Personality Disorder

Question 1

What is personality? What are the factors identified in your pre-reading which contribute to shaping our personalities?

Answer 1

Enduring and recognised characteristics that make us unique and shape our responses to live events. Factors that contribute are genetics, family, life events,, culture and society

Question 2

What are personality traits?

Answer 2

Aspects of maladaptive personality behaviours that do not meet the diagnosis for a disorder, often emerges when an individual is under stress.

Question 3

When is someone’s personality considered to be disordered?

Answer 3

When behavioural manifestation interfere significantly with a person’s life or those close to them

Question 4

Deliberate self-harm can be a feature in the experience of people with a personality disorder. List some of the reasons for self-harming:

Answer 4

*Self-control
* Emotional relief
* Relieving tension build up
* Alleviating empty feelings
*Escaping flashbacks
*Expressing anger
*Releasing self-hatred
* Decreasing alienation from others

Question 5

Summarise the criteria for the DSM-5 classifications of ‘cluster B’ personality disorders:
Antisocial personality disorder

Answer 5

A pervasive pattern of disregard for and violation of the rights of others, occurring since age 15 years

• Failure to conform to social norms with respect to lawful behaviours, as indicated by repeatedly performing acts that are grounds for arrest.
• Deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure.
• Irritability and aggressiveness, as indicated by repeated physical fights or assaults.
• Reckless disregard for safety of self or others.
  The individual is at least age 18 years. There is evidence of conduct disorder with onset before age 15 years. The occurrence of antisocial behaviour is not exclusively during the course of schizophrenia or bipolar disorder.

Question 6

Summarise the criteria for the DSM-5 classifications of ‘cluster B’ personality disorders: Borderline personality disorder

Answer 6

A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity, beginning by early adulthood and present in a variety of contexts,

• Frantic efforts to avoid real or imagined abandonment.
• A pattern of unstable and intense interpersonal relationships characterised by alternating between extremes of idealisation and devaluation.
• Impulsivity in at least two areas that are potentially self-damaging (e.g. spending, sex, substance abuse, reckless driving, binge eating).
• Recurrent suicidal behaviour, gestures, or threats, or self-mutilating behaviour.
• Chronic feelings of emptiness.
• Inappropriate, intense anger or difficulty controlling anger (e.g. frequent displays of temper, constant anger, recurrent physical fights).

Question 7

Summarise the criteria for the DSM-5 classifications of ‘cluster B’ personality disorders: Histrionic personality disorder

Answer 7

The person:
* Craves being the centre of attention and engages in self-dramatization and/or uses physical appearance to attain this

• Displays inappropriately sexually seductive behaviour
• Uses speech to impress
  others but is lacking in depth
• Is prone to exaggeration and dramatic expression of emotion
• Tends to exaggerate the degree of intimacy that they share with others
• Tends to be easily led by others

Question 8

Summarise the criteria for the DSM-5 classifications of ‘cluster B’ personality disorders: Narcissistic personality disorder

Answer 8

A pervasive pattern of grandiosity (in fantasy or behaviour), need for admiration, and lack of empathy, beginning by early adulthood and present in a variety of contexts:

• Has a grandiose sense of self-importance (e.g. exaggerates achievements, expects to be recognised as superior without commensurate achievements).
• Believes that he or she is “special” and unique and can only be understood by, or should associated with, other special or high-status people (or institutions).
• Requires excessive admiration.
• Has a sense of entitlement (i.e. unreasonable expectations of especially favourable treatment or automatic compliance with his or her expectations).
• Lacks empathy, unwilling to recognise or identify with the feelings and needs of others
• Is often envious of others or believes that others are envious of him or her.

Question 9

Having looked at these criteria what do you think could be some problems with diagnosing personality disorders?

Answer 9

• Subjective criteria
• Negative stereotyping
• Checklists, ie. what if some meets 4/5 criteria

Question 10

Outline the crisis assessment of a client with a personality disorder

Answer 10

1. Assessment: Current risk level of violence to self-and/or others
2. Rationale: Identify and manage risk
3. Assessment: Current treatment plan and strategies being used as part of the plan
4. Rationale: Identify current and agreed strategies of use to manage the crisis (advanced directives)

3.Assessment: Previous useful strategies

3. Rationale: Often clients are aware of what has worked previously – engaging in these is useful
4. Assessment: Drug and alcohol use
5. Rationale: Identify likelihood of intoxication, withdrawals, impulsivity and risk
6. Assessment: Help manage their anxiety and distress by focusing on the current problem
7. Rationale: Assists in short term management of distress and anxiety
8. Assessment: Identify short term changes

6.Rationale: What can be changed to regain control?