Lecture 4: Personality Disorders

Question 1

When do personality traits become disorders?

Answer 1

o When traits are so maladaptive that they significantly impair one’s work life and social life or cause major subjective distress

Question 2

What are personality disorders?

Answer 2

o Inflexible and maladaptive responses to stress
o Global, affecting work and relationships
o Stable and enduring
o Non-psychotic, except under severe stress
o Ego-syntonic (the world is the problem, not me)
o Multiple complications

Question 3

Age of onset of PD

Answer 3

Age of onset in late adolescence, early adulthood

if later life personality changes -> look for medical causes!!

Question 4

modifiable over time?

Answer 4

studies suggest yes

Question 5

Common co-morbid psychiatric conditions

Answer 5

i) Mood disorders
ii) Anxiety disorders
iii) Substance abuse/dependence

Question 6

True/False. There is significant diagnostic overlap among PDs

Answer 6

True

Question 7

prevalence of PD

Answer 7

(1) 1-5% of general population
(2) 10-30% of outpatients mental health facilities
(3) 15-30% of psychiatric inpatients

Question 8

Gender differences

Answer 8

Antisocial PD male > female

Borderline PD female > male

Question 9

causes

Answer 9

i) Almost certainly a combination of biological and environmental factors.
(1) Example: Antisocial PD
(a) 1000+ children followed ages 3-21.
(b) 2 genetic polymorphisms: low MAO-A activity, hi MAO-A activity
(c) Maltreatment, no maltreatment
(d) Low MAO-A genotype + severe maltreatment -> antisocial behavior
(85%)
(e) Hi MAO-A genotype + maltreatment -> no antisocial behavior

Question 10

Borderline personality disorder

Answer 10

i) Among the most common PDs
ii) High users of health care
iii) Challenging patients
(1) Chronic suicidality
(2) Medication abuse
(3) Desperate care-seeking
(4) Intense anger
(5) Dividing a health care team into good guys and bad guys

Question 11

Diagnostic criteria (at least 5) for Borderline personality disorder

Answer 11

(1) Frantic efforts to avoid abandonment
(2) Unstable, intense relationships
(3) Unstable self-image
(4) Self-damaging impulsivity
(5) Recurrent suicidal behavior, self-mutilation
(6) Affective instability
(7) Feelings of emptiness
(8) Intense and inappropriate or uncontrolled anger
(9) Transient paranoia or severe dissociative symptoms

Question 12

Treatment options for personality disorders

Answer 12

i) treat co-morbid psychiatric disorders
ii) Biological Treatments
(1) Medication
iii) Psychosocial Treatments
(1) Psychotherapies
(a) Cognitive/behavioral
(b) Insight-oriented
(c) Supportive
(d) Individual/group/family
(2) Skills training, e.g., coping skills for managing self-harm urges or
emotional instability
iv) Alternative Treatments
(1) Self-help groups

Question 13

Ground rules for treating people with personality disorders

Answer 13

i) Focus on behavior, not explanations of it
ii) Maintain a collaborative stance
iii) Attend to your own rescue fantasies
iv) Set limits on threats to safety
v) Do not shield patients from the consequences of their actions
vi) Manage your own feelings with support and consultation

Question 14

Cluster A

Answer 14

odd or eccentric:
▪ Paranoid
▪ Schizoid
▪ Schizotypal

Question 15

Cluster B:

Answer 15

dramatic, emotional, or erratic
▪	Antisocial
▪	Borderline
▪	Histrionic
▪	Narcissistic

Question 16

Cluster C

Answer 16

anxious or fearful
▪ Avoidant
▪ Dependent
▪ Obsessive-compulsive