History and exam
Key diagnostic factors
common
paranoia
A cognitive-perceptual feature characteristic of personality disorders.
Paranoid personality disorder patient: hidden meaning seen in neutral actions, may suspect harm or deception by clinician, suspects infidelity in partner.
Borderline personality disorder: paranoid thinking can emerge in response to stress.
odd thinking
A cognitive-perceptual feature characteristic of personality disorders.
Schizotypal personality disorder: experiences ideas of reference, magical thinking.
restricted range of emotions
A mood feature characteristic of the affective dysregulation of personality disorders.
Obsessive-compulsive personality disorder: prefers rational to emotional expression.
Schizoid personality disorder: restricted range of emotion displayed; may delay seeking medical care because of unwanted contact and may appear cold/indifferent.
anger and irritability
Mood symptoms characteristic of the affective dysregulation of personality disorders.
Antisocial personality disorder: often appears irritable.
Borderline personality disorder: episodic, intense anger states; may reflect history of trauma and mild dissociation.
Paranoid personality disorder: often appears angry.
excessive emotionality and unstable mood states
Mood symptoms characteristic of the affective dysregulation of personality disorders.
Borderline personality disorder: unstable and intense mood states often occurring in concert with idealisation and devaluation of others; chronic dysphoria is common.
Histrionic personality disorder: superficial and excessive emotionality.
anxiety and tension
Anxiety symptoms characteristic of the affective dysregulation of personality disorders.
Avoidant personality disorder: fearful of rejection, unlikely to disagree with physician, socially anxious.
Borderline personality disorder: fearful of rejection, separation, and abandonment.
Dependent personality disorder: experiences significant difficulty when asked to engage in decision making and tries to enlist others to take responsibility for health issues.
Histrionic personality disorder: becomes anxious with discussion of serious health issues or difficult feelings.
Obsessive-compulsive personality disorder: extreme concern about providing the 'right' answers to questions.
Paranoid personality disorder: often appears tense, hypervigilant.
Schizotypal and schizoid personality disorder: discomfort with social communication and physical examination.
impulsive behaviours
Indicators of the impulse dyscontrol characteristic of personality disorders.
Antisocial personality disorder: may appear cooperative and charming at first in an effort to obtain desired outcome from clinician, but repeatedly acts with disregard for safety and rights of others, with irresponsibility and lack of remorse; violence and substance use are common.
Borderline personality disorder: impulsive, recurrent self-destructive behaviours such as cutting, substance use and drug overdose, sexual promiscuity.
grandiosity
A cognitive-perceptual feature characteristic of personality disorders.
Narcissistic personality disorder: sense of self based on grandiosity and need for admiration, interpersonally exploitative, has difficulty accepting diagnoses that challenge sense of self as infallible. Often exists alongside intense degree of shame, rage in the face of humiliation.
evidence of self harm (e.g., scars, burns)
May be present.
Risk factors
strong
history of abuse
Childhood maltreatment, particularly a history of childhood physical abuse, sexual abuse, and neglect is associated with development of personality disorders.[39] Individuals who have experienced childhood abuse or neglect were found to be more than four times as likely as those without such a history to be diagnosed with personality disorders.[39] One cross-sectional study that compared self-reports of adults diagnosed with avoidant personality disorder to those with social phobia found that avoidant personality disorder was highly correlated with neglect, especially physical neglect.[40]
family history of schizophrenia
family history of borderline personality disorder (BPD)
One population-based Swedish study that included 1,851,755 participants, of whom 11,665 (0.6%) had a diagnosis of BPD according to the International Classification of Diseases (ICD-10), estimated that the heritability of BPD was 46%; the remaining 54% of variance was explained by non-shared environmental factors.[33]
negative parenting interactions
Home environments characterised by harsh punishment and lack of parental affection are associated with personality disorder into adulthood.[50]
emotional/disruptive disorder in childhood
Disruptive behaviour disorder in childhood is associated with a higher likelihood of having a cluster B (dramatic) personality disorder than having another emotional disorder.
For women, having an emotional disorder in childhood was associated with increased likelihood of having a cluster C (anxious/fearful) personality disorder.[51]
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