Personality Disorders Flashcards
What are the key features of personality disorders?
Long term, chronic, enduring and pervasive pattern
What percentage of patients with a personality disorder have only one personality disorder?
11%
What are the advantages of a Dimensional (spectrum continuum) criteria for Personality disorders?
- Retain max amount of information
- More flexible
- Eliminates classification dilemmas for borderline cases
What are the disadvantages of a Dimensional (spectrum continuum) criteria for Personality disorders?
- May mask underlying differences
What are the advantages of a Categorical criteria for Personality disorders?
- Ease in communication and conceptualisation
- Consistent with popular language and clinical decision making
What are the disadvantages of a Categorical criteria for Personality disorders?
- Loss of information
- Assumes all members of a class are homogenous and mutually exclusive
Describe the Dimensional 3 Dimensional Model.
- Social involvement v uninvolvement with others
- Assertion/dominance v passive submission
- Anxious rumination v behavioural acting out
Describe the Dimensional OCEAN (5 Factor Model)
Openess, Conscientiousness, Extraversion, Agreeableness, Neuroticism
Describe the alternate DSM-V Model
Combines dimensional and categorical comparing traits and disorders
What must be present for the classification of a Personality Disorder?
PERSISTENT over time, PERVASIVE across people and situations, PATHOLOGICAL clearly abnormal
What are the general diagnostic criteria for a Personality Disorder?
A. Enduring pattern of inner experience and behaviour that deviates from culture and manifest in 2 areas:
- Cognition
- Affect
- Interpersonal
- Impulse control
B. Inflexible and pervasive across a range of situations
C. Leads to distress and social/occupational impairment
D. Pattern is stable over a long period of time
E. Not better accounted for by another mental disorder
F. Not due to substance or medical condition
What four non-clinical features exist in Personality Disorders?
- Absence of motivation for affliation (Desire for relationships with others)
- Exaggerated motivation for power (and achievement)
- Unrealistic and unstable self-image
- Unable to understand others intentions and motives
What 3 Personality Disorders make up Cluster A (odd and eccentric)?
- Paranoid Personality Disorder
- Schizoid Personality Disorder
- Schizotypal Personality Disorder
What are the clinical features of Paranoid Personality Disorder?
- Pervasive distrust and suspicion of others
- Interpret what others say or do as being directed at them
- Conviction that others that advantage of them
- Difficulty trusting others
What are the clinical features of Schizoid Personality Disorder?
- Detachment from social relationships and restricted emotional expression
- Difficulty organising and directing their lives
- Absorbed in own thoughts
- Introverted, solitary, emotional inexpression and isolated
What are the clinical features of Schizotypal Personality Disorder?
- Pervasive pattern of social interpersonal deficits marked by acute discomfort
- Offbeat, peculiar, paranoid beliefs and thoughts
- Difficulty forming relationships and extreme social anxiety
- Magical thinking
What 4 Personality Disorders make up Cluster B (dramatic, emotional and erratic)?
- Borderline Personality Disorder
- Antisocial Personality Disorder
- Histrionic Personality Disorder
- Narcissistic Personality Disorder
What are the clinical features of Borderline Personality Disorder?
- Pervasive pattern of unstable interpersonal relationships, self image, affect and impulsivity
- Symptoms can be severe and fluctuate rapidly
- Intense bouts of anger, depression and anxiety
- Deep fear of abandonment
- Emotional dysregluation - mood swings and emotional instability
- Cognitive dysregulation - brief non-psychotic forms of thought disturbances
- Self-dysfunction - Persistent identity problems
What is emotional dysregulation?
Mood swings and emotional instability
What is Cognitive dysregulation?
Brief non-psychotic forms of thought disturbances
What is Self dysregulation?
Persistent identity problems
What percentage of Borderline Personality Disorder patients commit suicide?
6-10%
What are the clinical features of Anti-social Personality Disorder (psychopathy or sociopathy)?
- Pervasive pattern of disregard for and violation of the rights of others
- Impulsive, irresponsible, reckless, lies, threatens, steals, cheats and lies
- History of conduct disorder before 15yo
- High comorbidity with substance misuse
What are the clinical features of Histrionic Personality Disorder?
- Pervasive pattern of excessive and emotion and attention seeking
- Flamboyant, dramatic, theatrical, can’t tolerate being ignored
- Persistently draws attention to themselves
- Emotionally over-responsive to insignificant events
- Manipulative
What are the clinical features of Narcissistic Personality Disorder?
- Pervasive pattern of grandiosity, need for admiration and lack of empathy
- Preoccupied with own desires and expect others to serve their needs
- Continually self absorbed, exaggerated sense of self-importance and entitlement
- Constantly seeks admiration
What 3 Personality Disorders make up Cluster C (appear, anxious or fearful)?
- Avoidant Personality Disorder
- Dependent Personality Disorder
- Obsessive Compulsive Personality Disorder
What are the clinical features of Avoidant Personality Disorder?
- Pervasive pattern of social inhibition, feelings of inadequacy and hypersensitivity to negative evaluation
- Avoidance of new experiences and meeting new people
- Pattern of social discomfort, sensitive to criticism
- Fear of rejection, criticism or disapproval
What are the clinical features of Dependent Personality Disorder?
- Point out own inadequacies so others look after them
- Pervasive pattern of submissive and clinging behaviour
- Difficulty communicating disagreement for fear of being rejected
What are the clinical features of Obsessive Compulsive Personality Disorder?
- Pervasive pattern of perfectionism, inflexibility, orderliness
- Preoccupied with details and rules
- Extreme devotion to productivity to exclusion of leisure activities
What is the Biological view of the aetiology of Anti social Personality Disorder?
- Proxy of adult criminality shows higher in MZ than DZ
- Higher aggression in biological parents but interactive with environment
- Underarousal hypothesis - abnormally low levels or cortisol so seek stimulation
- Fearlessness Hypothesis - Higher threshold for experiencing fear. Lack of startle potential when looking at unpleasant pictures
What is the Social Factors view of the aetiology of Anti social Personality Disorder?
Family problems:
- Martial problems and divorce
- Modelling of anti-social behaviour
- Parental rejection and negativity
What is the Psychological Factors view of the aetiology of Anti social Personality Disorder?
Difficulty shifting attention to consider the negative consequences of their behaviour
What is the Psychoanalytic treatment of Anti social Personality Disorder?
Focus on transference relationship
What is the CBT treatment of Anti social Personality Disorder?
Social Skill Training, exposure and problem solving
What is the Integrative treatment of Anti social Personality Disorder?
- Schema Focused Therapies - identifying and changing maladaptive early schemas
- Dialectical Behaviour Therapy - Learning to be more comfortable with strong emotions. Being accepting of patient and their negative behaviour
What is the drug treatment of Borderline Personality Disorder?
Drugs for antipsychotics, anti depressants, lithium….
What is the most effective treatment for Borderline Personality Disorder?
Dialectical Behaviour Therapy which reduces self injury, suicide and impatient hospital days
What is the most effective treatment for Anti social Personality Disorder?
Token economies, family focused intervention, social skills training and CBT
What is the most effective treatment for Schizotypal Personality Disorder?
Social Skills Training and strategies for managing a solitary lifestyle
