6 personality disorders

Question 1

What does the term “personality disorder” generally refer to?

Answer 1

a diagnostic category of mental-health disorders characterised by a difficulty in relating to the world and to other people

inflexible and maladaptive thinking patterns with often negative impact on the immediate environment

Question 2

What are the four defining features of personality disorders?

Answer 2

1. distorted perception and thinking patters
2. problematic emotional responses
3. over- or under-regulated impulse control
4. interpersonal difficulties

Question 3

What are the three Clusters in the DSM-5?

Answer 3

Cluster A (the “odd, eccentric” cluster);

Cluster B (the “dramatic, emotional, erratic” cluster); and,

Cluster C (the “anxious, fearful” cluster).

Question 4

What personality disorders does Cluster A contain?

Answer 4

paranoid personality disorder
schizoid personality disorder
schizotypical personality disorder

social akwardness, social isolation and withdrawal
dominated by distorted thinking

Question 5

What are defining features of paranoid PD?

Answer 5

distrust and suspiciousness

• People with this disorder assume that others are out to harm them, take advantage of them, or humiliate them in some way.
• They put a lot of effort into protecting themselves and keeping their distance from others.
• They are known to preemptively attack others whom they feel threatened by.
• They tend to hold grudges, are litigious, and display pathological jealously.
• Distorted thinking is evident. Their perception of the environment includes reading malevolent intentions into genuinely harmless, innocuous comments or behavior, and dwelling on past slights.

For these reasons, they do not confide in others and do not allow themselves to develop close relationships.
- Their emotional life tends to be dominated by distrust and hostility.

Question 6

What are defining features of schizoid PD?

Answer 6

social detachment and restricted range of emotional expression

• choose solitary activities and seem to take little pleasure in life
• loners prefer mechanical or abstract activites with little interaction, appear indifferent of both criticism and praise
• emotionally aloof, detached or cold
• oblivious to social nuance and social cues causing them to appear socially inept and superficial
• restricted emotional range and failure to reciprocate gestures or facial expressions cause sdull, bland, inattentive appearance

Question 7

What are defining features of schizotypical PD?

Answer 7

acute discomfort in social settingsand have areduced capacity for close relationships

• perceptual and cogntivie distortions and/or eccentric behaviour hallucinations that only they can see
• odd beliefs, inconcistent with social/cultural norms
• found more frequently in families with schizophrenia, genetic commonalities

Question 8

What personality disorders does Cluster B entail?

Answer 8

Borderline Personality Disorder
Narcissistic Personality Disorder
Histrionic Personality Disorder
Antisocial Personality Disorder

Question 9

What are defining features of BPD?

Answer 9

tend to experience intense and unstable emotions and moods that can shift fairly quickly
impulsivity, substance abuse, sexual liaisons, self-injury, overspending, binge eating
polarized, over-simplified, all-or-nothing terms
harsh judgments
unstable sense of self
intense emotional reactions - difficulties regulating these
great distress - self-destructive behaviours

Question 10

What are clinical features of BPD?

Answer 10

life-threatening disorder
prevalence between 2 and 6%
30% of inpatient psychiatric samples and 22% outpatient samples
95% have received individual therapy over four years
72% psychiatric hospitalisation
up to 84% of self-injury across lifespan
10% suicide

Question 11

What are defining features of narcissistic PD?

Answer 11

sense of self-worth, powerful sense of entitlement
special treatment is deserved, uniquely talented, especially brilliant and attractive
preoccuied with fantasies of unlimited success and power, superiority
no effort in daily life and no energy to actual life goals
arrogant haughty
feel devastated when they realise they have normal, average human limitations
conflictual relationships and superficial ones
status - sense of importance
self-judgments - require a lot of admiration from other ppl

Question 12

What are defining features of histrionic PD

Answer 12

excessive emotionality and attention seeking
drama
uncomfortable when they are not the center of attention
flirtatious, seductive
flamboyant and theatrical, exagerated degree of emotional expression
yet it is vague, shallow, and lacking in detail
often embarasses friends or others
flighty and frickle - uncomfortable being alone
imagine more intimacy than actually present
easily influenced by others suggestions and opinions

Question 13

What are defining features of antisocial PD?

Answer 13

disregard for the rights of other people, hostility or aggression
deceit and manipulation
first appear during childhood
- hurt or torment animals or people
- engage in hostile acts such as bullying or intimidating others
- disregard for property - destruction
- deceit, theft, violations (conduct disorder, a juvenile form of ASPD)
- often in dangerous and risky situations
- impulse urges without considering the consequences
- no remorse, no responsibility

Question 14

What are diagnostic criteria for BPD according to the DSM-5?

Answer 14

A. pervasive patten of instability of interpersonal relationships, self-image, and affects, and marked impulsivity

• frantic efforts to avoid abandonment
• extreme idealisation and devaluation
• identity distubance
• impulsivity -> self-harming
• suicidal behaviour
• affective instability, mood reactivity
• chronic feelings of emptiness
• inappropriate anger
• stress related paranoid ideation

Question 15

Which personality disorders are part of Cluster C?

Answer 15

avoidant personality disorder
dependent personality disorder
OCPD

Question 16

What are defining features of avoidant PD?

Answer 16

social inhibitions, feelings of inadequacy, hypersensitivity to negative evaluation
intensely afraid others will ridicule them, reject them or criticize them
limited social skills
small circle
they are not good enough - negative self talk and thoughts
distant, shy, restricted, stiff

Question 17

What are defining features of dependent PD?

Answer 17

strong need to be taken care of by other people
fear of losing support of others
clingy manner
always seeking human interaction and support

Question 18

What are defining features of OCPD?

Answer 18

preoccupied with rules, regulations, and orderliness
at the expense of flexibility, openness and efficiency
perfectionist tendencies
rigid, unable to delegate tasks
controlling, stubborn

Question 19

How do cultural characteristics impact the diagnosis and treatment of PDs?

Answer 19

Culture is understood in terms of a context. Context refers to the social and environmental specificities of the local world in which individuals and groups develop. These specificities or specific elements include
(1) subjective perceptions, which indicate systems for interpreting human interactions and experience;
(2) social structures that limit and allow diverse possibilities of activity and access to resources across individuals in a particular society;
(3) the local physical environment, which sets standards for the group’s interactions with natural resources and technology; as well as
(4) the individual situations, which are variable across persons and over time

Question 20

What is cultural imperialism?

Answer 20

a social process by which values, experiences, and culture of the dominant group are viewed as a universal norm while groups or individuals who vary from this group are considered as inferior, deviant, or inadequate.

Question 21

How does culture impact psychiatric assessment?

Answer 21

(1) Culture shapes and directs the content, meaning, configuration, and the phenomenology of symptoms.

(2) Ethnopsychiatric diagnostic rationales as well as practices of grouping symptoms into patterns, including common culture-bound syndromes found in societies around the world.

(3) Culture provides a matrix for the interpersonal situation of the diagnostic interview.

(4) Since the clinical encounter is often inter-cultural, the dynamics of cross-cultural work are crucial for understanding and refining diagnostic categories and practices.

(5) Culture gives overall conceptualizations of the diagnostic systems, which usually become the products of their time and circumstances.

Question 22

What are some biological factors of BPD?

Answer 22

biological dysfunctions and environmental factors
neurochemical factors
serotonergic systems
cholinergic activity
dopaminergic activity
lower endogenous opiod levels
reduced hippocampal and amygdala volumes
hyperactivity of amygdala
reduced activity in prefrontal cortex
weakening of prefrontal inhibitory control may contribute to hyperactivity in amygdala
reduced basal parasympathetic activity (vagal tone) may be trait-like marker for emotional sensitivity
heightened negative arousal at baseline

Question 23

What are some environmental factors of BPD?

Answer 23

invalidating environment
chronically and inadverently negates, rejects or dismisses an individuals behaviour and emotional expression
punishes emotional displays and reinforces emotional escalation
oversimplifies ease of problem solving and meeting goals
traumatic home environment
lack of secure attachment base

social baseline theory (Coan, 2008) - childs ability to regulate emotions is disrupted by lack of accessibility to and responsivity of caregivers

Question 24

What are some genetic influences on BPD?

Answer 24

potential genetic component
definite and broad type
35% and 38% MZ
7% and 11% DZ

Question 25

What are common courses of BPD?

Answer 25

• chronic course
• remission is common
• recurrence is rare
• declining rates of the symptoms

Question 26

What is the main difference between a PD and a non-PD disorder?

Answer 26

primary symptoms need to be present consistently, no crisis

must persist

Question 27

What are common treatments for BPD?

Answer 27

• Dialectical behaviour therapy (DBT)
  strongest empirical support
  motivational and capability deficit model of BPD
  individuals lack important interpersonal and distress tolerance skills
  personal and environmental factors inhibit the use of coping strategies
  reduction of suicidial behaviours
• mentalisation based therapy
  bateman and fonagys (2006) psychodynamically oriented mentalisation based therapy
  that mentalization based therapy results in reductions in suicidality, diagnostic status, service use, use of medi - cations, global functioning, depression, social functioning and hospitalization
• transference focused therapy
  identity diffusion or failure to inegrate self-concept and concepts of others arising from early life exeriences
  reconstructing representations of the self and others
• schema-focused therapy
  cognitive-behavioural informed treatment
  alter dysfunctional schemas
• family therapy
  working collaboratively
  family dynamics, emphasising positive aspects
• pharmacotherapy
  no identified BPD drug (at the time)

Question 28

What benefits does DBT specifically show for BPD?

Answer 28

efficacious treatment for high-risk behaviours

should be followed by another treatment focusing on other components of BPD as soon as the high risk behaviours are sufficiently reduced

treatment of choice for severe, life-threatening impulse control disorders

Question 29

How is DBT structured?

Answer 29

four stages of treatment

each stage of treatment matches the clinical complexity of the clients “level of disorder”
level 1 - behavioural dyscontrol
level 2 - quiet desperation
level 3 - problems in living
level 4 - incompleteness

• pre-treatment: orienting and commitment
  mutual agreement between therapist and client
• stage 1: establishing stability and behavioural control
  general level of functioning is low
  significant progress after 1 year of treatment
  suicidal and life-threatening behaviours
  therapy-interfering behaviours
  quality of life-interfering behaviours
  behavioural skills
• stage 2: non-anguished emotional experiencing
  transition from a place of quiet desperation to emotional experiencing
• stage 3: establishing ordinary happiness and unhappiness
• stage 4: attaining the freedom and capacity for joy

Question 30

What are therapeutic strategies administered in DBT?

Answer 30

• dialectical strategies (replacing patterns with opposite emotional states)
• balancing (nurturing the client and demanding for change)
• paradox (tolerate ambiguity)
• methaphor
• devil´s advocate
• extending (taking them more seriously than they intend)
• making lemonade out of lemons
• core strategies (validation and problem solving)

Question 31

What exactly are core strategies in DBT?

Answer 31

emotional validation strategies, behavioural validation strategies, cognitive validation strategies, and cheerleading strategies.
listening and observing
accurate reflection of the clients feelings
conveying intuitive understanding of the clients state
validation is based on the past - understandable cus cause
behaviour is justifiable, reasonable, well-grounded, meaningful, efficacious in terms of current events, biological functioning and life goals
radical genuineness by recognizing the client and responding to their strengths
cheerleading
problem solving, behavioural analysis
Are ineffective behaviours being reinforced, and are effective behaviours followed by aversive outcomes? Does the client have the necessary behavioural skills to regulate his or her emotions, respond skilfully to conflict, and manage his or her own behaviour?
Are there patterns of avoidance, or are effective behaviours inhibited by unwarranted fears or guilt? Is the client unaware of the contingencies operating on his or her environment, or are effective behaviours inhibited by faulty beliefs or assumptions?
solution analysis
change procedures
skills training
contingency managment
cognitive modification
stylistic strategies - how to apply core treatment strategies
irreverent communication
reciprocal communication
cause management strategies
consultiation-to-the-client
consultation-to-the-therapist
environmental intervention

Question 32

What other disorders is DBT used for?

Answer 32

• Attention-deficit/hyperactivity disorder (ADHD)
• Bipolar disorder
• Borderline personality disorder (BPD)
• Eating disorders (such as anorexia nervosa, binge eating disorder, and bulimia nervosa)
• Generalized anxiety disorder (GAD)
• Major depressive disorder (including treatment-resistant major depression and chronic depression)
• Non-suicidalself-injury
• Obsessive-compulsive disorder (OCD)
• Post-traumatic stress disorder (PTSD)
• Substance use disorder
• Suicidal behavior