Personality Disorders

Question 1

What is personality?

Answer 1

• Characteristic way of thinking, acting and feeling that has been present since adolescence and is pervasive and persistent in nature
• Develops across time
• Babies are born with different temperaments and certain characteristics evident in early childhood, adolensence is key time for personality formation

Question 2

Influences on personality development

Answer 2

• Temperament
• Genetics
• Parenting styles **
• Culture and society
• Adversity (trauma eg ACEs)
• Relationships with others

Question 3

What is personality disorder?

Answer 3

• When personality traits become inflexible, maladaptive and significantly interferes with how a person functions in society or causes the person emotional distress

Question 4

Key points re personality disorders

Answer 4

• Problems present since childhood/adolescence
• In touch with reality

Question 5

Categories of personalities disorders (clusters)

Answer 5

• Cluster A - schizoid, paranoid (mad) - present as odd or eccentric
• Cluster B - psychopaths, antisocial, EUPD, histionic, narcisstic (bad) - dramatic, emotional, erratic
• Cluster C - anxious avoidant, dependent, obsessive-compulsive (anankastic) (sad) - anxious/fearful

Emotionally unstable personality disorder most common

Question 6

Antisocial personality disorder

Answer 6

• Pattern of socially irresponsible exploitative and guiltless behaviour reflecting the disregard for the rights of others

Question 7

Characteristics of antisocial persoanlity disorder

Answer 7

• No guilt/remorse
• Do not learn from mistakes
• Aggressive, violent, involved in fights
• Impulsive
• No responsibility
• Blame others
• Use other people as objects for own gratification

Question 8

Diagnosing antisocial personality disorder

Answer 8

• Diagnosed aged 18 - usually not diagnosed before this
• History of conduct behaviour - eg disruptive in school, animal cruelty
• Common among males
• Common in substance abuse settings and prison
• Lower socioeconomic status

Question 9

RF for antisocial personality disorder

Answer 9

• Child abuse
• Deprived environment
• Neglect
• Antisocial home, antisocial parents
• Alcoholic parents
• ADHD

Question 10

Management of antisocial personality disorder

Answer 10

• Manage symptoms and presentation eg if depressive symptoms treat this etc

Question 11

What is narcissistic personality disorder?

Answer 11

• Pattern of grandiosity of how they think and behave in private fantasies or outward behaviour
• Need for constant admiration from others and lack empathy for others

Question 12

Presentation vs perception for narcissitic personality disorder

Answer 12

• Present as winner (feel like loser)
• Appear powerful (are vulnerable)
• Admiration (feel humiliated)

Question 13

Characteristics of narsissistic personality disorder

Answer 13

• Grandiose sense of self importance
• Lives in dream world of exceptional success and power
• Think themselves as special, priveliged, can only be understood by people of higher status
• Demand for excessive amount fo praise/admiration from others
• Lacks empathy - do not identify with others feelings
• Hypersensitive to criticism

Question 14

Pre-disposing factors for NPD

Answer 14

• Childs needs not met - emptiness sense
• Physical/emoitonal abuse/neglect
• Environment - parents forcing child to achieve something they are not able to

Question 15

Differentials for NPD

Answer 15

• Depression - may present as this
• Grandiosity - mania
• Anxiety

Question 16

Emotionally unstable personality disorder - borderline PD characteristics

Answer 16

• Fear of abandonment
• Impulsive
• Intense unstable relationships - attachment problems
• Chronic emptiness
• Mood swings
• Identify issues
• Repeated deliberate self harm
• Rage
• Pseudohallucinations - within headspace

Question 17

What often contributes to EUPD?

Answer 17

• Significant childhood experience or trauma
• Can be sexual assault, emotional or physical abuse)
• Feeling not good enough, unlovable, self loathing
• Can be difficult to manage

Question 18

Differentials for EUPD

Answer 18

• Depression
• Mania/psychosis
• Schizophrenia
• Anxiety

Question 19

What is place of safety?

Answer 19

• When someone in outside space, causing disruption seems like something psychologically wrong
• Police have power to bring person to place of safety (section 136?)
• Can be home, hospital

Question 20

What is going on underlying with EUPD?

Answer 20

• Immature ego - self centred, find it difficult to understand how others feel
• Primative defence mechanisms - eg projection (try to push on undesirable trait onto other person), splitting (behave differently with different people)

Question 21

What does self harm mean to a person with EUPD?

Answer 21

• Suicide
• Self hatred
• Hate for their body
• Overcome numbness
• Physical pain rather than psychological
• Self soothing
• Cope with strong emotion
• A way of communicating, make others feel something or to get others to do something

Question 22

Attachment theory EUPD - John Bowlby -

Answer 22

• Secure vs insecure attachment
• If secure attachment - able to play and explore world knowing that attachment is stable
• Insecure attachement - fear of abandonment, can’t cope without reassurance

Question 23

Management for EUPD

Answer 23

• Bio - medication to manage symptoms, can be on antipsychotics if psychotic symptoms
• Psychological - Dialectical behavioural therapy (DBT), psychotherapy (9 months-1yr, go back in time, patient leads)
• Social - manage housing and activities

Question 24

How to manage a patient with EUPD overall

Answer 24

• Therapeutic relationship
• Encourage maturing of ego
• Provide stability and secure base, consistency
• Lots of therapies - problem re wait time, may need to bridge gap with meds between

Question 25

What does dialectical behavioural therapy involve?

Answer 25

• Mindfulness
• Acceptance
• Distress tolerance
• Emotional regulation