Personality disorders Flashcards
Describe what is meant by personality
Personality comprises of lasting characteristics which make us who we are:
easygoing or anxious, optimistic or pessimistic, placcid or histrionic, ambitious or stay at home, fearless or timid, self-deprecatory (excessively modest) or narcissistic (excessive interest in or admiration of oneself and one’s physical appearance) etc etc
In mental health, the word ‘personality’ refers to the collection of characteristics or traits that we have developed as we have grown up and which make each of us an individual. These include the ways that we:
- think
- feel
- behave
What is meant by the term personality disorder
A.n enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s culture. This pattern is manifested in two (or more) of the following areas:
- Cognition (i.e., ways of perceiving and interpreting self, other people, and events).
- Affectivity (i.e., the range, intensity, lability, and appropriateness of emotional response).
- Interpersonal functioning.
- Impulse control.
The enduring pattern is inflexible and pervasive across a broad range of personal and social situations.
The enduring pattern leads to clinically significant distress or impairment in social, occupational, or other important areas of functioning.
The pattern is stable and of long duration, and its onset can be traced back at least to adolescence or early adulthood.
The enduring pattern is not better explained as a manifestation or consequence of another mental disorder.
The enduring pattern is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., head trauma).
What is the past test description of personality disorders ?
Enduring abnormal behaviour patterns that are maladaptive to a broad range of personal and social situations they are best viewed as a category of mental disorder alongside mental illness and learning disability
How do you come to a working diagnosis of personality disorder ?
- Cannot be explained as a consequence of other mental disorder.
- Organic causes need to be excluded.
What are the possible causes of personality disorders ?
- growing evidence for a genetic link, with results from twin studies suggesting heritability of personality traits and personality disorders ranging from 30% to 60% - Genetic
- studies also suggests that family and early childhood experiences are important, including experiencing abuse (emotional, physical, and sexual), neglect, and bullying
- some PDs may be attenuated (reduced virulence) forms of mental illness e.g., cluster A and Schizophrenia / cluster C and Anxiety
Are people with personality disorders more likely to have mental health problems ?
Yes
This can make treatment more difficult
- treatment of psychiatric disorder can be more difficult if a co-morbid PD is present
- –e.g. treatment of schizophrenia and dissocial PD is complicated by aggression
What are the 3 main classifications of personality disorders ?
Cluster A - odd or eccentric (“MAD”)
- paranoid
- schizoid
Cluster B - dramatic, emotional, erratic (“BAD”)
- Anti-social/ dissocial
- Borderline or emotionally unstable
- histrionic
- Narcissistic
Cluster C - anxious, fearful (“SAD”)
- anxious/ avoidant
- dependent
- anankastic (obssessive-compulsive)
What are the typical features of paranoid personality disorder ?
A pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following:
- Suspects, without sufficient basis, that others are exploiting, harming, or deceiving him or her.
- Is preoccupied with unjustified doubts about the loyalty or trustworthiness of friends or associates.
- Is reluctant to confide in others because of unwarranted fear that the information will be used maliciously against him or her.
- Reads hidden demeaning or threatening meanings into benign remarks or events.
- Persistently bears grudges (i.e., is unforgiving of insults, injuries, or slights).
- Perceives attacks on his or her character or reputation that are not apparent to others and is quick to react angrily or to counterattack.
- Has recurrent suspicions, without justification, regarding fidelity of spouse or sexual partner.
What are the typical features of schizoid personality disorder ?
A pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following:
- Neither desires nor enjoys close relationships, including being part of a family.
- Almost always chooses solitary activities.
- Has little, if any, interest in having sexual experiences with another person.
- Takes pleasure in few, if any, activities.
- Lacks close friends or confidants other than first-degree relatives.
- Appears indifferent to the praise or criticism of others.
- Shows emotional coldness, detachment, or flattened affectivity.
- Think bruce wayne in batman
What are the typical features of Antisocial, or Dissocial personality disorder ?
A pervasive pattern of disregard for and violation of the rights of others, occurring since age 15 years, as indicated by three (or more) of the following:
- Failure to conform to social norms with respect to lawful behaviors, as indicated by repeatedly performing acts that are grounds for arrest.
- Deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure.
- Impulsivity or failure to plan ahead.
- Irritability and aggressiveness, as indicated by repeated physical fights or assaults.
- Reckless disregard for safety of self or others.
- Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations.
- Lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another.
What are the typical features of borderline or emotionally unstable 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, as indicated by five (or more) of the following:
- Frantic efforts to avoid real or imagined abandonment.
- A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization (reguarding something as perfect or better than in reality) and devaluation (underestimating the worth or importance of something)
- Identity disturbance: markedly and persistently unstable self-image or sense of self. 4.Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex,
- substance abuse, reckless driving, binge eating).
- Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior.
- Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria,irritability, or anxiety usually lasting a few hours and only rarely more than a few days).
- Chronic feelings of emptiness.
- Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights).
- Transient, stress-related paranoid ideation or severe dissociative symptoms.
What are the typical features of histrionic personality disorder ?
A pervasive pattern of excessive emotionality and attention seeking, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:
- Is uncomfortable in situations in which he or she is not the center of attention.
- Interaction with others is often characterized by inappropriate sexually seductive or provocative behavior.
- Displays rapidly shifting and shallow expression of emotions.
- Consistently uses physical appearance to draw attention to self.
- Has a style of speech that is excessively impressionistic and lacking in detail ( consistently lacks in detail and emphasizes emotions e.g. “just wonderful, fabulous“).
- .Shows self-dramatization, theatricality, and exaggerated expression of emotion.
- Is suggestible (i.e., easily influenced by others or circumstances).
- Considers relationships to be more intimate than they actually are.
What are the typical features of narcissistic personality disorder ?
- grandiose
- high ideals
- self-opinionated
- needs admiration
- expects privilege
- exploits others
- lacks empathy
- envy
- arrogant
What are the typical features of Obsessive-Compulsive (aka Anankastic) personality disorder ?
A pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following:
- Is preoccupied with details, rules, lists, order, organization, or schedules to the extent that the major point of the activity is lost.
- Shows perfectionism that interferes with task completion (e.g., is unable to complete a project because his or her own overly strict standards are not met).
- Is excessively devoted to work and productivity to the exclusion of leisure activities and friendships (not accounted for by obvious economic necessity).
- Is overconscientious (careful/ vigilant), scrupulous (high moral standards) , and inflexible about matters of morality, ethics, or values (not accounted for by cultural or religious identification).
- Is unable to discard worn-out or worthless objects even when they have no sentimental
value.
- Is reluctant to delegate tasks or to work with others unless they submit to exactly his or her way of doing things.
- Adopts a miserly spending style toward both self and others; money is viewed as
something to be hoarded for future catastrophes.
8.Shows rigidity and stubbornness.
What are the typical features of Avoidant (aka Anxious/Avoidant) personality disorder ?
A pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following:
- Avoids occupational activities that involve significant interpersonal contact because of fears of criticism, disapproval, or rejection.
- Is unwilling to get involved with people unless certain of being liked.
- Shows restraint within intimate relationships because of the fear of being shamed or ridiculed.
- Is preoccupied with being criticized or rejected in social situations.
- Is inhibited in new interpersonal situations because of feelings of inadequacy.
- Views self as socially inept, personally unappealing, or inferior to others.
- Is unusually reluctant to take personal risks or to engage in any new activities because they may prove embarrassing.
What proportion of the general population have a personality disorder ?
10.6%
- 1-in-10 people in the general population have a personality disorder
- 1-in-3 psychiatric outpatients have a personality disorder
- One half of all psychiatric inpatients have a personality disorder
