Personality Disorders Flashcards
The term complex emotional difficulties (CED) relates to which of the following:
1 - another term for personality disorder
2 - describes patients personalities who have personality disorder
3 - describes patients experiences who have personality disorder
3 - describes patients experiences who have personality disorder
- new services and care pathways that support people with PD and related difficulties are usually described as services/pathways for people with CED
- CED is also useful for identifying the difficulties patients with personality disorder are experiencing
What is personality?
1 - habits that a person has
2 - traits and characteristics that are innate
3 - traits and characteristics we can pick up from mirroring others
2 - traits and characteristics that are innate
- developed as we grow up
- shape us an individual
in terms of our attitudes, thoughts, feelings & behaviours
in response to different situations
Temperament related to the emotional and behavioural characteristics, essentially the ‘how’ of a behaviour. Does this relate to adults or children in psychiatry?
- children
- forms the basis of personality, which is then developed on top of this.
At what age have people generally developed their traits and personality by that will remain with them for the rest of their lives?
1 - 5-10 y/o
2 - 10-15 y/o
3 - 15-25 y/o
4 - >25 y/o
3 - 15-25 y/o
- late teens to early 20s
Which of the following is NOT a reason why personality is important in psychiatry?
1 - may be a predisposing factor to mental illness (e.g. may affect response to stressful events, which may be more likely to trigger anxiety)
2 - may affect the way that mental illness is experienced / presents (e.g. in depression
someone with obsessional personality may be more prone to rumination or
someone with emotional instability may be more prone to destructive behaviour)
3 - may affect the person’s views on and engagement with treatment
4 - may cause increased physiological stressors
4 - may cause increased physiological stressors
The big 5 model is an approach that that aims to encapsulate all different traits that make up personality into 5 factors. Which of the following is NOT one of the 5 factors?
1 - Openness to experience (novelty-seeking)
2 - Fear
3 - Conscientiousness
4 - Extraversion - introversion
5 - Agreeableness
6 - Neuroticism
2 - Fear
- each of the 5 factors cover a spectrum, and we all fall somewhere on this spectrum
Personality is said to be formed in a variety of ways. Which of the following is NOT one of the 4 most commonly cited ways in which personality is said to develop?
1 - childhood experiences
2 - psychoanalytic theories
3 - attachment theory
4 - type of birth
5 - genetics
The attachment theory proposed by Bowlby suggests that we are born with a biological drive to form attachments for survival. Do infants tend to form one or multiple attachments?
- tend to form just one attachment
The attachment theory proposed by Bowlby suggests that we are born with a biological drive to form attachments for survival. Is the primary determinant for attachment food or care and responsiveness?
care and responsiveness
The attachment theory proposed by Bowlby suggests that we are born with a biological drive to form attachments for survival. Bowlby believed that the primary attachment will form the basis for the development of all future relationships. What age did Bowlby define as the critical period this attachment occurs?
1 - 0-12 months
2 - 0-2 years
3 - 0-5 years
4 - 0-10 years
3 - 0-5 years
Which of the following styles of attachment fits the following description: care giver responds to the child’s needs and child greets caregiver with positive emotions?
1 - secure
2 - anxious (ambivalent)
3 - avoidant
4 - disorganised
1 - secure
Which of the following styles of attachment fits the following description: child is less confident in caregivers response and anxious about strangers.
1 - secure
2 - anxious (ambivalent)
3 - avoidant
4 - disorganised
2 - anxious (ambivalent)
- ambivalent means to have mixed feelings about something
Which of the following styles of attachment fits the following description: caregiver doesn’t respond to child’s needs and child feels they cannot rely on them. Child may avoid the parents.
1 - secure
2 - anxious (ambivalent)
3 - avoidant
4 - disorganised
3 - avoidant
Which of the following styles of attachment fits the following description: caregiver can appear frightened and/or frightening. Child may appear confused or disorganised about their feelings towards the caregiver.
1 - secure
2 - anxious (ambivalent)
3 - avoidant
4 - disorganised
4 - disorganised
We often share similar personalities do other people in our families. Which of the following is NOT a commonly cited cause of this?
1 - genetics
2 - birth type
3 - social learning
2 - birth type
What is the estimated genetic heritability of personality, based on monozygotic vs dizygotic twins studies?
1 - 3.5 - 50%
2 - 35-50%
3 - 20-75%
4 - >90%
2 - 35-50%
Personality traits are relatively stable throughout childhood. They do change as we gain further life experience. At what age does our personality mainly slow down in the way it changes?
1 - 30 y/o
2 - 50 y/o
3 - 70 y/o
4 - 90 y/o
1 - 30 y/o
- can still change, but slows from 30, and then even slower as we continue to age
Personality traits are relatively stable throughout childhood. They do change as we gain further life experience. which part of the brain is important in this?
1 - parietal
2 - frontal cortex
3 - temporal
4 - occipital
2 - frontal cortex
Understanding an individuals personality is important in psychiatry. How can it help us understand aetiology?
1 - helps identify attachment theory
2 - helps identify early life stressors
3 - helps identify why specific stressors may lead to psychiatric problems
3 - helps identify why specific stressors may lead to psychiatric problems
Understanding an individuals personality is important in psychiatry. How can it help us understand diagnosis?
1 - helps identify attachment theory
2 - helps identify early life stressors
3 - helps identify why specific stressors may lead to psychiatric problems
4 - personality may explain unusual features of a clinical presentation
4 - personality may explain unusual features of a clinical presentation
Which of the following is NOT important when assessing a patients personality?
1 - establish therapeutic relationship (patient/doctor interactions)
2 - understand patients health
3 - understand patient’s reaction to illness and its treatment
2 - understand patients health
- assessment of personality is important to ALL psychiatric formulations and NOT just patients with suspected personality disorders
An important questions about personality, and potentially one of the most useful questions is:
“How would your friends and family describe you as a person?”
- we are not good at describing our own personality, so useful to ask others about our personality who know the patient well
The International Classification of Diseases 11th Revision (ICD-11) have defined personality disorder. Which of the following is NOT part of this definition?
1 - marked disturbance in personality functioning, which is nearly always associated with considerable personal and social disruption.
2 - enduring
3 - manifest across a range of personal and social situations
4 - physical hallucinations
4 - physical hallucinations
The International Classification of Diseases 11th Revision (ICD-11) have defined personality disorder. This can be further subdivided into 2 categories:
- Impairments in functioning of aspects of the self e.g.
- Problems in interpersonal functioning
When looking at impairments in functioning of aspects of the self, which of the following is NOT included within this?
1 - self-worth
2 - identity
3 - relationship development
4 - capacity for self-direction
3 - relationship development
The International Classification of Diseases 11th Revision (ICD-11) have defined personality disorder. This can be further subdivided into 2 categories:
- Impairments in functioning of aspects of the self e.g.
- Problems in interpersonal functioning
When looking at problems in interpersonal functioning, which of the following is NOT included within this?
1 - Understanding ones identity
2 - Developing and maintaining close and meaningful relationships
3 - Understanding the perspective of others
4 - Managing conflict
1 - understanding ones identity
The International Classification of Diseases 11th Revision (ICD-11) have defined personality disorder. This can be further subdivided into 2 categories:
- Impairments in functioning of aspects of the self e.g.
- Problems in interpersonal functioning
Impairments that manifest in maladaptive patterns, which include both of the above can lead to impairments. Which of the following is NOT included within this?
1 - Cognition
2 - Conflict management
3 - Emotional experience/expression
4 - Behaviour
2 - Conflict management
All of the following are reasons why personality disorders are important:
1 - Have difficulties with social situations and relationships
2 - Have difficulties controlling their feelings and/or behaviour
3 - React in unusual ways to illness or to treatment
4 - Behave in unusual ways when mentally ill
5 - Have more extreme or unusual reactions to stressful events
6 - Behave in ways that cause harm to themselves or others
7 - Be more prone to developing other types of mental disorder
8 - Have high use of health services
Is personality disorder included within the mental health act?
- yes
Previously personality disorders were categorised based on the traits of the personality disorder. Category A is described as the ‘odd and eccentric cluster. Which of the following is NOT part of this category?
1 - antisocial
2 - paranoid
3 - schizotypal
4 - schizoid
1 - antisocial
- schizoid relates to people who are emotionally cold or detached and lack interest in others. Also includes excessive introspection (looking into ones own mind)
- schizotypal relates to interpersonal discomfort with peculiar ideas, perceptions, appearances and behaviours
Previously personality disorders were categorised based on the traits of the personality disorder. Category B is described as the ‘emotional and erratic cluster and is the most common to be diagnosed. Which of the following is NOT part of this category?
1 - antisocial
2 - paranoid
3 - emotionally unstable
4 - histrionic
5 - narcissistic
2 - paranoid
- narcissistic = related to the unreasonably high sense of their own importance
Previously personality disorders were categorised based on the traits of the personality disorder. Category B is described as the ‘emotional and erratic cluster and is the most common to be diagnosed. It includes antisocial, emotionally unstable, histrionic and narcissistic. The emotionally unstable aspect can be further divided into 2 categories. What are they?
1 - emotionally unstable impulsive
2 - emotionally unstable paranoid
3 - emotionally unstable borderline
4 - emotionally unstable anger
1 - emotionally unstable impulsive
- associated with anger or instability
3 - emotionally unstable borderline
- low confidence, feel empty, unstable relationships
Previously personality disorders were categorised based on the traits of the personality disorder. Category C is described as the ‘anxious and fearful cluster. Which of the following is NOT part of this category?
1 - avoidant
2 - dependent
3 - emotionally unstable
4 - obsessive compulsive
3 - emotionally unstable
Antisocial, often misused with sociopath is a term used to described as impulsive, irresponsible and often criminal behaviour. Which of the following have similar diagnostic criteria?
1 - generalised anxiety disorder
2 - dissocial personality disorder
3 - obsessive compulsive disorder
2 - dissocial personality disorder
- dissocial = impulsivity, high negative emotionality, low conscientiousness and associated behaviours, including irresponsible and exploitative behaviour, recklessness and deceitfulness
Antisocial and psychopathy are 2 diagnosis that have overlap when diagnosing personality disorders. However, which 2 of the following are key to distinguishing between the 2 diagnoses?
1 - selfishness
2 - lack of self remorse
3 - high risk tendencies
4 - paranoid
1 - selfishness
2 - lack of self remorse
- psychopathy = deficient emotional responses, lack of empathy, and poor behavioural controls, commonly resulting in persistent antisocial deviance and criminal behaviour.
- specific character traits
When using ICD-11 to classify a personality disorder, what is the most important diagnosis to be made?
1 - presence of a personality disorder
2 - if patient has aspects of the category based system for personality disorder
3 - if patient has previous psychiatric history
1 - presence of a personality disorder
- can then be categorised into mild, moderate or severe
- can be further categorised by stating the domains of personality traits that are present
What is personality difficulty, which is not included in the ICD-11 definition of personality disorder?
1 - anger
2 - anxiety
3 - problems with interpersonal interactions
3 - problems with interpersonal interactions
- can also cause pronounced personality traits that effects treatment of health services
- NOT severe enough to be diagnosed as a personality disorder
There are 5 main personality trait domains that are included in the new diagnosis of ICD-11. These are Negative affectivity, Dissociality, Disinhibition, Anankastia and Detachment. Which of the following would NOT be included in the Negative affectivity?
1 - Distressing emotions
2 - Emotional lability (over-reacting)
3 - Anxiety
4 - Negativistic attitudes (reject other attitudes/advice)
5 - ↓Self-confidence/esteem
6 - Mistrustful of others
3 - Anxiety
There are 5 main personality trait domains that are included in the new diagnosis of ICD-11. These are Negative affectivity, Dissociality, Disinhibition, Anankastia and Detachment. Which of the following would not be included in the Dissociality?
1 - Disregard for others’ feelings and rights
2 - Self-centredness
3 - Lack of empathy
4 - Emotional liability
4 - Emotional liability
There are 5 main personality trait domains that are included in the new diagnosis of ICD-11. These are Negative affectivity, Dissociality, Disinhibition, Anankastia and Detachment. Which of the following would not be included in the Disinhibition?
1 - Impulsivity
2 - Irresponsibility
3 - Distractibility
4 - Recklessness
5 - Lack of empathy
5 - Lack of empathy
There are 5 main personality trait domains that are included in the new diagnosis of ICD-11. These are Negative affectivity, Dissociality, Disinhibition, Anankastia and Detachment. Which of the following would not be included in the Anankastia?
Anankastia = rigid standard of perfection and of right and wrong
1 - Perfectionism
2 - Concern with rules and obligations
3 - Impulsivity
4 - Orderliness
5 - Constraint
6 - Stubbornness
7 - Inflexibility
3 - Impulsivity
- Anankastia also includes all of the things listed here and are related to applying the same rigorous rules on to others
There are 5 main personality trait domains that are included in the new diagnosis of ICD-11. These are Negative affectivity, Dissociality, Disinhibition, Anankastia and Detachment. Which of the following would not be included in the Detachment?
1 - Emotional /interpersonal distance
2 - Social withdrawal
3 - Indifference to people
4 - Avoid intimacy
5 - Lack of empathy
6 - Aloof, passive
7 - Reduced experience of emotion
5 - Lack of empathy
The big 5 model is an approach that that aims to encapsulate all different traits that make up personality into 5 factors, including Openness to experience (novelty-seeking), Conscientiousness, Extraversion - introversion, Agreeableness and Neuroticism, but these are relative to normal personality traits/
In contrast the new ICD-11 trait domains, including Negative affectivity, Dissociality, Disinhibition, Anankastia and Detachment. However, these 5 domains are relative to personality disorders
5 factor model = normal personality traits (healthy) (except for Neuroticism)
ICD-11 = patients on the spectrum of a personality disorder
- They can be thought of as a spectrum between normal personality and personality disorder
Which of the following has remained in the new ICD-11 diagnosis of personality disorders?
1 - category A
2 - paranoid
3 - borderline personality disorder
4 - antisocial
3 - borderline personality disorder
- most commonly diagnosed ICD-10 type
- uses the same diagnosis criteria as DSM-5
There are 5 main personality trait domains that are included in the new diagnosis of ICD-11. These are:
1 - Negative affectivity
2 - Dissociality
3 - Disinhibition
4 - Anankastia
5 - Detachment
Which 3 of the personality traits typically present with borderline personality disorder?
1 - Negative affectivity
2 - Dissociality
3 - Disinhibition
Mentalisation is the ability to understand one’s own and other people’s mental state and intentions. It helps to make sense of our thoughts, beliefs, wishes and feelings and to link these to our actions and behaviours. Is mentalisation affected in personality disorders?
- yes it is impaired
- impaired mentalisation means patients are unable to understand other peoples own thoughts or perspectives
- a lack of mentalisation ability means patients can take negative thoughts and think of them as fact
What is the estimated incidence of personality disorder in the community?
1 - 0.14-0.15%
2 - 1.4 - 1.5%
3 - 4-15%
4 - 14-15%
3 - 4-15%
- similar in men and women
What is the estimated incidence of personality disorder in the psychiatric outpatient setting?
1 - 5%
2 - 15%
3 - 25%
4 - 50%
4 - 50%
- more likely in females as they are likely to seek help more
What is the estimated incidence of personality disorder in the criminal justice setting?
1 - 5%
2 - 15%
3 - 25%
4 - 66%
4 - 66%
There are multiple causes of events that have been linked with causing personality disorders. Adverse childhood experiences increases the risk of personality disorders, but it is not inevitable. Which of the following is NOT one of these?
1 - Type of birth
2 - Early separation from parents
3 - Growing up in social care system
4 - Childhood abuse
5 - Erratic parenting or lack of supervision
1 - Type of birth
If early care giving conditions do not support development of skills in emotional literacy and self-soothing in infants, then adults may develop emotional difficulties, including:
1 - Struggling to identify & communicate emotions
2 - Finding it hard to manage strong feelings
3 - Finding it difficult to manage situations
4 - Use other strategies to manage emotions
There may be some neurobiology reasons responsible for personality disorders, including:
- 50% have EEG abnormalities, BUT non specific
- High rates of:
minor facial and cranial abnormalities
Learning difficulties
Hyperactivity disorders - Low levels of serotonin in csf associated with aggressive/violent behaviour
Although personality changes throughout life (slows after 30), BUT the personality of patients with personality disorder changes even faster. However, trait domains tend to decrease over the life course. Which 3 of the 5 trait domains decrease?
1 - Negative affectivity
2 - Dissociality
3 - Disinhibition
4 - Anankastia
5 - Detachment
1 - Negative affectivity
- stable tendency to experience negative emotions
2 - Dissociality
- disregard for social obligations, and callous unconcern for the feelings of others
3 - Disinhibition
- detachment remains stable up to 50 y/o and then declines
Treating patients with personality disorders can be difficult. What are the most common outcomes recorded when treating a patient with this disorder?
1 - FBC
2 - impact of the disorder
3 - questionnaires
4 - LFTs
2 - impact of the disorder
- Borderline personality disorder might see a reduction in self-harm or readmission to hospital
- Antisocial changes may be reduced aggression, reduced offending
The majority of research around treating personality disorders is based on borderline personality disorders. Which of the following is NOT a form of Psychological therapy?
1 - Mentalization-based therapy (MBT)
2 - Dialectical behaviour therapy (DBT)
3 - Cognitive behavioural therapy (CBT)
4 - Schema focused therapy
5 - Psychodynamic psychotherapy
6 - Cognitive analytic therapy (CAT)
7 - music therapy
8 - Transference focused therapy
7 - music therapy
- MBT, DBT and CBT are most commonly used approaches
Therapeutic community is a participative, group-based approach to long-term mental illness, personality disorders and drug addiction. This provides patients with an opportunity to understand more about personality disorder from those with similar difficulties and learn to take responsibility for self and actions. Is this treatment offered to all patients?
- no
- generally the most at risk patients and works on a day care approach where patients visit
Do NICE guidelines advocate the use of medication in personality disorders?
- no
- ONLY exception is if patients are in crisis with borderline personality disorder
NICE guidelines do not advocate the use of medications in personality disorders, except if a patient is in crisis
NICE guidelines do not advocate the use of medications in personality disorders, except if a patient is in crisis with borderline personality disorder. How long are they typically prescribed these medications?
1 - 1 dose
2 - 1 day
3 - 1 week
4 - 1 month
3 - 1 week
- drugs with least likely to cause dependence or toxicity in overdose should be used
Do patients with personality disorders respond in the same way to patients with non-personality disorders to anti-depressants and anti-anxiety medications?
- no
- normally not as effective
