Personality Disorders

Question 2

Personality

Answer 2

Pattern of thoughts, feelings, and behavior that makes each of us the individuals that we are.

Question 3

5 factor model of personality

Answer 3

Openness.
Conscientiousness.
Extraversion.
Agreeableness.
Neuroticism.

Question 4

Personality Disorder

Answer 4

Evident from early life.
Enduring, stable, inflexible, maladaptive.
Deviates from sociocultural norms/expectations.
Leads to distress and dysfunction.
Not due to other medical conditions/substances/mental disorders.
Not diagnosed before 18.
Not same as mental illness.

Question 5

Categorical

Answer 5

Unique types of abnormal development that are unrelated to normal personalities.

Question 6

Dimensional

Answer 6

personality traits are shared amongst general population with excessive dimensions in disordered individuals

Question 7

DSM 5: PD

Answer 7

Enduring pattern of inner experience & behaviour.
Deviates markedly from expectations of culture.
2 or more of following:
1) Cognition – ways of perceiving & interpreting self, others, events
2) Affectivity – appropriateness of emotional response
3) Interpersonal functioning
4) Impulse control
Inflexible, pervasive, long duration (at least from adolescence/early adulthood).
++ distress / dysfunction.
Not substance / another medical condition / another mental disorder.

Question 8

DSM 5: PD

Answer 8

Distress, stigma
Long-term care challenging
Common comorbidities: depression, anxiety, substance use disorder, suicidality
High service use; excess medical morbidity
Heritability 30-50%.
Early childhood adversity, incl. abuse, neglect & bullying.

Question 9

Cluster A

Answer 9

“odd and eccentric”.
Paranoid
Schizoid
Schizotypal

Question 10

Paranoid PD

Answer 10

Pervasive pattern of mistrust and suspiciousness.

Begins in early adulthood.

Presents in a variety of contexts.

Question 11

Schizoid PD

Answer 11

Detachment from social relationships.

Restricted range of emotional expressions.

Question 12

Schizotypical

Answer 12

Odd, eccentric behaviour & thinking.
- Cognitive / perceptual distortions
- Social and interpersonal deficits.
- Risk for schizophrenia.

Question 13

Cluster B

Answer 13

“Dramatic, emotional, and egocentric”.
Histrionic PD
Narcissistic PD
Antisocial PD
Borderline PD

Question 14

Historic PD

Answer 14

Excessive emotionality.
Attention-seeking behavior.

Question 15

Narcissistic PD

Answer 15

-Grandiosity
- Need for admiration
- Extreme jealousy, arrogance & lack of empathy.

Question 16

Antisocial PD

Answer 16

Disregard for rights of others.
Violation of rights of others.
Lack of remorse for wrongdoing.
Lack of empathy.

Question 17

Borderline PD

Answer 17

Instability of interpersonal relationships, self-image, and affects.
Marked impulsivity.

Question 18

Cluster c

Answer 18

“Anxious and fearful”.
Avoidant PD
Dependent PD
Obsessive-compulsive PD

Question 19

Avoidant PD

Answer 19

Feel socially inhibited & inadequate.
Extremely sensitive to any form of criticism or negative evaluation.

Question 20

Dependent PD

Answer 20

• Excessive need to be taken care of.
• Submissive behavior.
• Fear of separation.

Question 21

Obsessive-compulsive PD

Answer 21

• Preoccupation with orderliness and perfectionism.
• Mental and interpersonal control.
• Not same as OCD.

Question 22

Antisocial more

Answer 22

3-4%
Male:Female = 3:1
Genetic and environmental factors may be contributory
“Absent” fathers and childhood abuse
May “burn out” in later life, particularly if marry a strong partner

Question 23

DSM 5 antisocial

Answer 23

Pervasive pattern of disregard for, & violation of, rights of others.
Since age 15yrs.
At least 18yrs old.
Evidence of conduct d/o onset before 15 yrs.
Not due to another mental d/o.

Question 24

DSM 5: Antisocial criteria

Answer 24

• At least 3 of:
  Doesn’t conform to social norms re lawful behaviour (eg repeated arrests).
  Deceitfulness (eg repeated lying, conning other for profit/pleasure).
  Impulsivity or failure to plan.
  Irritability & aggression (eg assaults).
  Reckless disregard for safety of self/others.
  Consistent irresponsibility (eg failure to sustain work).
  Lack of remorse (eg indifferent to having mistreated another).

Question 25

More on: Antisocial PD

Answer 25

• Psychopath: charm; intelligence; egocentric; exploitative; lack remorse.
• Malingering; substance abuse.
• NB! Early identification & intervention
  → parenting skills, problem solving, emotional awareness, improved self-concept, control of arousal and emotions.
• Adolescent: Forensic hx? Risk? Need for secure placement??
• Caution: Firm boundaries!

Question 26

Mx of antisocial PD

Answer 26

Usually don’t seek help.
Risk of poor adherence, substance use disorder.
Evidence for effectiveness of psychological interventions lacking.
NICE guidelines:
- Group based CBT, focused on ↓ offending
- Anger management; violence reduction programmes
Sometimes forensic psych system.
Support & supervision of provider.

Question 27

Borderline PD

Answer 27

Prevalence: 2%
Male:Female = 1:2
Aetiology is primarily environmental (in vulnerable individuals), up to 80% have a history of abuse or neglect, especially sexual abuse in childhood
Comorbidity: depression, anxiety, self harm, dissociative symptoms, relationship problems, substance abuse
Prognosis: 1/3 “recovered” and 2/3 in stable employment 15y after diagnosis
Suicide Rate: 9%

Question 28

DSM 5: Borderline PD

Answer 28

Pervasive pattern of instability of interpersonal relationships, self-image and affects
& marked impulsivity

Question 29

DSM 5: Borderline PD Criteria

Answer 29

Since early adulthood, in various contexts, at least 5 of:
- Dreads abandonment
- Unstable and intense relationships (idealisation vs devaluation)
- Identity disturbance
- Impulsivity
- Recurrent suicidal behaviour
- Affective instability
- Chronic feelings of emptiness
- Inappropriate anger
- Transient paranoia or dissociation under stress (“micropsychotic episodes”)