Personality disorders

Question 1

What is a personality disorder?

Answer 1

Personality disorder (PD) is an umbrella term that covers a number of variations of maladaptive personality traits that cause significant psychosocial distress and interfere with everyday functioning. It is characterised by patterns of thought, behaviour and emotions that differ from what is normally expected by society. It leads to difficult relationships, reduced quality of life and poor physical health.

Personality disorders are thought to result from a combination of genetic and environmental factors. Patients often have a history of early childhood trauma and difficult circumstances.

Question 2

Presentation of personality disorders?

Answer 2

There are a wide range of symptoms and behaviours that can occur with personality disorders. Patients will vary in the symptoms they have. Symptoms can include:

Strong, intense emotions
Emotional instability
Anger
Low self esteem
Impulsive behaviour
Substance abuse
Poor sense of identity
Difficulty maintaining relationships
Risky behaviour, such as risky sex
Violence and aggression
Self harm
Suicide attempts

Question 3

Types of personality disorders?

Answer 3

There are many different types of personality disorder. The classification is based on the dominant features. They fall under three main categories:

Anxious
Suspicious
Emotional or impulsive

Question 4

Anxious personality disorders?

Answer 4

Avoidant personality disorder features severe anxiety about rejection or disapproval and avoidance of social situations or relationships.

Dependent personality disorder features heavy reliance on others to make decisions and take responsibility for their lives, taking a very passive approach.

Obsessive compulsive personality disorder features unrealistic expectations of how things should be done by themselves and others, and catastrophising about what will happen if these expectations are not met.

Question 5

Suspicious personality disorders?

Answer 5

Paranoid personality disorder features difficulty in trusting or revealing personal information to others.

Schizoid personality disorder features a lack of interest or desire to form relationships with others and feelings that this is of no benefit to them.

Schizotypal personality disorder features unusual beliefs, thoughts and behaviours, as well as social anxiety that makes forming relationships difficult.

Question 6

Emotional/impulsive personality disorders?

Answer 6

Borderline personality disorder features fluctuating strong emotions and difficulties with identity and maintaining healthy relationships.

Histrionic personality disorder features the need to be at the centre of attention and having to perform for others to maintain that attention.

Narcissistic personality disorder features feelings that they are special and need others to recognise this or else they get upset. They put themselves first.

Question 7

Management of personality disorders?

Answer 7

Management of personality disorders can be difficult. The patterns of thinking and behaviours are deeply ingrained and are difficult to change. Patient and carer education is very important to help them understand the condition. Cognitive behavioural therapy (CBT) and psychotherapy is the key management option of choice. Supportive care can be provided during crises to help keep the patient safe.

There are no medical treatments recommended for personality disorders. Personality disorders can co-exist with other psychiatric problems (e.g. depression) where medications may be beneficial.