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Flashcards in Personality disorders Deck (28):
1

Features of personality disorder

  • Pervasive: Not waxing/waning + present in a variety of situations (seek corroborative history)
  • Chronic: Stable + present since late adolescence
  • Disturbance: Behaviour deviates markedly from "norm" in more than one of cognition, affect, control of impulses, relating to others
  • Exclude: Other mental disorders as cause of disturbance
  • Dysfunction: Personal distress and/or adverse impact on the social environment

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Prevalence of personality disorders

2-15% of general population in UK

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Most common personality disorders

Obsessive-compulsive, avoidant, schizoid, borderline

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Most clinically common personality disorders

EUPD

Dissocial PD

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Populations with a higher prevalence of personality disorders

Prisoners (30-50%)

Substance misuse/eating disorder (70%)

Psychiatric patients (50%)

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Biological aetiological factors for personality disorders

  • Genetics 35-50% heritability
  • XXY chromosomal abnormalities may have a modest effect
  • Adverse childhood experiences (abuse/neglect) --> neurological abnormalities (cortical immaturity)

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Psychosocial aetiology for personality disorders

  • Adverse childhood events (abuse/neglect)
  • Attachment theory: Lack of parental figures during childhood
  • Object relations theory: Inability to reconcile good/bad experiences of same person/thing

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DSM-V classification of personality disorders

Cluster A: Eccentric

Cluster B: Dramatic

Cluster C: anxious

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ICD-10 disorders in cluster A

Eccentric

Paranoid

Schizoid

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ICD-10 disorders in cluster B

Dramatic

Dissocial (aka antisocial, psychopathic)

Borderline (aka emotionally unstable)

Narcisstistic

Histrionic

 

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ICD-10 disorders in cluster C

Anxious

Dependent

Anankastic (aka obsessional)

Anxious (aka avoidant)

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Features of paranoid personality disorder

Sensitivity to rebuffs/setbacks

Suspicious, misconstrues actions as hostile

Excessive self-importance

Bears grudges

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Features of schizoid personality disorder

Emotionally detached, cold, flat affect

Few activities pleasurable incl. sexual

Preference for solitary activities

Preoccupation w/ fantasy + introspection

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Differntial for cluster A personality disorders

Chronic delusional disorder (paranoid personality is a risk factor for development)

Depression/ASD (esp for schizoid)

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Histrioinic personality disorder

Over-dramatic, theatricality

Shallow, labile affect

Superficial relationships

Suggestible

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Narcissistic personality disorder features

Grandiose self-importance

Exploits other

Expects praise

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Features of dissocial personality disorder

Callous, inconsiderate of others

Lack of guilt

Persistent irresponsibility and disregard for societal norms/rules

Low threshold for frustration/aggression

Impulsivity

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Subtypes of emotionally unstable personality disorder

Impulsive

Borderline

19

Features of impulsive EUPD

Impulsivity

  • Tendency to act impulsively + w/o regard for consequences
  • Tendency to quarrelsome behaviours + conflicts with others
  • Difficulty maintaining course of action w/o immediate reward

Anger:

  • Liability to outbursts of anger
  • Unstable mood

20

Features of borderline personality disorder

Impulsive criteria PLUS:

Push-pull personality:

  • Frequent threats/acts of self-harm
  • Involvement in intense and unstable relationships
  • Excessive efforts to avoid abandonment

Internal conflict:

  • Chronic feelings of emptiness
  • Uncertainty about self-image, aims, preferences

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Features of dependent personality disorder

  • Encouraging/allowing others to make most life decisions
  • Fear of being left to care for oneself
  • Limited capacity to take everyday decisions w/o advice/reassurance from others
  • Subordination of own needs to those they are dependent on

22

Features of anankastic personality disorder

  • Excessive orderliness
  • Rigidity + stubborness 
  • Pedantry + adherance to conventions
  • Preoccupation with detail
  • No compulsions/relieving behaviours (c.f. OCD)

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Features of anxious/avoidant personality disorder

  • Fear of criticism/rejection
  • Persistent tension/apprehension
  • Avoidance of personal contact/relationships

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Prognosis of PD by cluster

Cluster A: Stable/worsen with age (mature)

B and C: Mellow with age (maturity)

All have worse morbidity + mortality compared to general population

25

Prognostic interaction between PD and other psychiatric conditions

Worsens prognosis

Increases risk of violence in psychosis

26

Psychological interventions for PD

  • CBT/CAT
  • Dialectical behavioural therapy
  • Complex needs services (i.e. therapeutic communities with group psychotherapy)
  • Treat substance/psychiatric comorbidities

27

Principles for management of PD

  • Consistency: Avoid splitting of staff
  • Boundaries: Avoid responding to manipulative behaviour
  • Admission to a minimum: Avoid dependence
  • Individuality: Treat person's actual problems and identify lifestyle modifications for their strengths

28

Screening tool for borderline personality disorder

Maclean Screening instrument

>=7 is determined as diagnostic cutoff