Personality Disorders Flashcards
What is a personality disorder (according to the DSM)
An enduring pattern of inner experience and behaviour that,
- deviates markedly from culture,
- is pervasive, inflexible & stable over time,
- leads to distress or impairment
Manifests in 2 or more of;
- cognition,
- affect,
- interpersonal functioning
- impulse control
What are the core features of PDs
- Functional inflexibility
- Self defeating behaviours
- Unstable response to stress
- Lack of insight
Also, involve self identity and are enduring and pervasive in all areas of life
Which PDs are in Cluster A?
Cluster A; Odd/Eccentric
- paranoid
- schizoid
- schizotypal
Which PDs are in Cluster B?
Cluster B; Dramatic/emotional/erratic
- antisocial
- borderline
- histrionic
- narcissistic
Which PDs are in Cluster C?
Cluster C; Anxious/fearful
- avoidant
- dependent
- obsessive compulsive
How does the DSM categorise PDs?
A categorical approach like the DSM assumes that personality disorders represent distinct clinical
syndromes
- Advantages: clarity and ease of communicating information
- Disadvantages: difficult to distinguish the threshold between ‘normal’ personality traits and a personality disorder
Axis I vs Axis II disorders:
- AXIS I: Major clinical disorders with acute symptoms that need treatment
- AXIS II: Personality disorders (& intellectual disabilities): early onset, enduring, poorer treatment response, diagnostic unreliability
What are the features of Paranoid PD?
Consistent & pervasive pattern of distrust, suspiciousness and prolonged grudges held:
- Believes others intentionally exploit, harm or deceive them
- Reluctance to disclose personal information
- Severely sensitive to criticism & threat (hypervigilent)
- Misinterprets comments to indicate concealed, hidden or malevolent intent or motivation
- Hostility, aggression & anger to perceived insults
- Jealousy (distrust & misinterpretation)
2/3 comorbid with other PDs
Behaviour tends to illicit hostility which reinforces cognitions
What are the features of Schizoid PD?
- Detachment and disinterest in social relationships
- Sees others as intrusive and controlling
- Flatness of affect: coldness, aloofness, self-absorption, social ineptitude or conceit
- Unresponsive to social criticism: sexually apathetic
reflecting incapacity to form interpersonal bonds - Anhedonia
Comorbid with schizotypal and avoidant PDs
What are the features of Schizotypal PD?
- Marked interpersonal deficits, behavioural eccentricities and distortions in perception & thinking
- Odd thoughts & speech patterns: vague, abstract but
retains coherence - Often seek treatment for anxiety, depression & affective dysphoria
Comorbid with borderline, avoidant, paranoid and
schizoid PDs
What are the features of Antisocial PD?
- Repeated reckless disregard for others
- Victimizing & blaming others for inadequacies
- Shallow & manipulative interpersonal relationships
- Self-centered focus & failure to adhere to regulations
- Impulsive, aggressive, charismatic, deceitful
- Experience guilt & depression but lack capacity to
empathize - Anti-social behaviour: criminal behaviours may or may not be present
Co-morbidity with borderline, narcissistic, histrionic &
schizotypal PDs
What are the features of Borderline PD?
- Emotional instability/affective dysregulation in
reaction to environmental & interpersonal situations - Impulse control (promiscuity, suicidal behaviour, spending, binge eating, poor limit setting)
- Identity/insecure attachments (Unstable self-concept, avoidance of relationships, Inability to integrate +ve and -ve aspects of self leading to sense of emptiness)
Most prevalent PD in clinical settings (10% of outpatients, 15-20% of inpatients)
comorbid with mood disorders, substance-use disorders & anxiety disorders (PTSD)
- patients with these disorders often meet BPD diagnosis
Arguably associated with the greatest levels of
disability of all the PDs
What are the features of Histrionic PD?
- Excessive emotionality, attention-seeking, ego-centric,
flirtatious, seductiveness (focus on grooming), - Denial of anger and hostility
- Gregarious, manipulative, low frustration tolerance,
suggestibility, somatization - Displays of emotions: shallow and fickle in interpersonal relationships
Comorbid: narcissistic, borderline, anti-social PDs &
psychoactive substance abuse
What are the features of Narcissistic PD?
- Personalities organised around maintenance of self-esteem by eliciting external adulation
- Pervasive pattern of grandiosity, sense of entitlement,
privilege, or expectation of preferential treatment,
exaggerated sense of self-importance, arrogant behavior & attitude - Fragile self-esteem, envy, self-consciousness, & vulnerability: “image replaces substance”
- Self-righteousness, pride, contempt, vanity & superiority
- Insensitivity or impatience to problem of others: cold, disinterested, snobbish, patronizing
Comorbid with: anti-social, histrionic, borderline PDs &
substance abuse
What are the features of Avoidant PD?
- Pervasive social inhibition, discomfort in social
situations, feelings of inadequacy, low self esteem,
hypersensitivity to criticism, disapproval, shame,
ridicule & rejection - Avoidance of activities involving personal contact
& groups - Socially inept/incompetent, personally unappealing, inferior to others
Comorbid with dependent PD & Axis I mood, anxiety, & eating disorders
What are the features of Dependent PD?
- Pervasive need to be taken care of
- Exaggerated fear of being incapable of doing things
or taking care of things on their own – reliance on
others - Lacking in self confidence & requiring constant
reassurance - Often find themselves exploited and in abusive
relationships fearing abandonment - Self view: needy, weak, helpless & incompetent View of Others: Strong caretaker idealized.
Threats: Rejection or abandonment
Strategy: Cultivate a dependent relationship by
subordinating
Affect: Anxiety heightened – disruption to the
relationship. Depression if their strong figure is
removed, euphoria/ gratification when dependent
wishes granted
