Personality Disorders Flashcards
What is personality and personality disorders?
Your personality is an enduring pattern of perceiving, relating to, and thinking about the environment and oneself’
- As revealed by our behaviour and relationships with others.
- Essentially who we are and what we are like.
We are a composition of personality traits e.g. stubbornness, outgoing, egotistical etc.
A personality disorder is a set of personality traits that are pervasive, ingrained, maladaptive and create significant functional impairment or subjective distress.
- Pervasiveness meaning it touches all aspects where applicable. For example, someone may be stubborn towards their parents, but not towards their piers.
- Ingrained meaning it has been a trait for a long time
- Maladaptive meaning it is not constrictive, and gets in the way of life.
What are the ICD-10 types and clusters of personality disorders?
Cluster A (odd/eccentric), Cluster B (dramatic, erratic, or emotional) and Cluster C (anxious and fearful).
- F60.0 Paranoid
- F60.1 Schizoid
- F60.2 Dissocial (antisocial)
- F60.3 Emotionally unstable (borderline)
- F60.4 Histrionic
- F60.5 Anankastic (Obsessive-Compulsive) - General tendency to seek rules and rigidity
- F60.6 Anxious (Avoidant)
- F60.7 Dependent
What features are required by ICD-10 in order to diagnose someone with a personality disorder?
The ICD-10 criteria for personality disorders requires the following features (REPODS):
- Relationships are affected
- Enduring
- Pervasive across different aspects of life
- Onset during childhood or adolescents
- Distress as a result
- Social and work life affected.
What are the features of paranoid personality disorder?
They have a marked sense of self-importance, but easily feel shame and humiliation. They are suspicious and constantly on the lookout for attempts by others to deceive or exploit them, which makes them difficult for others to get on with. Features include: Suspicious, mistrustful, jealous, sensitive, resentful, bears grudges, and self-important.
What are the features of Schizoid personality disorder?
The term ‘schizoid’ was suggested by Kretschmer (1936), who believed that this type of personality is related to schizophrenia. People with this disorder are emotionally cold, detached and aloof, introspective, and prone to engage in excessive fantasy. They are unable to express either tender feelings or anger, and show little interest in sexual relationships.
What are the features of antisocial (dissocial) personality disorder?
The term ‘antisocial’ is used in DSM-5 and in this book, whereas ‘dissocial’ is the term used in ICD-10. Antisocial personality disorder is not simply another term for delinquency. People with this disorder show a callous lack of concern for the feelings of others. They disregard the rights of others, act impulsively, lack guilt, and fail to accept responsivity and learn. They only form transient relationships with others.
What are the features of borderline/emotionally unstable personality disorder?
People with borderline personality disorder experience their lives as being dominated by strong and fluctuating emotions that often overwhelm them. They strive for affection and intimacy but are regularly disappointed, and may exhaust their partners with the intensity of their emotional demands. They are themselves confused by the strength and unpredictability of their moods as they plunge into anger or despair. They are often insecure in their personal identity and need reassurance and stability, which they may then find constricting and irritating. Self-harm is common. Characteristics include:
- Unstable and intense personal relationships
- Fears and avoids abandonment
- Unstable self-image
- Impulsivity
- Recurrent self-harm or suicidal behaviour
- Affective instability
- Chronic feeling of emptiness
- Difficulty controlling anger
ICD-10 has the subtype of impulsive personality disorder.
What are the features of histrionic personality disorder?
Self-dramatization is a striking feature, and may include ‘emotional blackmail’, angry scenes, and demonstrative suicide attempts. These individuals are suggestible and easily influenced by others, especially by figures of authority. They seek attention and excitement, are easily bored, and have short-lived enthusiasms. They also have shallow affect and are racy and seductive.
What are the features of anankastic personality disorders?
- Preoccupied with details, rules, etc.
- Inhibited by perfectionism
- Over-conscientious and scrupulous
- Excessively concerned with work and productivity
- Inflexible
- Reluctant to delegate tasks or work with others
- Miserly
- Rigidity and stubbornness
What are the features of anxious (avoidant) personality disorder?
Avoids social contact
Fears rejection/criticism
Restricted lifestyle
Apprehensive
Inferiority
Doesn’t get involved unless sure of acceptance
What are the features of dependent personality disorder?
They are often protected by support from a more energetic and determined partner, and may only come to medical attention when the partner leaves or dies.
- Allows others to take responsibility
- Unduly compliant
- Unwilling to make reasonable demands
- Feels unable to care for himself or herself
- Fear of abandonment
- Needs excessive help to make decisions
Describe the investigations for a personality disorder
A second interview and collateral history should be arranged to confirm that personality traits are actually a disorder (i.e. they are pervasive and pathological).
A psychosocial assessment perhaps with the help of a social worker may be helpful, as well as a safeguarding assessment.
Some of the personality traits are risk factors for alcohol and substance misuse, so this should be investigated.
Describe the management of personality disorder
- As always - risk assessment and safeguarding assessment.
- Social and occupational needs should be assessed, may require assessment by social services or occupational services. Social support should be provided to all patients e.g. support with housing or benefits.
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Psychotherapy can be initiated by referring to community mental health services. They are responsible for routine assessment, treatment and management. However, if they are in a crisis, the crisis service can be asked to manage (crisis resolution and home treatment team (CRHTT) in west Middlesex). There is no difference in the effectiveness of any of the psychotherapy options, however they are effective in reducing self-harm; patient should make the choice. A range of psychotherapies are indicated in personality disorders:
- Dialectical Behavioural Therapy (DBT) is the most widely used psychotherapy for personality disorders in the UK. Focuses on the patient’s failure to develop emotional and interpersonal skills. Tends to be more of a training than psychological inquiry. See Psychological Treatments for Personality Disorder.
- Mentalisation
- Psychodynamic and psychoanalytical therapy.
- Encourage involving families or carers.
- Screen for and manage co-morbid mental health conditions.
Medication is occasionally used to try to improve certain symptoms, facilitating psychosocial treatments. Anti-psychotics may reduce impulsivity and aggression. Antidepressants may have general effects in reducing impulsivity and anxiety. Mood stabilizers have been used for labile affect but their effects are unimpressive.
What psychotherapies can be offered to patients with personality disorder?
- There is no difference in the effectiveness of any of the psychotherapy options, however they are effective in reducing self-harm; patient should make the choice. A range of psychotherapies are indicated in personality disorders:
- Dialectical Behavioural Therapy (DBT) is the most widely used psychotherapy for personality disorders in the UK. A type of CBT that focuses on the patient’s failure to develop emotional and interpersonal skills. Tends to be more of a training than psychological inquiry. See Psychological Treatments for Personality Disorder.
- Mentalisation
- Psychodynamic and psychoanalytical therapy.
