Personality Disorders Flashcards
What is meant by personality?
predictable patterns of
- thinking
- feeling
- behaving
When did the theory of personality “traits” come about?
1920s-1930s
What is the 5 Factor model?
5 big personality traits: Openness Conscientiousness Extraversion Agreeableness Neuroticism
What does the ICD-10 define as a Personality Disorder?
- Individuals characteristics and behaviour deviate markedly from expected
- Manifests in >1 of cognition, affect, impulses, interpersonal functioning
- Behaviour is inflexible, maladaptive, dysfunctional
- Causes patient distress
- Stable and long duration
- onset in late childhood/adolescence
What four categories can a personality disorder manifest in?
Cognition
Affect
Impulses
Interpersonal functioning
What makes a characteristic more likely to be a personality disorder rather than a trait?
- Pervasive (not just related to specific situations)
- Causes distress and/or
- Causes impairment of functioning in most areas
Clinical assessment of personality disorders usually takes longer than one appointment. TRUE/FALSE?
TRUE
- Rating scales usually have many questions and take a bit of time to complete
Give examples of screening questionnaires used to assess personality disorders in clinic?
Zanarini Rating Scale for Borderline Personality Disorder (ZAN-BPD)
- carried out by clinician, qs based on DSM-IV
International Personality Disorder Examination (IPDE)
- Quick screening method, self administered
What is meant by heritability?
Proportion of the condition that is due to genetics
e.g. heritability of 0.6 = 60% genetic, and 40% environmental
What Clusters of personality disorders have a higher heritability?
Cluster B - Dramatic and Emotional = higher genetic heritability
Cluster C - all higher except Avoidant
What cluster of personality disorders have lower heritability?
Cluster A - Odd and Eccentric (paranoid, schizoid)
Avoidant (Cluster C) also has low heritability
What proportion of people in the general population have a personality ‘disorder’?
10.6%
Personality disorders are more common in the population than many physical conditions such as IBD, epilepsy, and diabetes. TRUE/FALSE?
TRUE
A high prevalence of personality disorders are unspecified. TRUE/FALSE?
TRUE
Compare the prevalence of Personality Disorders in the general population to that in psychiatric outpatients and inpatients.
General population - 10.6%
Psychiatric Outpatients - 31%
Psychiatric Inpatients - 54%
Describe the Clusters of Personality disorders described in the ICD-10
Cluster A - Odd and Eccentric
- Paranoid
- Schizoid
Cluster B - Dramatic and Emotional
- Dissocial (previously antisocial)
- Emotionally Unstable (Impulsive/ Borderline)
- Histrionic
Cluster C - Anxious and Dependent
- Avoidant
- Dependent
- Anankastic
What two types of personality disorders are not included in the ICD-10 criteria?
Narcissistic
schizotypal
What are the ICD-10 criteria for Paranoid personality disorder and how many criteria are required for a diagnosis?
4 or more of the following:
- Sensitive to setbacks
- Hold grudges
- Suspicious
- misconstrue neutral/friendly actions as hostile
- suspicions of sexual infidelity in partner
- excessive self-importance
- Preoccupation with “conspiracies” of the world
What are the ICD-10 criteria for Schizoid personality disorder and how many criteria are required for a diagnosis?
4 or more of the following:
- Few activities provide pleasure
- Cold/ flattened affect
- cant express warm feelings towards others
- difficulty accepting praise/criticism
- Little interest in sexual experiences with others
- Chooses solitary activities
- Preoccupation with fantasy
- No close friends
- Insensitive to social norms/conventions
What are the ICD-10 criteria for Schizotypal personality disorder and how many are required for this diagnosis?
5 or more of:
- Ideas of reference
- Odd beliefs/magical thinking (e.g. belief in clairvoyance/ telepathy)
- Unusual perceptual experiences, including bodily illusions
- Odd thinking and speech
- Suspicious/paranoid
- Inappropriate/ constricted affect
- Behaviour is odd/eccentric/peculiar
- Lack of close friends
- Social anxiety doesn’t diminish with familiarity
What are the ICD-10 criteria for Dissocial personality disorder and how many are required for this diagnosis?
3 or more of:
Callous unconcern for feelings of others
Irresponsible & disregard for social norms/rules/ obligations
Incapacity to maintain enduring relationships, though no difficulty to establishing them
Very low tolerance to frustration and low threshold for aggression/violence
Incapacity to experience guilt, or to profit from adverse experience, particularly punishment
Marked proneness to blame others
What is the difference between antisocial personality disorder and psychopathy?
Antisocial = based on behaviour psychopathy = set of ‘deficits’ in emotional and cognitive functioning
What are the 4 facets of psychopathy disorders?
Facet 1 - Interpersonal
- superficial charm
- grandiose self-worth
Facet 2 - Affective
- lack of remorse/guilt
- shallow affect
Facet 3 - Lifestyle
- Prone to boredom
- Impulsive/ Irresponsible
Facet 4 - Antisocial
- poor behavioural
- especially in childhood
What are the criteria of the ICD-10 for Impulsive Emotionally Unstable Personality Disorder?
3 of:
- act unexpectedly, without considering consequences
- Quarrelsome behaviour/conflicts with others
- outbursts of anger or violence
- Difficulty maintaining course of action offering no reward
- Unstable mood
What additional criteria of the ICD-10 indicate a Borderline Emotionally Unstable Personality Disorder ?
Plus 2 of:
- uncertainty about self-image
- Intense/unstable relationships
- efforts to avoid abandonment
- Recurrent threats/acts of self-harm
- Chronic feelings of emptiness
What criteria of Narcissistic Personality Disorder are outlined in the DSM-V?
5 of:
- grandiose logic of self-importance
- fixation with fantasies of infinite success/brilliance #
- belief they are extraordinary and can only be understood by other extraordinary people
- desire for admiration
- sense of entitlement
- oppressive behaviour
- No empathy
- Resentment of others/ feeling resentment from others
- egotistical/conceited behaviours
What ICD-10 criteria indicate an anankastic personality disorder?
4 of:
- doubt/caution
- Preoccupation with details/rules
- Perfectionism
- Conscientiousness
- preoccupation with productivity (causes exclusion of pleasure/relationships)
- Pedantic
- Rigidity and stubbornness
- insistence that others conform to their way of doing things
- reluctance to allow others to do things
What are the ICD-10 criteria of avoidant personality disorder?
4 of:
- feelings of tension/apprehension
- Belief that one is inferior to others
- worried about being criticised/rejected in social situations
- Unwilling to get involved with people unless certain of being liked
- Avoidance of social/occupational activities due to fear of criticism, disapproval or rejection
What are the ICD-10 criteria of dependent personality disorder?
4 of:
- allowing others to make important life decisions
- Unwilling to make reasonable demands on the people they depend on
- uncomfortable or helpless when alone
- fears of being left to take care of oneself
- Limited capacity to make everyday decisions without advice/reassurance
Describe the prognosis of personality disorders
- Most personality disorders are stable over time
- many people show improvements in symptoms/behaviour over time
What should be the focus of treatment in personality disorders?
Treatment of any comorbidity (e.g. depression, anxiety)
What personality disorders are thought of as “non-responders” to treatment?
Cluster A - Paranoid and Schizoid
Cluster B - Histrionic and Dissocial
Cluster C - Anankastic and Avoidant
Why are pharmacological treatments not recommended for personality disorders?
- cannot cure a personality disorder
- can impair functioning
- can contribute to pessimism when progress does not occur
What classes of drugs can be used in personality disorders to reduce individual symptoms/ tackle comorbidities?
Low dose antipsychotics
Antidepressants
Mood stabilisers
Benzodiazepines
Low dose antipsychotics are used to reduce what symptoms in personality disorders?
reduce the suspiciousness of Cluster A disorders
=> paranoid, schizoid and schizotypal
- Can help with borderline personality disorder if paranoid or hearing voices
What antipsychotics are used in low dose to treat individual symptoms of personality disorders?
quetiapine
olanzapine
haloperidol
What symptoms are reduced by antidepressants in personality disorders?
- mood/emotional difficulties with cluster B disorders
=> dissocial, EUPD, histrionic, and narcissistic - reduce anxiety in cluster C disorders
=> anankastic, avoidant and dependent
What types of antidepressant are used to treat personality disorder symptoms?
SSRIs + mirtazapine
What symptoms of personality disorders are treated by mood stabilisers, and what mood stabiliser is often used?
- unstable mood and impulsivity in EUPD
- lamotrigine often used
What drugs can be useful if a patient with a personality disorder is in crisis?
short-term use of Benzodiazepines/hypnotics
- sedative
- e.g. diazepam and zopiclone
What specific treatments are used for avoidant personality disorder?
- Social skills training (Helps increase self-efficacy and functioning)
- Some evidence for antidepressants
What specific treatments are used in emotionally unstable personality disorder?
- Dialectical Behavioural Therapy (GOLD STANDARD)
- Mentalization Based Therapy
- Systems Training for Emotional Predictability and Problem Solving (STEPPS)
- admission if required
What are the aims of Dialectical Behavioural Therapy?
- helps to accept/regulate emotions
- Individual or Group sessions
- Learn new skills to replace harmful behaviour
- Address mental health/personal problems
- Mindfulness
- Interpersonal effectiveness
- Distress tolerance
What are the aims of Mentalization Based Therapy?
- group and individual sessions
- to better understand and control impulses, emotions and behaviours and improve relationships
What is involved in the STEPPS programme?
- CBT based training programme
- Focus on stabilisation
- add on to usual treatment
- 20 weeks and includes homework
- Significant others are involved in training
When is inpatient care used to treat EUPD?
- acute increase in suicide risk
- Changes to medication not managed in the community
- Clarification/Treatment of comorbid diagnosis
What pharmacological treatments have SOME evidence for use in EUPD?
Topiramate
Antidepressants
Haloperidol
Olanzapine (BUT WEIGHT GAIN)
How should dissocial personality disorder be treated?
- group-based cognitive and behavioural interventions
- aim to solve problems such as impulsivity, interpersonal difficulties and antisocial behaviour
- pharmacological treatment is not recommended
