Anxiety Disorders & Personality Disorders Flashcards
(91 cards)
1
Q
What is a personality disorder?
A
An umbrella term that covers a number of variations of maladaptive personality traits that cause significant psychosocial distress and interfere with everyday functioning.
2
Q
There are 3 clusters of personality disorders: A, B, and C.
What typically defines a Type A personality disorder?
A
Characterised by odd or eccentric behaviors.
You find it difficult to relate to other people.
3
Q
What are the 3 types of Type A personality disorder?
A
- Paranoid
- Schizoid
- Schizotypal
4
Q
What characterises a paranoid personality disorder?
A
A pervasive and enduring pattern of irrational suspicion and mistrust of others
Demonstrates hypersensitivity to criticism and potential slights
Exhibits reluctance to confide in others due to fear of information being used maliciously against them
Often preoccupied with unfounded beliefs about perceived conspiracies against themselves
5
Q
What characterises a schizoid personality disorder?
A
Characterised by an enduring pattern of detachment from social relationships and a restricted range of emotional expression
Displays a pervasive lack of interest in or desire for interpersonal relationships, often preferring solitary activities
Shows an emotional coldness, detachment, or flattened affectivity
Often has few, if any, close relationships outside of immediate family
6
Q
What characterises a schizotypal personality disorder?
A
Characterised by a chronic pattern of impaired social interactions, distorted cognitions and perceptions, and eccentric behaviors
Demonstrates inappropriate or constricted affect, and peculiar, eccentric or bizarre behavior
Displays odd thinking and speech, such as magical thinking, peculiar ideas, paranoid ideation, and belief in the influence of external forces
Shares certain cognitive or perceptual distortions with schizophrenia, but maintains a more intact grasp on reality
7
Q
What type of personality disorder features a lack of interest or desire to form relationships with others and feelings that this is of no benefit to them?
A
Schizoid
8
Q
What type of personality disorder features difficulty in trusting or revealing personal information to others?
A
Paranoid
9
Q
What type of personality disorder features unusual beliefs, thoughts and behaviours, as well as social anxiety that makes forming relationships difficult?
A
Schizotypal
10
Q
What typically defines a Type B personality disorder?
A
Cluster B personality disorders are grouped based on those who find it difficult to control their emotions. You might be viewed as unpredictable by others.
Characterised by dramatic, emotional, or erratic behaviors
11
Q
What are the 4 types of Type B personality disorders?
A
- Antisocial
- Borderline
- Histrionic
- Narcissistic
12
Q
What characterises antisocial PD?
A
Defined by a pervasive pattern of disregard for and violation of the rights of others.
- Individuals with this disorder exhibit a lack of empathy and frequently engage in manipulative, impulsive actions.
- Manifestations include aggressive, unremorseful behavior, and consistent irresponsibility, which often results in a failure to obey laws and social norms.
13
Q
What characterises borderline PD?
A
Characterized by a recurring pattern of abrupt mood swings, unstable personal relationships, and self-image instability.
- The propensity towards self-harm is commonly observed in these patients.
- Relationships often fluctuate between extremes of idealization and devaluation, a process known as “splitting”.
- There is often an inability to control temper and manage affective responses appropriately.
14
Q
What characterises hisitrionic PD?
A
Predominantly characterized by attention-seeking behaviors and excessive displays of emotion.
- Individuals may display inappropriate sexual behaviors.
- Their emotional expressions tend to be shallow, dramatic, and often perceived as exaggerated.
- They often perceive relationships as being more intimate than they truly are, reflecting a distorted perception of interpersonal boundaries.
15
Q
What characterises narcissistic PD?
A
Characterized by a persistent pattern of grandiosity, a strong need for the admiration of others, and a marked lack of empathy.
- Individuals with this disorder often display a sense of entitlement and will exploit others to fulfill their own desires.
- Tendency to be arrogant and preoccupied with personal fantasies and desires, often at the cost of disregarding others’ feelings and needs.
16
Q
In which PD is there a propensity towards self-harm?
A
Borderline PD
17
Q
In which PD may patients display inappropriate sexual behaviors?
A
Histrionic
18
Q
Which type of PD features fluctuating strong emotions and difficulties with identity and maintaining healthy relationships?
A
Borderline
19
Q
Which type of PD features the need to be at the centre of attention and having to perform for others to maintain that attention?
A
Histrionic
20
Q
Which type of PD features feelings that they are special and need others to recognise this or else they get upset?
A
Narcissistic
21
Q
What typically defines a Type C personality disorder?
A
People with cluster C personality disorders have strong feelings of fear or anxiety.
22
Q
What are the 3 types of Type C PD?
A
- Avoidant
- Dependent
- Obsessive-compulsive
23
Q
What characterises avoidant PD?
A
Characterized by intense feelings of social inadequacy, fear of rejection, and hypersensitivity to criticism
Patients often self-impose isolation to avoid potential criticism, despite a strong desire for social acceptance and interaction
24
Q
What characterises dependent PD?
A
Characterized by a pervasive and excessive need to be taken care of, leading to submissive and clinging behavior
Individuals often lack self-confidence and initiative, relying excessively on others for decision-making
Patients may urgently seek new relationships as a source of care and support when existing ones end
25
What characterises obsessive-compulsive PD?
Characterized by an excessive preoccupation with orderliness, perfectionism, and control, often at the expense of flexibility, openness, and efficiency
- Contrary to obsessive-compulsive disorder (OCD), obsessive-compulsive personality disorder (OCPD) is not associated with recurrent, intrusive thoughts or rituals
- Indications may include strict adherence to routines, perfectionism to the point of dysfunction, and a persistent reluctance to delegate tasks to others
- Symptoms are generally ego-syntonic, meaning the patient perceives them as rational and desirable, thereby differentiating OCPD from OCD, where symptoms are typically ego-dystonic and distressing to the individual.
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What type of PD features severe anxiety about rejection or disapproval and avoidance of social situations or relationships?
Avoidant
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What type of PD features heavy reliance on others to make decisions and take responsibility for their lives, taking a very passive approach?
Dependent
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What type of PD features unrealistic expectations of how things should be done by themselves and others, and catastrophising about what will happen if these expectations are not met?
Obsessive-compulsive
29
Define anxiety
Anxiety can be defined as a constellation of psychological and physiological responses to a potential/uncertain threat and is an essential function of the central nervous system (CNS).
It is analogous to pain in that it is an unpleasant experience which exists to automatically motivate us to avoid harm.
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What are the most common mental health conditions globally?
Anxiety - lifetime prevalence ranges from 5% to 29%
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What is 'trait anxiety'?
Your propensity to experience the anxiety response when exposed to a stressor.
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What do trait anxieties arise from?
It is a stable characteristic arising from a multitude of genetic and environmental factors, particularly adaptive responses to experiences of potential threat during development (for instance bullying, trauma, neglect or parental loss), as well as the nature of early attachment relationships.
These experiences ‘calibrate’ the CNS response to a threat in adulthood.
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How do trait anxieties relate to survival?
High trait anxiety confers a greater survival advantage – if an organism tends to avoid harm in dangerous situations, it is more likely to survive and reproduce
34
How can early life attachments impact trait anxiety?
In brief, the close and reciprocal relationship between an infant/child and its parent(s) is the crucible within which the developing brain learns how to think and feel.
Through countless repeated daily experiences of being cared for, comforted when in pain, reassured when anxious – essentially, loved – a child gradually internalises and develops the ability to think, regulate emotion and cope with anxiety independently. For this development to take place, parental care simply needs to be “good enough” (the technical term in attachment psychology), but if this care is inconsistent, dismissive or perhaps even frightening, various problems can emerge, including high trait anxiety.
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What is 'state anxiety'?
“State anxiety” is simply the state of feeling anxious.
36
Give some pyschological symptoms of state anxiety
An unpleasant feeling of suspense, recurrent automatic thoughts about negative outcomes (rumination or “worrying”), reduced concentration, hypervigilance
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Give some behavioural symptoms of state anxiety
Avoidance of anxiogenic stimuli, restlessness/agitation
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Give some physiological symptoms of state anxiety
Palpitations, dyspnoea, muscle tension, disturbed sleep, fatigue, nausea
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Give some signs of state anxiety
Tachycardia, tachypnoea, tremor, sweating, pallor, pupil dilation (i.e. sympathetic nervous system arousal)
40
What is anxiety experienced by the observer?
This is a feature of something called “countertransference” and is part of the normal unconscious communication of affective states from one person to another
41
What are 5 processes thought to drive a spiral of anxiety?
1. Avoidance
2. Attentional and cognitive bias
3. Anxious rumination
4. Low self-worth
5. Poor sleep
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How can avoidance increase anxiety?
To motivate avoidance is largely the reason anxiety exists in the first place, but unfortunately, it minimises opportunities to unlearn your fear of a given stimulus.
It can perpetuate existing anxiety associated with specific situations or stimuli (such as social interaction or crowded places).
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How can attentional and cognitive bias contribute to anxiety?
State anxiety primes us to automatically pay attention to threats and to interpret ambiguous information as threatening.
This is useful to anticipate danger in a fight-or-flight situation, but in everyday circumstances (where the stressors driving state anxiety are often ubiquitous and cannot be easily escaped, i.e. pressure at school), this tendency to perceive threats in various situations is likely to heighten anxiety and increase the range of things you feel anxious about.
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What is rumination?
Continuously thinking about the same thing
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How can anxious rumination contribute to anxiety?
The process of recurrently thinking through possible catastrophic outcomes of one’s situation (also known as worrying) is another function of state anxiety which we can assume was useful in evolutionary terms; it is thought to represent an automatic attempt at problem-solving, which serves to maintain a state of vigilance for potential danger. However, again in this context, it may further increase state anxiety.
46
Which mental health problem is anxiety frequently seen with?
Depression - they can often be thought of as one extensive network of feedback loops which generate both anxiety and depressive symptoms.
47
How can low self-worth contribute to anxiety?
Negative beliefs about yourself and associated low mood are components of depression which can be seen to both exacerbate anxiety (for instance if you feel you are incompetent, you will experience more anxiety about tasks you have to complete) and be exacerbated by anxiety (for example, feelings of failure associated with recurrently avoiding situations due to anxiety).
48
What are the different types of anxiety disorder?
1. Generalised anxiety disorder (GAD)
2. Phobic anxiety disorder
3. Panic disorder
Other related disorders:
1. Post-traumatic stress disorder (PTSD)
2. Complex post-traumatic stress disorder (C-PTSD)
3. Obsessive-compulsive disorder (OCD) or related disorders
49
What is GAD?
A period of at least 6 months with persistent “free-floating” anxiety (not restricted to/predominant in any specific circumstances), or excessive worry focused on multiple everyday events.
50
Give some common features of GAD
Psychological --> worry, apprehension, fear, persistent nervousness, poor concentration, irritability
Arousal --> hypervigilance, restlessness, increased startle response
Motor --> muscle tension, tension headaches, trembling, purposeless activity
Sympathetic autonomic over-activity:
- CVS --> palpitations, tightness, pains, tachycardia
- Resp --> over breathing, difficulty inhaling
- GI --> epigastric discomfort, dry mouth, loose stools, butterflies
- GUS --> freq mictuiriton
- Neuro --> blurred vision, light headed
Other --> sleep disturbance, sweating, derealisation, depersonalisation
Fears --> patient or relative will shortly become ill or have an accident, impending danger, unrealistic ideas of danger, negative thoughts, feeling they can’t cope
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Depersonalisation and derealisation are often a clinical feature of GAD (and other mental health issues e.g. depression, schizophrenia, alcohol abuse).
What are depersonalisation and derealisation?
Depersonalisation --> altered or lost sense of personal reality or identity)
Derealization --> surroundings feel unreal
52
Give some differentials for GAD
Hyperthyroidism (look for goiter, tremor, tachycardia, weight loss, arrhythmia, exophthalmos)
Substance misuse (intoxication – amphetamines; withdrawal – benzodiazepines, alcohol)
Excessive caffeine intake
Depression: anxiety is a common feature of depression and vice versa. Identifying which condition appeared first and which is currently more prominent provides useful diagnostic cues. If both conditions are present, a diagnosis of mixed anxiety and depressive disorder is made.
Anxious (avoidant) personality disorder: the patient describes themselves as an anxious person without a recent significant increase in anxiety levels. (Note, this disorder can predispose the individual to anxiety disorders.)
Early-stage dementia
Early-stage schizophrenia
53
What are phobic anxiety disorders?
Abnormal state anxiety evoked only/predominantly by a specific external situation/object which is not currently dangerous. The key feature is the AVOIDANCE of that situation.
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What is agoraphobia?
Extreme or irrational fear of entering open or crowded places, of leaving one's own home, or of being in places from which escape is difficult.
e.g. crowds, public places, leaving home
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What is social phobia?
A long-term and overwhelming fear of social situations.
Associated with low self-esteem and fear of criticism.
56
Give some specific phobias
Claustrophobia, animal phobias etc
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Give some characteristics features of phobic anxiety disorders
Anticipatory anxiety (about exposure to precipitant, and about anxiety itself)
Somatic symptoms (e.g. palpitations, sweating, trembling, dyspnoea, chest pain, dizziness, chills, hot flushes)
58
What is panic disorder?
Recurrent unpredictable episodes of severe acute anxiety, which are not restricted to particular stimuli or situations (i.e. panic attacks).
Can occur with or without agoraphobia ie. fear of leaving house = panic disorder with or without agorophobia
59
Give some characteristic features of panic disorder
A crescendo of anxiety, usually resulting in exit from the situation
Somatic symptoms (e.g. palpitations, sweating, trembling, dyspnoea, chest pain, dizziness, chills, hot flushes)
Secondary fear of dying/losing control (often related to the somatic symptoms)
60
What is a positive feedback loop in anxiety?
There are several ways the brain can process anxiety, but under the wrong conditions (and/or given sufficiently prolonged and intense stressors) some of these automatic patterns of thought and behaviour can, themselves, perpetuate and worsen the anxiety.
This drives increasingly maladaptive coping strategies and these ongoing patterns gradually spiral into an illness.
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What 2ary fears are present in panic disorder?
Secondary fears include dying, losing control, or insanity.
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What is the age incidence of panic disorder?
Bimodal incidence, peaking at ages 20 and 50.
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Does panic disorder affect males or females more?
2-3 times more prevalent in females.
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What phobia is concurrent in 30-50% of panic disorder cases?
Agoraphobia
May result in fear of situations where panic attacks occur or lead to agoraphobia.
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Complications of panic disorder?
Increased risk of attempted suicide with comorbid depression, alcohol misuse, or substance misuse.
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What is mixed anxiety and depresive disorder?
Both anxiety and depression symptoms are present, with neither clearly predominating.
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Management options for anxiety disorders?
Often both psychological therapies to address the problem (e.g. breaking positive feedback loops) AND medications are required.
Stepwise treatment algorithm depending on severity:
1. Psychoeducation, sleep hygiene, and self-guided cognitive-based therapy (CBT)/ relaxation techniques
2. CBT
3. Pharmacological (equal 1st line with CBT)
68
What drug is 1st line in management of anxiety disorders?
The first-line drug therapy is selective serotonin reuptake inhibitors (SSRIs) or serotonin and norepinephrine reuptake inhibitors (SNRIs)
N.B. Combining an SSRI with CBT may be superior to either treatment alone
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What are escitalopram or sertraline examples of?
SSRIs
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What are duloxetine or venlafaxine examples of?
SNRIs
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Why should benzodiazepines be AVOIDED in chronic anxiety?
Due to their immediate effects (resulting in powerful negative reinforcement), this group of drugs is highly addictive. Tolerance develops rapidly, so after a month or two of benzodiazepines, your patient will be back to the same level of anxiety but also addicted to benzodiazepines.
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When can benzos be used?
They can be used for transient causes of anxiety (ie. fear of flying) or in crisis only, maximum of 2 weeks prescription advised.
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What is PTSD?
PTSD may develop following exposure to an extremely threatening/horrific event or series of events. It is thought to result from impaired memory consolidation of experiences too traumatic to be processed normally, which leads to a chronic hyperarousal of fear circuits.
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What are 4 characteristic features of PTSD
Use the acronym HARD:
H --> hyperarousal
A --> avoidance of situations/activities reminiscent of the events, or of thoughts/memories of the events the traumatic events (vivid intrusive memories, flashbacks, or nightmares)
R --> re-experiencing
D --> distress
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What is hyperarousal?
Persistently heightened perception of current threat (may include enhanced startle reaction)
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Management options for PTSD?
Trauma-focused CBT
Eye-Movement Desensitization and Reprocessing (EMDR) therapy
Pharmacological: SSRI or venlafaxine (possible adjunctive antipsychotic)
Plus psychoeducation/sleep hygiene/ relaxation etc. as above.
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What is C-PTSD?
C-PTSD is a disorder that may develop following exposure to series of extremely threatening/horrific events, commonly prolonged or repetitive situations from which escape is difficult (e.g. torture, slavery, genocide campaigns, prolonged domestic violence, repeated childhood sexual or physical abuse).
C-PTSD can be thought of as a constellation of significant modifications to a person’s automatic threat response, occurring because of having to adapt to prolonged/repetitive trauma.
This tends to leave the brain especially vulnerable to subsequent traumatic experiences later in life.
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Give some characteristic features for C-PTSD
Severe and persistent problems in affect regulation
Severe and persistent low self-worth, accompanied by feelings of shame/guilt/failure related to the traumatic events
Severe and persistent difficulties in sustaining relationships and in feeling close to others.
79
Give some examples of obsessive-compulsive or related disorders
Obsessive-compulsive disorder (OCD)
Body dysmorphic disorder (BDD)
Body-focused repetitive behaviour disorders (ie. trichotillomania, dermatillomania)
Hypochondriasis (health anxiety disorder)
Hoarding disorder
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What characterises obsessive-compulsive or related disorders?
A group of disorders characterised by repetitive thoughts and behaviours
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What is an obssession?
Obsessions are unwanted and uncontrolled thoughts and intrusive images that the person finds it very difficult to ignore.
E.g. an overwhelming fear of contamination with dirt or germs or violent or explicit images that keep appearing in their mind.
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What is a compulsion?
Compulsions are repetitive actions the person feels they must do, generating anxiety if they are not done. Often these compulsions are a way for the person to handle the obsessions
E.g. Checking that all electrical equipment is turned off to settle the anxiety of obsessing about the house burning down. This is a normal behaviour, but in OCD the person may check every plug in the house 10 times before being able to go to sleep or leave.
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Describe the cycle seen in OCD
The obsessions lead to anxiety, which leads to the compulsive behaviour, which leads to a temporary improvement in the anxiety. Shortly after the temporary improvement in anxiety the obsession reappears, leading to further anxiety, further compulsive behaviour with a temporary relief.
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What other mental health issues is OCD strongly related to?
Anxiety
Depression
Eating disorders
Autistic spectrum disorder
Phobias
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Management of OCD?
Mild OCD may be managed with education and self help resources.
More significant OCD may require:
Referral to CAMHS
Patient and carer education
Cognitive behavioural therapy
SSRIs medications (under the guidance of a CAMHS specialist)
86
What % of medical students are thought to suffer with anxiety disorders?
Around one in three medical students affected globally.20
87
Give the 2 main subtypes of anxiety disorders
1. Generalised anxiety disorder
2. Episodic anxiety
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Give the 3 subtypes of episodic anxiety
1. Panic disorder (any situation)
2. Phobias (specific situation)
3. Mixed pattern (agoraphobia and panic)
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When should you not diagnose panic disorder?
Don’t diagnose if secondary to depression
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When would beta blockers be considered in anxiety?
For palpitations and tremor only (peripheral symptoms)
BUT don’t alter problem itself, best to avoid
91
Describe the psychological and medical management for phobias
Psychological:
- Psycho education
- Exposure (systematic desensitisation)
Medical --> rarely used
