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Psychiatry > Personality Disorders > Flashcards

Personality Disorders Flashcards

1
Q

General criteria for a personality disorder

A

Enduring pattern of inner experience and behaviour that deviates markedly from the expectations of the individual’s culture. The pattern is manifested in 2 or more of the following areas;

  • cognition
  • affectivity
  • interpersonal functioning
  • impulse control

Pattern is inflexible and pervasive
Leads to clinically significant distress or impairment in a range of important areas of functioning
The pattern is stable and can be traced back at least to early adulthood
It is not better explained by another diagnosis
It is not attributable to a physiological change

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2
Q

What is personality?

A

Refers to individual differences in characteristic patterns of thinking, feeling and behaving

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3
Q

What does the study of personality focus on?

A

Two broad areas

  • understanding of individual differences in particular personality characteristics such as sociability or irritability
  • understanding how the various part of a person come together as a whole
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4
Q

What treatments do patients with personality disorder have more use of than patients with major depression?

A

Psychiatry outpatient
Psychiatry inpatient
Psychopharmalogic treatment

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5
Q

DSM IV Cluster Classification - Cluster A

A

Including paranoid, schizoid and schizotypal personality disorders, which may manifest in cognitive distortion and an interpersonal style that is odd, eccentric or detached
“Odd Eccentric”

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6
Q

DSM IV Cluster Classification - Cluster A, what are the prominent problems?

A

With the perceived safety of interpersonal relationships

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7
Q

DSM IV Cluster Classification - Cluster A, features of paranoid personality disorder

A

Don’t usually come for treatment as too paranoid, ongoing and enduring pattern rather than a state that someone enters, doesn’t just happen with other active symptoms

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8
Q

DSM IV Cluster Classification - Cluster A, features of schizoid personality disorder

A

Rarely come voluntarily for treatment, if they do, disorder is generally better controlled, appear to have absolute detachment from close relationships

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9
Q

DSM IV Cluster Classification - Cluster A, features of schizotypical personality disorder

A

Social and interpersonal deficits marked by acute discomfort with, and reduced capacity for, close relationships as well as by cognitive or perceptual distortions and eccentricities of behaviour, early adult onset

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10
Q

DSM IV Cluster Classification - Cluster B

A

Consisting of antisocial, borderline, histrionic and narcissistic personality disorders, which often involve behaviour that appears dramatic, erratic, impulsive, aggressive or affectively dysregulated
“Dramatic Erratic”

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11
Q

DSM IV Cluster Classification - Cluster B, features of antisocial personality disorder

A

Pervasive pattern of disregard for and violation of the rights of others, occurring since teens, as indicated by failure to conform to social norms, impulsivity etc.

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12
Q

DSM IV Cluster Classification - Cluster B, features of narcissistic personality disorder

A

Pervasive pattern of grandiosity, need for admiration, and lack of empathy, beginning by early adulthood and present in a variety of contexts, as indicated by e.g. grandiose sense of self-importance, preoccupied by fantasies of unlimited success, requires excessive admiration, arrogance etc.

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13
Q

DSM IV Cluster Classification - Cluster B, features of borderline personality disorder

A

Pervasive pattern of instability of interpersonal relationships, self-image and affects, and marked impulsivity, beginning by early adulthood and present in a variety of contexts e.g. frantic efforts to avoid real/imagined abandonment, unstable and intense interpersonal relationships, identity disturbance

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14
Q

DSM IV Cluster Classification - Cluster B, features of histrionic personality disorder

A

Pervasive pattern of excessive emotionality and attention seeking, beginning by early adulthood and present in contexts e.g. uncomfortable in situations where they are not the centre of attention, rapidly shifting and shallow expressions of emotions, interaction with others often characterised by inappropriate sexuality etc.

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15
Q

DSM IV Cluster Classification - Cluster C

A

Includes avoidant, dependent and obsessive-compulsive personality disorders that tend to involve fear, anxiety, apprehension or perceived avoidance of harm
Prominent problems relate to anxiety and how it is managed
“Anxious Fearful”

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16
Q

DSM IV Cluster Classification - Cluster C, features of obsessive compulsive personality disorder

A

Pervasive pattern of preoccupation with orderliness, perfectionism, and mental and inter-personal control, at the extent of flexibility, openness and efficiency beginning by early adulthood

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17
Q

DSM IV Cluster Classification - Cluster C, features of avoidant personality disorder

A

Pattern of social inhibition, feelings of inadequacy

18
Q

DSM IV Cluster Classification - Cluster C, features of dependent personality disorder

A

Pervasive and excessive need to be taken care of that leads to submissive and clinging behaviour and fears of separation, beginning by early adulthood and present in a variety of contexts e.g. difficulty making everyday decisions, needs others to assume responsibility for most major areas in life

19
Q

DSM V - types of personality disorder

A 
Paranoid 
Schizoid 
Schizotypal
Antisocial
Borderline 
Histrionic
Narcissistic
Avoidant 
Dependent 
Obsessive-compulsive
20
Q

What does personality comprise?

A

The natural and acquired impulses and habits, interests and complexes, the sentiments and ideals, the opinions and beliefs

21
Q

What is the ICD Classification of Mental and Behavioural Disorders

A
  1. Markedly disharmonious attitudes and behaviour, involving several areas of functioning
    - self-identity and worth
    - impulse control
    - fixed negative ways of perceiving and thinking
    - style of relating to others and relationships extreme
  2. Abnormal behaviour is enduring, of long-standing nature and not limiting to episodes of illness
  3. Abnormal behaviour is pervasive and maladaptive to a broad range of personal and social situations
  4. The manifestations appear during childhood or adolescence and continue into adulthood
  5. The disorder leads to considerable personal distress by not always evident
  6. Often but not always associated with significant problems in social and occupational performance
22
Q 
What is the approximate prevalence of personality disorder in;
Community
GP 
Psychiatric outpatients
Psychiatric inpatients 
Prison
A 
Community 10%
GP 20% 
Psychiatric outpatients 30% 
Psychiatric inpatients 40% 
Prison up to 80%
23
Q

What percentage of people with a personality disorder meet the criteria for another PD?

A

54%

24
Q

Features of paranoid personality disorder

A

Excessive sensitiveness to setbacks and rebuffs
Bears grudges persistently
Suspicious, misconstrues actions as hostile
Combative, tenacious sense of personal rights
Suspicious regarding fidelity of partner
Excessive self-importance
Conspiratorial explanations of events

25
Q

Features of schizoid personality disorder

A

Social detachment
Emotional coldness, detachment or flattened affect
Finds few activities pleasurable
Limited capacity to express feelings
Apparent indifference to praise or criticism
Little interest in sexual experiences with another person
Preoccupation with fantasy and introspection - eccentricity
Lack of desire for close friends or confiding relationships

26
Q

Features of antisocial personality disorder

A

Callous unconcern for feelings of others
Gross and persistent irresponsibility and disregard for social norms, rules and obligations
Incapacity to maintain enduring relationships
Low tolerance to frustration
Low threshold for violence and aggression
Incapacity to experience guilt or to profit from experience, especially punishment
Blames others

27
Q

What is psychopathy?

A

Severe form of antisocial PD
Characterised by antisocial behaviour, callous disregard and lack of empathy
Generally diagnosed using the PCL-R

28
Q

Features of impulsive-type borderline PD

A

Emotional instability and lack of control

Outbursts of violence and threatening behaviour are common, especially in response to criticism

29
Q

Features of borderline-type borderline PD

A

Emotional instability
Self-image, aims and internal preferences often unclear or disturbed
Chronic feelings of emptiness
Intense unstable relationships causing repeated emotional crises
Associated excessive efforts to avoid abandonment
Suicidal threats or self-harm

30
Q

Futures of histrionic PD

A 
Self-dramatisation, theatricality 
Suggestibility 
Shallow and labile affect
Seeks excitement, centre of attention
Inappropriate seductiveness
Over-Concern with physical attractiveness
31
Q

Features of obsessive compulsive PD

A

Preoccupation with details, rules, lists, order, organisation and schedule
Perfectionism interferes with task completion
Conscientiousness, scrupulousness, undue preoccupation with productivity to exclusion of pleasure and relationships
Pedantic, rigid and stubborn
Insists others submit to their way of doing things
Reluctant to allow others to do things
Intrusion of unwelcome, insistent thoughts or impulses

32
Q

Features of anxious/avoidant PD

A

Persistent, pervasive tensions and apprehension
Believe they are socially inept, unappealing or inferior to others
Preoccupation with being criticised or rejected in social situations
Unwillingness to become involved unless certain of being liked
Restriction in lifestyle because of need for security
Avoidance of activities involving interpersonal contact because of fear of criticism, disapproval or rejection

33
Q

Features of dependent PD

A

Allows others to make important life decisions
Subordination of own needs to those of others on whom they are dependent
Unwillingness to make demand on people on whom they are dependent
Fear of being abandoned
Uncomfortable or helpless when alone
Fear inability to care for themselves
Unable to make decisions without excessive help from others

34
Q

Diagnosis of PD

A

Clinical
Thorough history taking important
Can use structure interviews e.g. international personality disorder examination (IPDE), personality disorder questionnaire (PQD)

35
Q

Aetiology of personality disorder

A

Early trauma
- reported physical, sexual or verbal abuse and neglect in 60-80% of BPD patients

Non-trauma

  • emotionality
  • negative affectivity
  • affective instability
  • emotional dysregulation
  • inherited tendencies towards anxiety, emotional instability, reactivity, sensitivity, self-consciousness and being easily upset
36
Q

Where might there be neuropsychological impairment in BPD?

A

Attention - vigilance
Verbal learning
Memory

37
Q

Principles of management of PD

A

Patients need to be motivated to change/get better
Provide reliable and consistent therapeutic management
Try get patients to think about what they are feeling and to recognise them as thoughts and feelings rather than impulses
Therapy unlikely to be useful unless it lasts for at least 18 months

38
Q

Treatment methods for BPD

A

Dialectic behavioural therapy
Mentalisation-based treatment
Symptomatic prescribing
Co-occurring mental illness

39
Q

Rationale for pharmacotherapy in PD

A

Pharmacotherapy directly influences PDs
Exerts an effect over core or nuclear symptom clusters
Exerts its therapeutic effect by treating comorbid axis I disorders

40
Q

Effective components of psychotherapy treatment

A

Be well structured
Devote considerable effort to enhancing compliance
Be theoretically highly coherent to both therapist and patient
Be relatively-long term
Encourage a powerful attachment relationship between therapist and patient
Be well-integrated with other services available to the patient

41
Q

What is mentalising?

A

Process by which we make sense of each other and ourselves, implicitly and explicitly, in terms of subjective states and intentional varied mental processes

Psychiatry (21 decks)

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