personality disorders

Question 1

timing of personality disorders

Answer 1

something that is persistent across the lifespan, in different settings

in a way that isn’t better explained by another disorder

Question 2

what are the cluster A disorders

what are their general features

Answer 2

basic mistrust of others, tend towards a withdrawal from ordinary sociality

paranoid personality disorder
schizoid personality disorder
schizotypal personality disorder (not in ICD-10 as personality disorder)

Question 3

what is paranoid personality disorder

Answer 3

general distrust of others that markedly gets in the way of any ordinary relating

can be seen directly as distrust or by its effect e.g. tendency to anger and to feel slighted

rarely of clinical concern, pts don’t seek treatment

suffers may have important reasons to feel like their boundaries are at threat - incl those relating to their bodily integrity; often because they have been in the past

Question 4

what is schizoid personality disorder

Answer 4

indifference to social contact with others

pts often are strikingly unbothered by their lackof sociality

often a rich fantasy life - may have a deep yearning for relatedness

small number of pts who recognise they have a problem and want to change probably can improve in long term psychodynamic therapy

Question 5

what is schizotypal personality disorder

Answer 5

considered as a sz-spectrum condition

come across as markedly odd - beyond eccentric

often have psychotic like experiences - intuitions, magical thoughts etc

not a good prognostic sign for work in psychotherapy

Question 6

what are the cluster B disorders and what characterises them

Answer 6

serious problems of behaviour and impulse control

borderline personality disorder (emotionally unstable personality disorder)

narcissistic personality disorder - not in ICD-10

antisocial personality disorder (dissocial personality disorder)

histrionic personality disorder

Question 7

features of borderline personality disorder

Answer 7

distress when relationships are strained

difficult behaviours to try and manage strong feelings

frantic efforts to avoid abandonment

stormy sense of their emotions, below which they can often feel quite empty

tendency to be unsure about one’s identity

Question 8

why is there controversy surrounding borderline personality disorder

Answer 8

suggestion that it pathologises responses to the abuse that often has been part of the hx of people w/ the diagnosis

concern is applied to a higher degree to women

Question 9

management and natural hx of borderline personality disorder

Answer 9

people whose main problem is BPD often find that simple treatments (e.g. antidepressants) don’t improve things

if people want and can engage w/ meaningful therapy and are in a good place to use it - things can change

natural hx - improvement over time, 60% of people no longer met criteria at 6yrs after diagnosis

Question 10

mentalisation based treatment for BPD - what are the aims

Answer 10

aims to help people improve their ability to think about their feelings at times they feel more distressed

aims to help them make better sense of other’s intensions

Question 11

what are the aims of dialectical behaviour therapy for BPD and benefits

Answer 11

different set of aims to mentalisation based treatment

people often find their skills for distress tolerance can be improved by it

Question 12

medication for BPD

Answer 12

not favoured in guidelines but is sometimes used

sometimes use off-label medication symptomatically in BPD

avoid polypharmacy, use medications as trials w/ clear goals and review timetables

only ever used as an adjunct rather than definitive treatment

Question 13

self harm in BPD

Answer 13

high rate (one of the criteria for BPD is self harm)

self-injury/suicidal thoughts or communication of suicidal intent may be complicated in terms of their meaning

Question 14

what is narcissistic personality disorder

Answer 14

outwardly have a very high opinion of themselves and very little sense of what matters to others

in fact have a deep sense of their inadequacy that is very painful for them to get close to so they deny it

not of particular clinical concern

in some offending pts, narcissistic traits can be relevant to the formulation of their offending behaviour and way of approaching treatment - rarely meet DSM-5 criteria for NPD

Question 15

what is antisocial personality disorder

Answer 15

of clinical interest

characterised by persistent criminal conduct and a tendency to be remorselessness about those affected by it

spectrum of behaviour

Question 16

psychotherapeutic treatment for ASPD

Answer 16

high degree of callousness, enjoyment of violence, little capacity to experience anxiety, manipulative and charming - not amenable to psychotherapeutic treatment

antisocial, low degree of callous unemotionality - can in rare cases so well in therapy w/ specialists after careful assessment

Question 17

what is psychopathy

Answer 17

psychological construct rather than psychiatric diagnosis

used to describe people w/ high degree of callous-unemotionality and a high degree of antisocial acting

Question 18

what is histrionic personality disorder

Answer 18

rarely of clinical interest

small no of pts have a tendency to dramatic displays of emotion that seem to ring hollow

may be openly flirtatious and continuously seeking appreciation

Question 19

cluster C disorders

Answer 19

characterised by a constitutional difficulty in the way anxiety is managed

esp anxiety relating to ordinary social roles and responsibilities

obsessive compulsive personality disorder (anankastic personality disorder)
dependent personality disorder
avoidant personality disorder (anxious [avoidant] personality disorder)

Question 20

what is OCPD

Answer 20

different from OCD

tendency towards obstinateness, rigidity and significant anxiety about anything that is disorderly

not often directly a PC - presentation may be w/ the associated anxiety, lifelong rather than episodic

can improve on psychodynamic psychotherapy - rarely that someone has single OCPD diagnosis (usually have had something happen that lead to symptomatic anxiety disorder)

Question 21

what is dependent personality disorder

Answer 21

marked difficulty in assuming appropriate adult responsibilities

defers to others in all areas, rarely seeing any way in which they can manage things themselves

not of significant clinical concern

Question 22

what is avoidant personality disorder

Answer 22

tend not to allow conflict

tend to put off their problems

rarely off the degree that leads to clinically-significant impairment as a single diagnosis

Question 23

treatment of personality disorder

Answer 23

need a formulation that makes sense - provide a rationale for the treatment that suggests it has a chance of being helpful

good assessment is helpful for you and the patient - understanding of what the difficulty is, how it has developed, particular form, co-occuring disorders

Question 24

what is personality

Answer 24

those characteristic aspects of a person that distinguishes them, that allows them to be known by others and by themselves

in psychiatry - often thought of as the baseline, with an assumption of illness as an aberration or break from it

Question 25

what are the 5 factors in the five factor theory

Answer 25

openness-rigidity
recklessness-conscientiousness
introversion-extraversion
agreeableness-difficulty
neuroticism-psychoticism

Question 26

what impacts on the development of personality in early life

Answer 26

psychological and social life of the family before the infant arrives

innate temperament of the infant

early soothing and the early environment

Question 27

exploring the environment in early life - how does it affect our development

Answer 27

from a secure base, exploration - attachment behaviour

recapitulation in adolescence

continual developmental process/conflict and continues lifelong

development of an internal working model

Question 28

general personality disorder

• examples
• features

Answer 28

dysfunction or harmful dysfunction is what characterises personality disorders

marked deviation

Question 29

what is a personality disorder

Answer 29

problems in functioning of aspects of the self and/or interpersonal dysfunction that have persisted over an extended period of time

disturbance manifests in patterns of cognition, emotional experience/expression and behaviour that are maladaptive and present across a range of personal and social situations

patterns of behaviour aren’t developmentally appropriate and cannot be explained by social/cultural factors

disturbance is associated w/ substantial distress/significant impairment in important areas of functioning (personal, family, social, educational, occupational)

Question 30

features of borderline personality disorder

Answer 30

marked instability in affect, interpersonal relations and other functioning

proneness to feeling abandoned, w/ often frantic efforts to avoid it

disorder of attachment trauma (but not always)

frequently has self-injury and suicidal behaviour

Question 31

fMRI and BPD

Answer 31

changes related to aberrant functional connectivity between ACC and other frontal regions

Question 32

mentalisation and BPD

Answer 32

good progress in last decade w/ ideas from mentalisation

loss of mentalising ability in attachment situations
tactics for working w/ people having these difficulties

Question 33

treatment of BPD

Answer 33

therapy

• good clinical care
• psychotherapeutic treatment
• social treatment
• psychopharmacological treatment - management of co-morbid illness but otherwise isn’t particularly helpful
• inpatient care

Question 34

what is antisocial personality disorder

features

Answer 34

concept of psychopathy

antisocial behaviour, risk taking, inability to profit from prior experience incl punishment

Question 35

biological features of ASPD

Answer 35

F-HIAA metabolite and psychophysiological differences

Question 36

treatment of ASPD

Answer 36

little evidence for good treatment

consistent and firm boundaries about what’s expected and what’s not expected