Personality Disorders

Question 1

What are the essential features of a person with borderline personality disorder?

Answer 1

• A pattern of instability in interpersonal relationships, self-image, and affects, and marked impulsivity
• Full criteria
  
  • Frantic efforts to avoid real or imagined abandonment
  • A pattern of unstable and intense interpersonal relationships characterised by alternating between extremes of idealisation and devaluation
  • Identity disturbance
  • Impulsivity in a potentially self-damaging way in at least 2 areas (e.g. spending, sex, substance abuse)
  • Recurrent suicidal behaviour, gestures, threats, self-harm
  • Affective instability due to marked mood reactivity
  • Chronic feelings of emptiness
  • Inappropriate, intense anger or difficulty controlling anger
  • Transient, stress-related paranoid ideation

Question 2

What are the essential features of someone with antisocial personality disorder?

Answer 2

• A pattern of disregard for, and violation of, the rights of others. At least 18, with evidence of conduct disorder < 15
• Full criteria (3+ of)
  
  • Failure to conform to social norms with respect to lawful behaviours - repeatedly performing activities that are grounds for arrest
  • Deceitfulness, repeated lying, use of aliases or conning others for profit or pleasure
  • Impulsivity or failure to plan ahead
  • Irritability or aggressiveness - repeated fights or assaults
  • Reckless disregard for self or others safety
  • Consistent irresponsibility e.g. work or financial obligations
  • Lack of remorse - indifferent to or rationalising having hurt, mistreated or stolen from someone

Question 3

What are the essential features of a person with schizoid personality disorder?

Answer 3

• DISTANT: A pattern of detachment from social relationships and a restricted range of emotional expression beginning by early adulthood
• Full criteria (4+ of)
  
  • Neither desires nor enjoys close relationships, including family
  • Almost always chooses solitary activities
  • Has little, if any interest in having sexual experiences with another person
  • Takes pleasure in few, if any activities
  • Lacks close friends or confidants other than FDRs
  • Appears indifferent to the praise or criticism of others
  • Shows emotional coldness, detachment, or flattened affect

Question 4

What are the essential features of a person with schizotypal personality disorder?

Answer 4

• MEPECULIAR: A pattern of acute discomfort in close relationships, cognitive or perceptual distortions, and eccentricities of behaviour
• Full criteria (5+ of)
  
  • Ideas of reference (not delusions) - i.e. experiencing events and attributing them great personal significance
  • Odd beliefs or magical thinking that influences behaviour and is inconsistent with cultural norms (e.g. superstitiousness, sixth-sense)
  • Unusual perceptual disturbances including bodily illusions
  • Odd thinking/speech (vague, circumstantial, overelaborate)
  • Suspiciousness or paranoid ideation
  • Inappropriate or constricted affect
  • Behaviour or appearance that is odd/eccentric
  • Lack of close friends or confidants other than FDRs
  • Excessive social anxiety than does not diminish with familiarity and seems to be associated with paranoid fears rather than negative self-judgment

Question 5

What are the essential features of someone with narcissistic personality disorder?

Answer 5

• SPE₃CIAL: A pattern of grandiosity, need for admiration, and lack of empathy
• Full criteria (5+ of)
  
  • Grandiose sense of self-importance (exaggerates achievements, expects recognition without them)
  • Is preoccupied with fantasies of unlimited success, power, brilliance, beauty or ideal love
  • Believes self to be special or unique and can only be understood by or associate with other high-status people/institutions
  • Requires excessive admiration
  • Has a sense of entitlement
  • Is interpersonally exploitative e.g. takes advantage of others
  • Lacks empathy
  • Is often envious of others or believes others are envious of him/her
  • Shows arrogant, haughty behaviours or attitudes

Question 6

What are the essential features of someone with dependent personality disorder?

Answer 6

• RELIANCE: A pattern of submissive and clinging behaviour related to an excessive need to be taken care of
• Full criteria
  
  • Difficulty making everyday decisions without excessive advice/reassurance from others
  • Needs others to assume responsibility for most major areas of life
  • Has difficulty expressing disagreement with others because of fear of loss of support/approval
  • Has difficulty initiating projects or doing things solo (because of low self-confidence rather than fatigue/amotivation)
  • Goes to excessive lengths to obtain nurture and support from others to the point of volunteering to do unpleasant things
  • Feels uncomfortable when helpless or alone because of exaggerated fears of being unable to care for themselves
  • Urgently seeks another relationship as a source of care and support when another relationship ends
  • Is unrealistically preoccupied with fears of being left to take care of themselves

Question 7

What are some of the feature of a person with histrionic personality disorder?

Answer 7

• PRAISE ME
• Provocative or sexual behaviour
• Relationships considered more intimate than they are
• Attention (uncomfortable when not the centre)
• Influenced easily
• Style of speech (impressionistic, lacks detail)
• Emotions (rapidly shifting and shallow)
• Made up (physical appearance used to draw attention to self)
• Emotions exaggerated (theatrical)

Question 8

What are the general treatment principles for a person with a personality disorder/

Answer 8

• Psychotherapy
  
  • Dialectical behaviour therapy
  • Psychoanalytic oriented therapy