Personality Disorders

Question 1

What are personality disorders?

Answer 1

Deeply ingrained, enduring patterns of behaviour that are abnormal in a particular culture, lead to subjective distress, and may cause others distress

Question 2

When do PDs usually begin?

Answer 2

Childhood or adolescence

Question 3

How were PDs and mental illness originally distinguished?

Answer 3

PDs: lifelong and not treatable

Mental illness: briefer and treatable

Question 4

How has understanding of the original distinction between PDs and mental illness now shifted?

Answer 4

More effective treatment for PDs means original distinction less clear i.e. people can recover from PDs, BPD can be effectively managed.

Question 5

What are the Cluster A personality disorders?

Answer 5

Cluster A = odd / eccentric (all of or suspicious, solitary)

• Paranoid PD
• Schizoid PD
• Schizotypal PD

Question 6

What are the Cluster B personality disorders?

Answer 6

Cluster B = flamboyant / dramatic (emotionally labile and intense)

• Borderline / emotionally unstable PD
• Histrionic PD
• Narcissistic PD (DSM only)
• Antisocial PD / Dissocial (ICD)

Question 7

What are the Cluster C PDs?

Answer 7

Cluster C = fearful / anxious (timid, dependent, low SE)

• Avoidant (DSM) / Anxious (ICD)
• Dependent
• Anankastic (DSM) / Obsessive Compulsive

Question 8

What is the aetiology of PDs?

Answer 8

Genes and environment:
-genetic
-perinatal / postnatal facts => abnormal cerebral maturation
-poor parenting
-sexual abuse
-adverse childhood environment
Leads to unhelpful coping strategies, inability to form attachment.

Question 9

Which PD is childhood sexual abuse associated with?

Answer 9

BPD

Question 10

What is the cognitive theory of personality disorders?

Answer 10

People with PDs developed ways of coping with early life adversity (e.g. turning anger against themselves rather than expressing it if this may have resulted in parental violence) ==> manifest as maladaptive traits later in life (e.g. interpersonal problems)

Question 11

What is the psychodynamic theory of PDs?

Answer 11

PDs result from insecure attachment in childhood and thus in adult relationships

Question 12

Management of BPD?

Answer 12

• Written care plan
• Consistent responses to threats, don’t reinforce manipulative behaviour
• Clear boundaries re unacceptable behaviour and nature of care to be provided
• Adapted CBT; dialectical behaviour therapy (DBT) and mentalisation based treatments
• Help avoid situations that exacerbate (e.g. intoxication)
• Help find lifestyle which suits their strengths and minimises difficulties of their PD
• Treat comorbidities

Question 13

Management of antisocial PD?

Answer 13

• modest; main goal to exclude other dx
• aim for prevention by targeting children with conduct disorder (30% likely to develop APD) ==> provide parent training / education
• CBT / group based CBT focus on reducing offending and other antisocial behaviours

Question 14

What is personality?

Answer 14

The characteristic behavioural, emotional and cognitive attributes of an individual

Question 15

DSM definition of PD?

Answer 15

An enduring pattern of inner experience and behaviour that deviates markedly from the expectations of the individual’s culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, and leads to distress or impairment

Question 16

What are the main effects of personality deviations of PD?

Answer 16

Marked deviation in one or more aspects of personality; main effect may be on:

• cognitions (attitudes; ways others’ actions are interpreted)
• mood (range, intensity, appropriateness)
• impulse control and gratification of needs
• relationships and the way interpersonal situations are handled

Question 17

What are important areas to cover in assessment of PD?

Answer 17

Disorder itself:
-presence
-characteristics and fx
-severity
-treatability
Other issues:
-psych comorbidities
-risk to self / others
-D&A use
-Hx of DSH and violence
-current social situation
-psychosocial stressors

Question 18

Suggested core neuropsych abnormalities in antisocial personality disorder?

Answer 18

Involve impulsivity and decisions making; relate to abnormalities in the regulation of frontal lobe activity by dopamine and 5HT

Question 19

What are presented issues with personality disorder as diagnosis?

Answer 19

• Not a disease; medicalises individual variations
• Diagnosis unreliable
• PD may be virtue for others; many famous individuals meet PD criteria but may be tolerated because of (or the reason for) their success
• Perjorative term
• No clear distinction b/w PD/Psych Dx

Question 20

Ddx of teenager/ young adult with new “odd behaviour”?

Answer 20

• N adolescence
• Anxiety d/o
• Psychotic d/o
• Drug induced d/o
• Eating d/o
• Personality d/o (BPD)
• Medical (e.g. hypothyroidism)

Question 21

What are the 5 criteria for involuntary status under MHA Vic?

Answer 21

1. Appears to have mental illness
2. Imminent risk to self / others
3. Rx available at gazetted facility
4. Incapable of informed consent or unwilling to consent
5. Least restrictive method

Question 22

What are the initial steps in ITO?

Answer 22

• Request (person >18)
• Recommendation (medical practitioner; ITO must also be completed to give treatment)
• Statutory review (S12): delegated or authorised consultant psych, upholds/discharges pt from involuntary status

Question 23

What are the DSM criteria for BPD?

Answer 23

I DESPAIRR:

• identity disturbance
• dissociation
• emptiness
• suicidal behaviour
• paranoid ideation
• abandonment
• impulsivity
• relationships
• rage

Question 24

Ego defence mechanisms of BPD?

Answer 24

Splitting, projection