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Psychiatry > Personality disorders > Flashcards

Personality disorders Flashcards

1
Q

What’s a personality disorder?

A
  • a severe disturbance in characteristics and behaviour of an individual
  • usually involves several areas of the personality
  • associated with considerable personal and social disruption
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2
Q

Features of antisocial personality

A
  • no empathy/feeling towards the others
  • aggressive, committing crimes, cruelty with not feeling sorry for that
  • difficulty in forming intimate relationships
  • conduct disorder in childhood → antisocial in adults
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3
Q

Features of dependent personality

A
  • passive, relying on others to make decisions
  • fear of abandonment makes it difficult to cope with everyday tasks
  • excessive prioritisation of the needs and wishes of the others (over their own) in attempt to maintain close relationships
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4
Q

Features of emotionally unstable (borderline-type) personality

A
  • emotional instability
  • disturbed views of self-image
  • feelings of emptiness
  • intense but easily broken relationships
  • self-harm is common and often to avoid being abandoned
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5
Q

Features of emotionally unstable (impulsive-type) personality

A
  • similar to (border-line type): emotional instability, disturbed views of self-image, feelings of emptiness, intense but easily broken relationships, self-harm is common and often to avoid being abandoned
  • but lacks self-control and violent outbursts are more prominent features
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6
Q

Features of Schizoid personality

A
  • prefer their own company
  • lack emotional expression →may be perceived by others as cold and disinterested
  • may not gain pleasure from any activities
  • no interest in sex or relationships

*there are no thought disorders or psychoses (features of schizophrenia, but still can develop it)

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7
Q

Features of Histrionic personality

A
  • craving attention
  • preoccupation with appearance
  • inappropriately flirting
  • theatrical expressions of emotions (from excessive excitement to unexpected and manipulative anger)
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8
Q

Features of Paranoid Personality Disorder

A
  • being suspicious of others (including their partners)
  • very sensitive to rejection
  • they often misinterpret actions of the others as malicious to them
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9
Q

Features of Anxious/avoidant personality disorder

A
  • tendency to worry
  • extreme anxiety
  • feeling of inferiority
  • fear of criticism/disapproval to the point of avoiding people/situations where this may happen
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10
Q

Features of Anankastic personality

A
  • inflexible preoccupation with rules, order and attention to details
  • very cautious and stubborn
  • may try to enforce their way with others
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11
Q

Features of narcissistic personality disorder

A
  • arrogant
  • grandiose sense of self-importance
  • often lack empathy for others
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12
Q

Features of schizotypal personality disorder

A
  • eccentric behaviours, thinking, speech and appearance
  • lacking social confidence and close relationships
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13
Q

What are Cluster A personality disorders?

A

paranoid, schizoid, schizotypal → odd or narcistic

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14
Q

What are Cluster B personality disorders?

A

antisocial, borderline, histrionic, narcissistic → emotional or dramatic

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15
Q

What are Cluster C personality disorders?

A

avoidant, dependant, anankastic → anxious or fearful

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16
Q

How does personality disorder differ from mental disorder?

A

Personality Disorders differ from other forms of mental disorder in that it is the personality that is the primary problem.

  • People who experience dementia, psychosis, depression etc → have changes to their personality (but those changes are secondary to the other mental illness)
  • In a personality disorder → the flaws in the personality are the primary, central problem
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17
Q

What’s another name for an anankastic personality disorder?

A

ANANKASTIC PD

(OBSESSIVE-COMPULSIVE)

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18
Q

Is anankastic personality disorder like OCD?

A

This is NOT OCD … but it is similar.

The obsession and compulsions with this personality type are perfectionism, excessive detail and control. Order, structure, symmetry, cleanliness are key aspects.

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19
Q

Features of anankastic personality disorder (mnemonic)

A

Someone who is very DETAILED in their life and appearance

D Doubtful

E Excessive detail

T Tasks uncompleted

A Adheres to rules

I Inflexible

L Likes their own way

E Excludes others

D Dominating

20
Q

Features (but not mnemonic) of anxious/avoidant personality disorder

A
  • an extreme form of social phobia, where their anxieties about being judged negatively are so all-consuming it has become a series of disordered personality traits
  • unlike Schizoid, people with Avoidant PD have normal communication skills – they are just afraid to use them, so spend their lives avoiding meetings, parties … most forms of social contact.

*It is impossible to know how many people may have this … as they would be unlikely to present to services – ironically through fear of being judged negatively

21
Q

Mnemonic for features of anxious/avoidant personality disorder

A

People who are AFRAID

A Avoids social contact

F Fears rejection or humiliation

R Restricitve lifestyle (social isolation)

A Apprehensive (anxious constantly)

I Inferiority (feels inferior to others, low self-esteem)

D Detached (won’t mix with others)

22
Q

Another name for dissocial personality disorder

A

Psychopathic

23
Q

Features of dissocial (psychopathic) personality disorder - not mnemonic

A

This person is:

  • very charming and charismatic
  • often physically attractive
  • has a “likeable” personality initially
  • Underneath this ‘front’ is a very cruel, evil, sadistic person
  • They lack any remorse, are often violent and show no kindness or compassion for other people
  • Highly dangerous
24
Q

Mnemonic for dissocial/ psychopathic personality disorder

A

Someone who gets into FIGHTS

F Forms, but can’t maintain, relationships

I Irresponsible

G Guiltless – shows no remorse

H Heartless – lacks any compassion

T Temper is easily lost

S Someone else’s fault – always blames others

*A large percentage of prisoners and patients detained in High Secure psychiatric hospitals have this diagnosis

25
Q

Features of dependant personality disorder (not mnemonic ones)

A
  • underlying anxiety and a lack of confidence
  • person is needy, unable to make decisions, worries about upsetting other people
  • feel helpless and rely heavily on others for help
26
Q

Mnemonic for dependant personality disorder

A

Someone who SUFFERs

S Subordinate – always concedes to others wishes

U Undemanding – would be unwilling to make demands of others

F Feels helpless, especially when alone

F Fears abandonment – is terrified by the thought of isolation

E Encourages others to make decisions

R Reassurance – needs lots of reassurance that they are ok

27
Q

Features of emotionally unstable personality disorder (not mnemonic ones)

A

The most important PD to know about

  • There are 2 subtypes of this personality disorder – an impulsive type and a borderline type
  • This is the commonest PD seen in psychiatric settings and most inpatient wards and A + E departments will have regular contact with people with EUPD
  • a very complex personality disorder and people often experience hallucinations and have substance misuse problems
28
Q

Mnemonic for features of an emotionally unstable personality disorder

A

List of Vowels

A Affective Instability (unstable mood)

E Explosive behaviour (very quick changes in mood)

I Impulsive (reckless – lack of planning)

O Outburst of anger (often self-directed = deliberate self-harm)

U Unable to plan or consider consequences

29
Q

Features of histrionic personality disorder (not mnemonic one)

A
  • overly dramatic
  • prone to exaggeration, telling white lies, acting in a very melodramatic and outspoken way
  • dressing provocatively, being flirtatious and/or confrontational

Why?….. To gain attention. Attention seeking behaviour. People with this PD crave the limelight and being the centre of attention.

This behaviour is probably a compensation for low self-esteem

30
Q

Mnemonic for histrionic personality disorder

A

People who are ACTORS

A Attention Seeking

C Concerned with their own appearance

T Theatrical

O Open to suggestion (easily influenced)

R Racy and seductive (flirtatious)

S Shallow affect (superficial concern for others)

31
Q

Features of narcissistic personality disorder (not mnemonic one)

A

Narcissism is:

  • vanity, arrogance, and self-obsession
  • despite initially being charming they are manipulative and very sensitive to criticism
  • they believe they are ‘special’ and should be recognised for this and find it impossible to accept any negative comments – and become hostile and aggressive if challenged or confronted
32
Q

Mnemonic for narcissistic personality disorder

A

MNEMONIC: People who think I LOVE ME

I - Is easily jealous

L – Lacks empathy

O – Over reacts to criticism

V – Views themselves as ‘special’

E – Exaggerates own importance

M – Manipulative of others

E – Expectations are unrealistic

33
Q

Features of paranoid personality disorder (non-mnemonic ones)

A
  • self- obsessed, but in a negative way
  • they believe other people are conspiring against them
  • they are jealous, suspicious, guarded and sensitive
  • the nature of the belief is usually non-bizarre – so believing colleagues at work didn’t like you, or that your partner was being unfaithful
  • Paranoid PD isn’t psychosis, but the conviction with which the belief is held can be almost delusional
34
Q

Mnemonic for paranoid personality disorder

A

People who SUSPECT others

S Sensitive

U Unforgiving

S Suspicious

P Possessive (jealous of partners)

E Excessive self-importance

C Conspiracy Theories (person believes in conspiracies)

T Tenacious sense of rights (They are ALWAYS right)

35
Q

Features of Schizoid personality disorder

A
  • arguably part of the autistic spectrum
  • emotionally detached
  • different from Avoidant PD as people who are Schizoid will mix with others, but just won’t connect socially
  • generally have no friends; no close partners and are often difficult to communicate with as they don’t seem to be able to communicate emotions clearly

Think of an isolated, emotionally blunted social loner.

36
Q

Mnemonic for features of Schizoid personality disorder

A

People who are ALONE

A Anhedonia (no pleasure in lots of things)

L Lacks (friends, sexual; interest, emotions)

O Odd (emotionally blunted and detached)

N Normal social conventions ignored

E Excessive fantasy world

37
Q

Features of Schizotypal personality disorder

A
  • odd beliefs, unusual perceptions etc
  • the nature and impact of these traits cause severe problems to the individual
  • most of society views them as a weirdo, oddball, freak
38
Q

Mnemonic for schizotypal personality disorder

A

People who are WEIRD

W Weird (some very odd ideas/strange beliefs)

E Eccentric (strange clothing, unusual tastes and hobbies)

I Ideas of reference (unusual beliefs – Aliens/Wizards etc)

R Rule out psychosis (strange but not psychotic)

D Difficulty with friendships

39
Q

Assessment tool for dissocial personality disorder

A
  • The Hare PCL-R → for Dissocial PD (also known as psychopathy).
  • Hare PCL-R is Hare Psychopathy CheckList – Revised.

20 items are assessed:

  • No = 0
  • maybe = 1
  • yes = 2
  • score of 30+ indicates Dissocial PD
40
Q

How most of personalities disorders are assessed?

A

Most forms of Personality Disorder are assessed using clinical judgement.

However, Dissocial PD can be assessed using a checklist.

41
Q

General management of personality disorders

A
  • Because personality is part of us – it is very hard to ‘treat’
  • Most forms of medications and talking therapies have limited success with all forms of personality disorder – so interventions become symptom specific.
  • Mood stabilisers → may help people with impulsive traits – emotional unstable personality disorder/Dissocial
  • Antipsychotics → may help someone with Schizoid/Schizotypal/Paranoid PD
  • SSRI’s → may help people with associated mood and anxiety problems - so Anxious/Dependent/Anankastic/EUPD
  • Talking therapies may help depending on the level of insight the person has and type of personality disorder
42
Q

What personality disorders respond poorly to psychotherapies?

A

Psychotherapy would most likely be unhelpful for Dissocial/Histrionic/Narcissistic PD → as it would probably just indulge the person in an opportunity to talk about themselves

43
Q

What personality disorders respond best to talking therapy?

A
  • EUPD (emotional unstable personality disorder) responds best to a talking therapy called Dialectic Behaviour Therapy

This is a form of talking therapy that mixes CBT with Mindfulness and other approaches → so it is a hybrid mix that centres on language (dialect) and the use of metaphors to help people make sense of their lives – hence the term dialectic

44
Q

What’s DBT?

A
  • Usually it is out-patient treatment delivered over a period of 1 year, although patients may join a DBT programme for a second year or stay in therapy for even longer
  • The main components for the patients are a weekly individual out-patient session, attendance at a weekly skills training group and possible out-of-hours telephone contact
  • Individual sessions typically last for 45–60 minutes and occur weekly.
  • The past week is reviewed using ‘diary cards’ that the patient has filled in.
  • There is a recommended structure to sessions that follows a hierarchy of topics.
  • Life-threatening behaviours should be discussed and dealt with first
  • Then come therapy-interfering behaviours, quality-of-life-interfering behaviours and attention to skills.
  • In practice, the detailed content of sessions may be influenced by the style of the individual therapist.
  • However, the whole process should be aimed at providing a setting that is validating for the patient.
45
Q

How to view a person with a personality disorder?

A

REMEMBER…..

People with personality disorders don’t choose to have them; they are people with a distressing mental disorder that causes them problems in life. So should be treated with kindness and compassion like everyone else!

Psychiatry (8 decks)

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