MEDI7301 Study Guide - Final Guide: Telepathy, Crisis Management, Countertransference
Personality disorders
Introduction
Overview Personality disorder is an enduring pattern of inner experience and behaviour that
deviates markedly from the expectations of the individual's culture, is pervasive and
inflexible, onset in adolescence or early adulthood, stable over time & leads to distress or
impairment
It cannot be diagnosed until after age 18yo
Summary
Paranoid - pattern of irrational suspicion and mistrust of others,
interpreting motivations as malevolent
Schizoid - lack of interest and detachment from social relationships, apathy
and restricted emotional expression
Schizotypal - extreme discomfort interacting socially, and distorted
cognitions and perceptions
Antisocial - pervasive pattern of disregard for and violation of the rights of
others, lack of empathy, bloated self image, manipulative and impulsive behaviour
Borderline - pervasive pattern of instability in relationships, self image,
identity, behaviour and affects often leading to self harm and impulsivity
Histrionic - pervasive pattern of attention-seeking behaviour and excessive
emotions
Narcissistic - pervasive pattern of grandiosity, need for admiration and lack
of empathy
Avoidant - pervasive feelings of social inhibition and inadequacy, extreme
sensitivity to negative evaluation
Dependent - pervasive psychological need to be cared for by other people
Obsessive compulsive - rigid conformity to rules, perfectionism and control
to the point of satisfaction and exclusion of leisurely activities and friendships
Etiology General All 10 personality disorders are relatively heritable (20-60%
genetic inheritance)
3 common genetic risk factors
oNegative emotionality related to neuroticism
oHigh impulsivity/ low agreeableness
oIntroversion
Low MAO-A genotype (normally breaks down Ad, NAd, DA) +
maltreatment = patient is likely to develop conduct disorder and anti-social
personality disorder
Neglect, deprivation/ trauma and abuse ---> difficulty with trust
and engagement
Paranoid Biological - genetic link to paranoid traits, genetic link between
PPD and schizophrenia
Psychosocial - projection of negative internal feelings and
parental modelling
Schizoid Biological - genetic heritability
Schizotypal Biological - genetic link to schizophrenia, dysregulation of
dopaminergic pathways
Antisocial Biological - genetic contribution, low levels of behavioural
inhibition mediated by serotonegic dysregulation in septohippocampal
system, abnormalities in prefrontal brain systems, reduced autonomic
activity, low arousal, poor fear conditioning and decision-making deficits
Borderline Psychosocial - 80% experience early abuse (sexual, physical,
emotional), variant of PTSD
Biological - strong link to 1st degree relatives with mood
disorders, abnormal monoaminergic functioning (especially serotonergic),
prefrontal neuropsychological dysfunction
Histrionic Psychosocial - possible seductive and authoritarian attitudes by
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fathers of patient
Narcissistic Psychodynamic - an imbalance between +ve mirroring of
developing child & presence of adult figure who can be idealized
Avoidant Psychodynamic - expression of extreme traits of introversion and
neuroticism, overlap with social phobia
Dependent Psychodynamic - insecure form of attachment to others, possibly
resulting from clinging parental behaviour
Obsessive-
compulsive
Biological - genetic heritability
Psychodynamic - need control as a defence against shame or
powerlessness
Five factor
model
Five factor model is comprised of 5 main personality dimensions (OCEAN) that help
understanding of personality traits in humans
Openness to experience
Inventive/ curious <-----> consistent/ cautious
The degree of intellectual curiosity, creativity and preference for novelty;
imaginative aspect
High openness - unpredictable, lack of focus, greater risk of engaging in
risky behaviour, seek intense euphoric experiences
Low openness - pragmatic, data driven, close minded
Conscientiousness
Efficient/ organised <-----> easy going/ careless
The tendency to be organised, dependable, self-disciplined, dutiful, high
achieving and non-spontaneous
High conscientiousness - stubborn, obsessive
Low consciousness - flexible, spontaneous, sloppy, unreliable
Extraversion
Outgoing/ energetic <-----> solitary/ reserved
The amount of energy, positive emotions, surgency, talkativeness,
assertiveness, sociability and seeking stimulation in company of others
High extraversion - attention seeking, domineering
Low extraversion - reserved, reflective, aloof, self-absorbed
Agreeableness
Friendly/ compassionate <-----> challenging/ detached
A tendency to be compassionate and cooperative > suspicious and
antagonistic
High agreeableness - naïve, submissive, overly trusting, helpful
Low agreeableness - competitive, challenging, argumentative,
untrustworthy
Neuroticism
Sensitive/ nervous <-----> secure/ confident
The tendency to experience unpleasant emotions easily (anger, anxiety,
depression, vulnerability) or level of emotional stability
High need for stability - stable, calm, uninspiring, unconcerned
Low need for stability - reactive, excitable, unstable, insecure
NOTE:
Neuroticism - reality testing is good; patient understands their irrationality
Psychosis - reality testing is flawed; patient cannot discern reality vs
delusions/ hallucinations
Comorbidities Most common comorbidities in personality disorder include …
Alcohol or substance abuse
Depression
Self-harm, suicide
Borderline PD
Mental disorder comorbidities - mood disorders, anxiety disorders, PTSD,
substance abuse, eating disorder
Public health Impaired relationships
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Document Summary
It cannot be diagnosed until after age 18yo. Paranoid - pattern of irrational suspicion and mistrust of others, interpreting motivations as malevolent. Schizoid - lack of interest and detachment from social relationships, apathy and restricted emotional expression. Schizotypal - extreme discomfort interacting socially, and distorted cognitions and perceptions. Antisocial - pervasive pattern of disregard for and violation of the rights of others, lack of empathy, bloated self image, manipulative and impulsive behaviour. Borderline - pervasive pattern of instability in relationships, self image, identity, behaviour and affects often leading to self harm and impulsivity. Histrionic - pervasive pattern of attention-seeking behaviour and excessive emotions of empathy. Narcissistic - pervasive pattern of grandiosity, need for admiration and lack. Avoidant - pervasive feelings of social inhibition and inadequacy, extreme sensitivity to negative evaluation. Dependent - pervasive psychological need to be cared for by other people. Obsessive compulsive - rigid conformity to rules, perfectionism and control.
