Personality Problems Flashcards
Personality traits vs Personality disorder
Traits = enduring patterns of perceiving, thinking about, and relating to both self and the environment, exhibited in a wide range of social and personal contexts
Disorder = individual traits are persistently inflexible and maladaptive, stable over time, which cause significant personal distress or functional impairment
Classification of personality disorders by aetiology - acquired vs specific
Acquired
- develops after, or directly related to, recognisable insult
Specific
- difficult to find direct causal relationship, but genetic and environmental factors are implicated; adolescence or early adult onset
- -> dimensional approach: disorders exist on a continuum from normal to severely ill; used in research
- -> categorical approach: distinct types of personality disorder (seldom accurate representation of reality as there is considerable overlap of traits and most individuals don’t fit perfectly)
Diagnostic criteria for general personality disorder
- Enduring pattern of inner experience and behaviour that deviates markedly from the expectations of the individual’s culture in >2 of the following:
- cognition (way of perceiving and interpreting)
- affectivity
- interpersonal functioning
- impulse control - Inflexible and pervasive pattern across a broad range of personal and social situations
- Clinically significant distress or impairment in functioning
- Stable and long duration, onset traced back to adolescent or early adulthood
- Not better explained by another mental disorder and not attributable to substance or medical condition
Cluster A personalities - “odd or eccentric”
Paranoid
- suspects others are harming, exploiting, or deceiving them
- doubts spouse’s fidelity
- bears grudges
- tenacious sense of personal rights, litigious
Schizoid
- emotional coldness
- prefers solitary activities, takes pleasure in few activities
- indifferent to praise or criticism
Schizotypal
- eccentric, odd beliefs or magical thinking
- unusual perceptual experiences; ideas of reference, suspicious or paranoid ideas
- circumstantial thinking
- socially withdrawn
Cluster B personalities - “dramatic, emotional, erratic”
Borderline
- unstable, intense relationships
- unstable self-image, mood fluctuations
- impulsivity (binge eating, sex, spending money, substance abuse)
- chronic feelings of emptiness, repetitive suicidal or self-harm behaviour
- frantic efforts to avoid abandonment
Antisocial
- repeated unlawful or aggressive behaviour, lying, deceitfulness, reckless irresponsibility
- lack of remorse or incapacity to feel guilt
- often have conduct disorder in childhood
Histrionic
- dramatic, exaggerated expressions of emotion, attention seeking
- seductive behaviour
Narcissistic
- grandiose sense of self-importance, need for admiration
Cluster C personalities - “anxious or fearful”
Dependent
- excessive need to be cared for
- submissive, clinging, fear of separation
Avoidant
- hypersensitivity to critical remarks or rejection
- fears of inadequacy, inhibited in social situations
Obsessive compulsive
- preoccupation with orderliness, perfectionism and control
- devoted to work at expense of leisure
- pedantic, rigid, stubborn
Aetiology and associations of personality disorders
GENETIC
Disordered attachment leads to difficult relationships –> may manifest as personality disorders
Cluster A more common in FHx of schizophrenia
Schizoid and schizotypal neurodevelopment disorders?
Borderline personality disorder –> depression more common
Early adverse social circumstances a/w cluster B personality disorders
Management of borderline personality disorder
Careful planning, structure; autonomy and choice encouraged
Multidisciplinary approach
Crisis management
- self-management strategies, sources of support
- short term drugs to alleviate distress
- crisis resolution or home tx considered before admission
Pharmacological
- treat comorbid mental illness
- antidepressants may be used in depressive symptoms
- SSRI may have OC or impulsive behaviour
- mood stabilisers in aggression, impulsivity
Psychosocial
- psychoeducation
- coping strategies, relaxation, distraction, skills/hobbies
- social services: housing, finances, employment
Long term management
- CBT
- psychodynamic psychotherapy
- cognitive analytic therapy
- mentalisation based therapy - understand what is going on in their minds and minds of others
- dialectical behaviour therapy
