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Personality Disorder for physios

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Richard Duffy

on 5 June 2014

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Transcript of Personality Disorder for physios

Personality Disorder
Dr Richard Duffy MB BCh MRCPsych
Special Lecturer in Psychiatry, UCD

High rates of suicide especially amongst the Cluster B patients (ASPD and BPD)

With time, Borderline PD patients become less impulsive and engage in less frequent acts of self harm

With time, Antisocial PD patients commit less crime and abuse less substances

Reduces deliberate self harm amongst borderline patients
Mindfulness (regulation of thoughts and emotions)
Life skills (problem solving)
24 hour telephone access

Borderline PD Physical/ sexual abuse
Antisocial PD Social learning in family
Low levels of CSF 5-HIAA (serotonin metabolite)
Immature EEG activity in some psychopaths
High MZ : DZ twin concordance rates
Cluster A disorders more common amongst relatives of schizophrenics esp. schizotypal
Cluster B disorders higher rates of alcoholism and depression in themselves and relatives. XYY assoc. with antisocial PD.
Cluster C disorders are associated with anxiety and depression

A pervasive pattern of preoccupation with orderliness, perfectionism and mental and interpersonal control, at the expense of flexibility, openness and efficiency.

Preoccupied with details, rules, lists or schedules to the extent that the major point of the activity is lost
Shows perfectionism that interferes with task completion
Excessively devoted to work and productivity
Unable to discard worn out or worthless objects even when they have no sentimental value
Pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation

Has difficulty making everyday decisions without an excessive amount of advice and reassurance from others
Needs others to assume responsibility for most major areas of his or her life
Has difficulty expressing disagreement
Has difficulty initiating projects or doing things on his or her own
Feels uncomfortable or helpless when alone
Urgently seeks another relationship as a source of care and support when a close relationship ends
Mistrust of others
Extreme shyness/timidity
Emotional distancing related to intimacy
Highly self-conscious
Self-critical about their problems relating to others
Loss of self-identity
Problems in occupational functioning
Lonely self-perception
Feeling inferior to others
Chronic substance abuse/dependence
Hypersensitivity to criticism or rejection
Self-imposed social isolation
Extreme shyness in social situations, though feels a strong desire for close relationships
Avoids physical contact because it has been associated with an unpleasant or painful stimulus
Avoids interpersonal relationships
Feelings of inadequacy
Severe low self-esteem
Self loathing
Five (or more) of the following:
Grandiose sense of self-importance
Preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love
Believes that he or she is "special" and can only be understood by, or should associate with, people (or institutions) who are also "special" or of high status.
Requires excessive admiration
Sense of entitlement
Interpersonally exploitative
Lacks empathy
Often envious of others or believes others are envious
Arrogant, haughty behaviours or attitude
Mnemonic: PRAISE ME:
P - provocative (or seductive) behaviour
R - relationships, considered more intimate than they are
A - attention, must be at centre of
I - influenced easily
S - speech (style) - wants to impress, lacks detail
E - emotional lability, shallowness
M - make-up - physical appearance used to draw attention
E - exaggerated emotions - theatrical
Pervasive pattern of unstable relationships, self image and affects, and marked impulsivity.

Five or more of the following:
Frantic efforts to avoid real or imagined abandonment
Unstable and intense interpersonal relationships
Identity disturbance,unstable self-image
Impulsivity in at least 2 areas that are potentially self damaging
Recurrent suicidal behaviour, gestures or threats or self mutilating behaviour
Affective instability usually lasting a few hours and rarely more than a few days
Chronic feelings of emptiness
Inappropriate intense anger or difficulty in controlling anger eg. frequent fights
Transient stress related paranoid ideation or severe dissociative symptoms
Behaviour or appearance that is odd, eccentric, or peculiar
Unusual perceptual experiences
Odd thinking and speech (e.g., vague, circumstantial, metaphorical, overelaborate, or stereotyped)
Suspiciousness or paranoid ideation
Lack of close friends or confidants other than first-degree relatives
Social withdrawl
Sense of superiority (due to not needing approval)
Loss of affect (empathy may seem unnecessary)
Loneliness (inevitable consequence of withdrawal)
Depersonalization (dissociative defence)
Regression (overwhelmed by the world)
Four (or more) of the following:

Suspects, without sufficient basis, that others are exploiting, harming, or deceiving
Is preoccupied with unjustified doubts about the loyalty or trustworthiness
Is reluctant to confide in others because of unwarranted fear that the information will be used maliciously against him or her
Reads benign remarks or events as threatening or demeaning.
Persistently bears grudges
Perceives attacks on his or her character that are not apparent to others and is quick to react angrily
Has recurrent suspicions, without justification, regarding fidelity of spouse or sexual partner
Deeply ingrained and enduring behaviour patterns, manifest as inflexible responses to a broad range of social and personal situations
Extreme or significant deviations from the way in which an average individual thinks, feels and relates to others
Stable patterns; encompassing many domains of behaviour & psychological functioning
Associated with :
Subjective distress
Problems in social performance

Classified on Axis II (compared with mental disorders on Axis I)
Anna Freud “Defence mechanisms”

Defend the ego from the impulses of the id
Prevent anxiety and depression

Different personality disorders employ different ego defence mechanisms
Fantasy Schizoid personality
Denial Histrionic
Projection Paranoid
Splitting Borderline


Treat any co-morbid mental illness eg. depression/ anxiety
Prevalence of up to 15 %
High rates among those who self harm
40% of non-psychotic psychiatric outpatients have a personality disorder
High rates of borderline PD amongst patients with bulaemia
High rates of antisocial PD amongst prison inmates
Pervasive disregard for and violation of the rights of others occurring since the age of 15 years
Must be 18 years to have this diagnosis, and have shown evidence of Conduct Disorder with onset before age 15

3 or more of the following;

Failure to conform to social norms as indicated by repeatedly performing acts that are grounds for arrest
Deceitfulness eg. repeated lying, use of aliases or conning others for personal profit or pleasure
Impulsivity or failure to plan ahead
Irritability and aggressiveness as indicated by repeated fights/ assaults
Reckless disregard for safety of self or others
Consistent irresponsibility eg. unable to sustain work or honour financial obligations
Lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated or stolen from another
Personality describes an individuals behaviour (objective) and inner experience (subjective)

Co-morbidity with substance misuse, crime and mental illness

Affects presentation, illness course and prognosis
'Cause you're hot then you're cold
You're yes then you're no
You're in then you're out
You're up then you're down
You're wrong when it's right
It's black and it's white
We fight, we break up
We kiss, we make up

You! You don't really want to stay, no
You! But you don't really want to go-o

Used to laugh 'bout nothing
Now you're plain boring
I should know that you're not gonna change

Someone call the doctor
Got a case of a love bi-polar
Personality disorder
Cluster A
Schizotypal PD
Schizoid PD
Paranoid PD
Cluster C
Cluster B
Compulsive PD
Dependent PD
Avoidant PD
Histrionic PD
Emotionally unstable PD
Anti social PD
Narissistic PD
Psychosocial factors
Biological factors
Personality disorder
Also called anxious PD
Full transcript