Personality Disorders

Question 1

What is personality

Answer 1

A cluster of relatively predictable patterns of thinking, feeling, and behaving that is generally consistent across time, space, and context
How someone behaves in certain settings

Question 2

What is a personality disorder

Answer 2

An enduring pattern of inner experience and behaviour that deviates markedly from the expectations of the individual’s culture
Affects cognition, affectivity, interpersonal function and/or impulse control
However, as these behaviors are part of your personality they cannot be changed
May upset the person and those around them

Question 3

Does a personality disorder change across social settings?

Answer 3

No
It is inflexible and pervasive across a range of personal and social situations
Seen at home, work, social settings etc.

Question 4

When does a personality disorder usually start

Answer 4

Can be traced back to at least adolescence or early adulthood
Traits will be noticed at these ages and will persist
Condition of long duration

Question 5

What marks the difference between traits and the actual disorder

Answer 5

Most people will have some traits

Only becomes the disorder if it is pervasive and causes distress/impairment in their daily life

Question 6

How can you assess personality

Answer 6

Clinical assessment - complex and takes a lot of time

Rating scales and questionnaires exist

Question 7

Is PD inherited

Answer 7

There is some evidence of heritability however it is a complex gene/environment interaction

Question 8

How common are personality disorders

Answer 8

Around 10 of the population have one

More common than asthma, diabetes and RA

Question 9

List the subtypes of personality disorder

Answer 9

Schizoid 
Paranoid
Borderline - emotionally unstable
Anakastic
Antisocial 
Dependant 
Avoidant/anxious

Question 10

Describe paranoid PD

Answer 10

Patients will have a pervasive distrust and suspiciousness of others - think all intentions are malevolent
Reads hidden threats from benign remarks
Doesn’t trust friends and doesn’t confide in people
Bears grudges and is quick to become defensive

Question 11

Describe schizoid PD

Answer 11

A pervasive pattern of detachment from social relationships and a restricted range of expression of emotions
Neither desires nor enjoys close relationships
Chooses solitary activities
Little interest in sex
Indifferent to praise or criticism
Emotional coldness and detachment
Often have a rich fantasy world

Question 12

Describe antisocial PD

Answer 12

A pervasive pattern of disregard for and violation of the rights of others
Struggle to make close relationships
Failure to conform to social norms and lawful behaviour - criminal behaviour
Deceitfulness
Impulsivity
Irritability and aggression
Reckless disregard for safety of self or others
Lack of remorse
Consistent irresponsibility - doesn’t learn from mistakes

Question 13

Describe borderline PD

Answer 13

A pervasive pattern of instability of interpersonal relationships, self-image, and affect
Struggle to control emotions - e.g. inappropriate intense anger
Marked impulsivity - in at least two areas that are potentially self-damaging
Frantic efforts to avoid real/imagined abandonment
A pattern of unstable and intense interpersonal relationships
Identity disturbance
Brief psychotic symptoms when stressed
Recurrent suicidal behaviour, self harm or threats
Chronic feeling of emptiness
Transient paranoid ideation

Question 14

Describe histrionic PD

Answer 14

A pervasive pattern of excessive emotionality and attention seeking
Uncomfortable when not centre of attention
Inappropriate sexual, seductive or provocative behaviour
Rapidly shifting and shallow displays of emotion
Consistently uses physical appearance to draw attention to themselves - worries about appearance
Has a style of speech that is excessively impressionistic and lacking in detail.
Easily influenced/suggestible
Considers relationships to be more intimate than they actually are.

Question 15

Which PDs are in cluster A

Answer 15

Called the odd and eccentric one

Paranoid and Schizoid

Question 16

Which PDs are in cluster B

Answer 16

The dramatic and emotional cluster

Borderline/emotionally unstable, histrionic, narcissistic and antisocial

Question 17

Which PDs are in cluster C

Answer 17

The anxious and avoidant cluster

Avoidant, dependant and obsessive compulsive

Question 18

Describe avoidant PD

Answer 18

A pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation
Very anxious and tense
Avoids situations which significant interpersonal contact because of fears of criticism, disapproval, or rejection.
Is unwilling to get involved with people unless certain of being liked.
Shows restraint within intimate relationships
Preoccupied with being criticised or rejected in social situations
Is inhibited in new interpersonal situations because of feelings of inadequacy.
Views self as socially inept, personally unappealing, or inferior to others.
Is unusually reluctant to take personal risks or to engage in any new activities

Question 19

Describe dependant PD

Answer 19

A pervasive and excessive need to be taken care of that leads to submissive and clinging behaviour and fears of separation
Has difficulty making everyday decisions without an excessive amount of advice and reassurance from others
Needs others to assume responsibility for most major areas of his or her life.
Has difficulty expressing disagreement with others because of fear of loss of support - will do what others want
Has difficulty initiating projects or doing things on their own
Goes to excessive lengths to obtain nurturance and support from others, to the point of volunteering to do things that are unpleasant.
Feels uncomfortable or helpless when alone because of exaggerated fears of being unable to care for themselves
Urgently seeks another relationship as a source of care and support when a close relationship ends.
Is unrealistically preoccupied with fears of being abandoned

Question 20

Describe obsessive compulsive PD

Answer 20

A pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency
Rigid and stubborn - has to stick to routine
Struggles to adapt to new situations
Preoccupied with details, lists etc
Perfectionism that interferes with task completion
Is excessively devoted to work and productivity to the exclusion of leisure activities and friendships
Is over conscientious and inflexible about matters of morality, ethics, or values
Is unable to discard worn-out or worthless objects (even if not sentimental)
Doesn’t like spending - hoards for future
Can have obsessional thoughts and images - not as bad as OCD

Also called anakastic

Question 21

What is meant by psychopathy

Answer 21

It describes a set of deficits in emotional and cognitive functioning

Question 22

How do you treat PD

Answer 22

No good evidence for treatment of the disorder itself
Psychological therapy and support is commonly used
May use medication suited to subtype - e.g. mood stabilisers for BPD/EUPD

Treatment of comorbidity (anxiety etc) is effective and should be the focus

Question 23

How do you treat avoidant PD

Answer 23

Social skills training may be beneficial

Some evidence for antidepressants

Question 24

How can you treat emotionally unstable/borderline PD

Answer 24

Main psychological treatment is Dialectical Behavioural Therapy
Treat co-morbid depression etc
Antipsychotics and mood stabilisers may have a role

Question 25

Which of the personality disorders is most common

Answer 25

Obsessive compulsive

Question 26

There is a high rate of comorbidity with PD and which other conditions

Answer 26

Mood problems
Substance misuse
Anxiety

Question 27

Is there a genetic component to personality disorders

Answer 27

Yes

40-50% of personality is thought to be from genes

Question 28

Which factors can increase risk of developing a PD

Answer 28

Physical or sexual abuse in childhood
Violence in the family
Parental alcohol and drug abuse 
Some genetic factors 
Differences in brain structure/chemicals - no definitive test