Personality disorders Flashcards
What is the community prevalence of Personality disorder?
Prison?
- 4-13%
- 50-80% in prison
Aetiology
- Is there a strong genetic component, explain?
- What increases the risk of a personality disorder
- There is a strong genetic and environmental component. Similar disorders run in families e.g schizotypal personality disorder and schizophrenia
- Minimal brain damage, may be associated with EEG changes
What indicates that neurotransmitters have a significant affect on personality
-Low levels of serotonin and the facts that some pts improve on SSRIs
What is a common theory for the cause/development of a borderline personality disorder
-Early adverse social circumstances. May be physical, social or mental abuse. May prevent the child from progressing through the stages of psychosexual development with the subsequent development of characteristic defence mechanisms.
How does the DSM-IV define personality traits?
When is it said that there is a personality disorder?
- As enduring patterns of perceiving, thinking about and relating to the environment and oneself that are exhibited in an a wide range of social and personal contexts
- When these traits are persistently inflexible and maladaptive. this may cause personal distress
What do pts with a personality disorder usually have as a presenting complaint?
They do not regard their behaviour and coping style as abnormal and therefore will not present with that as their primary complaint
Usually present with; self harm, depression, anxiety, violence, PTSD, disorderly conduct ect
-Pts are also likley to have other mental illness; 30-60% of pts with a psychotic disorder also have a personality disorder
What is an acquired and organic personality disorder
Acquired; disorder clearly develops after and is directly related to a recognisable insult
They are organic; when the insult is some form of brain damage or disease. Characterised by sexual inhibition and abnormalities of emotional expression. Lesion is typically in the frontal lobe. This category also contains people who have an enduring personality change after experiencing a catastrophic event e.g. hostage situation, concentration camp.
What is the second group of personality disorders?
What is its usual age of onset?
- Specific personality disroders where there isn’t causal relationship with one specific thing, although genetic and environmental factors may be implicated
- Pts are on a continuum so rarely fit into one specific area
-Early adulthood or adolescence and they have a fairly steady course
What are the 3 categories these disorders are simplified into?
- Cluster A ‘odd or eccentric’
- Cluster B ‘dramatic, emotional, erratic’
- Cluster C ‘anxious or fearful’
What are the 3 cluster A personality types?
- Paranoid; suspecting others of hurting/deceiving them, doubt spouses fidelity
- Schizoid; emotional coldness, does not desire or enjoy relationships, takes pleasure in few activities, indifferent to praise or criticism
- Schizotypal; eccentric behaviour, odd beliefs or magic thinking, unusual perceptual experiences, social withdrawal, ideas of reference, circumstantial thinking
What are the 4 cluster B personalty types?
- Borderline; unstable, intense relationships fluctuating between extremes of idealisation and devaluation. Unstable self image, impulsive (sex, binge eating, substance abuse, spending money), repetitive suicidal or self harming behaviour, efforts to avoid abandonment
- Antisocial; repeated unlawful or aggressive behaviour, deceitfulness, lying, reckless, irresponsible, lack of remorse or incapacity to experience guilt
- Histrionic; drmatic, exaggerated expressions of emotion, attention seeking, seductive behaviour, labile shallow emotions
- Narcissistic; grandiose sense of self importance, need for admiration
What are the 3 cluster C ‘anxiety or fearful’ personality types?
- Dependent; excessive need to be cared for, submissive, need others to assume responsibility for major life areas, fear of separation
- Avoidant; hypersensitivity to critical remarks or rejection, fears of inadequacy, inhibited in social situations
Obsessive compulsive; preoccupation with orderliness, perfectionism and control. Devoted to work at expense of leisure, pedantic, rigid and stubborn. Overly cautious
Management
-What psychosocial interventions can be used in those with personality disorders?
What personality disorder has DBT been developed to treat?
In what conditions is assertive community outreach used?
- Assistance with social problems, such as housing finance and employment
- Supportive psychotherapy, providing an authoritative figure for pts in a time of crisis
- CBT; target specific symptoms or behaviour e.g. depression, anxiety, anger, deliberate self harm
- Group or individual psychotherapy
- Therapeutic communities may benefit highly motivated pts
DBT; to treat borderline PD, has been shown to reduce parasuicidal behaviour and give an improvement in social and global functioning
Assertive community outreach; for chronic schizophrenia and bipolar pts
What pharmacological treatment can be used and what do they help with?
- Mood stabilisers; help with aggression, impulsivity and mood instability
- Antipsychotics; help with psychotic symptoms, impulsivity and aggression
- Antidepressants; help with OCD and depression
- Benzodiazepines; use with caution as may lead to dependence and abuse. Useful to alleviate anxiety or to sedate an acutely agitated or aggressive pt
How does having a PD affect other psychiatric conditions?
Which cluster increases the risk of suicide or accidental death the most?
After how many years follow up will half of all borderline personality disorders show clinical recovery?
What is the difference in recovery between antisocial and schizotypal, obsessive personality disorders.
- Pts often have other psychiatric conditions, which tend to be more severe and have a worse prognosis
- Cluster B
- 10 to 15 years
- Antisocial personality disorders may improve with time, particularly if they have formed a relationship with a therapist.
- Schizotypal and obsessive compulsive personality disorders tend to be stable over time, although schizotypal pts may develop schizophrenia.
