Personality Disorders Flashcards
What is a personality disorder
When the enduring characteristics of an individual are such as to cause distress or difficulties for themselves or in their relationships with others, they can be said to be suffering from a personality disorder
- Personality disorder is separate from mental illness, although the two interact
- Personality disorder can manifest as problems in cognition, affect, or behaviour
Key Aspects to diagnosing a personality disorder
- Enduring i.e. starting in childhood/adolescence and continuing into adulthood
- Persistent
- Pervasive
- Causing distress or significant impairment in social functioning
- Out of keeping with social or cultural norms
How can personality disorders manifest
Cognition-Ways of perceiving and interpreting things, people and events, forming attitudes and images of self and others
Affectivity-Range, intensity and appropriateness of emotional arousal and response
Control over impulses and gratification of needs
Manner in relating to others of handling interpersonal situations
Clusters
Cluster A (odd/eccentric): paranoid, schizoid, schizotypal
- Cluster B (emotional/dramatic): histrionic, dissocial, narcissistic, borderline
- Cluster C (fearful/anxious): avoidant, dependant, anankastic
Paranoid Personality Disorder
Suspicious-misconstrues actions as hostile
Excessive sensitiveness to setback/rebuffs
Resentful
Bears grudges
Jealous
High sense of personal rights
Sense of self importance
Schizoid PD
Emotionally cold Detached and aloof Lacking enjoyment and humourless Introspective-prone to fantasy Lack of intimate relationships, solitary Insensitive to social norms Indifferent to praise or criticism
Schizotypal PD
Inappropriate or constricted affect Behaviour or appearance that is odd, eccentric or peculiar Social withdrawal Odd beliefs or magical thinking Suspiciousness or paranoid ideas Unusual perceptual experiences Obsessive ruminations Vague, circumstantial, stereotypes thinking with oddities of speech Transient quasi-psychotic episodes
Dissocial PD
Callous lack of concern Short lived, shallow relationships Irresponsible, depart from social norms Low tolerance to frustration, low threshold for aggression Lack of remorse or guilt Fail to accept responsibility
Emotionally Unstable PD
Impulsivity Affective instability Minimal ability to plan ahead Emotional outbursts Types: Impulsive, borderline
Borderline PD
Disturbed self-image/aims/internal preferences Chronic feelings of emptiness Intense, unstable relationships Efforts to avoid abandonment Recurrent threats/acts of self harm
Impulsive PD
Impulsive Liability to anger/violence Unstable mood Quarrelsome Difficulty maintaining a course of action with no immediate reward
Histrionic PD
Self-dramatization Suggestibility Shallow, labile affect Inappropriately seductive Seeks attention/excitement Over-concern with physical attractiveness
Narcissistic PD
Grandiose self-importance Fantasies of unlimited success, power Believe themselves to be special Requires excessive admiration Sense of entitlement to favours and compliance Exploits others Lacks empathy Arrogant, haughty and envious
Anankastic PD
Preoccupied with details, rules, schedules Inhibited by perfectionism Over conscientious Excessively concerned with productivity Rigid and stubborn Pedantic Excessive doubt and caution Expect others to submit to their ways
Anxious/Avoidant PD
Persistent, pervasive tension
Feel socially inferior
Preoccupied with rejection/being criticized
Avoids involvement with unfamiliar people
Restricts lifestyle due to need for security
Avoids social activity
Dependent PD
Allows other to make important life decisions
Unduly compliant
Unwilling to make reasonable demands
Feel unable to care for themselves
Fear of being left to care for themselves
Needs excessive help to make decisions
Aetiology:
Genetic
Genetic theory stems from evidence of ‘normal’ personality traits, as well as some evidence of heritability of cluster B personality disorders
Aetiology:
Neurobiological
- Immature EEG (posterior temple slow waves) in psychopathy
- Functional imaging abnormalities e.g. decreased activity of the amygdala
- Low 5-HT levels
Aetiology: Developmental
- Harsh and inconsistent parenting, childhood ADHD, difficult infant temperament, and severe childhood trauma are all related to personality disorder
Aetiology: Behavioural
use of maladaptive cognitive, behavioural and affective structures that affect information processing
- This means that core beliefs develop from an interaction between childhood experiences and patterns of behaviour/response
Aetiology: Sociological
- Freudian theory that there is arrested development at oral, anal and genital stages leading to dependent, obsessional and histrionic personalities
- Unfiltered reactions to experiences prevent individuals from putting things into perspective (Kernberg theory)
- Presence of an overly harsh superego due to internalisation of parental abuse
Co-morbid Psychiatric Disorder
Many theories as to why this might be the case
- Sharing common aetiology
- Personality disorders are prodromal
- There is a spectrum of disease severity
- Patients with personality disorders are more vulnerable to psychiatric disorders
Strong associations between PD and psychiatric disorder
Cluster A-Schizophrenia
Cluster B-Substance misuse, eating disorders, habit and impulse disorders, somatoform disorders, depression
Cluster C-Eating disorders, neurotic disorders, somatoform disorders, depression
Why assess personality
Explains why certain events are stressful
Explains presence of unusual features in a disorder
Understanding reaction to illness, treatment and prognosis
How to assess personality
History-taking and informant history
Semi-structured interviews
Personality inventories
Objective Personality Tests
Eysenck Personality Questionnaire
Minnesota Multiphasic Personality Inventory
Revised Neo-Personality Inventory
SAPAS
Management
general approach to management should involve a wide range of services including mental health services, substance misuse services, social care, and the criminal justice system. Specific aspects can include
- Management of any co-morbid psychiatric conditions
- Managing crises e.g. overdose, self-harm
Inpatient management is not recommended, and these patients are best managed in the community
Management: Medication
Cluster A-low dose antipsychotics
Cluster B-Mood stabilisers/anti-convulsants/for aggression/ impulsivity. Antidepressants (affective lability/co-morbidity)
Cluster C-SSRIs and Venlafaxine
Management: Psychotherapy
Dialectical Behaviour therapy-For self harming behaviour
Mentalization based therapy-Reflecting on our own thinking and regulating our own affective response
Psychodynamic psychotherapy
Cognitive Behavioural Therapy
Schema focused therapy-combines CBT, dynamic and mindfulness skills
Therapeutic communities
