Personality disorders

Question 1

Key factors and issues regarding DSM-5 classification of PDs

Answer 1

Categorical approach disadvantages
- Arbitrary cut-off
- High comorbidity between PDs
- No structural evidence that there are certain number of PDs
- Fails to define and account for earlier clinical stages when disorder is emerging
- Stark differences across the same PD in some cases
- Highly sigmatising

Question 2

Categorial vs dimensional approaches to PD classification

Answer 2

ICD-10
- Categorial approach: 9 distinct PDs but not clustered, also some PDS labelled differently
- Dimensional approach: assesses severity and manifestation of emotional, cognitive, and/or behavioural impairment

Question 3

DSM-5 General PD Criteria

Answer 3

MUST be met:
- Significant impairments in self and interpersonal functioning
- One or more pathological trait domains/facets

In addition MUST be:
- Relatively stable across time and consistent across situations
- Not understood as normative given individual’s sociocultural context or developmental stage
- Symptoms not better explained by a drug or a medical condition

Question 4

Key features of PDs in Cluster A and Cluster C in DSM-5

Answer 4

Cluster A: odd/eccentric
- Paranoid (“accusatory”) - generally distrustful, suspicious, hypersensitive, hold grudges)
- Schizoid (“aloof”) - avoids social interactions, flat emotions, uninterested in feeling pleasure, anhedonia
- Schizotypal (“awkward”) - magical thinking/ideation, overconfidence/socially inappropriate

Cluster B: dramatic emotional
- Antisocial (aggressive, criminal, hostility)
- Borderline (emotional and affective instability, fear of abandonment): often have experienced trauma before sense of self as developed
- Narcissistic (exaggerated sense of self-importance, grandiosity, fragile self-esteem)
- Histrionic (attention-seeking, uncomfortable when not centre of attention)

Cluster C: anxious/fearful
- Avoidant (“cowardly”) - feelings of low self-esteem, inadequacy, hypersensitive to criticism
- Dependent (“clingy”) - intense fear of seperation and rejection, feeling of incompetency.
- OCD (“ego syntonic) - orderliness, perfectionistic, need for control, rigid with beliefs and moral values

Definitions:
Complex Trauma:
- Repeated, cumulative experienced in childhood of a mis-attuned environment which forms and disforms the personality.

Question 5

Differentiate level 1 and level 2 evidence and each of the therapies categorised in these levels for treatment of PDs

Answer 5

Level 2 evidence: independent, blinded comparison with a valid reference standard among consecutive persons with a defined clinical presentation
- CBT
- ACT
- IPT
- Psychoeducation

Level 1 evidence: a meta-analysis or systematic review of level 2 studies that include a quantitative analysis
- Dialectical behavioural therapy (CBT)
- Schema therapy
- Psychodynamic therapy

Question 6

Describe DBT

Answer 6

DBT consists of a combinatino of change and acceptance strategies:

Acceptance:
- Mindfulness: being aware of the present moment without judgement
- Distress Tolerance: Managing a crisis without worsening the situation, accepting reality for what it is

Change:
- Emotional regulation: understanding and reducing vulnerability to emotions/changing emotions
- Interpersonal effectiveness: Getting needs met, learning to better navigate and maintain close relationships