Personality disorders Flashcards
define Personality disorders
A deeply ingrained and enduring pattern of inner experience and behaviour that deviates markedly from expectations in the individual’s culture .
It is pervasive and inflexible, has an onset during adolescence, is stable overtime and leads to distress or impairment (significant problems in occupation and social performance).
mneumonic: 3’P’s
- Persistent
- Problematic
- Pervasive – across different contexts
What is the difference between traits and disorders? ?
Trait - descriptive, low order elements of personality
Disorder - extreme traits which are inflexible, maladaptive and cause impairment/stress
What is the most prevelant personality disorder?
dissocial (3%) followed by histrionic (2–3%) and paranoid (0.5–2.5%).
Causes of PD?
Biological:
- genetic
- neurodevelopmental
Environmental
- adverse social circumstances
- difficult childhood experiences ex: abuse.
Risk Factors of PD?
SAD ginny
What should be considered when suspecting a diagnosis of personality disorder?
diagnosis must be based on many sources of info as possible
CANNOT diagnose under 17 yrs old
can overlap and have mix of PD
some people can have certain traits of a PD rather than it as a whole!
Types of personality disorders based on ICD-10.
Classified as Cluster A, B & C
Cluster A–>“weird” Odd/Eccentric’
- Paranoid
- Schizoid
- Schizotypal
Cluster B–> “wild” Dramatic/Emotional’
- Emotionally unstable (borderline personality)
- Histrionic
- Antisocial (dissocial)
- Narsastticis
Cluster C–>“worriers” Anxious/Fearful
- Dependent
- Anxious (avoidant)
- Anankastic (obsessional)
Clinical features of Cluster A
Paranoid–> “accusatory”
- suspicious in others (persecutory)
- unforgiving (GRUDGE HOLDER)
- Spouse loyalty questioned
- Perceives attack
- Envious (jealous)
- Criticism not liked/Cold affect
- TRUST ISSUES
- Self reference
Schizoid–> “aloof”
- Detached/solitory (flat affect) or blunt
- indifferent to praise or critisim
- Absence of close friends
- No emotion (cold)
- no interest in others or activites
- sexual drive reduced
- carries tasks alone
Schizotypal (different from schizophrenia but can go on to develop schizophrenia!)
- social isolation
- odd behaviour/thinking
- unconventional beliefs such as being convinced of having extra sensory abilities
how would you differentiate btw ‘Cluster A’ PDs and psychotic disorders?
Although they present with similar features (e.g. suspiciousness, odd beliefs and social withdrawal in schizophrenia),
the differentiating factor is that hallucinations and true delusions are ABSENT in Cluster A PDs.
Clinical features of Cluster B
Borderline (zainab)
- Abandonment feared
- Mood instability (very sensitive!)
- Suicidal behaviour
- UNSTABLE relationships (alternate btw idealization & devaluation)
- Intense relationships
- Poor anger control
- Impulsivity
- Disturbed sense of self (identity)
- Emptiness (chronic)
Histrionic
- Provocative behaviour
- Real concern for physical attractiveness
- ATTENTION seeker
- Influenced easily
- Shallow/Seductive
- inappropriately Egocentric (vain)/
- Exaggerated emotions
Antisocial (dissocial)–>common in men, the JOKER
- Callous (insensitive)
- BLAMES others!
- Reckless disregard for safety/ laws
- NO GUILT
- deceitful (na9aaab)–> repeatedly lying
- Poor planning (impulsive)
- Temper/Tendency to violence
Narsassitic (donald trump)
- Grandiose sense of self centered
- Preoccupation w/ fantasies of unlimited success, power, or beauty
- Sense of entitlement
- Taking advantage of others to achieve own needs
- Lack of empathy
- Excessive need for admiration
- Chronic envy
- Arrogant and haughty attitude
they tend to be choosy about picking friends, since they believe that n_ot just anyone is worthy of being their friend._ Uninterested in the feelings of others and may take advantage of them.
Clinical features of cluster C
Dependent
- Reassurance needed
- Experiencing diasagreement FATAL
- Lack of self confidence
- Iinitiating projects feared
- Abandonment feared
- Needy
- Companionship sought
- Exaggerated fear
Avoidant (anxious)
- Certainity of being LIKED
- Restriction of lifestyle in order to be secure
- Inadequency felt
- Embarressment feared so avoids social situations
- Social inhibition/Self esteem zag
Ankastic (obessional)
- stubborn
- fussy
- inflexible
- easily stressed
- perfectionist
- workaholic
- attention to details
- inefficient (spends too much time planning)
How is OCD different from OCPD?
How is social phobia different from avoidant personality disorder?
OCD: Ego-DYStonic
wishes it could STOP
OCPD: Ego-SYNtonic
happy with they way they are, dont wanna change
How is social Phobia different than Avoidant PD?
Social phobia: anxiety of SPECIFIC situations ex: public speaking
Avoidant: anxiety of GENERAL situations
Do patients with PD have insight?
Patients with PDs often have NO insight!
Reliable collateral history to elicit the pervasiveness and stability of the presentation.
A detailed personal and social history to understand the impact of the disorder on relationships, friendships and occupation must be taken.
Ix and DDx of PD?
Differntial diagnosis:
- Mood disorders–> ex: Mania/ Depression
- Psychotic disorders–> ex: Schizophrenia/ Schizoaffective disorder
- Substance misuse
- Organic–> Frontal lobe tumours/ Intracranial bleed
Investigations:
1) Questionnaires
- Personality Diagnostic Questionnaire (PDQ4)
- Eysenck Personality Questionnaire
2) Psychological testing
Minnesota Multiphasic Personality Inventory (MMPI)
3) CT head/MRI (rule out organic causes of personality change such as frontal lobe tumours and intracranial bleeds)
