Personality and Gender

Question 1

What is personality trait?

Answer 1

Enduring patterns of perceiving, thinking about and relating to both self and the environment, exhibited in a wide range of social and personal contexts

Innate and enduring characteristics of an individual which shape their attitudes, thoughts, and behaviours in response to situations

Question 2

New trait domain specifiers

Answer 2

-Negative affectivity
-Detachment
-Dissociality
-Disinhibition
-Anankastia
-Borderline pattern

Question 3

What is personality disorder?

Answer 3

-When an individual has traits that are persistently inflexible and maladaptive, are stable over time, appeared in adolescence or early adulthood and cause significant personal distress or functional impairment to the person or those around them

series of maladaptive personality traits that interfere with normal function in life
=Manifests as problems in cognition, affect, behaviour

Question 4

ICD-11 criteria for personality disorder

Answer 4

-Problems functioning of aspects of self (identity, self-worth, accuracy of self-view, self-direction)
-Interpersonal dysfunction (ability to develop and maintain close and mutually satisfying relationships, ability to understand other perspective and manage conflict in relationships)
-Persisted over an extended period of time (2 years or more)
-Disturbance in patterns pf cognition, emotional experience, emotional expression, behaviours that are maladaptive

Question 5

Classification and clinical presentations of personality disorders

Answer 5

-Cluster A = ‘odd or eccentric’
=Paranoid PD – suspects others are exploiting, harming or deceiving them
=Schizoid PD – emotional coldness, little desire for close or sexual relations, solitary
=Schizotypal

-Cluster B = ‘dramatic, emotional, erratic’
=Emotionally unstable PD/ borderline – unstable, intense relationships, impulsive, feelings of emptiness, self-harm, suicidality, paranoid ideation, mood fluctuations
=Antisocial (dissocial) PD – repeated unlawful or aggressive behaviour, deceitful, recklessly irresponsible, lack of remorse or guilt
=Histrionic PD – dramatic, exaggerated emotional expression, attention seeking
=Narcissistic

-Cluster C = ‘anxious or fearful’
=Dependent PD – need to be cared for, clingy, submissive, fear of separation, relies on others to take responsibility for major life areas
=Anxious (avoidant) PD – hypersensitive to criticism and rejection, social inhibition
=Anankastic (obsessive-compulsive) PD – preoccupation with orderliness, perfectionism and control, devoted to work over leisure, rigid and stubborn, cautious

Question 6

Epidemiology of personality disorders

Answer 6

1 in 20 people

Question 7

Pathophysiology of personality disorders

Answer 7

-Genetic factors:
=Heritability of 30-60%
=Cluster A personality disorders are more common in the relatives of patients with schizophrenia
=Depressive disorders are more common in the relatives of those with emotionally unstable personality disorder

-Environmental factors:=Cluster B personality disorders are associated with early adverse social circumstances (i.e. parental substance misuse, physical or emotional neglect, violence, sexual abuse)
=There is a strong association between EUPD and childhood sexual abuse(not universal)
=Disordered attachment to caregivers as a infant has also been implicated in PD development

Question 8

Differential diagnosis of PD

Answer 8

-Schizophrenia
-Mania

Question 9

Assessment of PD

Answer 9

-History:
=Sources of distress (thoughts, emotions, behaviour and relationships)
=Any comorbid mental illness
=Specific impairments of functioning at work, home or in social circumstances
=Get an idea of their personality (history of their life – education, work, criminality, relationships, sexual behaviour, how family/friends might describe them)
=Collateral history (with patient’s permission)

-Examination and investigations:
=There are no specific physical signs of PD
=However, consequences of associated behaviours may be seen (e.g. self-harm injuries, injuries from reckless behaviours, drug or alcohol misuse sequalae, STIs following disinhibition)

Question 10

Principles of care of PD

Answer 10

-Non-judgmental approach – be positive and kind, many are victims of abuse-Consistency – do what you say you will do
-Encourage autonomy – help patient to acknowledge problems and be actively involved in finding solutions
=What is the current issue?
=What have you tried before? Has anything worked?
=What would you like to try?
=What is an achievable goal / change?
-Plan and manage any changes carefully
-Monitor for comorbid illnesses (depression, substance misuse etc…)

Question 11

Crisis management plan for PD

Answer 11

-Recognising triggers (substance use, relationships issues, occupational issues)
-Self-management strategies (hobbies, sleep hygiene, exercise, avoiding drugs / alcohol)
-Sources of support (friends, family, telephone based services such as Samaritans)
-How to access emergency care (Samaritans, GP, CPN, crisis team, NHS24)

Question 12

Describe short-term managenent if PD

Answer 12

=Psychopharmacology – no current recommended drugs exist for PD treatment, however medication can be useful in treating comorbid psychiatric illness or severe distress or behavioural disturbance during severe phases / crises

-Psychosocial – MDT approach, including: supportive psychotherapy, psychoeducation, coping strategies, relaxation and distraction techniques, skill and hobby development

Question 13

Long-term psychological therapy

Answer 13

-Dialectical behaviour therapy
-Mentalisation-based therapy
-Cognitive behavioural therapy

Question 14

Prognosis of PD

Answer 14

-Personality disorders tend to gradually improve over decades
=>78% of patients with EUPD show sustained symptomatic remission at16-year follow-up
-Patients with PDs have high levels of comorbid psychiatric disorders (i.e. depression, bipolar, anxiety, schizophrenia) which are generally more severe and harder to treat than for patients without a PD
-Patients with cluster B PDs have significantly higher rates of suicide than the general population

Question 15

Paranoid

Answer 15

-Hypersensitivity (to setbacks and rebuffs) and an unforgiving attitude when insulted (tendency to bear grudges)
-Unwarranted tendency to questions the loyalty of friends
=suspiciousness and a pervasive tendency to distort experience by misconstruing the neutral or friendly actions of others as hostile or contemptuous
=suspicions, without justification, regarding sexual fidelity of spouse or sexual partner
-Reluctance to confide in others
-Preoccupation with conspirational beliefs and hidden meaning
-Unwarranted tendency to perceive attacks on their character
-A combative and tenacious sense of personal rights out of keeping with the actual situation
-Persistent self-referential attitude, associated particularly with excessive self-importance

Question 16

Schizoid

Answer 16

-Indifference to praise and criticism (limited capacity to express warm, tender feeling for others as well as anger)
-Preference for solitary activities
-Lack of interest in sexual interactions
-Lack of desire for companionship
-Emotional coldness, detachment, flattened affectivity
-Few interests
-Few friends or confidants other than family
-Excessive preoccupation with fantasy and introspection
-Marked insensitivity to prevailing social norms and conventions; if these are not followed it is unintentional

Question 17

Schizotypal

Answer 17

-Ideas of reference (differ from delusions in that some insight is retained)
-Odd beliefs and magical thinking
-Unusual perceptual disturbances
-Paranoid ideation and suspiciousness
-Odd, eccentric behaviour
-Lack of close friends other than family members
-Inappropriate affect
-Odd speech without being incoherent

Question 18

Antisocial

Answer 18

-Failure to conform to social norms with respect to lawful behaviours as indicated by repeatedly performing acts that are grounds for arrest;
-More common in men;
-Deception, as indicated by repeatedly lying, use of aliases, or conning others for personal profit or pleasure;
-Impulsiveness or failure to plan ahead (very low tolerance to frustration and low threshold for discharge of aggression);
-Irritability and aggressiveness, as indicated by repeated physical fights or assaults;
-Reckless disregard for the safety of self or others;
-Incapacity to maintain enduring relationships, though having no difficulty to establish them
-Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behaviour or honour financial obligations;
-Lack of remorse or incapacity to experience guilt, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another (callous unconcern for feelings of others)
-Marked proneness to blame others, or to offer plausible rationalizations for the behaviour bringing the subject into conflict with society

Question 19

EUPD/ Borderline

Answer 19

-Efforts to avoid real or imagined abandonment
-Unstable interpersonal relationships which alternate between idealization and devaluation, leading to emotional crises
-Unstable self image, aims and internal preferences (including sexual)
-Impulsivity in potentially self damaging area (e.g. Spending, sex, substance abuse)
-Recurrent suicidal behaviour, recurrent threats or acts of self-harm
-Affective instability
-Chronic feelings of emptiness
-Difficulty controlling temper
-Quasi psychotic thoughts

Question 20

EUPD: impulsive type

Answer 20

-A marked tendency to quarrelsome behaviour and to conflicts with others, especially when impulsive acts are thwarted or criticized
-A marked tendency to act unexpectedly and without consideration of the consequences
-Liability to outbursts of anger or violence, with inability to control the resulting behavioural explosions
-Difficulty in maintaining any course of action that offers no immediate reward
-Unstable and capricious mood.

Question 21

Histrionic

Answer 21

-Inappropriate sexual seductiveness
-Need to be the centre of attention, continually seeks excitement
-Rapidly shifting and shallow expression of emotions, labile affectivity
-Suggestibility, easily influenced by others or by circumstances
-Physical appearance used for attention seeking purposes, overly concerned
-Impressionistic speech lacking detail
-Self dramatization, theatricality, exaggerated expression of emotions
-Relationships considered to be more intimate than they are

=: Egocentricity, self-indulgence, continuous longing for appreciation, lack of consideration for others,
feelings that are easily hurt, and persistent manipulative behaviour

Question 22

Narcissistic

Answer 22

-Grandiose sense of self importance
-Preoccupation with fantasies of unlimited success, power, or beauty
-Sense of entitlement
-Taking advantage of others to achieve own needs
-Lack of empathy
-Excessive need for admiration
-Chronic envy
-Arrogant and haughty attitude

Question 23

Obsessive-compulsive

Answer 23

-Feelings of excessive doubt and caution
-Is occupied with details, rules, lists, order, organization, or agenda to the point that the key part of the activity is gone
-Demonstrates perfectionism that hampers with completing tasks
-Is extremely dedicated to work and efficiency to the elimination of spare time activities (excessive conscientiousness and scrupulousness)
-Is meticulous, scrupulous, and rigid about etiquettes of morality, ethics, or values
-Is not capable of disposing worn out or insignificant things even when they have no sentimental meaning
-Is unwilling to pass on tasks or work with others except if they surrender to exactly their way of doing things
-Takes on a stingy spending style towards self and others; and shows stiffness and stubbornness
-Unreasonable insistence that others submit to exactly his or her way of doing things, or unreasonable reluctance to allow others to do things

Question 24

Avoidant

Answer 24

-Persistent and pervasive feelings of tension and apprehension
-Avoidance of occupational activities which involve significant interpersonal contact due to fears of criticism, or rejection.
-Unwillingness to be involved unless certain of being liked
-Preoccupied with ideas that they are being criticised or rejected in social situations
-Restraint in intimate relationships due to the fear of being ridiculed
-Reluctance to take personal risks due to fears of embarrassment
-Views self as inept and inferior to others, personally unappealing
-Social isolation accompanied by a craving for social contact

Question 25

Dependent

Answer 25

-Difficulty making everyday decisions without excessive reassurance from others
-Need for others to assume responsibility for major areas of their life, undue compliance with wishes
-Difficulty in expressing disagreement with others due to fears of losing support
-Lack of initiative
-Unrealistic fears of being left to care for themselves
-Feeling uncomfortable or helpless when alone, because of exaggerated fears of inability to care for oneself
-Urgent search for another relationship as a source of care and support when a close relationship ends
-Extensive efforts to obtain support from others
-Unrealistic feelings that they cannot care for themselves