personality disorders REVISE Flashcards
what axis of DSM V do personality disorders come under?
axis 2
characteristics of all personality disorders?
persitent not episodic
problems in relationships and social functioning
inflexible perception of the outside world and self which deviates from cultural exceptions
violence towards themselves (towards others in antisocial PD)
psychiatry compared to psychology
psychiatry - all about diagnostic categories
psychology - work on basis of formulations not diagnosis
statistics of GP visits of those with a PD?
stats for A&E?
visits 5x as often as a regular person
24% of GP visits are by those with a PD
9% of A&E visits
example of when a PD isn’t persistent?
Zannarini found that 93% of those diagnosed with borderline PD no longer met criteria 16 years later (remission) due to personality maturation
however, all still experiencing psychological difficulties such as impairment of social functioning so not completely cured
definition of remission?
a temporary reduction of disease severity or pain
stat of how many world wide given diagnosis of PD?
1 in 16 people
morbidity stats related to those with PD?
one of the highest suicide rates of any mental health disorder (8-10%)
death also due to health issues relating to disorder e.g substance abuse
men with PD die 18 years earlier
women with PD die 19 years earlier
what makes PDs much more difficult to treat?
when it is paired with another mental disorder in an individual
what percent of those in mental health clinics have a PD?
over 30%
what percentage of the prison population has a PD?
over 70%
difference between axis 1 and axis 2?
axis 1 more episodic psychiatric disorders
axis 2 PDs and other persistent psychiatric disorders
how many with BPD have a depressive disorder?
40%
what does depression + personality disorder increase likelihood of?
the PD part increases likelihood of chronicity (long duration) of depression
what percentage of those with bipolar disorder have a PD?
13%
what disorder is almost ubiquitous (simultaneous) with PD?
anxiety
what percent of drug users have a PD?
37%
what percent of alcohol misusers have a PD?
53.2%
how many have an eating disorder alongside their PD?
80%
which forms of PDs are in cluster A?
paranoid, schizoid, schizotypal
which forms of PD are in cluster B?
antisocial, borderline, histrionic, narcissistic
which forms of PD are in cluster C?
avoidant, dependent, obsessive-compulsive
what are the criticisms of taking a categorical approach to diagnosising PD?
PDs generally fulfill the criteria for more than one form of the disorder
personality not naturally idvided into these categories
characteristics of cluster A?
paranoid and withdrawn so little contact with services
characteristics of Paranoid PD?
see others as critical and attacking of them
so react in a violent manner towards others
characteristics of Schizoid PD?
withdrawn and not engage in social contexts
characteristics of schizotypal PD?
causes?
odd and excentric ideas and behaviour (milde symptoms of schizophrenia)
61% heritability and at risk if 1st degree relative has schizophrenia
characteristics of APD?
causes?
disregard for rights of others
tendency towards agressive behaviour towards others
3/4 of criminals meet criteria
genetics, exposure to violence and poverty
characteristics of BPD?
comorbidity?
suicide rates?
causes?
instability and impulsivity in interpersonal relationships and mood
bouts of being psychotic and hearing voices as lack of realitiy understanding
highest rates of suicide behaviour and 2/3s engage in self mutilation (high contact with services and accident emergency)
high comorbidity with mood disorders and ptsd
genetics (35% concordance with MZs and only 7% in DZs) and childhood abuse
characteristics of histrionic PD?
dramatic presentations
often with conversion disorders (physical symptoms presenting with psychological basis e.g paralysis of arm but not functional problem as psychological problem)
characteristics of narcissistic PD?
and parental cause
self agrandising
require constant attention
lack of empathy
caused by emotional coldness but overemphasis on child’s achievements by parents
characteristics of obsessive-compulsive PD?
not the same as OCD
tidy and controlling in beh in general
“control freaks”
(not particular obessions and compulsions)
characteristics of avoidant and dependent?
avoidance due to fear over negative feedback
comorbid with anorexia and bulimia and 80% major depression
cluster with highest heritability?
C - 0.62
al PD - 0.6
which sorts of PD behaviours are more heritable than others?
more aggressive antisocial behaviour than non aggressive
how may ICD 11 diagnose PDs?
using a dimensional not categorical approach
separate personality into 4 descriptive domains
which behaviours of PD have been linked with serotonergic dysfunction?
impulsiveness, auto-aggression and outwardly directed aggression
which behaviours of PD are associated with noradrenergic abnormailities?
risk taking and sensation seeking?
desrcibe Kernberg’s developmental theory of PDs?
viewed that excess agression (constitutional) leads to splitting
what is splitting?
psychoanalytic idea of failure to bring together positive and negative qualities of self and others into a cohesive whole, dividing world into all good and all bad
e.g view ‘mean mum’ as a separate person to ‘nice mum’ and can’t comprehend that they are the same person
describe Adler & Buie’s developmental theory of PD?
have lack of object constancy (lack any sense of self comfort in their mind when they’re alone so rely on others to cope - can’t be alone and cope)
describe Mahler’s developmental theory of PD?
develops when abandoned and alone
describe Bowlby’s develpomental theory of PD?
BPD associated with anxious-resistant and avoidant attachment
is there strong evidence for any treatments of PD?
no, poor evidence
need more research
which psychological therapies have the best supporting evidence for treating BPD?
group therapy:
dialectical behaviour therapy
mentalisation based therapy
(have randomised control trials supporting effectiveness)
transference focussed therapy (developed by Kernberg)
therapeutic community
schema focussed CBT
(have less randomised control trials supporting effectiveness)
what does invalidation mean?
child constantly treated that their P.O.V is not important and told wrong
what is mentalisation?
what is mentalisation based therapy focused on improving?
mentalisation - thinking about their own and others’ feelings
(parents who can’t mentalise produce children who can’t mentalise)
MBT improves reflective function - think about mental states of others by being thoughtful
neurological basis of mentalisation?
critical period for emotional development in 1st and 2nd year of life (e.g developing theory of mind)
hardwiring of attachment interactions
which tiers are commissioned by who?
tier 4-6 nationally commissioned
tier 1-3 locally commissioned
above which tier do patients begin to cost a lot of money?
tier 4
what does the relational affective model contain?
understanding neurodevelopmental and relational problems and underlying defenses
(psychoanalytic)
what does the relational affective model do?
stay with someone from tier 4 to outpatient for 3 years
therapy interventions and interventions for teams
what is the relational affective formation?
all patients have in common that operate in 2 states of mind:
need to ‘get in’side something to be looked after (driven by) and want people to stay with them (don’t ask but behaviour telling) e.g hospital
PROXIMITY SEEKING
need to ‘get out’ as feels trapped in care and wants to escape people
DISENGAGING
what symptoms do people present when in ‘get in’ frame of mind?
suicidal
binging
somatic symptoms to get to doctor and into hospital
issue with admitting someone in state of ‘get in’ into hospital or care?
become more babylike and dependent and therefore mor suicidal
symtpoms of ‘get out’ frame of mind?
low mood and depressed often diagnosed of depressed restrciting not binging on food and help won't turn up to appointments and claim 'don't need help' want to look after others not themselves
which frame of mind more often gets discharged?
‘get out’
what happens when ‘get out’ happens?
when alone feel ‘get in’ and abandoned
can you be aware of both ‘get in’ and ‘get out’ states at once?
no,
don’t see themselves as ever being dependent or suicidal etc.
what is the get in get out cycle?
trapped, get outside, dropped, get inside
is there increasing prevalence in higher or lower tiers?
lower tiers
how is system exacerbating get in get out?
constantly being dropped and trapped
who is Jaak Panksepp?
took focus from just cognition to emotion using 7 basic emotion command systems in neuroscience research
what does each basic emotion command system have?
its own set of neurotransmitters and pathways
hardwired emotion equiptment which have affect on mood
e.g panic and seeking
difference between classification of personality disorders in DSM4 and DSM5?
DSM4 - 10 PDs (clusters)
DSM5 - 6 PDs
what are some of the general psycho-social causes of personality disorders?
low emotional care but overprotective parents or parental loss/separation
childhood trauma
history of mood disorder and substance abuse
