Personality Disorders - Burton Flashcards

1
Q

How does the ICD-10 define personality disorders?

A

A severe disturbance in the personality and behavioural tendencies of the individual.

Not directly resulting from disease, damage, or other insult to the brain, or from another psychiatric disorder.

Usually involving several areas of the personality.

Nearly always associated with considerable personal distress and social disruption.

Usually manifest since childhood or adolescence and continuing throughout adulthood.

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2
Q

How does the DSM-5 group personality disorders and which apply to each group?

A

A - Mad - Odd, bizarre (Paranoid, Schizoid, Schizotypal)
B - Bad - Dramatic, erratic (Antisocial, Borderline, Histrionic, Narcissistic)
C - Sad - Anxious fearful (Avoidant, Dependent, Anankastic)

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3
Q

What is the prevalence of personality disorders in the normal population and in psychiatric out- and in-patients?

A

10% - normal population

Considerably higher in psychiatry

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4
Q

What is the aetiology of personality disorders?

A

Genetic factors
Adverse early life experiences (parental loss or emotional, physical, or sexual abuse)
Highly threatening or catastrophic experiences
Recovery from mental disorder
Brain disease and head injury

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5
Q

What are the 11 types of personality disorder?

A

Paranoid, Schizoid, Schizotypal (Mad)
Borderline, antisocial, histrionic, narcissistic (Bad)
Dependent, anankastic, avoidant (Sad)

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6
Q

What is paranoid personality disorder?

A

Pervasive distrust of others, including even friends, family, and partner.
Guarded and suspicious
Constantly trying to validate his fears
Strong sense of personal rights
Easily feels shame and humiliation
Persistently bears grudges
Withdraws from others and struggles building close relation ships

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7
Q

What is schizoid personality disorder?

A

Detached and aloof
Prone to introspection and fantasy
No desire for social or sexual relationships
Indifferent to others and to social norms and conventions
Lacks emotional response
No desire to interact with others

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8
Q

What is schizotypal personality disorder?

A

Oddities of appearance, behaviour and speech
Unusual perceptual experiences and anomalies of thinking similar to those seen in schizophrenia
Magical thinking (speak of devil and he appears)
Suspiciousness
Obsessive ruminations
Fear social interaction and think of others as harmful
Ideas of reference
Fear others

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9
Q

What is antisocial personality disorder?

A
Much more common in men that women
Callous unconcern for the feelings of others
Disregards social rules and obligations
Irritable and aggressive
Acts impulsively
Lacks guilt
Fails to learn from experience
Highly correlated with crime

Presence of Macdonald’s triad in childhood is indicative of later development of PD: bedwetting, cruelty to animals, and pyromania.

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10
Q

What is borderline (emotionally unstable) personality disorder?

A
Lacks a sense of self
Experiences feelings of emptiness 
Fears of abandonment
Pattern of intense but unstable relationships
Emotional instability
Outbursts of violence and anger
Impulsive behaviour
Suicidal threats and act of self-harm are common.
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11
Q

What is histrionic personality disorder?

A

Lack a sense of self-worth
Depend on attracting the attention and approval of others
Seem to be dramatising or playing a part in a bid to heard and seen
Take great care of their appearance
Behave in a manner that is overly chamring or inappropriately seductive

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12
Q

What is avoidant personality disorder?

A

Believe they are socially inept, unappealing, or inferior
Constantly fear being embarassed, criticised, or rejected
Avoid meeting others unless they are certain of being lived
Strongly associated with anxiety disorders

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13
Q

What is narcissistic personality disorder?

A

Person has an excessively high regard for his own importance
Sense of entitlement
Needs to be admired
Envious of others and expects them to be the same of him
Lacks empathy, readily exploits to achieve aims
Self-absorbed, controlling, intolerant, selfish, or insensitive.

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14
Q

What is dependent personality disorder?

A

Characterised by a lack of self-confidence
Excessive need to be looked after
Person needs a lot of help in decision making
Leaves important life decisions to care of others
Greatly fears abandonment, goes to considerable lengths to secure and maintain relationships
Naive and childlike perspective

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15
Q

What is anankastic personality disorder?

A

Characterised by excessive preoccupation with details, rules, lists, order, organisation, or schedules
Perfectionism so extreme it prevents a task from being completed
Devotion to work and productivity at the expense of leisure and relationships
Doubting, cautious, rigid and controlled, humourless and miserly

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16
Q

What are the differential diagnoses for PDs?

A

Affective disorder, substance misuse, psychotic disorders, anxiety disorders (especially phobia and panic), OCD, intellectual disability, dementia, and autism

17
Q

How should these conditions be managed?

A
Psychotropic drugs should be minimised
Emotional and practical support
Psychological treatments
Monitoring
Crisis contingencies
18
Q

What psychological treatments are indicated in PDs?

A
Individual therapy (DBT)
Group therapy
Milieu therapy (therapeutic community)
19
Q

What is the prognosis of personality disorders?

A

Tend to mitigate in middle and old age.

Important complications: depression, substance misuse, accidents, and deliberate self harm and suicide, social complications (isolation, unemployment and crime)

20
Q

What is the estimated prevalence of PDs in the prison population?

A

75%