- Suicide attempts/self harm
What is splitting
Relationships often fluctuate between extremes of idealisation and devaluation
What are the features of impulsive type EUPD
LOSEIT
- Lacks impulse control
- Outbursts and threats of violence
- Sensitive to criticism
- Emotional instability
- Inability to plan ahead
- Thoughtless of consequences
In EUPD what may there be a pt history of
Previous trauma, including sexual abuse.
What are the features of OC PD
- Demonstrates perfectionism that hampers with completing tasks
- Is extremely dedicated to work and efficiency to the elimination of spare time activities
- Is meticulous, scrupulous, and rigid about etiquettes of morality, ethics, or values
- Is not capable of disposing worn out or insignificant things even when they have no sentimental meaning
- Is unwilling to pass on tasks or work with others except if they surrender to exactly their way of doing things
- Takes on a stingy spending style towards self and others; and shows stiffness and stubbornness
Features of dependent PD
- Reliance on others to make decisions
- Passive compliance with the wishes of others
- Fear of abandonment
- Need to gain support from others, feel as though they cannot care for themselves
What are the features of avoidant PD
- Unwillingness to be involved unless certain of being liked
- Preoccupied with ideas that they are being criticised or rejected in social situations
- Restraint in intimate relationships due to the fear of being ridiculed
Reluctance to take personal risks due to fears of embarrassment - Views self as inept and inferior to others
- Social isolation accompanied by a craving for social contact
What is the first line management for PDs
CBT
What is DBT
Modified CBT for people who experience intense emotions, particularly good for EUPD
How does DBT work
2 concepts: validation (patients should face their emotions and recognise them as valid), and dialectics (telling patient most things aren’t black and white, therefore helps them face things with less of an emotional reaction).
When is medication used in PDs
Specific symptom management:
- Antidepressants (SSRI) - for impulsivity and anxiety
- Antipsychotics - for impulsivity and aggression
- Mood stabilisers - for labile affect (not much evidence)
PD prognosis
- Disrupt relationships and environment
- BPD has high risk of self harm/suicide (therefore risk assessment is crucial)
- Persistent, but their severity man change over time
