how would you define personality disorder
group of mental health conditions characterised by persistent patterns of thinking, feeling, and behaving that are significantly different from cultural expectations. These patterns can lead to distress or problems in personal, social, and occupational functioning
- majority of people have less favourable aspects to our personality but we either work around them or have other traits which are more favourable/prominent
- in a minority of people, these less favourable traits are so prominent they might cause issues for people around them or for themselves
give 5 things people with a personality disorder might struggle with
- difficulties with social situations and relationships
- difficulties controlling feelings and/or behaviour
- react unsually to illness/treatment
- have more extreme/unusual reactions to stressful events
how has the ICD-11 classification changed in diagnosing personality disorders
moves away from specific ‘named’ personality disorder e.g. narcisstic or paranoid and moves towards a more dimensional model e.g. severity (mild, moderate, severe) and identifying specific trait domains that represent the predominant problematic areas
- allows for more flexible and comprehensive understanding
what are the 4 key features of personality disorder according to ICD-11
PIDD
- Persistent Pattern: The individual’s patterns of cognition, emotional experience, behaviour, and interpersonal functioning deviate from cultural expectations. These patterns are stable over time and span across various personal and social situations.
- Impairment: The deviation results in significant problems or dysfunctions in the person’s life, especially in relationships, work, or social functioning.
- Duration: These characteristics are stable over time, beginning in adolescence or early adulthood, and are not transient.
- Distress or Dysfunction: The impairment may result in distress to the individual or others. These patterns are not explained by another mental disorder, a medical condition, or substance misuse
what are 6 personality disorder trait domains ICD-11
- negative affectivity
- detachment
- dissociality
- disinhibition
- anankastia
- borderline partern
describe negative affectivity
- Tendency to experience a wide range of negative emotions such as anxiety, depression, guilt, and anger.
- Individuals may be prone to mood swings, insecurity, and emotional lability
describe detachment
- Avoidance of social interactions, emotional withdrawal, and limited pleasure from relationships
- Individuals may appear cold, aloof, and isolated
describe dissociality
- Disregard for the rights and feelings of others, lack of empathy, and difficulty forming prosocial relationships.
- Impulsivity and manipulative behaviours are common traits
describe disinhibition
- Impulsiveness, risk-taking, and difficulty controlling behaviours.
- Individuals may struggle with planning and foresight, leading to reckless or irresponsible actions
describe anankastia
- Preoccupation with orderliness, control, and perfectionism.
- Individuals may be rigid, stubborn, and excessively focused on rules and details
how do personality disorders affect morbidity and mortality
- reduced life expectancy: combo of suicide rates, physical health problems and risky lifestyle choices
- inc risk of CVD/resp disease
- higher rates of suicide/death by homicide
- increased rate of serious accidental injuries
what is the aetiology of personality disorders
interaction of genetic factors and upbringing
- genetics
- brain abnormalities
- adverse childhood experiences e.g. early separation from parents, social care, abuse
- association w parents w personality/mental health problems
how might a clinician gather info to get an accurate description of an individual’s personality
- description of person by someone who knows them well e.g. family or GP
- patient’s own account of thoughts, feeling, behaviour in present/past
- patient’s behaviour in interview
what is the mainstay of treatment for personality disorders and give 4 examples
pyschological intervention
- CBT
- DBT
- mentalisation-based therapy
- psychodynamic therapy
- therapeutic communities
risk management also v important - regularly reviewed by MDT
what does mentalisation based therapy aim to do
combines elements of dynamic therapy and cognitive techniques
- focsues on helping pt to recognise and deal with how they are feeling at that point in time and to become better at managing those feelings
what are therapeutic communities and how do they help
groups of patients and clinical facilitators (psychologists) who meet regularly to work together to tryand overcome personality related problems
- learn more about the disorders from others with similar problems
- work in closed confidential environment which promotes trust
- learn to take responsibility for themselves and actions
do pharmacological interventions have a place in treating personality disorder
limited; mainly used to treat co-morbid mental illness
- avoid benzo where possible as highly prone to dependency
- antipyschotics/mood stabilisers to treat impulsivity/aggression
what is cluster A personality disorder
odd or eccentric
- paranoid
- schizoid
- schizotypal
what is cluster B personality disorder
- Antisocial
- Borderline (Emotionally Unstable)
- Histrionic
- Narcissistic
what is cluster C personality disorder
- Obsessive-Compulsive
- Avoidant
- Dependent
what are the features of schizoid personality disorder
Displays negative symptoms of schizophrenia
- indifferent to praise and criticism
- emotional coldness
- preference for solitary activities
- lack of desire in sexual interactions
what are the features of schizotypal personality
- ideas of reference which differ from delusions in that some insight is retained
- odd beliefs and magical thinking
- lack of close friends
- paranoid ideation and suspiciousness
- odd speech without being incoherent
what are the features of borderline (emotionally unstable) personality
- Efforts to avoid real or imagined abandonment
- Unstable interpersonal relationships which alternate between idealization and devaluation
- Unstable self image
- Impulsivity in potentially self damaging area (e.g. Spending, sex, substance abuse)
- Recurrent suicidal behaviour
