Personality Disorders Flashcards
what is personality
a cluster of relatively predictable patterns of thinking, felling and behaving that is generally consistent across time, space and context
what are the five factors of personality
openness conscientiousness extraversion agreeableness neuroticism
what is a disorder of adult personality
when an individuals characteristic and enduring patterns of inner experience and behaviour deviate markedly as a whole from the culturally expected and accepted range
in what areas will a PD manifest
more than one of: cognition -affectivity -impulse control -interpersonal functioning (relating to others and handling interpersonal situations)
what are the features of PDs in general
is pervasive behaviour that is inflexible, maladaptive of dysfunctional
causes personal distress and/ or has adverse impact on the social environment
stable, long duration, onset late in childhood/ adolescence
cannot be explained as a manifestation or consequence of other adult mental health disorders
what are the features of anankastic personality disorder
feelings of excessive doubt and caution
preoccupation with details, rules, lists, order, organisation or schedule
perfectionisn that interferes with task completion
excessive conscientiousness and scrupulousness
undue preoccupation with productivity to the exclusion of pleasure and interpersonal relationships
excessive pedantry and adherence to social conventions
rigidity and stubbornness
unreasonable insistence other submit to exactly their way/ reluctance to allow others to do things
(aka obsessive compulsive)
when do personality traits become a disorder
is they are pervasive (not just related to specific situations)
cause distress and/ or impairment of functioning in most areas
which PDs have the most heritability
obsessive compulsive, borderline, histrionic, anxious and fearful, dramatic and emotional
all influenced by genes
what people in general population have PD
10.6%
1 in 10
what is the most common PD
obsessive compulsive
how many psychiatric outpatients have a PD
1 in 3
how many psychiatry inpatients have a personality disorder
half
what are the types of PD
cluster A- (odd and eccentric) paranoid, schizoid
cluster B- (dramatic and emotional) emotionally unstable (impulsive or borderline), histrionic, dissocial
cluster C- (anxious and fearful) anxious, dependent, anankastic
what are the features of paranoid PD
Excessive sensitivity to setbacks
Tendency to bear grudges
Suspiciousness & tendency to misconstrue the neutral/friendly actions of others as hostile/contemptuous
A combative and tenacious sense of personal rights out of keeping with the actual situation
Recurrent suspicions, without justification, regarding sexual fidelity of partner
Persistent self-referential attitude, associated particularly with excessive self-importance
Preoccupation with unsubstantiated “conspiratorial” explanations of events in the world at large
what are the features of schizoid PD
Few, if any, activities provide pleasure
Emotional coldness, detachment, or flattened affectivity
Limited capacity to express warm feelings for others as well as anger
Indifferent to either praise or criticism of others
Little interest in having sexual experiences with another person
Almost always chooses solitary activities
Excessive preoccupation with fantasy/introspection
Neither desires, nor has, any close friends or confiding relationships (or only one)
Marked insensitivity to prevailing social norms /conventions
what are the features of schizotypal PD
Ideas of reference (excluding delusions of reference)
Odd beliefs or magical thinking, inconsistent with subcultural norms (e.g. superstitious, belief in clairvoyance, telepathy, or “sixth sense”)
Unusual perceptual experiences, including bodily illusions
Odd thinking and speech (e.g. vague, circumstantial, metaphorical, elaborate, or stereotyped)
Suspiciousness or paranoid ideation
Inappropriate or constricted affect
Behaviour or appearance that is odd, eccentric, or peculiar
Lack of close friends or confidants other than first-degree relatives
Excessive social anxiety that does not diminish with familiarity and tends to be associated with paranoid fears rather than negative judgments about self
what are the features of dissocial PD
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
how is antisocial PD different to psychopathy
antisocial based on behaviour, psychopathy describes a set of emotional and cognitive deficits
what are the features of psychopathy (not a PD)
superficial charm grandiosity pathological lying conning/ manipulation lack of remorse/ guilt shallow affect callous/ lack of empathy failure to accept responsibility for actions prone to boredom parasitic lifestyle lack of realistic long term goals impulsivity irresponsibility poor behavioural controls/ early behavioural problems juvenile delinquency criminal versatility
what are the features of an emotionally unstable impulsive PD
Tendency to act unexpectedly, without consideration of consequences
Quarrelsome behaviour and conflicts with others, especially when impulsive acts are thwarted/criticized
Liability to outbursts of anger or violence
Difficulty in maintaining any course of action that offers no immediate reward
Unstable mood
what are the features of emotionally unstable borderline PD
same as impulsive +:
Disturbances in and uncertainty about self-image, aims & internal preferences (including sexual)
Intense and unstable relationships, often leading to emotional crises
Excessive efforts to avoid abandonment
Recurrent threats or acts of self-harm
Chronic feelings of emptiness
what are the features of histronic PD
Self-dramatization, theatricality, or exaggerated expression of emotions
Suggestible
Shallow/labile affectivity
Continually seeks excitement & activities in which the subject is the centre of attention
Inappropriately seductive in appearance or behaviour
Overly concerned with physical attractiveness
what are the features of narcissistic PS
A grandiose logic of self-importance
A fixation with fantasies of infinite success, control, brilliance, beauty, or idyllic love
A credence that he or she is extraordinary and exceptional and can only be understood by, or should connect with, other extraordinary or important people or institutions
A desire for unwarranted admiration
A sense of entitlement
Interpersonally oppressive behaviour
No form of empathy
Resentment of others or a conviction that others are resentful of him or her
A display of egotistical and conceited behaviours or attitudes
what are the features of anankastic PD
Excessive doubt and caution
Preoccupation with details, rules, lists, order, organization or schedule
Perfectionism that interferes with task completion
Excessive conscientiousness
Undue preoccupation with productivity to the exclusion of pleasure/interpersonal relationships.
Pedantic, excessive adherence to social conventions
Rigidity and stubbornness
Unreasonable insistence that others submit to exactly his or her way of doing things, or unreasonable reluctance to allow others to do things
(aka obsessive compulsive)
what are the features of anxious PD
Persistent pervasive feelings of tension/apprehension
Belief that oneself is socially inept/inferior to others
Excessive preoccupation about being criticized/rejected in social situations
Unwillingness to get involved with people unless certain of being liked
Restrictions in lifestyle because of need of security
Avoidance of social or occupational activities that involve significant interpersonal contact, because of fear of criticism, disapproval or rejection
what are the features of dependent PD
Encouraging or allowing others to make most of one’s important life decisions
Subordination of one’s own needs to those of others on whom one is dependent, and undue compliance with their wishes
Unwillingness to make even reasonable demands on the people one depends on
Feeling uncomfortable or helpless when alone, because of exaggerated fears of inability to care for oneself.
Preoccupation with fears of being left to take care of oneself
Limited capacity to make everyday decisions without an excessive amount of advice/reassurance
what is the outcome for PDs
usually pretty stable over time
can get better/ worse
what is the focus of treatment on in PD
treatment of comorbidities (depression/ anxiety)
what types of PD do not respond to treatment
cluster A- schizoid, paranoid
cluster B- histrionic, dissocial
cluster C- anankastic, avoidant
should you use drugs to treat PDs
no
can sometimes be used to help individual symptoms
how can antipsychotic drugs (low dose) help in PDs
Can reduce the suspiciousness of the three cluster A personality disorders (paranoid, schizoid and schizotypal)
Can help with borderline personality disorder if people feel paranoid or are hearing voices
give three examples of antipsychotics
quetiapine, olanzapine, haloperidol
how can antidepressants help in PDs
with the mood and emotional difficulties with cluster B personality disorders (dissocial, emotionally unstable, histrionic, and narcissistic)
Some of the SSRIs can help people to be less impulsive and aggressive in borderline and antisocial personality disorders.
Can reduce anxiety in cluster C personality disorders (anankastic, avoidant and dependent)
how can mood stabilisers help in PDs (e.g. lamotrigine)
Can help with unstable mood and impulsivity that people with emotionally unstable personality disorder, borderline subtype may experience
how can benzodiazepines/ hypnotics be used to help PDs
as sedatives in a crisis (short term)
what are the 1st, 2nd and third line drugs for difficulties with impulse control
1st- SSRI 2nd + 3rd - Olanzapine Sodium Valproate Carbamazepine Low dose antipsychotic
what are the 1st, 2nd and third line drugs for affective dysregulation
1st- SSRI / mitrazepine 2nd - different SSRI 3rd - Olanzapine Sodium Valproate Carbamazepine Low dose antipsychotic
what drug for cognitive perceptual symptoms
low dose antipsychotic
what drug for interpersonal difficulties
NOT APPROPRIATE
What treatment for avoidant PD
social skills training
some evidence for antidepressants
treatment for emotionally unstable personality disorder
dialetical behavioural therapy (learn to accept and regulate emotions) (DBT)
individual and group sessions
telephone crisis coaching
lasts 6 months to a year
focuses on: mindfulness, regulating emotions, distress tolerance, interpersonal effectiveness
what drugs are evidenced to work in EUPD
topiramate for anger and aggression
antidpressants
olanzapine (aware of weight gain)
haloperidol
treatment for dissocial PD
group based cognitive and behavioural interventions
