Personality Disorders

Question 1

What is personality?

Answer 1

• Personality refers to individual differences in characteristic patterns of thinking, feeling and behaving that are stable across settings and time.
• It consists of enduring traits that originate in biology, and is often measured using the OCEAN or Big 5 personality traits.

Question 2

What are personality disorders?

Answer 2

• Personality disorders are maladaptive variations of several domains of personality, including traits, emotions (capacity for empathy), cognitions, motives, self concepts (sense of self), and interpersonal relationships (including capacity for intimacy).
• They are generally distressing and inflexible, leading to interpersonal conflict and difficulty in daily functioning, and are difficult to treat.
• They generally last for years and start in adolescence or early adulthood but sometimes childhood.

Question 3

What is the difference between DSM-5 and ICD-10 approaches to personality disorders?

Answer 3

• The DSM-5 and ICD-10 have a categorical approach to personality disorders, meaning that individuals either have the disorder or they do not, and if they do not fulfill all symptoms, they are not considered to suffer from it.
• This approach has high comorbidity and it is difficult to establish reliability amongst clinicians.
• In contrast, the ICD-11 has a dimensional approach, which is continuous.

Question 4

What are the three clusters of personality disorders in the DSM-5?

Answer 4

• The three clusters of personality disorders in the DSM-5 are:
  o Cluster A (odd or eccentric) which includes paranoid, schizoid, and schizotypal
   Do not have close social ties/relationships – have relationship problems
   Paranoid – because they don’t trust others
   Schizoid – because they don’t want others
   Schziotyal – because they are odd and anxious around others
  o Cluster B (dramatic, emotional, erratic) which includes antisocial, narcissistic, borderline, and histrionic
   Dramatic, emotional, erratic behavioural patterns – very hard to form giving and satisfying relationships
   More commonly diagnosed because more problematic for others
  o Cluster C (anxious or fearful) which includes avoidant, dependent, and obsessive-compulsive.

Question 5

What is Paranoid Personality Disorder?

Answer 5

• Paranoid Personality Disorder is a personality disorder characterized by extreme distrust of others and seeing others as a constant threat.
• People with this disorder tend to be suspicious of others, believe that others will exploit and deceive them, and are less likely to forgive and forget.
• they also tend to misinterpret social events and are argumentative and hostile.
• They have ongoing patterns of suspiciousness and lack of trust, and often unjustifiably suspect that others are conspiring against them.

Question 6

What are some traits of Schizoid Personality Disorder?

Answer 6

• Schizoid Personality Disorder is characterized by a disinterest in relationships and people.
• People with this disorder generally have no desire for intimate relationships or friendships, are indifferent to social interactions, and gain little pleasure from bodily or sensory experiences.
• They tend to choose solitary hobbies or jobs and like to spend time alone. They are emotionally cold and socially clumsy.

Question 7

What is Schizotypal Personality Disorder?

Answer 7

• Schizotypal Personality Disorder is a personality disorder characterized by unusual, eccentric thoughts, perceptions, and behaviors.
• People with this disorder may believe in having magical powers or the ability to predict the future.
• They have difficulty forming close relationships because of anxieties and tend to exhibit odd and peculiar behaviors.
• This disorder is classified under psychotic disorders in ICD-10/11.

Question 8

What is Antisocial Personality Disorder?

Answer 8

• Antisocial Personality Disorder is a mental disorder characterized by a general disregard for the rights of others, a lack of empathy, deceitfulness, disregard for social norms and laws, impulsivity, and often criminal behavior.
• Individuals with this disorder may show signs of behavioral problems in childhood and may have higher rates of alcoholism and substance use disorders.

Question 9

Can Antisocial Personality Disorder be treated?

Answer 9

• It is generally hard to change this personality disorder through therapy, as individuals with this disorder lack conscience, have no desire to change, and often do not respect therapy. Therapy is often forced upon them, such as by law.

Question 10

What is Borderline Personality Disorder?

Answer 10

• Borderline Personality Disorder is a mental disorder characterized by unstable relationships, a rapidly shifting sense of self and emotions, high emotional intensity, impulsive and unpredictable behavior, and a tendency to hurt themselves physically to get rid of the feeling of emptiness inside.
• Individuals with this disorder may also be comorbid with other disorders such as depression and eating disorders.

Question 11

When do individuals with Borderline Personality Disorder typically seek treatment?

Answer 11

• Individuals with Borderline Personality Disorder may come to treatment after a suicide attempt, as they may engage in parasuicidal behaviors.

Question 12

What is Histrionic Personality Disorder?

Answer 12

• Histrionic Personality Disorder is a mental disorder characterized by excessive attention-seeking and emotionality, theatrical behavior, a desire to be at the center of attention, and flirtatious behavior.
• It may be hard to treat, but individuals with this disorder often come to treatment willingly.

Question 13

What is Narcissistic Personality Disorder?

Answer 13

• Narcissistic Personality Disorder is a mental disorder characterized by a strong sense of self-importance and superiority, a sense of entitlement, lack of empathy for others, and a desperate need for admiration.
• Individuals with this disorder may have a fragile self-esteem and be sensitive to criticism.
• They may seek therapy for another comorbid problem, but are unlikely to acknowledge their weaknesses and criticism.

Question 14

What is Avoidant Personality Disorder and what are some common symptoms?

Answer 14

• Avoidant Personality Disorder is a mental health condition where individuals avoid social interactions due to fear of rejection, a pervasive feeling of inadequacy, sensitivity to criticism and rejection from others, and being sensitive to what others think of them.
• They may avoid going to new places, doing new things, and making new friends because of fear of criticism or disapproval.
• They generally have low self-esteem, feel easily hurt, and think of themselves as unappealing or inferior to others.

Question 15

How is Avoidant Personality Disorder different from Social Anxiety Disorder?

Answer 15

• While both Avoidant Personality Disorder and Social Anxiety Disorder involve fear in social situations, they differ in focus. Social Anxiety Disorder primarily involves a fear of social circumstances, while Avoidant Personality Disorder involves a fear of social relationships.
• However, they can also be comorbid, meaning that they occur together in some individuals.

Question 16

What is Dependent Personality Disorder and what are some common symptoms?

Answer 16

• Dependent Personality Disorder is a mental health condition where individuals seek out others excessively and are highly dependent on others.
• They have an excessive need to be taken care of, nurtured, and told what to do.
• They are submissive to others, need lots of encouragement and advice from others, and have difficulty making decisions without reassurance from others.
• They are open to being abused in relationships due to their fear of abandonment and put all responsibility of treatment on their therapist.

Question 17

How is Dependent Personality Disorder treated?

Answer 17

• Treatment for Dependent Personality Disorder involves therapy, particularly cognitive-behavioral therapy and psychodynamic therapy.
• While individuals with Dependent Personality Disorder may put all responsibility of treatment on their therapist, they also have some responsibility in their treatment.
• Therapy can be modestly helpful in improving symptoms.

Question 18

What is Obsessive Compulsive Personality Disorder and what are some common symptoms?

Answer 18

• Obsessive Compulsive Personality Disorder is a mental health condition where individuals are preoccupied with order, rules, and control.
• They are perfectionistic and rigid, have very high standards for themselves and others in tasks and morals/ethics.
• They may also believe that if they want something done correctly, they must do it themselves. They may be devoted to work at the expense of leisure and friendships and may never be satisfied with their work.

Question 19

How is Obsessive Compulsive Personality Disorder different from Obsessive Compulsive Disorder?

Answer 19

• While Obsessive Compulsive Personality Disorder (OCPD) and Obsessive Compulsive Disorder (OCD) are related and can be comorbid, they differ in focus.
• OCPD does not include obsessions or compulsions, while OCD involves intrusive thoughts and repetitive behaviors in response to those thoughts.
• Individuals with OCPD may come to therapy for other comorbid reasons and can benefit from therapy.

Question 20

What is the biological perspective on personality disorders?

Answer 20

• The biological perspective on personality disorders focuses on the brain chemistry and structure of individuals with specific disorders, including antisocial, borderline, and schizotypal personality disorders.
• Low serotonin levels have been associated with antisocial and borderline personality disorders, while excessive dopamine has been linked to schizotypal personality disorder.
• Medications such as antidepressants, mood stabilizers, and antipsychotics are commonly used to reduce symptoms, but their effectiveness is still questionable.

Question 21

What is the psychodynamic perspective on personality disorders?

Answer 21

• The psychodynamic perspective on personality disorders suggests that personality is shaped within the first six years of life and that attachment relationships influence internal working models of self, others, and relationships.
• Early abuse and neglect can lead to the development of personality disorders, such as narcissism as a defense mechanism against feelings of shame due to parental rejection and mistreatment.
• Psychodynamic therapies aim to use the relationship between client and therapist to help rectify rigid and ineffective patterns of interaction that were learned in early childhood.

Question 22

What is the cognitive-behavioral perspective on personality disorders?

Answer 22

• The cognitive-behavioral perspective on personality disorders focuses on the behavioral conditioning and development of unhelpful but fixed beliefs about self, others, and relationships.
• Therapy aims to loosen and change these inflexible beliefs and teach, model, and practice appropriate social skills and behaviors.
• Schema therapy aims to revise dysfunctional schemas formed in early life, while dialectical behavior therapy (DBT) focuses on skill acquisition, strengthening, and generalization, including mindfulness, emotion regulation, and distress tolerance.

Question 23

What is the humanistic perspective on personality disorders?

Answer 23

• humanistic perspective on personality disorders suggests that children who did not receive the three core conditions of empathy, genuineness, and unconditional positive regard may have trouble establishing supportive relationships to achieve self-actualization.

Question 24

What is the socio-cultural perspective on personality disorders?

Answer 24

• The socio-cultural perspective on personality disorders considers the influence of culture on an individual’s personality.
• It explores whether personality is culturally universal or culturally relative, and how much the culture influences one’s personality.
• For example, Western cultures tend to be more narcissistic and extraverted and more open to experience.
• Gender is also a factor, with women generally expressing emotions more, being diagnosed with borderline and histrionic personality disorders more often, showing more deference and support-seeking behavior, and being more likely to have a dependent personality disorder.
• Trauma is also a significant factor, with 73% of individuals with personality disorders reporting abuse and 82% reporting neglect.
  o Additionally, some argue that personality disorders may be specialized coping strategies for survival in negative environmental conditions, similar to post-traumatic stress disorder.