Personality Disorders Flashcards
What are personality disorders?
Deeply ingrained, enduring patterns of behaviour that are abnormal in a particular culture, lead to subjective distress, and may cause others distress
When do PDs usually begin?
Childhood or adolescence
How were PDs and mental illness originally distinguished?
PDs: lifelong and not treatable
Mental illness: briefer and treatable
How has understanding of the original distinction between PDs and mental illness now shifted?
More effective treatment for PDs means original distinction less clear i.e. people can recover from PDs, BPD can be effectively managed.
What are the Cluster A personality disorders?
Cluster A = odd / eccentric (all of or suspicious, solitary)
- Paranoid PD
- Schizoid PD
- Schizotypal PD
What are the Cluster B personality disorders?
Cluster B = flamboyant / dramatic (emotionally labile and intense)
- Borderline / emotionally unstable PD
- Histrionic PD
- Narcissistic PD (DSM only)
- Antisocial PD / Dissocial (ICD)
What are the Cluster C PDs?
Cluster C = fearful / anxious (timid, dependent, low SE)
- Avoidant (DSM) / Anxious (ICD)
- Dependent
- Anankastic (DSM) / Obsessive Compulsive
What is the aetiology of PDs?
Genes and environment:
-genetic
-perinatal / postnatal facts => abnormal cerebral maturation
-poor parenting
-sexual abuse
-adverse childhood environment
Leads to unhelpful coping strategies, inability to form attachment.
Which PD is childhood sexual abuse associated with?
BPD
What is the cognitive theory of personality disorders?
People with PDs developed ways of coping with early life adversity (e.g. turning anger against themselves rather than expressing it if this may have resulted in parental violence) ==> manifest as maladaptive traits later in life (e.g. interpersonal problems)
What is the psychodynamic theory of PDs?
PDs result from insecure attachment in childhood and thus in adult relationships
Management of BPD?
- Written care plan
- Consistent responses to threats, don’t reinforce manipulative behaviour
- Clear boundaries re unacceptable behaviour and nature of care to be provided
- Adapted CBT; dialectical behaviour therapy (DBT) and mentalisation based treatments
- Help avoid situations that exacerbate (e.g. intoxication)
- Help find lifestyle which suits their strengths and minimises difficulties of their PD
- Treat comorbidities
Management of antisocial PD?
- modest; main goal to exclude other dx
- aim for prevention by targeting children with conduct disorder (30% likely to develop APD) ==> provide parent training / education
- CBT / group based CBT focus on reducing offending and other antisocial behaviours
What is personality?
The characteristic behavioural, emotional and cognitive attributes of an individual
DSM definition of PD?
An enduring pattern of inner experience and behaviour that deviates markedly from the expectations of the individual’s culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, and leads to distress or impairment
What are the main effects of personality deviations of PD?
Marked deviation in one or more aspects of personality; main effect may be on:
- cognitions (attitudes; ways others’ actions are interpreted)
- mood (range, intensity, appropriateness)
- impulse control and gratification of needs
- relationships and the way interpersonal situations are handled
What are important areas to cover in assessment of PD?
Disorder itself: -presence -characteristics and fx -severity -treatability Other issues: -psych comorbidities -risk to self / others -D&A use -Hx of DSH and violence -current social situation -psychosocial stressors
Suggested core neuropsych abnormalities in antisocial personality disorder?
Involve impulsivity and decisions making; relate to abnormalities in the regulation of frontal lobe activity by dopamine and 5HT
What are presented issues with personality disorder as diagnosis?
- Not a disease; medicalises individual variations
- Diagnosis unreliable
- PD may be virtue for others; many famous individuals meet PD criteria but may be tolerated because of (or the reason for) their success
- Perjorative term
- No clear distinction b/w PD/Psych Dx
Ddx of teenager/ young adult with new “odd behaviour”?
- N adolescence
- Anxiety d/o
- Psychotic d/o
- Drug induced d/o
- Eating d/o
- Personality d/o (BPD)
- Medical (e.g. hypothyroidism)
What are the 5 criteria for involuntary status under MHA Vic?
- Appears to have mental illness
- Imminent risk to self / others
- Rx available at gazetted facility
- Incapable of informed consent or unwilling to consent
- Least restrictive method
What are the initial steps in ITO?
- Request (person >18)
- Recommendation (medical practitioner; ITO must also be completed to give treatment)
- Statutory review (S12): delegated or authorised consultant psych, upholds/discharges pt from involuntary status
What are the DSM criteria for BPD?
I DESPAIRR:
- identity disturbance
- dissociation
- emptiness
- suicidal behaviour
- paranoid ideation
- abandonment
- impulsivity
- relationships
- rage
Ego defence mechanisms of BPD?
Splitting, projection
