Personality disorddr

Question 1

What is personality disorder?

Answer 1

A set of personality traits that are pervasive, ingrained, maladaptive and create significant functional impairment or subjective distress.

Question 2

What are the 2 main axes studied?

Answer 2

Unstable, stable, introvert vs extrovert.

Question 3

What are hte big 5?

Answer 3

Neuroticism- sensible, sensitive

Extraversion- high energy level, people person

Openness- emotional, adventurous

Conscientiousness- self disciplined, result oriented

Agreeableness- compassionate, cooperative

Question 4

What are the 3 clusters of personality disorders?

Answer 4

A: Paranoid, schizoid

B: Dyssocial, emotionally unstable, histrionic

C: Anankastic, anxious, dependent

Question 5

Describe cluster A.

Answer 5

Prefer isolation, very limited number of close relationships, tendency to introspection and fantasy, suspiciousness of others, strange beliefs and interests.

Question 6

Describe cluster B.

Answer 6

Emotionally unstable, aggression to self or others, impulsiveness, selfishness, self dramatisation, irresponsibility.

This is the most widely studied cluster as it causes the most harm to people and society.

Question 7

Describe cluster C.

Answer 7

Anxiety prone, meticulous, help seeking, rigid, fearful of new situations, abnormal high standards.

Question 8

What are the 4 domains of borderline personality disorder?

Answer 8

Affective (anger, feelings of emptiness)

Cognitive (paranoid ideation, identity disturbance)

Behavioural (Suicidal behaviour, threats, self mutilating, harmful acts)

Interpersonal (avoid abandonment, intense relationships)

Question 9

What are the problems when assessing personality?

Answer 9

This takes time- people can change personalities at different times.

Complicated by presence of acutely unwell with other conditions e.g depression.

Antisocial personality disorder- deceiptful personality.

Question 10

How do you asses personality?

Answer 10

Use information from personal, employment and forensic history.

Interviewing on more than 1 occasion.

Validated semi structured interviews.

Police documentation for offending behaviour.

Question 11

What is the aetiology of personality disorder?

Answer 11

A combination of environment and genetics.

Temperament-> Personality

Unstable family background: Early childhood neglect and abuse has a huge effect.

Question 12

What are the consequences of ambivalence, attachment, and avoidance?

Answer 12

Develop sense of self- less sense = more negative perception of self.
Self hatred and self harm
Ability to tolerate stress.
Ability to calm yourself
Ability to trust others
Knowing how to express needs: Having to scream to get something can translate into adulthood.

Question 13

What is the international distribution of personality disorders?

Answer 13

Highest in unstable countries: Colombia, Lebanon, Mexico, SA, Nigeria, China, Europe

Question 14

Which clusters increase and which reduce?

Answer 14

A & C: Get worse over 20 years.

B: Improve. Reduced impulsivity and self harm. However, lower life expectancy.

Question 15

What is transference?

Answer 15

A redirection of a persons feelings on to someone else. (A clinician?).

Counter-transference is what the therapist does with the transference.

If you can understand the way you feel about a patient, you can understand how the patient feels.

Question 16

What are the pros and cons of diagnosing personality disorder?

Answer 16

Pros:
Helps inform relatives and patients
Guiding patient management
Avoids treatments that don't work
Can offer treatments that do work. 

Cons: 
Mislabelling social deviance
Diverts limited resources from those who need them most. 
Undermining personal responsibility
Creating dependency
Stigma

Question 17

What is fundamental attribution error?

Answer 17

Tendency for people to place an undue emphasis on internal characteristics to explain someone else’s behaviour in a given situation rather than considering the situations external factors.

‘Im late because of transport, you are because you’re disorganised’

Question 18

What is the DSM criteria for Borderline personality disorder?

Answer 18

Affective: Inappropriate intense anger

Chronic feelings of emptiness
Affective instability

Cognitive: Transient paranoid ideation
Identity disturbance

Behavioural: Recurrent suicidal behaviour or threats, impulsivity harmful acts other than suicidal behaviour.

Interpersonal: Frantic efforts to avoid abandonment, unstable and intense relationships.

Question 19

What are the challenges of delivering psychological treatments?

Answer 19

Trust
Commitment
Motivation
Treatment endings

Question 20

What is mentalising?

Answer 20

Interpreting the actions of oneself and others as meaningful on the basis of intentional mental states.

May be implicit (unconscious) or explicit (conscious). Someone staring at you on the tube- why are they doing that?

Question 21

What is contingent mirroring?

Answer 21

If a child screams and the caregiver screams back, they accurately match infants mental state and mark it- indicating the caregiver is not expressing their real feelings. This allows the baby to recognise self and develop emotional regulation.

Unmarked mirroring leads to the caregivers expression making the baby think that it is how they actually feel.

Question 22

What happens if you are stressed and get no mirrored response?

Answer 22

You don’t understand what your feelings are like through the eyes of others, and can lead to development of a poor sense of emotions and who you are.

Question 23

What happens to mentalisation in BPD?

Answer 23

Mentalising capacity is diminished. People make poor judgements and aren’t aware they are making judgements.

Question 24

What is mentalisation based treatment?

Answer 24

Mentalisation groups- focus on interpersonal interactions between group members- everyone stops and thinks rather than jumps to conclusions.

Therapist should take a ‘not knowing’ stance.

Stop, listen, look- think about the feelings people have which drive interpersonal difficulties.

Clinical trials showed mentalisation treatment to be markedly superior to treatment as usual.

Question 25

What are 2 other treatment options?

Answer 25

1. Schema focused therapy (maladaptive cognitions)

2. Emotional and interpersonal skills (Dialectical behavioural therapy)

Question 26

What is schema focused therapy?

Answer 26

A modified CBT that targets early maladaptive schemata understanding impact on patient function.

Question 27

What is dialectical behavioural therapy?

Answer 27

Most widely used therapy for BPD.

Concepts:
Validation- psychoeducation about how temperament or past experiences have led them to feel/react the way they did, WHILE being clear of the impacts on themselves and others.

Dialetics: The inter-related nature of actions and behaviour. How hard it can be to change established patterns of behaviour.

Teach new skills (mindfulness, emotion regulation, interpersonal effectiveness)
Mind wandering, enhancing, motivation.

8 RCTs showed marked reduction in self harm and reductions in emotional distress.

Question 28

What is problem solving therapy?

Answer 28

Psychoeducation where individuals are informed and talked to about their personality disorder with the aim of building rapport, improving knowledge and motivating to work towards a solution.