PERSONALITY DISORDERS

Question 1

What is personality?

Answer 1

The collection of characteristics or traits that we have developed as we have grown up and which make each of us an individual. These include the ways that we think, feel and behave

Question 2

What are the psychodynamic theories of personality?

Answer 2

This theory was developed by Sigmund Freud and focuses on the influence of unconscious thoughts and childhood experiences on personality development. It suggests that human behavior is driven by unconscious conflicts and motivations, and that personality is shaped by the interplay between three elements of the psyche - the id, ego, and superego.

Question 3

What is Freuds psychoanalytic theory on personality?

Answer 3

This theory emphasizes the role of unconscious thoughts and feelings in shaping human behavior, and proposes that human behavior is determined by unconscious conflicts between different parts of the psyche, including the id, ego, and superego.
He explained that traumatic childhood experiences pushed into the unconscious mind can later lead to mental disorders, and developed psychotherapy to help release problematic repressed memories and relieve symptoms.

Question 4

What are the 3 parts of the psyche?

Answer 4

The id - the most primitive and instinctual part of the psyche, representing our unconscious drives and desires. It develops from birth and operates according to the pleasure principle, seeking immediate gratification of our basic needs.

The ego - the rational, conscious part of the psyche that mediates between the demands of the id, the realities of the external world, and the moral standards of the superego. It develops around the age of 2 and operates according to the reality principle, seeking to balance the conflicting demands of the other two parts.

The superego - the moral component of the psyche, representing our internalized values, ideals, and social norms. It develops between the ages of 5-7 and serves as a critical and judgmental voice, guiding us to behave according to societal standards and ethical principles.

Question 5

What is The Humanistic Theory of Personality?

Answer 5

This theory emphasizes the importance of subjective experiences and personal growth in personality development. It suggests that people have an innate drive towards self-actualization, and that personality can be shaped by individual experiences and interactions with the environment.

Question 6

What is The trait theory of personality?

Answer 6

This theory suggests that personality can be described and measured in terms of a set of underlying traits or characteristics. Trait theorists argue that personality is relatively stable across time and situations, and that individual differences in personality are a result of variation in the degree to which people possess certain traits.

Question 7

What is Eysencks 3 factor theory on personality?

Answer 7

Extraversion-Introversion: This factor refers to the degree to which a person is outgoing, talkative, sociable, and seeks stimulation from the external environment (extraversion) or is reserved, quiet, and prefers less stimulation (introversion).
Neuroticism-Emotional Stability: This factor refers to the degree to which a person is emotionally stable, calm, and resilient (emotional stability) or experiences negative emotions such as anxiety, depression, and anger (neuroticism).
Psychoticism: This factor refers to the degree to which a person is prone to impulsive and aggressive behavior, lacks empathy and concern for others, and tends to be unconventional and nonconformist.

Question 8

What are the big 5 personality factors?

Answer 8

Openness: This trait reflects a person’s willingness to experience new things, ideas, and sensations. People who score high in openness tend to be creative, imaginative, curious, and open-minded. Those who score low in this trait may be more traditional, conventional, and resistant to change.

Conscientiousness: This trait reflects a person’s degree of organization, responsibility, and dependability. People who score high in conscientiousness tend to be dependable, hardworking, organized, and self-disciplined. Those who score low in this trait may be more impulsive, disorganized, and less responsible.

Extraversion: This trait reflects a person’s level of sociability, assertiveness, and talkativeness. People who score high in extraversion tend to be outgoing, sociable, assertive, and energized by social interactions. Those who score low in this trait may be more introverted, reserved, and prefer quieter environments.

Agreeableness: This trait reflects a person’s level of compassion, empathy, and cooperativeness. People who score high in agreeableness tend to be kind, empathetic, considerate, and cooperative. Those who score low in this trait may be more competitive, assertive, and less concerned with the feelings of others.

Neuroticism: This trait reflects a person’s level of emotional stability and reactivity. People who score high in neuroticism tend to experience more negative emotions, such as anxiety, depression, and insecurity. Those who score low in this trait may be more emotionally stable, calm, and confident.

Question 9

Whats the social learning theory of personality?

Answer 9

The theory that a person’s behaviour is controlled by their response to their environment, which includes factors derived from their upbringing and the social expectations they confront.

Question 10

What is learned helplessness?

Answer 10

A psychological phenomenon where an individual learns to believe that they have no control over their situation, even when that control is possible. This leads to a sense of powerlessness and a lack of motivation to take action, even in situations where they could make a difference.

The concept of learned helplessness was first proposed by psychologists Martin Seligman and Steven Maier in the 1960s, based on their research with dogs. In one experiment, dogs were subjected to a series of electric shocks that they could not control or escape from. Eventually, the dogs stopped trying to avoid the shocks, even when they were given the opportunity to do so.
This pattern of behavior can occur in humans as well, especially when faced with situations that are beyond their control, such as poverty, discrimination, or abuse. Over time, individuals may learn to feel helpless and unable to change their circumstances, even when opportunities for change arise. This can lead to a sense of resignation and depression, as well as a lack of motivation to take action.

Question 11

Whats the aetiological factors behind personality?

Answer 11

Genetics
Adverse intrauterine, perinatal and postnatal experience (this affects neurodevelopment)
Childhood trauma, attachment disorders and early life adversity - associated with children developing ways of coping
Environment we live in e.g. domestic violence

Question 12

What is the cognitive behavioural theory of personality development?

Answer 12

people with personality disorders act in the dysfunctional ways that they do because their core beliefs. Core beliefs represent assumptions about ourselves, other people, and the world around us.

Question 13

Whats the function of the amygdala?

Answer 13

the core of a neural system for processing fearful and threatening stimuli, including detection of threat and activation of appropriate fear-related behaviors in response to threatening or dangerous stimuli.

Question 14

Outline why living in an unfriendly environment predisposes us to personality disorders?

Answer 14

Living in unfriendly environments sensitizes the amygdala to fearful or angry facial expressions, and greatly lowers the threshold for triggering defensive reactions to other people later in life
Poor care when young leads to diminished expression of genes for oxytocin and dopamine receptors which means you will experience relationships in a less pleasurable way than those with good care

Question 15

When can you say a personality is disordered?

Answer 15

When there is a marked deviation in affect, impulse control, arousal, perception and relation with others and the expectations of one’s culture
It must be enduring and stable over time
It affects a broad range of personal and social situations
It appears during childhood/adolescence and continues into adulthood

Question 16

What is the most prevalent personality disorder?

Answer 16

EUPD

Question 17

What proportion of those with borderline personality disorder are female?

Answer 17

75%

Question 18

Whats the biopsychosocial theory of personality disorders?

Answer 18

It suggests that the development of personality disorders is influenced by multiple factors, including biological, psychological, and social factors.
Biological - genetics, brain structure and function
Psych - early life experience, personality traits and cognitive patterns
Social - family dynamics, culture, societal norms

Question 19

What proportion of those with diagnosed borderline personality disorder have a history of serious childhood abuse and/or neglect prior to the age of 7?

Answer 19

87%

Question 20

Whats the social-cognitive theory of personality disorders?

Answer 20

It suggests that people learn to behave in certain ways through observation and imitation of others, and that personality can be shaped by changes in cognitive processes and environmental factors
E.g. developed their behaviours as ways of coping with early life adversity

Question 21

Whats the heritability of personality traits?

Answer 21

30-60%

Question 22

What proportion of the prison population have personality disorders?

Answer 22

50%

Question 23

What proportion of the population have personality disorders?

Answer 23

10-13%

Question 24

Whats the suicide risk for those with personality disorders?

Answer 24

3x higher than average
12% of all suicides are related to PD
10% of individuals with BPD complete suicide

Question 25

What are the 3 clusters of personality disorders?

Answer 25

A - odd or eccentric behaviour
B - dramatic, emotion, erratic behaviour
C - anxious or fearful behaviour

Question 26

What specific personality disorder belong to cluster A?

Answer 26

Paranoid
Schizoid
Schizotypal

Question 27

What specific personality disorder belong to cluster B?

Answer 27

Antisocial
Borderline
Histrionic
Narcissistic

Question 28

What specific personality disorder belong to cluster C?

Answer 28

Avoidant
Dependant
Obsessive-compulsive

Question 29

What are the 2 types of emotionally unstable personality disorders?

Answer 29

Impulsive and borderline

Question 30

What are the characteristics of paranoid PD?

Answer 30

Hypersensitivity and an unforgiving attitude when insulted
Unwarranted tendency to questions the loyalty of friends
Reluctance to confide in others due to fear the info will be used against them
Preoccupation with conspirational beliefs and hidden meaning
Unwarranted tendency to perceive attacks on their character

Question 31

What are the characteristics of schizoid PD?

Answer 31

Dont show much emotion
Avoid relationships
Seek jobs that require little social contact
Social skills weak
Prefer to alone

Question 32

What are the characteristic features of schizotypal personality disorder?

Answer 32

Social and interpersonal deficits
Thinking that coincidences or events have personal meaning
Ideas of reference
Odd beliefs and magical thinking
Unusual perceptual disturbances
Paranoid ideation and suspiciousness
Odd, eccentric behaviour
Lack of close friends other than family members
Inappropriate affect
Odd speech without being incoherent

Social anxiety

Question 33

What are the differences between schizoid and schizotypal personality disorders?

Answer 33

schizoid does not have any paranoid ideation or suspiciousness.
For people with schizotypal personality disorder the isolation and lack of close friendships is due to social anxiety or eccentricity. For schizoid personality disorder this type of isolation is due to a lack of interest in other people. People with schizotypal personality disorder might still want to have social relationships. However, they might be unable to have them due to the social anxiety or strange behavior. On the other hand, people with schizoid personality disorder generally do not want close relationships.
People with schizotypal personality disorder tend to have odd or eccentric behavior. This behavior is usually do to paranoia or suspiciousness of others. People with schizoid personality disorder tend not to show this same kind of “strange” behavior.

Question 34

What are the characteristic features of antisocial PD?

Answer 34

disregard/violation of the rights of others
tend to lie and steal
lack of conscience
prone to criminal behavior
believing that their victims are weak and deserving of being taken advantage of - hurt others to get what you want
careless with money
Act impulsively
low threshold for discharge of aggression
often ‘charming’ but ruthless

Question 35

What is emotially unstable PD?

Answer 35

Efforts to avoid real or imagined abandonment
Unstable interpersonal relationships which alternate between idealization and devaluation
Unstable self image
Impulsivity in potentially self damaging area (e.g. Spending, sex, substance abuse)
Recurrent suicidal behaviour
Affective instability
Chronic feelings of emptiness
Difficulty controlling temper
Quasi psychotic thoughts

Question 36

What are the characteristic features of the impulsive type of emotionally unstable PD?

Answer 36

characterized predominantly by emotional instability and lack of impulse control

Question 37

What are the characteristic features of the borderline type of emotionally unstable PD?

Answer 37

Marked impulsivity
Emotional instability
Poor self-image
Suicidal threats and actions
Unstable interpersonal relationships

Question 38

What are the characteristic features of histrionic PD?

Answer 38

Inappropriate sexual seductiveness
Need to be the centre of attention
Rapidly shifting and shallow expression of emotions
Suggestibility
Physical appearance used for attention seeking purposes
Impressionistic speech lacking detail
Self dramatization
continuous seeking for appreciation, excitement and attention.
tend to exaggerate friendships and relationships, believing that everyone loves them

Question 39

What are the characteristic features of obsessive-compulsive PD?

Answer 39

Is occupied with details, rules, lists, order, organization, or agenda to the point that the key part of the activity is gone
Demonstrates perfectionism that hampers with completing tasks
Is extremely dedicated to work and efficiency to the elimination of spare time activities
Is meticulous, scrupulous, and rigid about etiquettes of morality, ethics, or values
Is not capable of disposing worn out or insignificant things even when they have no sentimental meaning
Is unwilling to pass on tasks or work with others except if they surrender to exactly their way of doing things
Takes on a stingy spending style towards self and others; and shows stiffness and stubbornness

Question 40

What are the characteristic features of narcissistic PD?

Answer 40

Grandiose sense of self importance
Preoccupation with fantasies of unlimited success, power, or beauty
Sense of entitlement
Taking advantage of others to achieve own needs
Lack of empathy
Excessive need for admiration
Chronic envy
Arrogant and haughty attitude

Question 41

What are the characteristic features of avoidant PD?

Answer 41

Avoidance of occupational activities which involve significant interpersonal contact due to fears of criticism, or rejection.
Unwillingness to be involved unless certain of being liked
Preoccupied with ideas that they are being criticised or rejected in social situations
Restraint in intimate relationships due to the fear of being ridiculed
Reluctance to take personal risks due to fears of embarrassment
Views self as inept and inferior to others
Social isolation accompanied by a craving for social contact

Question 42

What are the characteristic features of dependant PD?

Answer 42

Difficulty making everyday decisions without excessive reassurance from others
Need for others to assume responsibility for major areas of their life
Difficulty in expressing disagreement with others due to fears of losing support
Lack of initiative
Unrealistic fears of being left to care for themselves
Urgent search for another relationship as a source of care and support when a close relationship ends
Extensive efforts to obtain support from others
Unrealistic feelings that they cannot care for themselves

Question 43

Outline the diagnostic criteria for PD?

Answer 43

G1 markedly disharmonious attitudes and behaviour, involving usually several areas of functioning, manifesting in more than one of the
following areas:
a) Cognition b) Affectivity c) Control over impulse and gratification needs d) Manner of relating to others and of handling interpersonal situations

• G2 The deviation must manifest itself pervasively as behaviour that is inflexible, maladaptive or otherwise dysfunctional across a broad range of personal and social situations
- G3 There is personal distress, or adverse impact on the social environment, or both, clearly attributable to the behaviour referred to in criterion G2.
• G4 There must be evidence that the deviation is stable and of long duration, having its onset in late childhood or adolescence.
• G5 The deviation cannot be explained as a manifestation or consequence of other adult mental disorders, although episodic or chronic conditions from coexist.
• G6 Organic brain disease, injury or dysfunctional must be excluded as the possible cause of the deviation.

Question 44

What are the ICD10 diagnostic criteria of the impulse type of emotionally unstable PD/

Answer 44

A: The general criteria for personality disorder (F60) must be met.
B: At least three of the following must be present, one of which must be (2):
1. marked tendency to act unexpectedly and without consideration of the consequences;
2. marked tendency to quarrelsome behaviour and to conflicts with others, especially when impulsive acts are thwarted or criticized;
3. liability to outbursts of anger or violence, with inability to control the resulting behavioural explosions;
4. difficulty in maintaining any course of action that offers no immediate reward;
5. unstable and capricious mood

Question 45

What are the ICD10 diagnostic criteria for borderline type of emotionally unstable PD?

Answer 45

A: The general criteria for personality disorder (F60) must be met.
B: At least three of the symptoms mentioned in criterion for impulsive type must be present, with at least two of the following in addition:
1. disturbances in and uncertainty about self-image, aims and internal preferences (including sexual);
2. liability to become involved in intense and unstable relationships, often leading to emotional abandonment;
3. excessive efforts to avoid abandonment;
4. recurrent threats or acts of self-harm;
5. chronic feelings of emptiness.

Question 46

What thought process type does BPD have?

Answer 46

Polarised thinking

Question 47

Whats the most common psychosis signs that BPD present with?

Answer 47

Auditory verbal hallucinations
‘Pseudo-hallucinations’ i.e.. its heard in the thoughts , from within

Question 48

Whats the ICD10 criteria for antisocial personality disorder?

Answer 48

At least four of the following must be present:
1.callous unconcern for the feelings of others;
2. gross and persistent attitude of irresponsibility and disregard for social norms, rules and obligations;
3. incapacity to maintain enduring relationships, though having no difficultyin establishing them;
4. very low tolerance to frustration and a low threshold for discharge of aggression, including violence;
5. incapacity to experience guilt or to profit from experience, particularly punishment;
6. marked proneness to blame others, or to offer plausible rationalizations, for the behaviour that has brought the patient into conflict with society.

Question 49

How are personality disorders diagnosed?

Answer 49

Assessment
Information from other sources
Good history
Interference with functioning
Coping strategies
Comorbidities psychiatric disorders
Substance misuse
Questionnaires
Triggers/sources of distress

Question 50

How can you tell the difference between bipolar and borderline personality disorder?

Answer 50

People with bipolar disorder tend to experience mania and depression while people with BPD experience intense emotional pain and feelings of emptiness, desperation, anger, hopelessness, and loneliness.
In BPD, mood changes are often short-lived (may last for only a few hours at a time) In contrast, mood changes in bipolar disorder tend to last for days/weeks.
Mood shifts in BPD are usually in reaction to an environmental stressor, such as an argument with a loved one, whereas mood shifts in bipolar disorder may occur out-of-the-blue.
The mood shifts typical of BPD rarely involve elation. Usually, the shift is from feeling upset to feeling OK, not from feeling bad to feeling a high or elevated mood, which is more typical of bipolar disorder.
In BPD self harm and suicide is more common in order to manage their emotions

Question 51

What are examples of questionnaires used for diagnosing personality disorders?

Answer 51

Minnesota multiphasic personality inventory
Eysenck personality questionnaire
Zanarini rating scale

Question 52

What proportion of those diagnosed with PD will, 10-25 years later no longer meet the criteria for diagnosis with or without treatment and why?

Answer 52

50%
As personality develops

Question 53

What proportion of those with schizotypal personality disorder will develop schizophrenia?

Answer 53

50%

Question 54

What proportion of completed suicides show evidence of personality disorder?

Answer 54

30-60%

Question 55

How do we treat PD?

Answer 55

Psychological therapies for at least 3 months
No pharmacological measures have efficacy but If sedation is needed then best option is a sedative antihistamine

Question 56

Which psychotherapy is best for BPD?

Answer 56

Dialectical behaviour therapy

Question 57

What is DBT?

Answer 57

Based on CBT but adapted to help people who experience emotions very intensely
Teaching skills in a group session

Question 58

What are the 4 skill modules in DBT?

Answer 58

Mindfulness
Distress tolerance
Interpersonal effectiveness
Emotion regulation

Question 59

Outline the skill module ‘mindfulness’ used in DBT?

Answer 59

A set of skills that help focus a pt attention to living life in the present rather than being distracted by worries

Question 60

Outline the skill module ‘distress tolerance’ used in DBT?

Answer 60

Teaching to deal with crises in a more effective way, without having to resort to harmful behaviours such as self harm

Question 61

Outline the skill module ‘interpersonal effectiveness’ used in DBT?

Answer 61

focuses on helping individuals develop effective communication and relationship skills. The goal of this module is to help individuals build and maintain healthy relationships, while also respecting their own needs and boundaries.

Question 62

Outline the skill module ‘emotion regulation’ used in DBT?

Answer 62

A set of skills used to recognise and manage intense and overwhelming emotions in a healthy way

Question 63

What is cognitive analytic therapy?

Answer 63

a form of psychotherapy that combines elements of cognitive and psychodynamic therapies.
The therapy is designed to help individuals identify and change negative patterns of behavior that may be causing difficulties in their lives.
It mainly focuses on relationship patterns and is based on the idea that our early life experiences influence the way we relate to other people and how we treat ourselves.

Question 64

What is psychodynamic therapy?

Answer 64

Based on psychodynamic theory

focuses on unconscious processes as they are manifested in the client’s present behavior. The goals of psychodynamic therapy are client self-awareness and understanding of the influence of the past on present behavior.

Question 65

Whats the difference between psychodynamic therapy and CBT?

Answer 65

CBT focuses on the practical effects of a problem
Psychodynamic therapy focuses on the meaning of the problem and the reasons behind it

Question 66

Why are people with paranoid PD particularly diffiuclt to treat?

Answer 66

Because of their lack of trust

Question 67

what age do you have to be to be diagnosed with antisocial pd

Answer 67

> 18

Question 68

What is ‘splitting’ in BPD?

Answer 68

It causes a person to view everything and everyone in black and white, ‘absolute’ terms

It’s a commonly used defence mechanism that is done subconsciously in an attempt to protect against intense negative feelings such as loneliness, abandonment and isolation.

Question 69

What are the 3 traits of a histrionic pd?

Answer 69

Very emotional
Attention seeking
Sexually provocative

Question 70

What is schizoaffective disorder?

Answer 70

A person who has schizophrenia along with a different disorder, such as depression or being bipolar.

Question 71

what mental health probelm can predispose you to avoidant pd?

Answer 71

Anxiety disorders

Question 72

What are the differences between OCD and OCPD?

Answer 72

OCD is ruled by obsessions that cause anxiety and force the person to perform compulsions for relief
OCPD is ruled by perfectionism and detail.
Unlike individuals with OCD, people with OCPD are not self-aware and can hurt the people around them.
OCPD is constant whilst OCD fluctuates

Question 73

What types of relationships do people with dependant pd often get into?

Answer 73

Abusive as they are clingy and have low self esteem

Question 74

Which cluster of pd does anxiety have a genetic link with?

Answer 74

C
(Dependant, avoidant, obsessive compulsive)

Question 75

What are personality disorders?

Answer 75

A pervasive pattern of behaviour which causes the individual long-term difficulties in their interpersonal relationships and functioning in society.
The diagnosis can therefore only be made once a person’s personality has fully developed and their adaptive behaviours have become fixed. Because of this, it is generally accepted that a personality disorder can only be diagnosed after the age of 18 but in practice it occurs many years later.