Personality Disorders

Question 1

What is personality?

Answer 1

Our tendency towards patterns of behaviours, emotions, cognition and interaction that show through regardless of the situation we are in

Question 2

Being anxious before an exam is a ____

Answer 2

State

Question 3

Being anxious all the time is a ____

Answer 3

Trait

Question 4

When is personality viewed negatively?

Answer 4

When it doesn’t fit in with the world or its rules

Question 5

Why is it problematic to define personality as a disorder?

Answer 5

Because we aren’t very good at agreeing on what is weird or not acceptable

Question 6

Personality varies along ____

Answer 6

Dimensions

Question 7

What is the problem with viewing personality disorders as a variation on a dimension?

Answer 7

How do we establish a cut off? Is the top 0.5% actually qualitatively different to the top 1%?
Does the bottom group also count as a disorder?

Question 8

DSM-IV definition of personality disorder (APA, 1994)

Answer 8

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

Question 9

DSM-V definition of personality disorder (APA, 2013)

Answer 9

The impairments in personality functioning and the individuals personality trait expression are relatively stable across time and consistent across situations
The impairments are not better understood as normative for the individual’s development stage or socio-cultural environment
The impairments are not solely due to the direct physiological effects of a substance (misuse or medication) or a general medical condition (head trauma)

Question 10

Did the DSM-5 change the number of personality disorders?

Answer 10

No, there are still 10 as they had too many arguments

BUT they added research proposals to allow for future potential change

Question 11

Key issues in reaching a diagnosis

Answer 11

Diagnoses cannot be made in a single clinical meeting
Has to be independent of biological factors
Shouldn’t really diagnose in children as their personality is not yet stable
Needs to be a long-term presentation of symptoms

Question 12

Three clusters of disorders

Answer 12

The weird (odd/eccentric) Cluster A
The wild (dramatic/emotional) Cluster B
The wimpish (anxious/fearful) Cluster C

Question 13

Odd/eccentric

Answer 13

Personality disorders with some schizophrenia like symptoms

Paranoid PD
Schizoid PD
Schizotypal PD

Question 14

Dramatic/emotional

Answer 14

Personality disorders characterised by erratic and/or self-centred behaviours, emotions and thinking

Antisocial PD
Borderline PD
Narcissistic PD
Histrionic PD

Question 15

Anxious/fearful

Answer 15

Personality disorders characterised by anxiety that is lifelong (not related to any trigger)

Avoidant PD
Dependent PD
Obsessive-compulsive PD

Question 16

Paranoid PD

Answer 16

Pattern of distrust and suspiciousness

Resistant to challenge by others

Question 17

Schizoid PD

Answer 17

Pattern of separation from social relationships

Limited emotional expression and experience

Question 18

Schizotypal PD

Answer 18

Pattern of eccentric ideas, magical thinking

Question 19

Antisocial PD

Answer 19

Pattern of disregard of others’ rights
Strong links to conduct disorder and criminality
Selfishness and lack of empathy

Question 20

Borderline PD

Answer 20

Pattern of unstable relationships, mood and behaviour

Efforts to control emotion (drink, self-harm) and avoid rejection

Question 21

Narcissistic PD

Answer 21

Pattern of overestimation of own abilities an accomplishments
Pervasive need for admiration, while not caring about others
Anger when not recognised for their specialness
Fragility of self-esteem

Question 22

Histrionic PD

Answer 22

Attention-seeking, need to be centre of attention
Dramatic behaviour, undue emotional expression
Exaggerated presentation

Question 23

Avoidant PD

Answer 23

Pattern of social avoidance

Inadequacy, and sensitivity to others’ views of them

Question 24

Dependent PD

Answer 24

Pattern of dependence on others’ care

Submissive, clingy, seek others’ approval/support

Question 25

Obsessive-compulsive PD

Answer 25

Pattern of excessive perfectionism - focus on doing the task well but forget the goal Need for order, patterns and control Performing the behaviour purely because there is a rule in their head

Question 26

How is obsessive-compulsive PD different from OCD?

Answer 26

In obsessive compulsive PD there is no consequence if they don't perform the behaviour, they just do it In OCD people perform behaviours because they think something bad will happen if they don't

Question 27

Is the focus on prevalence or incidence in PDs and why?

Answer 27

The focus is on prevalence as there is not clear onset and therefore incidence rates are hard to work out

Question 28

Most reliable studies estimate a prevalence of ____?

Answer 28

10-15% for all personality disorders

Question 29

Why do the prevalence rate figures vary hugely?

Answer 29

Clinicians are human too and suffer from biases | Some use weak measures and overestimate the prevalence hugely and some use better ones

Question 30

Comorbidity

Answer 30

PDs suffer from a high rate of comorbidity

Question 31

What does high comorbidity lead us to think?

Answer 31

That PDs are not as distinct as it may appear and that they all interlink

Question 32

Is a personality disorder for life?

Answer 32

No, a large number of studies have shown that a large number of cases are not diagnosable a few years later

Question 33

Critique of thinking personality disorder diminishes with age

Answer 33

Newton-Howes (2015) argues that classification systems don't take into account the roles played in later life and therefore it is harder to understand PDs in this age group (e.g. if a person is retired it doesn't matter if they are able to hold down a job) Personality disorders related to neuroticism or negative affect diminish over time and there is an increased representation of schizoid, schizotypal and paranoid presentations Clinical diagnostic systems need to take a more lifespan view of the disorder to be able to adapt to changes in later life

Question 34

General risk factors for PD

Answer 34

Genetic links Modest but there Trauma Sexual, physical and emotional abuse Development of dysfunctional core beliefs I am not loveable/worthy

Question 35

_____ of people with substance misuse problems have symptoms of personality disorder _____

Answer 35

35-55% | Bennett (2006)

Question 36

Why are PDs often assessed with a dimensional approach rather than a categorical one?

Answer 36

The characteristic and experiences of people with the disorders are not distinctly different from the normal population but are just extremes of the distribution as opposed to categorically different

Question 37

Is the dimensional model better at predicting outcomes compared to the categorical approach?

Answer 37

Yes Ullrich et al., (2001) found that scores on personality tests were able to produce better predictions of subsequent offending behaviour than categorical diagnoses of antisocial personality disorder

Question 38

What is more reliable, categorical diagnosis or dimensional scores?

Answer 38

Dimensional scores have been shown to be more reliable across clinicians than categorical diagnosis (Heumann & Morey, 1990)

Question 39

How does schizotypal personality disorder differ from schizophrenia?

Answer 39

Schizophrenia is an episodic psychotic-based disorder Schizotypal PD is grounded in long-term, fairly stable, development of personality (Bennett, 2006) Symptoms are continuously and consistently presented that are long lasting, if not permanent

Question 40

Antisocial personality disorder hypothetical profile

Answer 40

``` Lynam & Gudonis (2005) suggested that someone with antisocial PD would score low on all the dimensions of Costa & McCrae's (1995) 5 factor model of personality Low neuroticism Low conscientiousness Low agreeableness Low extroversion Low openness ```