Personality Disorders

Question 1

What is personality

Answer 1

Combination of characteristics that forms a person’s distinctive character.

Exhibited in wide range of important social and personal context
Totality of emotional and behavioural trails
Relatively stable and predictable

Question 2

Outline the aetiology of personality

Answer 2

Nature: Genes
Nurture: family, peers, upbringing, trauma, culture, values, beliefs
Interactive model: nature provides the template that life experience modifies
Evolutionary model: “life experience” of the species has modified the genome
“ontogeny recapitulates phylogeny”

Question 3

Outline the Erickson stages of the life cycle

Answer 3

0-1: Basic trust vs. basic mistrust
1-3: Autonomy vs. shame and doubt
3-5: Initiative vs. guilt
6-11: Industry vs. inferiority
11-20: Identity vs. role diffusion
21-40: Intimacy vs. isolation
40-65: Generativity vs. stagnation
65+: Integrity vs. despair

Question 4

Describe the difference between categorical and dimensional approach to classifying personality disorders

Answer 4

Dimensional personality disorders- personality traits are shared amongst general population which excessive dimensions in disordered people
Categorical approach relies on diagnostic criteria to determine presence or absence of disruptive or other abnormal behaviours

Question 5

The five factor model: Dimensional approach

Question 6

Define Personality Disorder

Answer 6

Patterns of maladaptive traits that cause a person to be distressed and significantly impaired their social or occupational functioning or both

Foster vicious cycles
Deviate markedly from cultural norms
DSM4 Axis II
Generally safer to talk about “traits” than a personality disorder

Question 7

What is a paranoid personality disorder

Answer 7

Pervasive mistrust and suspiciousness of others such that their motives are interpreted as malevolent.
Suspects others are exploiting them.
Doubts the loyalty of friends.
Reluctant to confide in others.
Bears grudges
Feels attacked by others and reacts to this
Suspects partner of deceit/disloyalty/unfaithfulness.

Question 8

How is paranoid personality disorder managed

Answer 8

Low dose antipsychotics
Establish a trusting and non threatening relationship

Question 9

What is Schizoid personality disorder

Answer 9

Pervasive pattern of detachment from social relationships and a restricted range of expression of emotion in interpersonal settings.
Neither desires nor enjoys close relationships (including family)
Chooses solitary activities
Little sexual interest
Few close friends
flattened affectivity
Indifferent

Primarily genetic aetiology?

Question 10

What is schizotypical personality disorder

Answer 10

A pervasive pattern of social and interpersonal deficits marked by acute discomfort with close relationships as well as by cognitive or perceptual distortions or eccentricities of behaviour
Ideas of reference
Odd beliefs
Odd thinking, speech and affect paranoid ideation
Eccentric behaviour or aappearance
No close relationships except family
Social anxiety

Question 11

Management of Schizotypical personality disorder

Answer 11

Low dose of neuroleptics
Differentiate from Schizophrenia
Relatively may need advice and reassurance

Question 12

What is antisocial personality disorder

Answer 12

A pervasive pattern of disregard for and violation of the rights of others.
Since age 15
Repeated acts that are grounds for arrest
Deceitful, impulsive, irritable and aggressive
Reckless
Irresponsible
Lack remorse
Conduct disorder before age 15

Question 13

Who is at more risk of antisocial personality disorder

Answer 13

M:F = 3:1

Question 14

What is Borderline personality disorder

Answer 14

A pervasive pattern of instability of interpersonal relationships, self-image and affects, and marked impulsivity
Abandonment issues
Unstable and intense relationships
Identity disturbance
Impulsivity
Suicidal behavior
Affective instability
Chronic feelings of emptiness
Inappropriate anger
Transient paranoia or dissociation under stress (“micropsychotic episodes”)

Question 15

What is the main ethology of borderline personality disorder

Answer 15

Primarily environmental (in vulnerable individuals)
Up to 80% have a history of abuse or neglect

Question 16

WHO is borderline personality disorder common in

Answer 16

M:F = 1:2

Question 17

Management of borderline personality disorder

Answer 17

Know what you are dealing with, avoid “red herrings”eg. “depression” “voices in the head”
Be honest,consistent and non-judgmental
Firm boundaries, beware of idealization (the action of regarding or representing something as perfect or better than in reality), be realistic about treatment targets as well as risks and side effects.
Treat presenting pathology
SSRI’s, mood stabilizers and low dose antipsychotics may be helpful
Psychotherapy, counseling and regular long term support.

Question 18

What is histrionic personality disorder

Answer 18

A pervasive pattern of excessive emotionally and attention seeking
Needs to be the centre of attention
Sexually seductive or provocative
Rapidly shifting, shallow expressed emotions
Uses physical appearance to draw attention to self
Impressionistic style of speech
Exaggerates emotions, prone to self –dramatization
Suggestible
Exaggerates intimacy of relationships

Question 19

Who is histrionic personality disorder common in

Answer 19

Women

M:F = 1:2

Question 20

What is the management of histrionic personality disorder

Answer 20

Treat presenting illness
Long term psychotherapy may be helpful
Long term, consistent support.
NB depression & substance abuse when relationships end or social support lost

Question 21

Describe Narcissistic Personality disorder

Answer 21

A pervasive pattern of grandiosity, need for admiration and lack of empathy.
Self important
Fantasies of unlimited success
Believes is special
Requires excessive admiration
Sense of entitlement
Arrogant and exploitative
Lacks empathy

Question 22

WHO is narcissistic personality disorder common in

Answer 22

M:F = 2:1
High incidence in doctors

Question 23

What is Dependent Personality Disorder

Answer 23

A pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation
Need excessive advice and reassurance
Needs others to take responsibility
Struggles to disagree
Lack of initiative
Goes to great lengths for support/nurturance
Uncomfortable alone
Urgently seeks to replace ended relationship with new one
Preoccupied with fears of being left alone

Question 24

WHO is the Dependent Personality disorder common in

Answer 24

1:1 both male and female
Common pathology in stalkers

Question 25

What are people with dependent personality disorders at risk of

Answer 25

Anxiety and depression after separation
Vulnerable to abusive relationships

Question 26

How to manage individuals with dependent personality disorder

Answer 26

Need long term support and structure

Question 27

Describe avoidant personality disorder

Answer 27

‘Avoids’ occupations involving contact with people.
A pervasive pattern of social inhibition, feelings of inadequacy,and hypersensitivity to negative evaluation, beginning by early adulthood and present in a variety of contexts
Unwilling to get involved with people unless sure of being liked
Restrained in relationships for fear of shame
Preoccupied with social rejection and ridicule
Feels inadequate
Views self as inept, unappealing or inferior
Avoids personal risk for fear of embarrassment

Question 28

Management for avoidant personality disorder

Answer 28

Imipramine,SSRI’s and RIMA’s may be useful.

Question 29

Describe Obsessive Compulsive Personality Disorder

Answer 29

A pervasive pattern of preoccupation with orderliness, perfectionism and control at the expense of flexibility, openness and efficiency
Preoccupied with rules and lists
Perfectionism interferes with task completion
Excessively devoted to work
Scrupulous and inflexible morality, ethics and values.
Cannot discard objects.
Miserly, saving for future catastrophe
Rigid and stubborn.

Question 30

A pervasive pattern of instability of interpersonal relationships, self-image and affects, and marked impulsivity

Answer 30

Boarderline personality disorder