Personality Disorders

Question 1

What are personality disorders?

Answer 1

An enduring pattern of inner experience or behaviour that deviates markedly from the expectations of an individual’s culture that are inflexible, pervasive, not manifestations of another illness, and result in distress or impairment in normal function

Question 2

What is the prevalence of personality disorders?

Answer 2

10%

Question 3

What are the clusters of personality disorders, and how can each be described?

Answer 3

Cluster A - odd and eccentric
Cluster B - dramatic and emotional
Cluster C - anxious and avoidant

Question 4

What are the commonest and least common clusters?

Answer 4

Cluster C is most common

Cluster B is least common

Question 5

What personality disorders are included in cluster A?

Answer 5

Paranoid personality disorder
Schizoid personality disorder
Schizotypal personality disorder (DSM)

Question 6

What is the main feature of paranoid personality disorder?

Answer 6

Distrustful and suspicious of others

Question 7

What are the features of paranoid personality disorder?

Answer 7

Unsubstantiated thoughts that others are exploiting, harming or deceiving them
Doubts loyalty of friends
Reluctant to confide in others because of unwarranted fear that information will be used against them
Hold grudges
Perceives attacks on character that aren’t apparent to others, very quick to respond to these attacks
Recurrent suspicions without justification about fidelity of their partner
Persistent self-referential attitude, excessive self-importance
Preoccupation with unsubstantiated “conspiratorial” explanations of events in the world at large

Question 8

What is the main feature of schizoid personality disorder?

Answer 8

Socially withdrawn with restricted range of emotions

Question 9

What are the features of scizoid personality disorder?

Answer 9

Doesn’t desire or enjoy close relationships
Prefers solitary activities
Little interest in sexual experiences
Indifferent to praise or criticism
Restricted expression of emotion, emotional closeness
No enjoyment from any activities
Excessive preoccupation with fantasy/introspection

Question 10

What is the main feature of schizotypal personality disorder?

Answer 10

Eccentric with distorted reality

Question 11

What are the features of schizotypal personality disorder?

Answer 11

Cold and aloof
Inappropriate affect
Poor rapport due to interpersonal deficits - leads to social withdrawal
Odd beliefs and magical thinking
Ideas of reference
Unusual perceptual disturbances and delusions
Suspicious and paranoid ideas
Odd and eccentric behaviour
Vague and circumstantial in their thinking
Odd speech without being incoherent
Suspicious or paranoid ideation

Question 12

What are the management options for cluster A personality disorders?

Answer 12

Tend to be stable, don’t achieve much with management
Schizoid - psychodynamic and group therapy, but tend to relapse
Antipsychotic drugs can reduce suspiciousness

Question 13

What personality disorders are included in cluster B?

Answer 13

Antisocial personality disorder
Borderline personality disorder (emotionally unstable)
Histrionic personality disorder
Narcissistic personality disorder (DSM)

Question 14

What is the main feature of antisocial personality disorder?

Answer 14

Disregard and violation of the rights of others

Question 15

What are the features of antisocial personality disorder?

Answer 15

Usually young men
Lack of concern for others’ feelings or safety
Unlawful and irresponsible behaviour
Lack of remorse, failure to accept responsibility for actions
Impulsivity
Deceitfulness
Irritable and easily frustrated
Incapacity to maintain enduring relationships, though no difficulty to establishing them
Prone to blaming others

Question 16

What is the management of antisocial personality disorder?

Answer 16

Therapy to improve discipline
Very unresponsive to management
Antidepressants or mood stabilisers can help with emotional difficulties (SSRIs)

Question 17

What is antisocial personality disorder known as in under 18s?

Answer 17

Conduct disorder

Question 18

What is the main feature of borderline personality disorder?

Answer 18

Impulsive and emotionally unstable

Question 19

What are the 2 subtypes of borderline personality disorder?

Answer 19

Impulsive

Borderline

Question 20

What are the features of the impulsive subtype of borderline personality disorder?

Answer 20

Tendency to act unexpectedly without consideration of consequences
Difficulty controlling anger
Quarrelsome behaviour and conflicts with others, especially when impulsive acts are thwarted/criticised
Difficulty in maintaining any course of action that offers no immediate reward
Intense mood swings

Question 21

What are the features of the borderline subtype of borderline personality disorder?

Answer 21

Features of impulsive, plus:
Unstable self-image and sense of self
Intense and unstable relationships
Efforts to avoid real or imagined abandonment
Recurrent suicidal behaviour, threats or self-harm
Feelings of emptiness

Question 22

What are management options in borderline personality disorder?

Answer 22

Dialectal behavioural therapy
Antipsychotics (olanzapine) if paranoid
Mood stabilisers (lamotrigine) can help with unstable mood and impulsivity
Antidepressants (SSRIs) can help with emotional difficulties

Question 23

What is the main feature of histrionic personality disorder?

Answer 23

Excessively emotional and attention-seeking

Question 24

What are the features of histrionic personality disorder?

Answer 24

Exaggerated, theatrical displays of emotion
Pre-occupied with appearance
Vain and uses appearance to get attention
Easily influenced by others
Shallow and labile affect
Inappropriate sexually seductive or provocative behaviour

Question 25

What are management options in histrionic personality disorder?

Answer 25

Psychodynamic and dialectal behavioural therapy

Question 26

What is the main feature of narcissistic personality disorder?

Answer 26

Preoccupied with power, prestige and vanity

Question 27

What are the features of narcissistic personality disorder?

Answer 27

Inflated ideas of self-importance Preoccupied with fantasies about their success Believes they are special and unique Has a sense of entitlement Takes advantage of others to meet their goals Arrogant and require excessive admiration Lacks empathy Chronic envy

Question 28

What personality disorders are included in cluster C?

Answer 28

``` Avoidant (anxious) personality disorder Dependent personality disorder Obsessive compulsive (anankastic) personality disorder ```

Question 29

What is the main feature of avoidant (anxious) personality disorder?

Answer 29

Social inhibition, inadequacy

Question 30

What are the features of avoidant (anxious) personality disorder?

Answer 30

Avoids activities as they fear criticism or rejection Don’t get involved with people until they are sure they are liked (aka need to be sure of security) Shows restraint within intimate relationships because of the fear of being shamed or ridiculed Persistent tense and apprehensive feelings View themselves as inferior to others Preoccupied with sense of rejection and criticism Is unusually reluctant to take personal risks or to engage in any new activities because they may prove embarrassing Social isolation accompanied by a craving for social contact

Question 31

What are management options in avoidant (anxious) personality disorder?

Answer 31

Social skills training Group therapy Psychodynamic therapy Antidepressants can help with anxiety

Question 32

What is the main feature of dependent personality disorder?

Answer 32

Excessive need to be taken care of

Question 33

What are the features of dependent personality disorder?

Answer 33

Need excessive amounts of advice before making everyday decisions Let others make important decisions for them Struggles to do things for themselves due to lack of self confidence Feels uncomfortable or helpless when alone Preoccupied with fears of being left to take care of themselves Doesn't disagree with or demand from others Subordination of one's own needs to those of others on whom one is dependent, and undue compliance with their wishes

Question 34

What are management options in dependent personality disorder?

Answer 34

Assertiveness training Psychodynamic therapy CBT Antidepressants can help with anxiety

Question 35

What is the main feature in obsessive compulsive (anankastic) personality disorder?

Answer 35

Order, control, perfectionist and inflexible

Question 36

What are the features of obsessive compulsive (anankastic) personality disorder?

Answer 36

Perfectionism that interferes with task completion Preoccupied with detail to the point where productiveness is lost Excessively devoted to work to the exclusion of leisure activities and friendships Reluctant to delegate tasks Rigid and stubborn Unable to discard worthless objects Excessive desire to save money

Question 37

What are management options in obsessive compulsive (anankastic) personality disorder?

Answer 37

Psychotherapy CBT Antidepressants can help with anxiety

Question 38

What is the pharmacological management for difficulties with impulse control?

Answer 38

First line: SSRI | Second line: mood stabiliser (olanzapine, valproate, carbamazepine, low dose antipsychotic)

Question 39

What is the pharmacological management for affective dysregulation?

Answer 39

First line: SSRI or mirtazapine | Second line: mood stabiliser (olanzapine, valproate, carbamazepine, low dose antipsychotic)

Question 40

What is the pharmacological management for cognitive perceptual symptoms?

Answer 40

Low dose antipsychotic

Question 41

What is the pharmacological management for interpersonal difficulties?

Answer 41

Not appropriate