Personality Disorder

Question 1

What does personality disorder broadly describe?

Answer 1

pervasive- begins in adolescence, continues to adulthood.
persistent- affects behaviour in a variety of settings
pathological- causes distress to self/others and impairs function i.e. social, occupational

Question 2

What does personality disorder broadly describe?

Answer 2

That which affects an individual’s thoughts, feelings and behaviour consistently through time and across circumstances
pervasive- affects behaviour in a variety of settings
persistent- begins in adolescence (when personality is thought to be formed. Must be evidence of pathology at this stage), continues to adulthood.
pathological- causes distress to self/others and impairs function i.e. social, occupational

Question 3

What are common co-morbidities for PD?

Answer 3

PTSD
substance misuse
self-harm
depression
adjustment/ stress disorder
anxiety disorder
eating disorders
Bipolar disorder

Question 4

What are common co-morbidities for PD?

Answer 4

PTSD
substance misuse
self-harm
depression
adjustment/ stress disorder
anxiety disorder

Question 5

What is the epidemiology of PD based on setting i.e. primary care, in patient etc?

Answer 5

Community 10%
Primary Care 20%	
Psychiatric outpatients 30%	
Psychiatric inpatients 40%	
Prison 50%

Question 6

What are the types of PD classified by ICD-10 and what cluster are they found in according to DSM5?

Answer 6

1. Emotionally Unstable- Impulsive/ Borderline subtypes Cluster B
2. Paranoid Cluster A
3. Schizoid Cluster A
4. Dissocial Cluster B
5. Histrionic Cluster B
6. Anankastic Cluster C
7. Anxious Cluster C
8. Dependent Cluster C
   Cluster A: Odd and Eccentric
   Cluster B: Emotional + Dramatic- partic associated with suicide
   Cluster C: Anxious and Fearful

Question 7

Name some of the traits associated with Paranoid PD. (not super imp)

Answer 7

Sensitive
    Unforgiving
    Suspicious
    Possessive and jealous of partners
    Excessive self-importance
    Conspiracy theories
    Tenacious sense of rights

Question 8

Name some traits associated with Schizoid PD (not super imp)

Answer 8

Anhedonic
    Limited emotional range
    Little sexual interest
    Apparent indifference to praise or criticism
    Lack of close relationships
    One-player activities
    Normal social conventions ignored
    Exessive fantasy world

Question 9

Name some traits associated with Dissocial PD (not super imp)

Answer 9

Forms but cannot maintain relationships
    Irresponsible
    Guiltless
    Heartless
    Temper easily lost
    Someone else’s fault

Question 10

What is EU Personality Disorder?

Answer 10

Affective instability
Explosive behaviours
Impulsive
Outbursts of anger
Unable to plan or consider consequences
Borderline type: self image unclear, self-harm and suicide attempts, abandonment fears, impulsive behaviour, feeling “empty”, relationships are intense and unstable. Rapid fluctuations in confidence and despair that are much more sudden than those seen in Bipolar Disorder and can result in crises which include self-harm and aggression. They are at high risk of suicide.
Impulsive: no control of impulses, sensitive to criticism/ let down, unable to plan ahead/ consider consequences, emotionally unstable, threats of violence.

Question 11

Name some traits associated with Histrionic PD (not super imp)

Answer 11

Attention Seeking
    Concerned with own appearance
    Theatrical
    Open to suggestion
    Racy and seductive
    Shallow affect

Question 12

Name some traits associated with Anakastic PD (not super imp)

Answer 12

Similar to OCD but not unpleasant thoughts. Also similar to Autism- likes own routines and inflexible. 
    Doubtful
    Excessive detail
    Tasks not completed
    Adheres to rules
    Inflexible
    Likes own way
    Excludes pleasure and relationships
    Dominated by intrusive thoughts

Question 13

Name some traits associated with Anxious/ Avoidant PD (not super imp)

Answer 13

Avoids social contact
    Fears rejection / criticism
    Restricted lifestyle
    Apprehensive
    Inferiority
    Doesn't get involved unless sure of acceptance

Question 14

Name some traits associated with Anxious/ Avoidant PD (not super imp)

Answer 14

Avoids social contact
    Fears rejection / criticism
    Restricted lifestyle
    Apprehensive
    Inferiority
    Doesn't get involved unless sure of acceptance

Question 15

Name some traits associated with Dependent PD (not super imp)

Answer 15

Subordinate
    Undemanding
    Feels helpless when alone
    Fears abandonment
    Encourages others to take decisions
    Reassurance needed

Question 16

How is Personality Disorder managed?

Answer 16

Short term- RISK RISK RISK assessment- does it warrant admission or can they be safely managed in the community by crisis team, consider co-morbidities and if these can be treated
Long term- A range of psychotherapies.
Cognitive Behavioural Therapy (CBT)
Dialectical Behavioural Therapy (DBT)
Cognitive Analytical Therapy (CAT)
Therapeutic communities
Social interventions may also be appropriate. These might include support arround stigma, social inclusion activites, finance, housing etc. etc.
Medication is not indicated in most cases particularly EU PD or Dissocial PD. Only used if comorbidities e.g. depression/ anxiety
- encourage them to take responsibility and be involved in decisions about their care.
- clear boundaries is important.
- be consistent and reliable
- try to transition them in a structured way between services

Question 17

What is the prognosis of PD?

Answer 17

Its course is variable and although many people recover over time, some people may continue to experience social and interpersonal difficulties.