Personality Disorders

Question 1

Diagnosis of a personality disorder

-general criteria

Answer 1

2 years consistent in a range of situations with moderate impacts without other causes or cultural explanation

Persistent marked deviation from culturally expected and accepted range of inner experience and behaviour in 1+

• cognition, perception of events and actions
• range, intensity, appropriateness of affect
• impulse control and gratification of needs
• interpersonal interactions
• inflexible, maladaptive behaviours in personal, social situations
• adverse impact on social environment

Childhood, teen => stable, long duration
Behaviour cannot be explained by any other diagnosis
-no organic cause

Question 2

Types of emotionally unstable personality disorders

Answer 2

Impulse type

Borderline type

Question 3

Diagnosis of impulsive personality disorder

Answer 3

3+ of

• Acts impulsively
• Frequent conflict with others
• Outburst of anger, violence which cannot be controlled
• Difficulty maintaining actions without immediate rewards

Question 4

Diagnosis of borderline personality disorder

Answer 4

Can present like depression

• premorbid personality, more persistent symptoms with PD
• PD can be more labile than depression
• reduced response to antidepressants in PD

3+ of

• Disturbance in self image and personal goals
• Intense, unstable relationships => excess efforts to avoid abandonment
• Recurrent threats and acts of self harm
• Chronic emptiness

Question 5

Other aspects of the history that may contribute to emotionally unstable personality disorder

Answer 5

Broken, poor relationships in early years
Abandonment, poor parental history
Physical, sexual, emotional abuse

Question 6

Management of emotionally unstable personality disorder

• medication
• psychotherapeutic
• behavioural

Answer 6

Minimise medication use
Restrict use of addictive medication - sleeping tablets, BZ
Treat any underlying psychiatric problems - depression, psychosis

Dialectical behavioural therapy
Mentalisation based treatment
Therapeutic community

Behavioural management

Question 7

How to promote engagement between the

• clinician
• patient

Answer 7

Engagement

• develop rapport
• establish boundaries
• manage expectations
• crisis/chaos management

Clinician

• consistent treatment plan and management
• minimise staff changes => reduce feelings of abandonment
• clear boundaries and goals

Patient

• encouraged to take responsibility for actions and behaviour
• clear management plan for crisis
• hospital admissions to be reserved for crises involving risk of significant harm to self and others

Question 8

Describe dialectical behavioural therapy

-how does this differ from CBT

Answer 8

Based on CBT but adapted for people who feel emotions very intensely

Aims to help you

• understand and accept your difficult feelings
• learn skills to manage them so you don’t have to turn to harmful behaviours
• make positive changes in your life

Question 9

Describe mentalisation based treatment

Answer 9

Views BPD as a developmental disturbance in attachment => reduced ability to understand your mental state and of others

Intervention focuses on increasing self reflection

Question 10

Describe therapeutic community treatment

Answer 10

Group based approach where interpersonal, emotional issues are openly discussed
-mutual feedback helps develop an awareness of interpersonal actions and problems

Question 11

What are the 3 clusters of personality disorder

Answer 11

Cluster A - odd or eccentric disorders

• paranoid PD
• schizoid PD
• schizotypal PD

Cluster B - dramatic, erratic, emotional

• dissocial/amtisocial PD
• emotionally unstable PD (BPD type or impulsive type)
• histrionic PD

Cluster C - anxious or fearful

• obsessive/anankastic PD
• anxious/avoidant PD
• dependent PD

Question 12

Describe

• paranoid PD
• schizoid PD
• schizotypal PD

Answer 12

Paranoid - delusional/paranoid

• paranoia, distrusting of others
• easily offended

Schizoid - social withdrawal

• uninterested in others or activities
• emotionally detached, cold to others
• difficulty forming relationships

Schizotypal - distorted reality

• odd ideas, eccentricities
• interpersonal difficulties, social anxiety

Question 13

Describe

• dissocial/antisocial PD
• narcissistic PD
• histrionic PD

Answer 13

Antisocial -

• lack of remorse, empathy, guilt
• disregard for social norms
• difficulty sustaining relationships
• prone to blaming others
• low tolerance for frustration => aggression

Narcissistic - grandiosity

• belief of unlimited success and entitlement, admiration
• take advantage of others to achieve own goals
• chronic envy
• lack empathy

Histrionic

• preoccupation with attractiveness, dressing/behaving provocatively to stay at the center of attention
• easily influenced
• labile affects

Question 14

Describe

• anankastic PD
• avoidant PD
• dependent PD

Answer 14

Anankastic - rigid, needs order

• needs rules, organisation
• perfectionism

Avoidant - inhibited

• belief that they are socially inept
• avoid social situations due to fear of embarrassment
• low self esteem

Dependent - insecure

• indecision, clingy
• require constant reassurance
• fears being alone

Question 15

How to promote stabilisation of the patient

Answer 15

Team management of risk

• awareness of toxic communication
• triage when to admit for risky behaviour

Use of structured psychotherapies and medications to manage symptoms if needed.

Question 16

Communicating with the patient

Answer 16

Containment - develop rapport with clear boundaries that can tolerate disturbance, difficult thoughts and feelings => patient becomes confident in trying alternative strategies

Listen and believe in them
Acknowledge and validate experiences of symptoms and system
-talk to them about the positives despite the negatives
Emphasise the struggle

Question 17

What is the theory of developmental processes

Answer 17

Infant starts life with innate potentials
Our relationships with our primary caregiver shapes our mind, personality and ability to cope

Baby changes behaviour => mother reacts => baby learns

Question 18

What are the characteristics of a mature individual

Answer 18

Coherent and stable sense of self
Perceives other as separate own mind
Capacity to manage one's emotional state
Enjoy intimate relationships
Tolerates being separate and alone
Able to be productive and creative

Question 19

What does treatment aim to achieve

Answer 19

Psychosocial treatment to help people develop a healthy sense of self

Question 20

How else could you classify personality disorders

Answer 20

ICD11, DSM 5 - severity or impariment of functioning

• no PD
• personality difficulty - in certain situations only
• mild - definite well demarcated problems in a range of situations
• moderate - definite problems covering several domains
• severe - affects all areas of their life

ICD11, DSM 5 - traits

• negative affect - broad range of negative emotions out of proportion and frequency too situation
• detachment - socially and emotionally
• disinhibition - act rashly based on immediate stimuli without thought to consequences
• dissociality - disregard of rights and feelings of others, lack of empathy, self centeredness
• anakastia - rigid focus on perfection, right and wrong, controlling own and others’ behaviours and situations to maintain conformity