Psychiatry - Personality Disorder Flashcards
Personality Disorder?
Definition?
DSM-V
An enduring pattern of inner experience and behaviour that deviates markedly from the expectations of the individual’s culture. This pattern is manifested in two (or more) of the following areas :
- Cognition
- Affect
- Interpersonal skills
- Impulse control
The enduring pattern is inflexible and pervasive across a broad range of personal and social situations
Personality Disorder?
Definition?
DSM-V Continued..
- The enduring pattern leads to clinically significant distress or impairment in social, occupational or other important areas of functioning
- The pattern is stable and of long duration and its onset can be traced back to at least adolescence or early childhood
- The enduring pattern is not better accounted for as a manifestation or consequence of another mental disorder
- The enduring pattern is not due to the direct physiological effects of a substance or a general medical condition
Personality Disorder?
ICD-10 Definition?
ICD-10 Definition
A severe disturbance in the characterological condition and behavioural tendencies of the individual, usually involving several areas of the personality and nearly always associated with considerable personal and social disruption
Personality Disorder?
General Features?
- Enduring, inflexible, pervasive
- Associated with significant distress or disability
- Stable across a variety of domains
- Differs significantly from that which is culturally expected
Personality Disorder?
Aetiology and Risk Factors?
- The aetiology of personality disorders remains obscure.
- Traditional belief is that these behaviours result from a dysfunctional early environment that prevents the evolution of adaptive patterns of perception, response and defence
Factors in childhood linked to PD:
- Sexual abuse
- Physical abuse
- Emotional abuse
- Neglect
- Being bullied
Personality Disorder?
Risk Factors?
Emotional or behavioural factors that might play a part include:
- Truanting
- Bullying others
- Being expelled/suspended
- Running away from home
- Deliberate self-harm
- Prolonged periods of misery
Personality Disorder?
Risk Factors?
- Increase in evidence showing a link between PD and genetic factors
- People with personality disorders are at an increased risk for many psychiatric disorders, particularly mood disorders
- If depression with PD then depression more persistent cf to depression alone
- PD sufferers more likely to have a forensic his
Personality Disorder?
Classification?
- ICD-10 gives 9 categories of personality disorder
- DSM-IV gives 10 personality disorders that are divided into three clusters, designated A, B, C:
- CLUSTER A (Odd or Eccentric) - Paranoid, Schizoid, Schizotypal
- CLUSTER B (Dramatic, Emotional & Erratic) - Histrionic, Narcissistic, Antisocial and Borderline
- CLUSTER C (Anxious and Fearful) - obsessive-compulsive, avoidant and dependent
Personality Disorder?
Classification DSM-IV?
Cluster A: Schizoid?
- Lifelong pattern of voluntary social withdrawal – social isolation
- Quiet, unsociable, constricted affect
- Eccentric and reclusive, preference for fantasy
- Restricted emotions, detachment
- Indifferent to praise or criticism, emotionally cold
- No desire for close or sexual relationships – too much work
- No thought disorder, paranoia, illusions, or perceptual disturbance
- M>F
- Treatment – group therapy & CBT, low dose antidepressants or antipsychotics
- Higher risk of developing schizophrenia
Personality Disorder?
Classification DSM-IV?
Cluster A: Schizotypal?
- Eccentric behaviour
- Peculiar thought processes e.g. ideas of reference, superstitions, claims of telepathy
- Suspicious
- Excessive social anxiety
- Inappropriate or restricted affect
- Severe social detachment, social deficits…. Fear of people!
- Usually diagnosed in early adulthood
- Treatment - psychotherapy, low dose of antipsychotics
Personality Disorder?
Classification DSM-IV?
Cluster A:
- Persuasive distrust of people
- Suspicious without reason
- Unforgiving
- Exaggerated sense of own rights
- Blames own problems on others
- Avoids confiding in others
- M>F, diagnosed early adulthood
- Treatment - psychotherapy, short course antipsychotic
Personality Disorder?
Classification DSM-IV?
Cluster B: Dissocial (Antisocial)
- Disregard for social obligations
- Does not conform to social norms
- Callous unconcern for feelings of others
- Behaviour not readily modifiable by experience
- Low tolerance for frustration
- Tendency to blame others
- Deceitful, lying, manipulative, impulsive
- Can be irritable and aggressive
- Traits can be identified in childhood (conduct disorder)
- M>F, familial pattern
- Substance abuse and depression common
Personality Disorder?
Classification DSM-IV?
Cluster B: Borderline (Emotionally unstable)
- Most common type presenting to GP
- Unstable, unpredictable mood, affect & behaviour
- Usually in a state of crisis
- Inappropriate anger and difficulty in managing anger appropriately
- Underlying fear of rejection
- Feel are treated unjustly compared to others
- Poor self-image, underlying insecurities
- Short transient psychotic episodes (i.e. “borderline” psychosis…!)
- Paranoid ideation and impulsivity
- Self-harm and suicide attempts = greatest risk for suicide
- Unstable and intense relationships
- Treatment - psychotherapy, anti-depressants, anti-psychotics (not recommended by NICE but used in practice)
Personality Disorder?
Classification DSM-IV?
Cluster B: Histrionics?
- Shallow and labile affect
- Over-emotional, dramatic, flamboyant
- Superficial, unable to maintain relationships
- Theatricality
- Exaggerated expressions of emotion
- Egocentric, lack of concern for others
- Constantly seeking appreciation
- Exaggeration of thoughts & feelings
- Treatment - antidepressants, psychotherapy
Personality Disorder?
Classification DSM-IV?
Cluster B: Narcissistic?
- Inflated self-image, pattern of grandiosity
- Self-entitled
- Arrogant, haughty
- Need for admiration
- Lack of empathy
- Fragile self-esteem
- Depression common
- Treatment – psychotherapy, lithium, antidepressants
Personality Disorder?
Treatment?
Social?
- Activities – self esteem, reduce dependence
- Interpersonal relationships
- Housing
- Psycho-education – for support workers, family
