Personality Disorders Flashcards
What is a personality disorder?
Helpful to think about personalities as a continuum = LOOK AT PP 1
3 DSM-5 clusters
Cluster A - Odd/eccentric
Cluster B - Dramatic/emotional
Cluster C - Anxious/avoidant
Cluster A - Odd/eccentric PD:
(1) Paranoid:
- Signs - 4
- What do they tend to bear and what may that lead to?
(2) Schizoid:
- They are cold and aloof. What does aloof mean?
- They are introspective. Define?
- They are misanthropic. Define?
- What else do they lack which might be found in depression?
(3) Schizotypal:
- What type of anxiety do they have?
- What about their behaviours and beliefs?
Resentful and self-important
Suspicious and distrustful
Aloof - not friendly or forthcoming
Introspective - spends considerable time examining his own thoughts and feelings.
Misanthropic - having or showing a dislike of other people; unsociable.
Social anxiety
Odd behaviours and beliefs
Cluster B - Dramatic/emotional PD:
(1) Antisocial (Dissocial PD):
- why is this one important? - what do they disregard?
- what do they have little of?
(2) Borderline (Emotionally unstable PD):
- 2 signs
- Impulsive PD is a subclass of this. What do these people tend to do? - 2
- What about their relationships?
- Who is it common in?
Psychopathy
Dangerous and severe PD
Disregard rights of others
Rapid fluctuating mood and strong emotions
Implusive so self-harm and substance misuse
Intense unstable relationships
Young women
Cluster B - Dramatic/emotional PD:
(3) Histrionic:
- What is there affect like? - 2
- What 2 other signs to you see?
- What do they usually have concern over?
(4) Narcissistic:
- What are the pre-occupied with? - 2
- What do they think about themselves? - 2
- What do they lack? - 2
- What do they tend to do to others that they hate being done to them?
Shallow and labile affect
Dramatic and suggestible (easily swayed)
Preoccupied with prestige and appearance, attention seeking
Think they’re superior and have a strong sense of entitlement.
Lack of empathy or true intimacy
Criticism
Cluster C - Anxious/avoidant PD:
(1) Avoidant/anxious PD:
- What do they want but expect?
- What do they fear?
- What happens when they are criticised?
- What does this lead to?
(2) Dependent:
- What is the main sign of this?
Want acceptance but Expect rejection
Fear embarrassment
Severely hurt
Submissive
Feel like they can’t look after themselves and allow others to make decisions for them.
How is it diagnosed?
Those under 18 cannot be diagnosed with PD. What is it called instead?
History
Emergent PD
Aetiology:
Biological
Psychological
Social
Poor understanding of genetic basis
Abnormality of serotonin system
———————–
Problematic attachment with parents/caregivers
Invalidating environment
Trauma and shame
---------------------- Childhood abuse Neglect Poor parenting Adverse childhood events
Q’s to ask in history?
In general, do you have difficulty making and keeping friends?
Would you describe yourself as a loner?
In general do you trust other people?
Do you normally lose your temper easily?
Are you an impulsive sort of person?
Are you normally a worrier?
In general, do you depend on others a lot?
In general, are you a perfectionist?
ICD-10 for Emotionally-unstable PD:
Features - just list of the top of your head
Marked tendency to act impulsively (without consideration of the consequences)
Affective (emotional) instability
Ability to plan ahead may be minimal
Outbursts of intense anger
Often lead to violence or “behavioural explosions“
Easily precipitated when impulsive acts are criticized or thwarted by others
The general theme of impulsiveness and lack of self-control
ICD-10 for Impulsive PD:
Features - just list of the top of your head
Emotional instability
Lack of impulse control.
Outbursts of violence or threatening behaviour
(particularly in response to criticism by others).
ICD-10 for Borderline PD:
Features - just list of the top of your head
Characteristics of emotional instability
Patient’s own self-image, often unclear/ disturbed
Chronic feelings of emptiness
Intense and unstable personal relationships
Repeated emotional crises
Excessive efforts to avoid abandonment
Suicidal threats or acts of self-harm
Why do people self-harm?
What is transference and counter-transference?
Struggling with intolerable stress or unbearable situations
The patient may transfer defiance felt toward a parent onto the doctor.
Doctor reacts to the individual as one would react to their own child, e.g. by becoming increasinglycontrolling.
Management:
Why is biological Rx not used?
Psychological therapies:
- CBT as always
- DBT - How is it different from CBT?
Little evidence to support it but may be used for comorbid activities.
CBT
Dialectical behavioural therapy - CBT focuses on how your thoughts, feelings and behavior influence each other. While DBT does work on these things, emphasis is given more towards regulating emotions, being mindful, and learning to accept pain.
