Personality Disorders

Question 1

What is personality?

Answer 1

A cluster of relatively predictable patterns of thinking, feeling, and behaving that is generally consistent across time, space and context

Question 2

What features contribute to the structure of personality?

Answer 2

Openness
Neuroticism
Agreeableness
Extraversion
Conscientiousness

Question 3

How is a personality disorder defined?

Answer 3

An enduring pattern of inner experience and behaviour that deviates markedly from the expectations of the individual’s culture.

Question 4

Where is the pattern in PD manifested from (must be 2 or more)?

Answer 4

Cognition (ways of perceiving and interpreting self, other people, and events)
Affectivity (the range, intensity, lability, and appropriateness of emotional response)
Interpersonal functioning
Impulse control

Question 5

How is the enduring pattern described in PD?

Answer 5

Inflexible
Pervasive across a broad range of personal and social situations
Leads to clinically significant distress or impairment in social, occupational, or other important areas of functioning

Question 6

How long does the pattern in PD last?

Answer 6

Stable and long duration, its onset is in adolescence or early adulthood if not younger

Question 7

What is important to distinguish about the pattern to clarify it is not related to anything else?

Answer 7

Pattern is not better explained as a manifestation or consequence of another mental disorder
Not attributable to the physiological effects of a substance or medical condition

Question 8

What are the features of Anankastic PD?

Answer 8

Feelings of excessive doubt and caution.
Preoccupation with details, rules, lists, order, organization or schedule.
Perfectionism that interferes with task completion.
Excessive conscientiousness and scrupulousness.
Undue preoccupation with productivity to the exclusion of pleasure and interpersonal relationships.
Excessive pedantry and adherence to social conventions.
Rigidity and stubbornness.
Unreasonable insistence that others submit to exactly his or her way of doing things, or unreasonable reluctance to allow others to do things.

Question 9

What are the aetiological influences on antisocial PD?

Answer 9

Additive genetic
Non-additive genetic
Shared environmental
Non-shared environmental

Question 10

What is the average heritability of PD?

Answer 10

60%

Question 11

What are the 3 DSM-5 clusters of PD?

Answer 11

A: Odd and Eccentric
B: Dramatic, emotional, erratic
C: Anxious and fearful

Question 12

What is included in cluster A: odd and eccentric?

Answer 12

Paranoid
Schizoid
Schizotypal

Question 13

What is included in cluster B: dramatic, emotional, erratic?

Answer 13

Antisocial
Borderline
Histrionic
Narcissistic

Question 14

What is included in cluster C: anxious and fearful?

Answer 14

Avoidant
Dependent
Obsessive-Compulsive

Question 15

What is Paranoid PD?

Answer 15

A pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent, beginning by early adulthood and present in a variety of contexts?

Question 16

What features are required to diagnose Paranoid PD (4 or more required)?

Answer 16

Suspects, without sufficient basis, that others are exploiting, harming, or deceiving him or her.
Is preoccupied with unjustified doubts about the loyalty or trustworthiness of friends or associates.
Is reluctant to confide in others because of unwarranted fear that the information will be used maliciously against him or her.
Reads hidden demeaning or threatening meanings into benign remarks or events.
Persistently bears grudges (i.e., is unforgiving of insults, injuries, or slights).
Perceives attacks on his or her character or reputation that are not apparent to others and is quick to react angrily or to counterattack.
Has recurrent suspicions, without justification, regarding fidelity of spouse or sexual partner.

Question 17

What is Schizoid PD?

Answer 17

A pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings, beginning by early adulthood and present in a variety of contexts

Question 18

What features are required to diagnose Schizoid PD (4 or more)?

Answer 18

Neither desires nor enjoys close relationships, including being part of a 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 first-degree relatives.
Appears indifferent to the praise or criticism of others.
Shows emotional coldness, detachment, or flattened affectivity.

Question 19

What is Antisocial PD?

Answer 19

A pervasive pattern of disregard for and violation of the rights of others, occurring since age 15yo

Question 20

What features are required for a diagnosis of Antisocial PD (3 or more)?

Answer 20

Failure to conform to social norms with respect to lawful behaviors, as indicated by repeatedly performing acts that are grounds for arrest.
Deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure.
Impulsivity or failure to plan ahead.
Irritability and aggressiveness, as indicated by repeated physical fights or assaults.
Reckless disregard for safety of self or others.
Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations.
Lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another.

Question 21

What is Borderline PD?

Answer 21

A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity, beginning by early adulthood and present in a variety of contexts

Question 22

What features are required for a diagnosis of Borderline PD (5 or more)?

Answer 22

Frantic efforts to avoid real or imagined abandonment.
A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.
Identity disturbance: markedly and persistently unstable self-image or sense of self. 4.Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex,
substance abuse, reckless driving, binge eating).
Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior.
Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria,
irritability, or anxiety usually lasting a few hours and only rarely more than a few days).
Chronic feelings of emptiness.
Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of
temper, constant anger, recurrent physical fights).
Transient, stress-related paranoid ideation or severe dissociative symptoms.

Question 23

What is Histrionic PD?

Answer 23

A pervasive pattern of excessive emotionality and attention seeking, beginning by early adulthood and present in a variety of contexts

Question 24

What features are required for a diagnosis of Histrionic PD (5 or more)?

Answer 24

Is uncomfortable in situations in which he or she is not the center of attention.
Interaction with others is often characterized by inappropriate sexually seductive or provocative behavior.
Displays rapidly shifting and shallow expression of emotions.
Consistently uses physical appearance to draw attention to self.
Has a style of speech that is excessively impressionistic and lacking in detail.
Shows self-dramatization, theatricality, and exaggerated expression of emotion.
Is suggestible (i.e., easily influenced by others or circumstances).
Considers relationships to be more intimate than they actually are.

Question 25

What is Avoidant PD?

Answer 25

A pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation, beginning by early adulthood and present in a variety of contexts

Question 26

What features are required for a diagnosis of Avoidant PD (4 or more)?

Answer 26

Avoids occupational activities that involve significant interpersonal contact because of fears of criticism, disapproval, or rejection.
Is unwilling to get involved with people unless certain of being liked.
Shows restraint within intimate relationships because of the fear of being shamed or ridiculed.
Is preoccupied with being criticized or rejected in social situations.
Is inhibited in new interpersonal situations because of feelings of inadequacy.
Views self as socially inept, personally unappealing, or inferior to others.
Is unusually reluctant to take personal risks or to engage in any new activities because they may prove embarrassing.

Question 27

What is Dependent PD?

Answer 27

A pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation, beginning by early adulthood and present in a variety of contexts

Question 28

What features are required for a diagnosis of Dependent PD (5 or more)?

Answer 28

Has difficulty making everyday decisions without an excessive amount of advice and
reassurance from others.
Needs others to assume responsibility for most major areas of his or her life.
Has difficulty expressing disagreement with others because of fear of loss of support or approval. (Note: Do not include realistic fears of retribution.)
Has difficulty initiating projects or doing things on his or her own (because of a lack of self-confidence in judgment or abilities rather than a lack of motivation or energy). 5.Goes to excessive lengths to obtain nurturance and support from others, to the point of
volunteering to do things that are unpleasant.
Feels uncomfortable or helpless when alone because of exaggerated fears of being unable to care for himself or herself.
Urgently seeks another relationship as a source of care and support when a close relationship ends.
Is unrealistically preoccupied with fears of being left to take care of himself or herself

Question 29

What is Obsessive Compulsive PD?

Answer 29

A pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency, beginning by early adulthood and present in a variety of contexts

Question 30

What features are required for a diagnosis of Obsessive Compulsive PD (4 or more)?

Answer 30

Is preoccupied with details, rules, lists, order, organization, or schedules to the extent that the major point of the activity is lost.
Shows perfectionism that interferes with task completion (e.g., is unable to complete a project because his or her own overly strict standards are not met).
Is excessively devoted to work and productivity to the exclusion of leisure activities and friendships (not accounted for by obvious economic necessity).
Is overconscientious, scrupulous, and inflexible about matters of morality, ethics, or values (not accounted for by cultural or religious identification).
Is unable to discard worn-out or worthless objects even when they have no sentimental
value.
Is reluctant to delegate tasks or to work with others unless they submit to exactly his or her way of doing things.
Adopts a miserly spending style toward both self and others; money is viewed as
something to be hoarded for future catastrophes.
Shows rigidity and stubbornness.

Question 31

What should be the focus of PD treatment?

Answer 31

Treat the comorbidity e.g. depression, anxiety etc

Question 32

What can be helpful in treating avoidant PD?

Answer 32

Social skills training

Some antidepressants evidence

Question 33

What is the main psychotherapy treatment of Borderline PD?

Answer 33

Dialectical Behavioural Therapy

Question 34

What is mentalisation?

Answer 34

The process by which we interpret our own actions as being meaningful, based on our own internal mental states

Question 35

What is drug treatment for borderline PD focused on?

Answer 35

Comorbid conditions, no drug has a licence for borderline PD

Question 36

What should be used in antisocial PD treatment?

Answer 36

Psychological interventions