Personality Disorders

Question 1

How many clusters are there within Personality Disorders?

Answer 1

3: Clusters A, B and C.

Question 2

Which cluster within Personality Disorders is the most common? Why?

Answer 2

Cluster B. Because people within this category present more to clinicians and thus we are able to study it and know much more about it.

Question 3

Personalities are made up of multiple traits that are formed from two dimensions, what are the dimensions?

Answer 3

Nature (innate temperament) and Nurture (acquired characteristics).

Question 4

In a personality, the ‘nature’ dimension involves what?

Answer 4

Innate temperament (disposition) that is genetic and constitutional of the personality.

Question 5

In a personality, the ‘nurture’ dimension involves what?

Answer 5

Acquired characteristics that are made of values and attitudes learnt through experience.

Question 6

Based on the notion that personality is formed by ‘nature’ and ‘nurture’, what happens to people with Borderline Personality Disorder that contributes to the formation of their personality?

Answer 6

Often people with BPD experience trauma in childhood (sexual, physical, emotional) and this influences how they perceive the world. The trauma adjusts their personality and they learn to feel unsafe.

Question 7

How is personality expressed?

Answer 7

Personality is expressed in the psychosocial context (social interactions).

Question 8

The expression of personality is important for diagnosis, why is that?

Answer 8

As personality is expressed in the psychosocial context, social interactions are very important in diagnosing an individual - particular because the clinician needs to see that the maladaptive traits are stable across all social interactions.

Question 9

What is the origin of the word personality?

Answer 9

It comes from the latin word for mask: ‘persona’. Was first used in a theatre sense, but now relates to the characteristics you communicate to the world.

Question 10

For all of the Personality Disorders and clusters, there are three core (maladaptive) features. What are they?

Answer 10

1. Functional inflexibility: failure to adapt to situations and a rigid response.
2. Self-defeating: behavioural responses are damaging.
3. Unstable in response to stress: emotional, behavioural and; cognitive instability.

Question 11

We all have these traits and knowing this, what needs to be recognised in order to diagnose someone as having a disorder?

Answer 11

These traits lie on a spectrum between adaptive and maladaptive. Need to recognise the THRESHOLD where the trait becomes maladaptive and impairs the person.

Question 12

There is one major aspect of personality disorders that contributes to their ‘functional inflexibility’, ‘self-defeating behaviours’ and; ‘instability’ and also makes people with a personality disorder difficult to treat, what is this aspect?

Answer 12

Lack of insight. There is a failure to recognise the dysfunctional aspect of personality.

Question 13

Lack of insight is a key issue in personality disorders, what does it create in people with personality disorders?

Answer 13

It causes them to blame others, as they cannot recognise the dysfunctional aspects of their personality.

Question 14

According to the DSM-5, before being diagnosed with a specific disorder, what must happen first?

Answer 14

The person must meet criteria for a general personality disorder.

Question 15

What is criteria A. for the General Personality Disorder and its five symptoms?

Answer 15

A. Personality Disorder is an enduring pattern of inner experience and behaviour that:
- deviates markedly from the expectations of the individual’s culture,
- is pervasive and inflexible,
has an onset in adolescence or early adulthood,
- is stable over time, and
- leads to distress or impairment.

Question 16

One symptom in the criteria A. of General Personality Disorder states that the enduring pattern of inner experience and behaviour must be ‘pervasive and inflexible’, what does this mean?

Answer 16

That those maladaptive aspects of personality do not shift or change, even when the person experiences the negative consequences of their behaviour. They are fixed in their pattern of response.

Question 17

One symptom in the criteria A. of General Personality Disorder states that the enduring pattern of inner experience and behaviour must be ‘stable over time’, what does this mean?

Answer 17

That those traits really are a part of the person’s personality and are not episodic. They are fixed features that are not specific to a certain interaction or certain setting. It is who they are all the time.

Question 18

One symptom in the criteria A. of General Personality Disorder states that the enduring pattern of inner experience and behaviour must ‘lead to distress or impairment’. If the person ‘lacks insight’, how can they be distressed about their behaviour?

Answer 18

Because they are distressed about the consequences of their behaviour, which often leads them to feel depressed, anxious or angry. They will present to clinicians needing help for these feelings, without realising that the problem is them.

Question 19

If a person who actually has a Personality Disorder presents to a clinician expressing they have anxiety or depression, how might the clinician realise the truth?

Answer 19

They must do a thorough assessment first but often psychologists and psychiatrists say that they feel that something is not right… that the person is not responding in a way that is expected.

Question 20

After Criteria A. for General Personality Disorders, there are two more specific criteria to be met in order to diagnose a personality disorder. What is the first one?

Answer 20

• Significant impairments in self (identity or self-direction) and interpersonal (empathy or intimacy) functioning.

Question 21

After Criteria A. for General Personality Disorders, there are two more specific criteria to be met in order to diagnose a personality disorder. What is the second one?

Answer 21

• One or more pathological personality trait domains/facets.

Question 22

The two specific features of General Personality Disorder (1. significant impairments in self and; interpersonal functioning and 2. needing a pathological personality trait) must also meet three other criteria, what are they?

Answer 22

The features must be:

• relatively stable across time and consistent across situations.
• not better understood as normative for the individual’s developmental stage or sociocultural environment.
• not solely due to the direct physiological effects of a substance or general medical condition.

Question 23

How many personality disorders are there in the DSM-5 compared with the ICD-10? How are they classified?

Answer 23

DSM-5: 10 personality disorders, 3 clusters.

ICD-10: 9 personality disorders, no clusters and; with slightly different labels.

Question 24

In the DSM-5, what are the three clusters of Personality Disorders?

Answer 24

• Cluster A: ‘odd, eccentric’.
• Cluster B: ‘dramatic, emotional’.
• Cluster C: ‘anxious, fearful’.

Question 25

What Personality Disorders are in Cluster A?

Answer 25

Cluster A (odd, eccentric):

• Paranoid.
• Schizoid.
• Schizotypal.

Question 26

What Personality Disorders are in Cluster B?

Answer 26

Cluster B (dramatic, emotional):

• Antisocial.
• Borderline.
• Histrionic.
• Narcissistic.

Question 27

What Personality Disorders are in Cluster C?

Answer 27

Cluster C (anxious, fearful):

• Avoidant.
• Dependant.
• Obsessive-compulsive.

Question 28

Although there are the distinct clusters of Personality Disorders, why is it rare that someone will present with textbook symptoms for one Personality Disorder? (lack of diagnostic reliability within and between the clusters?)

Answer 28

Because they overlap so much. The clusters recognise that there is a huge similarity in traits BUT the presentation of symptoms don’t always fit nicely even into the clusters.

Question 29

When a group of psychologists and psychiatrists were asked about how patient’s with a Personality Disorder fir into the categories, what was the response?

Answer 29

That 60% of patient’s did not present with a distinct disorder, they had a huge overlap in symptoms.

Question 30

The DSM-5 uses a categorical approach to Personality Disorders, which is compatible with the disease classification systems used in medicine. What are some advantages and disadvantages of this system?

Answer 30

Advantages: clarity and ease of communicating information.
Disadvantages: difficult to distinguish the threshold where the person goes from what’s considered ‘normal’ to having a disorder, as well as clearly seeing a distinction between the disorders.

Question 31

DSM-4 had a multi-axial system, which was dropped in DSM-5 due to a lack of scientific evidence (now it is a single axial model). What did the multi-axial system involve?

Answer 31

AXIS I: major clinical disorders with acute symptoms that need treatment.
AXIS II: Personality Disorders & Intellectual Disabilities (differentiated due to:
- early age of onset,
- enduring & more pervasive,
- involves self & identity,
- presumed to have poorer self-awareness,
- lower treatment response).

Question 32

As an overview (4 points), PDs are associated with patterns of maladaptive personality which:

Answer 32

1. endure over a long period of time (are fixed in the person’s personality).
2. are traceable to adolescence or early adulthood.
3. are pervasive across many social situations (are not episodic).
4. lead to impairment in important areas of life functioning.

Question 33

As PDs can be confused with other mental disorders/substance abuse/medical conditions, what much be done to establish an appropriate diagnosis?

Answer 33

An extensive and complete assessment and history.