Summary Final year MD notes - personality disorders
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Course
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Macquarie University (MQ
)
A collection suite of final psychiatric and mental health MD notes to ace your penultimate and final year exams!
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-Talley and...
PERSONALITY DISORDERS
Personality disorders "mad (A) /bad (B)/sad (C)"
CLUSTER A ( ODD/ECCENTRIC/MAD)
Pervasive distrust with 4 of the following: Risk factors for cluster A
• Recurrent suspicions without justifications about other harming and deceiving them • Strong FHx of schizophrenia (esp. biological parents)
Paranoid • Unjustified doubt loyalty/trustworthiness • Immigrants (minority groups)
suspicious • Unforgiving of insults and bears grudges
• transition from rural to urban
• Interpret hidden/threatening meanings into benign events/remarks
• Reluctant to confide info in fear as it would be maliciously used against them
Pervasive pattern of detachment from social relationships with At least 4 of the following
General Mx:
Schizoid
socially • Solitary lifestyle • Sexual libido 1) Always be honest and respectful to these patients
indifferent / • Indifferent to praise or • Anhedonia 2) Understand that paranoid patient like to project
detached criticism • Friends lacking 3) Minimise interactions and provide factsheets or
• Relationships of no • Emotionally cold and detached technical information
SIR SAFE interest
Pervasive pattern of social and interpersonal deficits marked by acute discomfort and reduced
capacity to make close relationships with 5 or more of the following:
#1: Personality disorders (Sigmund Freud)
Schizotypal • Unusual perceptions • Affect – inappropriate, constricted All disorders related to fixation to ONE
eccentric + psychosexual stage of development e.g. oral
• Friendless except for • Ideas and Delusions of refence
distortions family stage = dependent and passive characteristic
• Doubts others – suspicious
• Odd beliefs / thinking and • Eccentric appearance / behaviour #2: B criteria for all
UFO AIDER speech (magical thinking) • Reluctant in social situations and XS social anxiety that
does NOT diminish with increasing familiarity
All do NOT occur exclusively during course
• of schizophrenia or bipolar disorder or
depressive disorder with psychotic features
CLUSTER B - Bad (dramatic/emotional)
A. Persistent Sx of disregard for and violation of rights of others since the age of Risk factors for cluster B
15yo with at least 3 or more of the following • Cluster B have Genetic component
• Conduct disorder before age 15y • Unstable • Strong assoc. between histrionic & somatisation disorders
Antisocial
• Current age at least 18 • Safety of self/others ignored • High risk of antisocial PD developing somatisation disorder
CALLOUS
• Antisocial acts that warrant arrest • Manipulative - others to profit, gain
MAN • High TT levels = impulsive traits
• Lies frequently power or materials
NO empathy • Tendency to talk more than listen
• Lacks a superego • Aggressive / apathetic
• Obligations not honoured • Not exclusively occurring during
schizophrenia or mania General Mx:
Pervasive pattern of unstable relationships, self-image and affect and marked 1) Gain an understanding of personality factors (sometimes
impulsivity starting from early adulthood with 5 or more of the following including their family of origin)
• Identity disturbance • Affective instability 2) Reduce idealisation of unit before admission to reduce
• Relationships unstable • Paranoid ideation devaluation after
Borderline • Abandonment frantically avoided • Anger poorly controlled 3) Appreciate that self-harm (e.g. cutting self) may be
“I RAISED A • Impulsive in ≥ 2 areas = e.g. XS spending, • Idealisation followed by protective mechanism to halt suicidal execution
PAIN!” sex, substance use, binge eating devaluation
4) Pharmacotherapy (for antisocial PD)
unstable ID • Suicidal behaviours, gestures and self- • Negativity – undermine
themselves with self-
• Nb: firm limit setting BEFORE therapy
mutilating behaviours
• Emptiness – chronic feeling defeating behaviour • Anti-psychotics for anxiety, rages
• Dissociative symptoms • Anti-depressants (SSRI) ® depression
Rx: Dialetic behavioural therapy (MINDFULLNESS® accept and change) 5) Dialetic behavioural therapy for borderline PD
Pervasive pattern of XS emotionality and attention seeking in early adulthood with 5 or 6) Validation through positive feedback (sandwich method),
more of the following • Important for narcissistic PD to accept narcissism
• Inappropriate behaviour – seductive or provocative before they can make progress
Histrionic • Centre of attention
attention • Relationships seen as closer than they really are
seeker
• Appearance most important
• Vulnerable to other’s suggestions (suggestive)
I CRAVE SIN
• Emotions exaggerated
• Shifting emotions, shallow
• Impressionist speaking (i.e. lack details) è Novelty is craved
Pervasive pattern of grandiosity (in fantasy or behaviour) with need for admiration and
self-entitlement with 5 or more of the following
Narcistic • Admiration required in XS amounts • Grandiose (sense of importance)
self-centred • Fantasise about unlimited success emphasise VIP status/wealth
grandiose and brilliance è requires XS admiration
• Arrogant / haughty behaviours - • Associated with special people
A FAME devalues others • Me first attitude
GAME • Manipulative • Empathy lacking for others
• Envious of others and thinks others
enby them
CLUSTER C - (anxious/fearful)
Avoidant Social inhibition (feeling inadequate) and hypersensitive with at least 4 of the following Risk factors
Inhibited – • Restrained within relationships • Criticism ( expected in social situations) • Nb: some cultures emphasise
feeling • Inhibited in interpersonal situations • Unwilling to get involved passivity, politeness, while others
inferior to • Disapproval expected at work • Longs for attachment to others discourage dependence
others • Inadequate view of self • Embarrassment is the feared emotion
RIDICULE Hallmarks
Nb: If blushing (DDx: social anxiety disorder)
Submissive and fear of separation with 5 of the following • risk of burnout
Dependent • Disagreement is difficult to express • Helpless when alone • always staying back after work
submissive • Advice- needs XS input • Unrealistically preoccupied with being left to care for • constant worry
anxious • Responsibility delegated to others self
DARN HURT • Nurturance – VOLUNTEER to do unpleasant • Relationships desperately sought after General Mx:
things to obtain nurturance and support • Tasks – difficulty to start projects 1) Psychotherapies - give time, things
Orderliness, perfectionism, mental and interpersonal control with 4 or more: may need to be repeated, meet
• Pre-occupied with orderliness (rules, lists, schedules) è Interferes with task completion when not hectic
Obsessive • XS devotion to work/productivity at expense of leisure and friendship 2) Goal to become independent,
rigid • Overly conscientious – inflexible about morality/values/ethics assertive and self-reliant
perfectionist
(self-critical)
• Cannot discard worthless objects or delegate tasks 3) Provide support to avoid burnout as
• Rigid and stubborn (miserly pending) work very slowly
• Does NOT spend time on self (unlike anti-social and narcistic personalities)
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