Personality disorders Flashcards
Features of personality disorder
- Pervasive: Not waxing/waning + present in a variety of situations (seek corroborative history)
- Chronic: Stable + present since late adolescence
- Disturbance: Behaviour deviates markedly from “norm” in more than one of cognition, affect, control of impulses, relating to others
- Exclude: Other mental disorders as cause of disturbance
- Dysfunction: Personal distress and/or adverse impact on the social environment
Prevalence of personality disorders
2-15% of general population in UK
Most common personality disorders
Obsessive-compulsive, avoidant, schizoid, borderline
Most clinically common personality disorders
EUPD
Dissocial PD
Populations with a higher prevalence of personality disorders
Prisoners (30-50%)
Substance misuse/eating disorder (70%)
Psychiatric patients (50%)
Biological aetiological factors for personality disorders
- Genetics 35-50% heritability
- XXY chromosomal abnormalities may have a modest effect
- Adverse childhood experiences (abuse/neglect) –> neurological abnormalities (cortical immaturity)
Psychosocial aetiology for personality disorders
- Adverse childhood events (abuse/neglect)
- Attachment theory: Lack of parental figures during childhood
- Object relations theory: Inability to reconcile good/bad experiences of same person/thing
DSM-V classification of personality disorders
Cluster A: Eccentric
Cluster B: Dramatic
Cluster C: anxious
ICD-10 disorders in cluster A
Eccentric
Paranoid
Schizoid
ICD-10 disorders in cluster B
Dramatic
Dissocial (aka antisocial, psychopathic)
Borderline (aka emotionally unstable)
Narcisstistic
Histrionic
ICD-10 disorders in cluster C
Anxious
Dependent
Anankastic (aka obsessional)
Anxious (aka avoidant)
Features of paranoid personality disorder
Sensitivity to rebuffs/setbacks
Suspicious, misconstrues actions as hostile
Excessive self-importance
Bears grudges
Features of schizoid personality disorder
Emotionally detached, cold, flat affect
Few activities pleasurable incl. sexual
Preference for solitary activities
Preoccupation w/ fantasy + introspection
Differntial for cluster A personality disorders
Chronic delusional disorder (paranoid personality is a risk factor for development)
Depression/ASD (esp for schizoid)
Histrioinic personality disorder
Over-dramatic, theatricality
Shallow, labile affect
Superficial relationships
Suggestible
Narcissistic personality disorder features
Grandiose self-importance
Exploits other
Expects praise
Features of dissocial personality disorder
Callous, inconsiderate of others
Lack of guilt
Persistent irresponsibility and disregard for societal norms/rules
Low threshold for frustration/aggression
Impulsivity
Subtypes of emotionally unstable personality disorder
Impulsive
Borderline
Features of impulsive EUPD
Impulsivity
- Tendency to act impulsively + w/o regard for consequences
- Tendency to quarrelsome behaviours + conflicts with others
- Difficulty maintaining course of action w/o immediate reward
Anger:
- Liability to outbursts of anger
- Unstable mood
Features of borderline personality disorder
Impulsive criteria PLUS:
Push-pull personality:
- Frequent threats/acts of self-harm
- Involvement in intense and unstable relationships
- Excessive efforts to avoid abandonment
Internal conflict:
- Chronic feelings of emptiness
- Uncertainty about self-image, aims, preferences
Features of dependent personality disorder
- Encouraging/allowing others to make most life decisions
- Fear of being left to care for oneself
- Limited capacity to take everyday decisions w/o advice/reassurance from others
- Subordination of own needs to those they are dependent on
Features of anankastic personality disorder
- Excessive orderliness
- Rigidity + stubborness
- Pedantry + adherance to conventions
- Preoccupation with detail
- No compulsions/relieving behaviours (c.f. OCD)
Features of anxious/avoidant personality disorder
- Fear of criticism/rejection
- Persistent tension/apprehension
- Avoidance of personal contact/relationships
Prognosis of PD by cluster
Cluster A: Stable/worsen with age (mature)
B and C: Mellow with age (maturity)
All have worse morbidity + mortality compared to general population
Prognostic interaction between PD and other psychiatric conditions
Worsens prognosis
Increases risk of violence in psychosis
Psychological interventions for PD
- CBT/CAT
- Dialectical behavioural therapy
- Complex needs services (i.e. therapeutic communities with group psychotherapy)
- Treat substance/psychiatric comorbidities
Principles for management of PD
- Consistency: Avoid splitting of staff
- Boundaries: Avoid responding to manipulative behaviour
- Admission to a minimum: Avoid dependence
- Individuality: Treat person’s actual problems and identify lifestyle modifications for their strengths
Screening tool for borderline personality disorder
Maclean Screening instrument
>=7 is determined as diagnostic cutoff
