Personality disorders Flashcards
What is a personality disorder?
Enduring pattern of behaviour that manifests itself as inflexible responses to personal and social situations
What are the different types of personality disorder?
EUPD Paranoid Schizoid Antisocial Narcissistic Histrionic Anankastic (obsessional) Dependent
What is EUPD?
Impulsive actions
Intense, short-lived emotional attachments
Chronic internal emptiness
Frequent self-harm
Transient pseudo-psychotic features
Strong family history of mood disorders
A disorder of mood and how a person interacts with others
Differs significantly from an average person in terms of how he/she thinks, perceives, feels, or relates to others
Emotionally unstable, anxiety, and pattern of self-destructive behaviour
What is paranoid PD?
Extreme sensitivity Suspicion Litgiousness Self-importance Preoccupations with conspiracy theories
What is schizoid PD?
Emotional coldness and detachment Limited capacity to express emotions Indifference to praise or criticism Preference for solitary activities Lack of close friendships Marked insensitivity to social norms
What is antisocial PD?
Callous unconcern for the feelings of others
Incapacity to maintain enduring relationships
Very low tolerance of frustration
Incapacity to experience guilt and to learn from experience
Tendency to blame others
What is narcissistic PD?
Inflated sense of self-importance
Need to be admired
Self-referential nature
Arrogance
What is histrionic PD?
Self-dramatization, theatrically, suggestibility
Shallow and labile emotions
Continual seeking for excitement and appreciation
Inappropriately seductive appearance and behaviour
What is anankastic PD?
Feelings of excessive doubt and caution
Preoccupation with details, rules and order
Perfectionism
Excessive conscientiousness, scrupulousness, pedantry, and rigidity
What is dependent PD?
Encouragement of others to make their personal decisions
Subordination of their needs to others
Unwillingness to make demands on others
Feelings of inability to care for themselves
Preoccupation with fears of being abandoned
What are the different types of EUPD?
Borderline - more difficulties with relationships, self-harming, and feelings of emptiness
Impulsive - more difficulties with impulse behaviour and angry feelings
What important questions should you ask in a history?
What are your relationships like? Do you change your emotions a lot? Have you ever self-harmed? Have you ever had any suicidal thoughts? Have you ever heard voices? How quickly do their emotions change? Do you make impulsive decisions?
What are the risk factors for EUPD?
Abandonment in childhood/adolescence Disrupted family life Poor communication in family Sexual, physical, and emotional abuse Female Hospitalised psychiatric patients
How common is EUPD?
Most often seen in women
0.7-2%
20% of patients in psychiatric wards
High in prison population
What are the differential diagnoses of EUPD?
Bipolar disorder Major depression Schizophrenia ADD PTSD
How does EUPD present?
Emotional instability
- Severe mood swings over a short space of time
- Repeated crises and acts of self-injury
- Frequent displays of inappropriate anger
Disturbed patterns of thinking or perception
- Upsetting thought
- Brief episodes of strange experiences - hallucinations
- Prolonged episodes of abnormal experiences
Impulsive behaviour
- Impulse to self-harm
- Impulsiveness such as substance abuse or sexual relationships
- Spending sprees, binge drinking, drug misuse, gambling
Intense but unstable relationships with others
- Intense fear of being abandoned
- May also feel smothered leading to a love-hate relationship
- Cannot tolerate being alone
- Views of other people changing quickly
Uncertainty about identity
Interests and values change rapidly
Frequent feelings of emptiness and boredom
What is the pathology of EUPD?
Genetics
Altered levels of serotonin in brain
Smaller amygdala, hippocampus, and orbitofrontal cortex
Environmental factors - emotional, physical, or sexual abuse, neglect, growing up with family member with severe mental health conditions
What investigations should you do for EUPD?
Answering yes to 5/more of following questions
- Do you have an intense fear of being alone, causing you to act in ways that, on reflection, seem out of the ordinary or extreme such as constantly phoning someone?
- Do you have a pattern of intense and unstable relationships with other people switching between thinking you long someone to hating them?
- Do you ever feel you don’t have a strong sense of your own self and are unclear about you self-image?
- Do you engage in impulsive activities in 2 areas that are potentially damaging?
- Have you made repeated suicide threats/attempts in your past and engaged in self-harming?
- Do you have mood swings?
- Do you have long-term feelings of emptiness and loneliness?
- Do you have sudden and intense feelings of anger and aggression?
- When you find yourself in stressful situations, do you have feelings of paranoia or do you feel you are disconnected from the world or from your own body?
How is EUPD managed?
CPA - Assessment of health and social needs - Care plan - Appointments of care co-ordinator - Reviews Psychotherapy DBT/MBT Therapeutic communities Art therapies Numbers to contact if you're experiencing a crisis
What is the prognosis of EUPD?
With treatment, many learn to manage symptoms and improve quality of life
Without treatment, often have increased risk of drug and alcohol abuse, depression, self-harm and suicide
