9. Personality Disorder

Question 1

What is a personality disorder?

Answer 1

Maladaptive pattern of thinking, functioning and behaving, also has trouble perceiving and relating to situations and people, faulty narrative of self

(Personality = characteristic sets of behaviours, cognitions, and emotional patterns that evolve from biological and environmental factors)

Causes = genetics, environment (early parenting, attachment trauma, loss)

3Ps = Persistent, Problematic, Pervasive

Question 2

How is personality disorder Dx?

Answer 2

ICD10 or DSM-V

Long lasting ridge patterns of thought, affect and behaviour
1 = disharmonious attitudes and behaviour
2 = chronic abnormal behaviour patterns
3 = present in a broad range of personal/social situations
4 = <18y and continue to adulthood
5 = considerable personal distress
6 = significant social/occupational problems

Structured personality assessment tool = PDQ-4

Question 3

Outline the Mx of personality disorder

Answer 3

Treat individual - see the same clinician (attachment disorder)

Reflect their goals

Help manage crisis

Treat co-morbid conditions

Self-harm minimisation - replace with less damaging strategies (elastic band, ice)

Therapy

• Dialectical behavioural therapy (DBT) - mindfulness, CBT, eastern philosophy
• Group Tx/therapeutic community
• Mentalisation based therapy
• Transference focused therapy

Question 4

Outline the types of personality disorders (8)

Answer 4

A = odd or eccentric

• Paranoid (suspicious, distrusts, stay inside, complains)
• Schizoid (emotionally cold, detached affect, low libido, solitary)

B = dramatic or emotional

• Antisocial (dissocial) (aggressive, impulsive, alcohol, cocaine, weapons)
• Emotional unstable (BPD) (emptiness, unpredictable affect, abandonment feared, mood fluctuation)
• Histrionic (self-centred, shallow, seeks attention, manipulative)

C = anxious or avoidant

• Anankastic (worries, orderliness/control, rule, perfectionist)
• Anxious-avoidant (self-conscious, insecure, fearful)
• Dependent (passive, clingy, submissive, excessive need, no reasonable expectation of others, pass responsilbility)

Question 5

What is emotional unstable personality disorder (EUPD/BPD)?

Answer 5

AKA ‘borderline personality disorder’ (BPD)

Intense and fluctuating emotions, which can last anywhere from a few hours to several days at a time, fear of rejection/abandonment

S+S =

• Impulsivity
• Mood swings
• An overwhelming fear of abandonment
• Extreme anxiety and irritability
• Anger
• Paranoia and being suspicious of other people
• Feeling empty, hopeless and worthless
• Suicidal thoughts
• Takes relationship breakdown badly

Mx =

• Dialectical behaviour therapy: CBT + eastern philosophy
• Mentilization-based therapy: roots in attachment theory, understand own/others mental state
• Transference-focused psychotherapy
• Tx co-morbidities: antipsychotics, antidepressants, mood stabilizers

Question 6

How should suspected personality disorder be investigated?

Answer 6

Questionnaires = personality diagnostic questionnaire 4, Eysenck Personality Questionnaire

Psychological testing = Minnesota Multiphasic Personality Inventory (MMPI)

CT head/MRI = rule out organic causes (frontal lobe tumour, intracranial bleeds)

Question 7

Outline antisocial/dissocial PD

Answer 7

S+S = aggressive, disregard/violation of the rights of others, pervasive deviance, deception, impulsivity, irritability, recklessness, and callous and unemotional traits

DDx = conduct disorder, narcissistic PD, substance use, BAD, EUPD, schizophrenia, criminal behavioural

Mx =

• No drugs (tend to blame behaviour on meds), no therapy
• Criminal justice system

Question 8

What is transference?

Answer 8

Occurs when a person redirects some of their feelings or desires for another person to an entirely different person

For example, transference in therapy happens when a patient attaches anger, hostility, love, adoration, or a host of other possible feelings onto their therapist or doctor

Question 9

Describe dialectical behaviour therapy

Answer 9

Mindfulness

Distress tolerance

Regulation of emotions

Interpersonal effectiveness

Question 10

What is conduct disorder?

Answer 10

Diagnosed in childhood or adolescence

Repetitive and persistent pattern of behaviour in which the basic rights of others or major age-appropriate norms are violated

• socialised = less serious, phasic in nature
• unsocialised = more serious, criminality, later Dx antisocial personality disorder

Dx = core Sx in last 12m
1 = defiance towards authority 
2 = aggression
3 = anti-social behaviour

***often seen as the precursor to antisocial PD