Personality Disorders Flashcards
Historical ideas on personality types: Kretschmer
Endomorph - fat and relaxed
Ectomorph - aloof and thin
Mesomorph - sturdy
What is distinct about personality disorders?
Persistent (non episodic)
Pervasive (whole person)
Value laden and stigmatising
Diagnosis of exclusion
Historical ideas on personality types: Jung
Introvert vs Extrovert
Historical ideas on personality types: Eysenck
Two axes:
Extroversion - Introversion
Neuroticism - Psychoticism
Friedman and Rosenman
Type A - coronary prone, high achieving
Type B - relaxed
ICD-10 criteria for personality disorder
Enduring/ingrained ways of thinking,relating,behaving and feeling
Significantly deviant from the norm
Causing significant personal and social disruption
Usually start during childhood or teens and persist for much of life
Personality clusters
Segments of normal healthy personalities which when too dominant can lead to the development of personality disorders
Cluster A disorders
Cluster A is ‘odd’
DSM-IV: Paranoid, schizoid, schizotypal
ICD-10: Paranoid, schizoid
Cluster B disorders
Cluster B is ‘dramatic’
DSM-IV: Antisocial, Borderline, Histrionic, Narcissistic
ICD-10: Dissocial, Emotionally unstable, Histrionic, Other
Cluster C disorders
Cluster C is ‘anxious’
DSM-IV: Avoidant, Dependent, Obsessive-compulsive
ICD-10: Anxious/Avoidant, Dependent, Anankastic
Axis II
The section of the DSM describing personality disorders and mental retardation
Problems with personality disorder classification
Discrete categories verses dimensions
The longitudinal course is more similar to axis disorders than thought
Problems communicating dimensions/severity to other clinicians
Prevalence of personality disorders
In the community - 10-13%, 2% antisocial PD
In primary care - 10-30% (cluster C most common)
In-patients - 36%, 78% of alcohol in-patients
In prison - 60-70%
How enduring are personality disorders?
Zanarini et al (2006) - prospective study for borderline PD
- 70% meet remission criteria at 8 years
- 6% of remitted patients experience recurrence within 8 years
Different symptoms resolve at different rates - impulsivity, then interpersonal and cognitive, then affective
Principle problems related to PD
Self-harm and suicide
Increased service utilisation and poor treatment outcome
Antisocial behaviour
Interview based Assessments of PD
- International personality disorder examination (IPDE)
- Structured clinical interview for DSM-IV axis II PD (SCID-II)
- Personality disorder interview - 4 (PDI-4)
Self report measures of PD
Million clinical multiracial inventory (MCMI)
Minnesota multiphasic personality inventory PD scales (MMPI - PD)
Personality assessment inventory ( PAI)
Personality diagnostic questionnaire 4 (PDQ-4)
Borderline personality disorder
Unstable and intense interpersonal relationships
Frantic efforts to avoid abandonment
Impulsivity, affect instability and anger with feelings of emptiness
Risk of suicide/self-harm with psychotic or dissociative symptoms
Aetiology of Borderline Personality Disorder
Childhood abuse, neglect or separation with critical or negative family interactions
Heritable component
Impulsive aggression linked to 5HT in the cingulate and PFC
Emotional disturbance linked to amygdala and PFC function
Antisocial personality disorder
Failure to conform to social norms
Deceitfulness, impulsivity/irritability and aggressiveness
Disregard for the safety of others and self, irresponsibility and lack of remorse
Conduct disorder with onset before 15yrs
Aetiology of antisocial PD
Childhood abuse, neglect or separation
Life-long APD shows higher heritability than adolescent onset, linked to MAOA polymorphism
PFC and temporal cortex abnormalities with aggression associated with reduced central 5HT
Treatments of PD
treatment enabling environments
Psychological treatments
Pharmacotherapy
Treatment enabling environment
Shared, friendly and supportive care environment
Staff support and supervision
Supportive organisations
Psychological treatments
CBT, MBT (mentalisation based treatment) or DBT (dialectical behaviour therapy)
NICE recommends - group CBT for antisocial PD
- MBT/DBT for borderline PD
Pharmacotherapy in PD
No good evidence for use in PD
Poly pharmacy common - rationale often eating symptoms or underlying neurobiology.
Attachment theory for personality disorders
A theory arguing that different types of attachment to parents when young effects the development of adult personality
Tested with the strange situation test
Unhealthy attachment types leads to difficulty in relationships when young and is linked to PDs
Techniques for testing attachment styles
Strange situation test - 18 month infant is separated from their carer for 2mins and then their reunion is analysed
Adult attachment interview - a person is analysed on their ability to form a coherent, balanced narrative about their attachments
Infant attachment styles
Secure - initially distressed but welcome return without anger
Insecure/avoidant - look unconcerned, but are, and avoid mother once returned
Insecure/ambivalent - angry and clingy,demand contact but show resistance to it
Insecure/bizarre - may show fear or start to approach then retreat. Often h/o of loss or abuse
Adult attachment styles
Autonomous - coherent and aware of others’ states’ of mind
Dismissing - 20% - idealise early relationships but dismiss importance of attachments/claim they do not need other people
Preoccupied - 15% - value attachment but preoccupied with early relationships, have unresolved feelings about this and ramble
Bizarre - sig psych difficulties and may be very incoherent
