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Y4 Psych > Personality Disorders > Flashcards

Personality Disorders Flashcards

1
Q

Define personality?

A

Individual differences in characteristic patterns of thinking, feeling and behaving.

Shaped by biological, psychological and social factors.

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2
Q

Define Personality Disorder?

A

Group of conditions in which an individual differs significantly from an average person, in terms of how they think, perceive, feel or relate to others.

Characterised by enduring maladaptive patterns of behaviour, cognition and inner experience, exhibited across many contexts and deviating markedly from those accepted by the individual’s culture

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3
Q

What are the 3 Ps of personality disorders?

A

Easy way of identifying when a person has a disordered personality.

Personality problems that are…

  • Persistent
  • Problematic (interferes with daily functioning)
  • Pervasive (occurring across different contexts).
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4
Q

How are personality disorders categorised?

A

Into clusters (A,B,C), however it should be noted that many if not most patients have multiple PDs across these clusters.

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5
Q

What are Cluster A personality dsorders?

A
  • Paranoid
  • Schizoid
  • Schizotypal
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6
Q

Describe paranoid PD?

A

Presents as suspicious and mistrustful, misinterpreting events as persecutory, bearing grudges, strong sense of personal rights.

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7
Q

Describe schizoid PD?

A

Present as detached, solitary, aloof, little interest in people and sex, indifferent and lacking close friends.

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8
Q

Describe schizotypal PD?

A

Presents as eccentric, odd behaviour and thinking, unconventional beliefs.

(possibly Kanye).

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9
Q

What are the Cluster B personality types?

A
  • Borderline
  • Narcissistic
  • Antisocial
  • Histrionic
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10
Q

Describe Borderline PD (aka emotionally unstable PD)?

A

Present with emotional instability, impulsivity, parasuicidal acts, chronic feelings of emptiness, intense and unstable relationships, fear of abandonement.

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11
Q

Describe narcissistic PD?

A

Presents as grandiose, self-important and degrading of others

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12
Q

Describe Antisocial PD?

A

Presents with lack of concern for the feelings of others, disregard for rules, impulsivity, low tolerance for frustration, failure to take responsibility

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13
Q

Describe histrionic PD?

A

Presents as theatrical, dramatic, exhibit superficial emotionality, seductiveness, suggestibility

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14
Q

What are the cluster C personality disorders?

A
  • Anankastic
  • Dependent
  • Anxious-Avoidant
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15
Q

Describe Anankastic PD (aka Obsessive Compulsive PD)?

A

Presents as rigid, stubborn, perfectionistic, preoccupied with rules, order, routine, and have a higher sense of morality.

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16
Q

Describe Dependent PD?

A

Presents as needing others to make decisions for them, fear of abandonment, unable to cope alone, need for reassurance.

17
Q

Describe Anxious-Avoidant PD?

A

Presents with persistent anxiety, sensitive to rejection, tend to avoid relationships unless acceptance is guaranteed.

18
Q

How are personality disorders diagnosed in practice?

A

The presence of a PD can be diagnosed through ICD-10 and DSM-5.

A structured personality assessment can be used to more accurately diagnose personality disorder e.g. PDQ-4. Semi-structured interviews can be effective but can take as long as two hours.

SAPAS (standardised assessment of personality- abbreviated scale) is a brief, 8 question screening method for PD.

19
Q

What is the potential link between attachments in childhood and PD?

A
  • When babies have an experience of the world that is unsafe and abusive, they might grow up to be adults who cannot trust others, expect rejection, hostility, neglect etc..
  • They may lack the necessary brain connections and neurochemicals to help them manage their feelings which then tend to overwhelm them.

Relevance to healthcare:

  • Patients with PD related to childhood attachments may view their doctor-patient relationship in this same light
  • Therefore must be careful to not appear hostile and/or neglectful of the patient.
20
Q

What is a main concern when dealing with patients with PDs?

A

Self-harm! Normally in the form of cutting or drug overdoses.

Tends to occur as a response to an overwhelming state of mind, self-harm should be thought of as a coping mechanism.

21
Q

What are the principles of PD management?

A

PDs should be understood as problems of disrupted attachments, HCPs should aim to modulate this anxiety.

Principles:

  • Understand the importance of attachment, the therapeutic relationship and CONTINUITY OF CARE!
  • Understanding crisis indicators
  • Empower patient, recovery focused approach
22
Q

How are PDs managed?

A

BPS!!!

Harm minimisation:

  • Self-harm releases endorphins and can become addictive
  • If patient has issues like these, can aim to replace self-harm with less damaging strategies e.g. elastic bands on the wrists, holding ice cubes.
  • High risk of sexual abuse. bear in mind when risk assessing.

Treatment:

  • Psychotropic medication used to treat comorbidities e.g. depression, anxiety
  • Group treatment, therapeutic community
  • Dialectical Behavioural Therapy
  • Mentalisation Based Therapy
  • Transference Focused Therapy
23
Q

What are the main symptom domains in personality disorders? (i.e. what aspects of a person’ life might be dysfunctional in cases of PD)

A
  • Emotional domain
  • Interpersonal
  • Behavioural
  • Cognitive
24
Q

Describe the emotional symptoms seen in someone with BPD?

A
  • Heightened emotional sensitivity
  • Reduced control over emotions
  • Slow return to baseline after emotional episode
  • Chronic feelings of loneliness
  • Difficulty controlling feelings of anger
25
Q

Describe some of the interpersonal symptoms/features seen in someone with BPD?

A
  • Relational instability

- Fear of abandonement

26
Q

Describe some of the behaviouralsymptoms/features seen in someone with BPD?

A
  • Impulsive behaviour

- Self harm and/or suicide

27
Q

Describe some of the cognitive symptoms/features seen in someone with BPD?

A
  • Dissociative experiences
  • Identity disturbance
  • Dissociative experiences
28
Q

What are the key features of emotionally unstable PD?

A
  • Intense and unstable relationships
  • Impulsivity
  • Unclear sense of identity
  • Unpredictable affect
  • Thoughts/ threats/ acts of self harm
  • Unpredictability
29
Q

Broadly, what are the theories behind how personality disorders develop?

A

Childhood development – insecure childhood attachments, childhood trauma, inconsistent parenting.

Genetic – there is some evidence that some personality traits can be inherited.

Psychodynamic theories – discusses the use of maladaptive or primitive defence mechanisms.

Cognitive-behavioural theories – relates to the development of maladaptive schemata/core beliefs derived from early experiences.

30
Q

What are the principle treatment options for PDs?

A

Psychotherapy, pharm options only really used to treat co-morbidities.

Available options =

  • Dialectical Behavioural Therapy (DBT)
  • Cognitive Analytic Therapy (CAT)
  • Psychodynamic Psychotherapy

No real preference, describe them to patients and see which one they feel they’d best be able to engage with.

31
Q

What are the principles of management for antisocial PD?

A
  • Avoid pharmacological therapy
  • Be aware of the misuse of prescribed medication
  • Consider group based cognitive and behavioural interventions (to help with problems e.g.
    impulsivity, interpersonal difficulties)
  • Consider comorbid drug and alcohol misuse and offer appropriate psychological and
    pharmacological options
  • Ideally avoid inpatient admissions – only use admit if necessary in a crisis for a brief, predefined period. Admission should not usually be to hospital under the MHA (and if this is
    done, seek advice from forensic/specialist personality disorder services).
32
Q

What is involved in DBT?

A

Weekly individual sessions and weekly life-skills group
sessions that teach skills in 4 domains: mindfulness, distress tolerance, regulation of
emotions and interpersonal effectiveness. The therapy is designed to last at least 1 year

Y4 Psych (13 decks)

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