Personality disorders Flashcards
Personality disorders
5-13% of the population has at least one personality disorder
Dissocial PD
- most prevalent PD in prison
- 78% of male remand, 64% of sentenced men and 50% female prisoners
Inpatients with drug, alcohol and eating disorders
-70% have a PD
Antisocial PD
-63% remand prisoners 49% sentenced prisoners -31% female prisoners -in general population the prevalence is 0.6% -rate is 5x more in men than in women
Borderline PD
- seen in nearly 2% general population
- 10% outpatients
- 15-20% inpatients
- 30-60% of all PD patients in clinical samples
- 3:1 female :male
- 5x more common in first degree relatives of borderline patients
McLean Study of Adult development
- 5 core borderline symptoms are found to decline with particular rapidilty: quasi-psychotic thought, self-mutilation, help-seeking suicide efforts, treatment regressions and countertransferance problems
- however, chronic dysphoria, intense anger, nondelusional paranoia and general impulsivity remain common even after 10 years
Collaborative Longitudinal Personality Disorders Study
-abandonment fears and physically self-destructive acts are found to be the least stable and rapidly remitting
J shape curve
-over age, PDs decrease with a small increase in PDs in older people
Seivewright and Tyrer
- 12 year follow up
- Cluster B traits become less prounounced over 12 years
- CLuster A and C types become more pronounced
Remission
- McLean
- 40% of patients with BPD remit after 2 years
- 88% no longer meet the criteria after 10 years
Cluster A personality disorders
- odd and eccentric
- Paranoid personality disorder
- Schizoid personality disorder
- Schizotypal personality disorder
Paranoid personality disorder
- suspicious of other people and their motives
- hold longstanding grudges against people
- believe others are not trustworthy
- emotionally detached
- feel other people are deceiving, threatening or making plans against them
Schizoid personality disorder
- have difficulties in expressing emotions, particularly around warmth or tenderness
- prefer loneliness
- aloof or remote
- difficulty developing social relationships
- remain unaware of social trends
- unresponsive to praise or criticism
Schizotypal personality disorder
- in ICD10 this in under schizophrenia
- odd and eccentric
- may have illusions, magical thinking
- obsessions without resistance
- may be members of quasi-cultural groups
- thoughts disorders and paranoia
- may believe in ESP, clairvoyance
- have transient psychotic features
Cluster B personality disorders
- dramatic and erratic
- Antisocial personality disorder
- Borderline personality disorder
- Histrionic personality disorder
- Narcissistic personality disorder
Antisocial PD
- cluster B
- lack of regard for the rights and feelings of other people
- lack of remorse for actions that may hurt others
- ignore social norms about acceptable behaviour
- may disregard rules and break the law
- make relations easily but break them easily
- a small proportion may be psychopathic
Borderline PD
- cluster B
- poor self image
- unstable relationships
- impulsive behaviour
- may self harm, feel suicidal
- have instability of mood
- feelings of chronic emptiness
- fears of abandonment
Histrionic PD
- cluster B
- extreme or overdramatic behaviour
- may form relationships quickly but be demanding
- attention seeking
- may appear self centred
- have shallow emotions
- being inappropriately sexually provocative
Narcissistic PD
- cluster B
- an exaggerated sense of own importance
- frequently self-centred
- intolerant of other people
- grandiose plans and ideas
- cravings for attention and admiration
Cluster C disorders
- anxious and inhibited
- avoidant personality disorder
- dependent PD
- Obsessive compulsive PD
Avoidant personality disorder
- cluster C
- fears being judged negatively by others
- feelings of discomfort in a group or social settings
- may come across as being socially withdrawn
- have low self-esteem
- may crave affection but fears of rejection overwhelming
Dependent PD
- cluster C
- assumes a position of passivity
- allows others to assume responsibility for most areas of their daily life
- lack self-confidence
- feel unable to function independently of another person
- feels own needs are of secondary importance
Obsessive-compulsive PD
- cluster C
- 2-3% prevalence
- difficulties expressing warmth
- frequently perfectionists
- often lack clarity in seeing other perspectives or ways of doing things
- rigid attention to detail
- some may be hoarders, scrupulous with money
- may not be able to delegate tasks
- aka anankastic pd
ICD 10 schizotypal PD
-characterised by occasioanl transient quasipsychotic episodes with intense illusions, hallucinations and delusion-like ideas, usually occurring without external provocation
Amitriptyline
- no effect on EUPD
- haloperidol compares better
Flupentixol
-some efficacy on self-harm behaviour
Antipsychotics
- low doses may be effective in EUPD and schizotypal
- cognitive/perceptual disturbances
SSRIs
- reduce aggressive, impulsive and angry behaviour in those with EUPD and aggressive PDs
- affective dysregulation
Anticonvulsants and lithium
- some effect against affective dysregulation in EUPD and aggressive outbursts in cluster B
- impulsive behaviour dyscontrol
EUPD
- no defined onset
- changes in mood are not observable and are precipitated by internal or external events
- mood elation is rare
- chronic impulsivity and risk taking
- recurrent suicidal gestures
- self-mutilation is common
- endorse ‘emptiness’ as a descriptor
- family history is negative for BPAD I, II and recurrent depression
Why do patients with EUPD prefer to have Bipolar?
Richardson and Tracy
1. greater public awareness
2/ delivery of diagnosis is perceived to be taken more seriously
3. illness causes are more medical
4. illness management is more medical
5. less stigma and blame
6. relationships with others- families are more supportive of BPAD than EUPD
Sexual dysfunction
- coded in F50 in ICD10
- sexual desire disorder (sexual aversion, hypoactive sexual desire)
- sexual arousal disroder( female sexual arousal disorder, male erectile disorder)
- Orgasmic disorders
- Sexual pain disorder
- others
Hypoactive sexual desire
- most common female sexual dysfunction
- most difficult to treat
- testosterone has be tried but with modest effects largely due to side effects
DSM-5 specified paraphilic disorders
- voyeurism
- exhibitionism
- Frotteurism
- Sexual masochism
- Sexual sadism
- paedophilia
- fetishism
- transvesitic disorder
- other specified paraphilic disorder: zoophilia, scatalogia (obsene phone calls), necrophilia, coprophilia, klismaphilia (enemas), urophilia
