Personality Disorders

Question 1

What is personality?

Answer 1

The (mainly) stable internal factors that keep a person’b behaviour consistent from one moment to another AND different from the behaviour of others

Question 2

What is personality disorder as defined by ICD-10?

Answer 2

Lifelong, persistent, deeply ingrained maladaptive behaviour that

• characterises an individual
• deviates from culturally expected ‘normal’ range
• onset in late childhood/early adolescence

Question 3

What is abnormal personality an issue?

Answer 3

When it is maladaptive, causing suffering to either the patient or their associates.
Can’t be explained by other mental health or organic disorders

Question 4

Deviation from the normal personality manifests in which areas?

Answer 4

Congition - thinking about self and others
Affectivity - emotional response 
Occupational and social performance 
Impulse control and need gratification 
Interpersonal function

Question 5

What are the three clusters of personality disorder?

Answer 5

Cluster A - odd/eccentric behaviour (the mad)
Cluster B - dramatic or emotional behaviour (the bad)
Cluster C - anxious/avoidant behaviour (the sad)

Question 6

What are the subtypes of personality disorder found in cluster A?

Answer 6

Paranoid
Schizoid
Schizotypal

Question 7

What are the subtypes of personality disorder found in cluster B?

Answer 7

Antisocial
Histrionic
Narcissistic
Emotionally unstable (includes borderline)

Question 8

What are the subtypes of personality disorder found in cluster C?

Answer 8

Avoidant
Dependent
Obsessive-Compulsive

Question 9

Describe paranoid personality disorder

Answer 9

Excessive sensitivity
Unforgiving
Suspicious of/misconstrues the actions of others
Combative - strong sense of personal rights
Tends to not respond to treatment because the patient’s don’t frequently present

Question 10

Describe schizoid personality disorder

Answer 10

Solitary and introspective
Little interest in sex
Limited capacity for pleasure or emotional expression
Flattened affect
Indifferent to praise or criticism
Managed with psychodynamic or group therapy

Question 11

Describe schizotypal personality disorder

Answer 11

Eccentric behaviour
Bizarre ideas and interpretation or the world, magical thinking
Perceptual disturbance
Thought disorder
No real treatment - disciplined environment

Question 12

Describe antisocial personality disorder

Answer 12

Disregard for social obligations
Unconcern for others
Behaviour outside social norms
- not modified by experiences or punishments
- blames others
Low tolerance for frustration and aggression
Can’t experience guilt
This type of personality disorder has an unremitting course and often leads to early death

Question 13

Describe histrionic personality disorder

Answer 13

Shallow and labile affect
Dramatic
Preoccupied with physical attraction
Exaggerated expression and emotions
Self-indulgence and lack of consideration for others
Approval, attention and excitement seeking
Managed with CBT/psychodynamic therapy/group therapy

Question 14

Describe narcissistic personality disorder

Answer 14

Lack of empathy
Very sensitive
Feel they are special and unique, required excessive admiration
Sense of entitlement, yet envious of others

Question 15

Describe emotionally unstable personality disorder (includes borderline)

Answer 15

Act without regard for consequences 
Quarrelsome and outbreaks of anger
Unstable and intense relationships 
Unstable and capricious mood
Self harm 
Feels empty
Avoids potential abandonment 
Managed with DBT (dialectical behavioural therapy)

Question 16

Describe avoidant personality disorder

Answer 16

Tense and apprehensive
Inferiority complex
Preoccupied by feeling rejected /criticised
Needs security (avoids potential dangers)
Managed with psychodynamic/CBT/group therapy

Question 17

Describe dependent personality disorder

Answer 17

Reliance on others to make decisions
Feels helpless/incompetent 
Follows what others do
Fear of abandonment
Scared to make demands
Managed with assertiveness training/CBT

Question 18

Describe obsessive-compulsive personality disorder

Answer 18

Perfectionist, pre-occupied with details
Stubborn and rigid
Excessive doubt and conscientiousness
Managed with psychotherapy (insight-orientated techniques)/CBT

Question 19

What is borderline personality disorder?

Answer 19

There is unstable affect regulation, poor impulse control, poor interpersonal relationships and self-image
e.g. repeated self-harm, suicide and a difficult life trajectory

Question 20

How is borderline personality disorder diagnosed?

Answer 20

At least 3 of
- impulsive
- quarrelsome 
- angry outbursts 
- limited perseverance 
- emotional instability 
And at least 2 of 
- disturbed identity 
- intense relationships 
- sensitive to rejection 
- self-harm 
- emptiness

Question 21

How is borderline personality disorder managed?

Answer 21

Dialectical behaviour therapy (DBT)
Inpatient programmes
Anti-depressants, anti-psychotics and mood stabilisers as appropriate
Supportive interpersonal dyads can be achieved

Question 22

What medications can be used in the management of personality disorders?

Answer 22

Anti-psychotics - for cognitive symptoms, impulse trouble or angry affect
Monoamine oxidase inhibitors - BPD only to alleviate abnormal mood
Lithium - episodic behavioural dyscontrol and agression