Personality Disorders

Question 0

Historical ideas on personality types: Kretschmer

Answer 0

Endomorph - fat and relaxed
Ectomorph - aloof and thin
Mesomorph - sturdy

Question 1

What is distinct about personality disorders?

Answer 1

Persistent (non episodic)
Pervasive (whole person)
Value laden and stigmatising
Diagnosis of exclusion

Question 2

Historical ideas on personality types: Jung

Answer 2

Introvert vs Extrovert

Question 3

Historical ideas on personality types: Eysenck

Answer 3

Two axes:
Extroversion - Introversion
Neuroticism - Psychoticism

Question 4

Friedman and Rosenman

Answer 4

Type A - coronary prone, high achieving

Type B - relaxed

Question 5

ICD-10 criteria for personality disorder

Answer 5

Enduring/ingrained ways of thinking,relating,behaving and feeling
Significantly deviant from the norm
Causing significant personal and social disruption
Usually start during childhood or teens and persist for much of life

Question 6

Personality clusters

Answer 6

Segments of normal healthy personalities which when too dominant can lead to the development of personality disorders

Question 7

Cluster A disorders

Answer 7

Cluster A is ‘odd’
DSM-IV: Paranoid, schizoid, schizotypal
ICD-10: Paranoid, schizoid

Question 8

Cluster B disorders

Answer 8

Cluster B is ‘dramatic’
DSM-IV: Antisocial, Borderline, Histrionic, Narcissistic
ICD-10: Dissocial, Emotionally unstable, Histrionic, Other

Question 9

Cluster C disorders

Answer 9

Cluster C is ‘anxious’
DSM-IV: Avoidant, Dependent, Obsessive-compulsive
ICD-10: Anxious/Avoidant, Dependent, Anankastic

Question 10

Axis II

Answer 10

The section of the DSM describing personality disorders and mental retardation

Question 11

Problems with personality disorder classification

Answer 11

Discrete categories verses dimensions
The longitudinal course is more similar to axis disorders than thought
Problems communicating dimensions/severity to other clinicians

Question 12

Prevalence of personality disorders

Answer 12

In the community - 10-13%, 2% antisocial PD
In primary care - 10-30% (cluster C most common)
In-patients - 36%, 78% of alcohol in-patients
In prison - 60-70%

Question 13

How enduring are personality disorders?

Answer 13

Zanarini et al (2006) - prospective study for borderline PD
- 70% meet remission criteria at 8 years
- 6% of remitted patients experience recurrence within 8 years
Different symptoms resolve at different rates - impulsivity, then interpersonal and cognitive, then affective

Question 14

Principle problems related to PD

Answer 14

Self-harm and suicide
Increased service utilisation and poor treatment outcome
Antisocial behaviour

Question 15

Interview based Assessments of PD

Answer 15

• International personality disorder examination (IPDE)
• Structured clinical interview for DSM-IV axis II PD (SCID-II)
• Personality disorder interview - 4 (PDI-4)

Question 16

Self report measures of PD

Answer 16

Million clinical multiracial inventory (MCMI)
Minnesota multiphasic personality inventory PD scales (MMPI - PD)
Personality assessment inventory ( PAI)
Personality diagnostic questionnaire 4 (PDQ-4)

Question 17

Borderline personality disorder

Answer 17

Unstable and intense interpersonal relationships
Frantic efforts to avoid abandonment
Impulsivity, affect instability and anger with feelings of emptiness
Risk of suicide/self-harm with psychotic or dissociative symptoms

Question 18

Aetiology of Borderline Personality Disorder

Answer 18

Childhood abuse, neglect or separation with critical or negative family interactions
Heritable component
Impulsive aggression linked to 5HT in the cingulate and PFC
Emotional disturbance linked to amygdala and PFC function

Question 19

Antisocial personality disorder

Answer 19

Failure to conform to social norms
Deceitfulness, impulsivity/irritability and aggressiveness
Disregard for the safety of others and self, irresponsibility and lack of remorse
Conduct disorder with onset before 15yrs

Question 20

Aetiology of antisocial PD

Answer 20

Childhood abuse, neglect or separation
Life-long APD shows higher heritability than adolescent onset, linked to MAOA polymorphism
PFC and temporal cortex abnormalities with aggression associated with reduced central 5HT

Question 21

Treatments of PD

Answer 21

treatment enabling environments
Psychological treatments
Pharmacotherapy

Question 22

Treatment enabling environment

Answer 22

Shared, friendly and supportive care environment
Staff support and supervision
Supportive organisations

Question 23

Psychological treatments

Answer 23

CBT, MBT (mentalisation based treatment) or DBT (dialectical behaviour therapy)
NICE recommends - group CBT for antisocial PD
- MBT/DBT for borderline PD

Question 24

Pharmacotherapy in PD

Answer 24

No good evidence for use in PD

Poly pharmacy common - rationale often eating symptoms or underlying neurobiology.

Question 25

Attachment theory for personality disorders

Answer 25

A theory arguing that different types of attachment to parents when young effects the development of adult personality
Tested with the strange situation test
Unhealthy attachment types leads to difficulty in relationships when young and is linked to PDs

Question 26

Techniques for testing attachment styles

Answer 26

Strange situation test - 18 month infant is separated from their carer for 2mins and then their reunion is analysed
Adult attachment interview - a person is analysed on their ability to form a coherent, balanced narrative about their attachments

Question 27

Infant attachment styles

Answer 27

Secure - initially distressed but welcome return without anger
Insecure/avoidant - look unconcerned, but are, and avoid mother once returned
Insecure/ambivalent - angry and clingy,demand contact but show resistance to it
Insecure/bizarre - may show fear or start to approach then retreat. Often h/o of loss or abuse

Question 28

Adult attachment styles

Answer 28

Autonomous - coherent and aware of others’ states’ of mind
Dismissing - 20% - idealise early relationships but dismiss importance of attachments/claim they do not need other people
Preoccupied - 15% - value attachment but preoccupied with early relationships, have unresolved feelings about this and ramble
Bizarre - sig psych difficulties and may be very incoherent