Personality Disorders

Question 1

Describe Personality

Answer 1

 Complex pattern of characteristics that are not easily altered

 Largely outside of the person’s awareness

Distinctive patterns of perceiving, feeling, thinking, coping and behaving

 Emerges within a complexBio/psycho/social/spiritual framework

Question 2

Describe personality disorders in general terms

Answer 2

 An enduring pattern of inner experiences and behaviour. Starts without insight.

 Deviates markedly from the expectations of a person’s culture

 It is pervasive, inflexible and stable

 Leads to distress, impairment and significant interference with interpersonal relationships

Question 3

4 common features and Diagnostic Criteria for Personality Disorders

MESI

Answer 3

1) Maladaptive cognitive schema
(Don’t always interpret stimuli effectively)

2) Affectivity and emotional instability
(Minor Irritant becomes drama)

3) Impaired self identity
(Fragile self esteem, holds to others)

4) Impulsivity and destructive behaviour
(quick reactions without insight, can be destructive inwardly or outwardly)

Question 4

Does gender impact PD prevalence?

Answer 4

No, affects both the same but women seem to report more.

Question 5

General characteristics of cluster A

3 Subtypes?

Answer 5

Described as “odd” and “eccentric” personalities, thinking and/or behaviour

Common characteristics include social awkwardness and social withdrawal

These disorders are dominated by distorted thinking

3 Subtypes include:
Schizotypal, paranoid, schizoid

Question 6

Describe Schizotypal Disorder

Answer 6

FOCUS is Delusional Beliefs

1) Perceptual distortion and eccentricity

2) Ideas of reference (newspaper example)
(broad statements speaking directly to pt)

3)  Odd beliefs or magical thinking
4)  Flat or incongruent emotional responses (emotional response don’t match situation)

Question 7

Describe Paranoid Personality Disorder

Answer 7

Pervasive distrust and suspiciousness of other people

 Assume that others are out to harm them, take advantage of them or humiliate them in some way

Tend to hold grudges, are litigious and may display pathological jealousy

Question 8

What is the difference between paranoid PD and schizophrenia

Answer 8

Some overlap with paranoid symptoms of schizophrenia, but Schizophrenia includes voices and hallucinations.

Question 9

Describe Schizoid PD

Answer 9

Pervasive pattern of social detachment and a restricted range of emotional expression. (Often experience little Joy)

Tend to be socially isolated, don’t seek out or enjoy close relationships and almost always chose solitary activities

 Appear indifferent to both criticism and praise

 Lacking a desire for intimacy

EX (tinkering with radio guy, not anxious about leaving house, but just didn’t care)

Question 10

Describe Cluster B in general terms

“B” Subtypes?

DADE…

Answer 10

 Described as dramatic, emotional and erratic cluster of personalities

 General features include:

• Dissociation or denial
• Abusive behaviours (physical and emotional) -Splitting/dichotomous thinking
• Emotional dysregulation

SUBTYPES:
Histrionic, Narcissistic, antisocial, Borderline PD

Question 11

Describe Histrionic Personality Disorder

Answer 11

 Inappropriate, sexually seductive or provocative behaviour

Seek excitement and attention (attention-seeking behaviours) and quick attachment)

Outwardly appear charming and lively but have a threatened self-esteem and sense of attractiveness

Describes relationships as more intimate than they are.

Question 12

Narcissistic personality DIsorder

Answer 12

 Grandiosity (believes they are god like)

Believes that they are special, unique and can only be understood by high status

Sense of entitlement.

Needs constant admiration

Lacks empathy and takes advantage of others to achieve his/her own need. (tend to abuse others)

(require strict and uniform boundaries in care

Question 13

Antisocial Personality Disorder

Answer 13

Disregards and violates others’ rights.

Can be charming BUT No remorse for wrongdoing and no empathy

 Irritability and aggressiveness

Marked readiness to blame others or to offer plausible rationalizations for their behaviour

History of a conduct disorder before age 15 years. (oppositional defiant disorder)

Question 14

Management of ASPD

Answer 14

 Rarely seek help directly for ASPD  Key assessments:

• Quality of relationship
• Impulsivity
• Violence risk

 Self-awareness (nurse)

 Structured, consistent environment

Question 15

Describe Borderline PD

MURFI…

Answer 15

Mood lability (happy to suicide)

 Unstable relationships, self image and affect

Recurrent suicidal behaviour, gestures, threats, self-mutilation

Fear of Rejection in relations (KEY feature, rejection can bring on break)

Impulsivity

Question 16

etiologies of Borderline PD

Answer 16

Neurobiologic and genetic factors  (First degree relative at risk, Serotonologic defecit)

Psychosocial risk factors

 Psychological theories (Maladaptive cognitive processes- misunderstanding of events or environment)

Question 17

Risk Factors of Borderline PD

Answer 17

 Risk factors include :
-Physical and sexual abuse (55%-80%) -Parental abandonment and alienation

( 70% of people with BPD will have at least one suicide attempt in their lifetime, 10% will be successful)

Question 18

What is Parasuicide

Answer 18

DEFINITION: Deliberate self-injury with the intent to harm oneself. (Not attention seeking, but maladaptive)

Compulsive self-injurious behaviour  (often when numb, attempt to feel)

Question 19

Why would DBT be particularly effective to someone with Borderline PD and involved in parasuicide?

Answer 19

It’s an attempt to reconnect with their body.

Mindfulness is reconnecting with one’s body

Question 20

The behaviours that someone with Borderline Personality Disorder exhibit directly cause the outcome which they fear the most:

Answer 20

abandonment

Question 21

Dialectical Behavioural Therapy (DBT)

(Common approach to Borderline PD)

4 common approaches?

Answer 21

-Skills group (could be facilitated by someone who has gone through Borderline PD)

-Interpersonal effectiveness skills -
(Build self image)

Mindfulness skills

-Distress tolerance

Question 22

Tx for borderline PD

Answer 22

 Dialectical Behavioural Therapy (DBT)

 Psychopharmacotherapy

Question 23

General characteristics of cluster “C”

Answer 23

 Anxious or fearful thinking or behaviour

 In isolation:

• Orderly
• Anxious

 Passive-Aggression (indirect aggression):
-Self-chosen failure

• Masochistic (often exposed to harm and abuse and feel as though they deserve it)
• Dysthymic (Symptoms of depression on and off)

Question 24

Subtypes of Cluster “C”

Answer 24

Obessive Compulsive, Dependent, Avoident

Question 25

OCPD

Answer 25

 Inhibited, stubborn, rigid and a perfectionist

 Preoccupied with orderliness or perfection

Excessively devoted to work and productivity and excludes recreation and friendships

 Reluctant to delegate tasks to others

Can have difficulty discarding worthless objects

Question 26

Contrast OCD and OCPD

Answer 26

OCD requires an obsessive behviour which creates anxiety and is relived by compulsion.
Wheres OCPD there isn’t really anxiety, so much as the thought that this is the best way to do it

Question 27

Dependent PD

Answer 27

 Difficulty making everyday decisions without significant advice and reassurance from others

 Need to be taken care of (Vulnerable to abuse)

 Submissive behaviour as they fear disagreement and the loss of support/approval

 Urgently needs to replace one relationship when another one ends

Question 28

Avoidant PD

Answer 28

Socially inhibited, shy and lonely

Sense of inadequacy with low self-esteem

Desperate for relationships but avoid social contact. (Not anxiety, just avoid at all costs)

Reluctant to take risks or try new activities as they might be embarrassed