Week 4- Personality disorders

Question 1

What is personality?

Answer 1

A cluster of relatively predictable ways of thinking, feeling and behaving that is generally consistent across time, space and context.

Question 2

What makes up the structure of personality?

Answer 2

Neuroticism 
Agreeableness
Openness 
Conscientiousness 
Extraversion

Question 3

What is personality disorder?

Answer 3

An enduring pattern of inner experience and behaviour that deviates from the expectations of the individuals culture. This pattern is manifested in two or more of the following areas

• Cognition (ways of perceiving and interpreting self, other people and events)
• Affectivity (the range, intensity, appropriateness etc of the emotional response)
• Interpersonal functioning
• Impulse control

Question 4

What is the criteria for having a PD? (this includes the above card)

Answer 4

A-The enduring pattern is inflexible and pervasive across a broad range of personal and social situations.
B- The enduring pattern leads to significant distress or impairment in social, occupational or other important areas of functioning.
C-The pattern is stable and of long duration, and its onset can be tracked back to at least adolescents or early adulthood
D- The enduring pattern is not better explained as a consequence of mental disorder
E-The pattern is not attributable to the physiological effects of a substance (a drug of abuse, medication) or another medical condition (head trauma)

Question 5

What is anankastic personality disorder also known as?

Answer 5

Obsessive compulsive personality disorder.

Question 6

What criteria is there for anankastic personality disorder?

Answer 6

1- feelings of excessive doubt or caution
2-Preoccupation with details, rules, lists, orders, organisation or schedule
3-Perfectionism that interferes with task completion
4-Excessive conscientiousness and scrupulousness (careful)
5-Undue preoccupation with productivity to the exclusion of pleasure and interpersonal relationships
6-Excessive pedantry and adherence to social behaviours
7-Rigidity and stubbornness
8- Unreasonable insistence that others submit to his/her way of doing things, or unreasonable reluctance to allow others to do things.

Question 7

How can you distinguish between it being a personality trait or a personality disorder?

Answer 7

If it is pervasive (in different situations its still there) and causes distress and/or impairment of functioning in most areas.

Question 8

Which personality disorders are described as being ‘odd and eccentric’?

Answer 8

Cluster A

• Paranoid
• Schizoid
• Schizotypal

Question 9

Which personality disorders are described as being ‘dramatic and emotional’?

Answer 9

Cluster B

• Antisocial
• Borderline

Question 10

Which personality disorders are described as being ‘anxious and fearful’?

Answer 10

Cluster C

• Avoidant
• Dependent
• Obsessive-compulsive

Question 11

Which is the most common type of PD?

Answer 11

Obsessive compulsive personality disorder.

Question 12

Describe the criteria for paranoid PD?

Answer 12

A pervasive distrust and suspiciousness of others such as their motives are interpreted as malevolent (evil), beginning by early adulthood and presenting in a range of contexts. Need four of more of:
1- suspects without basis that others are exploiting, harming or deceiving them
2-Is preoccupied with unjustified doubts about the loyalty or trustworthiness of friends or associates.
3- Is reluctant to confide in others because of unwarranted fear that the information will be used maliciously against him or her.
4-Reads hidden demeaning or threatening meanings into benign remarks
5-Persistently bears grudges
6- Perceives attacks on his/her character or reputation that are not apparent to others and is quick to react angrily or counterattack
7- Has recurrent suspicions regarding fidelity of spouse or sexual partner.

Question 13

Describe the criteria for schizoid PD?

Answer 13

A pervasive pattern of detachment from social relationships and a restricted range of emotions in interpersonal settings, beginning by early adulthood and present in a variety of contexts, as indicated by 4 or more of the following:
1-Neither desires nor enjoys close relationships, including being part of a family
2- Almost always chooses solitary activities
3-Has little, if any, interest in sexual experiences
4-Takes pleasure in few, if any, activities
5-Lacks friends or confidents other than 1st degree relatives
6- Appears indifferent to the praise or criticism of others
7- Shows emotional coldness, detachment or flattened affectivity

Question 14

Describe the criteria for antisocial PD?

Answer 14

A pervasive pattern of disregard for and violation of rights of others, occurring since the age of 15, as indicated by three or more of the following:
1-Failure to conform to social norms with respect to lawful behaviours, as indicated by repeatedly performing acts that are grounds for arrest
2-Decietfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure
3- Impulsivity or failure to plan ahead
4-Irritability and aggressiveness, as indicated by repeated physical fights and assaults
5- Reckless disregard for safety of themselves/others
6-Consistant irresponsibility, as indicated by repeated failure to sustain consistent work behaviour and honour financial obligations
7- Lack of remorse, as indicated by being indifferent to or rationalising having hurt, mistreated or stolen from another.

Question 15

Describe the criteria for borderline PD?

Answer 15

A pervasive pattern of instability of interpersonal relationships, self-image and affects and marked impulsivity, beginning in early adulthood and present in a variety of contexts, as indicated by five or more of the following:
1- Frantic efforts to avoid real or imagined abandonment
2- A pattern of unstable and intense interpersonal relationships characterised by alternating between extremes of idealisation and devaluation
3- Identity disturbance- markedly and persistently unstable image of ones self-image or sense of self
4- Impulsivity in atleast two areas that are potentially self- damaging e.g. spending, sex, substance abuse, reckless driving, binge eating
5- Recurrent suicidal behaviour, gestures or threats of self mutilating behaviour
6- Affective instability due to marked reactivity of mood (e.g. intense episodic dysphoria, irritability or anxiety usually lasting a few hours)
7- Chronic feeling of emptiness
8- Inappropriate intense anger or difficulty controlling anger
9- Transient, stress-related, paranoid ideation or severe dissociative symptoms.

Question 16

Describe histrionic PD?

Answer 16

A pervasive pattern of excessive emotionality and attention seeking, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:
1- Is uncomfortable in situations in which he or she is not the center of attention.
2-Interaction with others is often characterized by inappropriate sexually seductive or provocative behavior.
3-Displays rapidly shifting and shallow expression of emotions.
4- Consistently uses physical appearance to draw attention to self.
5-Has a style of speech that is excessively impressionistic and lacking in detail.
6-Shows self-dramatization, theatricality, and exaggerated expression of emotion.
7-Is suggestible (i.e., easily influenced by others or circumstances).
8-Considers relationships to be more intimate than they actually are.

Question 17

Describe avoidant PD?

Answer 17

A pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following:
1-Avoids occupational activities that involve significant interpersonal contact because of fears of criticism, disapproval, or rejection.
2-Is unwilling to get involved with people unless certain of being liked.
3-Shows restraint within intimate relationships because of the fear of being shamed or ridiculed.
4-Is preoccupied with being criticized or rejected in social situations.
5-Is inhibited in new interpersonal situations because of feelings of inadequacy.
6-Views self as socially inept, personally unappealing, or inferior to others.
7-Is unusually reluctant to take personal risks or to engage in any new activities because they may prove embarrassing.

Question 18

Describe dependent PD?

Answer 18

A pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:
1-Has difficulty making everyday decisions without an excessive amount of advice and
reassurance from others.
2-Needs others to assume responsibility for most major areas of his or her life.
3-Has difficulty expressing disagreement with others because of fear of loss of support or approval. (Note: Do not include realistic fears of retribution.)
4-Has difficulty initiating projects or doing things on his or her own (because of a lack of self-confidence in judgment or abilities rather than a lack of motivation or energy). 5.Goes to excessive lengths to obtain nurturance and support from others, to the point of
volunteering to do things that are unpleasant.
6-Feels uncomfortable or helpless when alone because of exaggerated fears of being unable to care for himself or herself.
7-Urgently seeks another relationship as a source of care and support when a close relationship ends.
8-Is unrealistically preoccupied with fears of being left to take care of himself or herself.

Question 19

Describe obsessive compulsive PD?

Answer 19

A pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following:
1-Is preoccupied with details, rules, lists, order, organization, or schedules to the extent that the major point of the activity is lost.
2-Shows perfectionism that interferes with task completion (e.g., is unable to complete a project because his or her own overly strict standards are not met).
3-Is excessively devoted to work and productivity to the exclusion of leisure activities and friendships (not accounted for by obvious economic necessity).
4-Is overconscientious, scrupulous, and inflexible about matters of morality, ethics, or values (not accounted for by cultural or religious identification).
5-Is unable to discard worn-out or worthless objects even when they have no sentimental
value.
6-Is reluctant to delegate tasks or to work with others unless they submit to exactly his or her way of doing things.
7-Adopts a miserly spending style toward both self and others; money is viewed as
something to be hoarded for future catastrophes.
8-Shows rigidity and stubbornness.

Question 20

What personality deficits would make someone a psychopath?

Answer 20

Superficially charming however manipulative. They have a grandiose self worth and are often pathological liars.
They lack remorse, guilt and empathy. They tend to fail to accept responsibility for their actions.
They need stimulation and are prone to boredom. They are often impulsive and irresponsible and lack long term goals.
They have poor behavioural controls, early behavioural problems and have criminal versatility.

Question 21

Can you treat personality disorder?

Answer 21

Not really. However can treat co-morbidities e.g. depression, schizophrenia etc.

Question 22

What is the main psychological treatment used for PD?

Answer 22

Dialectical Behavioural Therapy

however mentalisation has become increasingly popular