Personality Disorders

Question 1

what are the characteristics of anankastic personality disorder?

Answer 1

feelings of excessive doubt and caution
preoccupation with details, rules, lists, order, organisation or schedule
perfectionism and conscientiousness
preoccupation with productivity
excessive pedantry to social conventions
rigidity and stubbornness
unreasonable insistence that others submit to their way of doing things

Question 2

what does a trait become a disorder?

Answer 2

only if it is pervasive (not just related to specific situations) and causes distress and/or impairment of function

Question 3

what causes most personality disorders?

Answer 3

complex interaction between genes, the individual and their environment

Question 4

what % of people in the general population have a personality disorder?

Answer 4

10.6%

Question 5

what does ICD-10 class as a cluster A personality disorder?

Answer 5

paranoid

schizoid

Question 6

what does ICD-10 class as a cluster B personality disorder?

Answer 6

dissocial
emotionally unstable - I or B
borderline
histrionic

Question 7

what does ICD-10 class as a cluster C personality disorder?

Answer 7

anxious / avoidant
dependent
anankastic

Question 8

what is paranoid PD (0.7% prevalence)?

Answer 8

a pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent, beginning by early adulthood and present in a variety of contexts

Question 9

paranoid PD is indicated by four (or more) of what 7 symptoms?

Answer 9

suspects, without basis, that others are exploiting, harming or deceiving them
is preoccupied with unjustified doubts about others loyalty
is reluctant to confide in others due to fear info will be used against them
reads hidden demeaning or threatening messages into benign remarks
persistently bears grudges
perceives attacks on his or her character that are not apparent to others and is quick to react angrily
has recurrent suspicious about fidelity of spouse

Question 10

what is schizoid PD (0.8% prevalence)?

Answer 10

a pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings, beginning by early adulthood

Question 11

schizoid PD is indicated by four (or more) of what 7 symptoms?

Answer 11

neither desires nor enjoys close relationships
almost always chooses solitary activities
has little, if any, interest in sexual experiences
takes pleasure in few, if any, activities
lacks close friends
appears indifferent to praise or criticism of others
shows emotional coldness, detachment or flattened affectivity

Question 12

what is antisocial PD (0.6% prevalence)?

Answer 12

a pervasive pattern of disregard for and violation of the rights of others, occurring since age 15 years

Question 13

antisocial PD is indicated by three (or more) of what 7 symptoms?

Answer 13

failure to conform to social norms with respect to lawful behaviours - repeatedly performing illegal acts
deceitfulness - repeated lying, conning others
impulsivity or failure to plan ahead
irritability and aggressiveness - repeated fights
reckless disregard for safety of self or others
consistent irresponsibility - failure to sustain work or financial obligations
lack of remorse

Question 14

what is borderline PD (0.7% prevalence)?

Answer 14

a pervasive pattern of instability of interpersonal relationships, self image and affects, and marked impulsivity, beginning by early adult hood

Question 15

borderline PD is indicated by five (or more) of what 9 symptoms?

Answer 15

frantic effort to avoid abandonment
unstable and intense relationships
persistently unstable self image or sense of self
impulsivity in 2 areas that are self damaging (spending, sex, substance abuse, reckless driving, binge eating)
recurrent suicidal behaviour or self mutilating behaviour
instability due to marked reactivity of mood
chronic feelings of emptiness
inappropriate, intense anger
transient, stress related paranoid ideation of severe dissociative symptoms

Question 16

what is histrionic PD (1% prevalence)?

Answer 16

a pervasive pattern of excessive emotionality and attention seeking beginning by early adulthood and present in a variety of context

Question 17

histrionic PD is indicated by five (or more) of what 8 symptoms?

Answer 17

uncomfortable in situations where they not centre of attention
inappropriate sexually seductive or provocative behaviour
displays rapidly shifting and shallow expression of emotions
consistently uses physical appearance to draw attention
speech that is impressionistic and lacking in detail
self-dramatisation and exaggerated emotion
is suggestible (easily influenced)
considers relationships to be more intimate than they are

Question 18

what is avoidant PD (0.8% prevalence)?

Answer 18

a pervasive pattern of social inhibition, feelings of inadequacy and hypersensitivity to negative evaluation, beginning by early adulthood

Question 19

avoidant PD is characterised by four (or more) of what 7 symptoms?

Answer 19

avoids occupational activities that involve significant interpersonal contact because of fears of criticism
unwilling to get involved unless certain of being liked
shows restraint in intimate relationships
is preoccupied with being criticised or rejected in social situations
inhibited in new interpersonal situations because of feelings of inadequacy
views self as socially inept, unappealing or inferior
unusually reluctant to take personal risks or engage in new activities that may cause embarrassment

Question 20

what is dependent PD (0.1% prevalence)?

Answer 20

a pervasive and excessive need to be taken care of that leads to submissive and clinging behaviour and fears of separation beginning by early adulthood

Question 21

dependent PD is indicated by five (or more) of what 8 symptoms?

Answer 21

difficulty making decisions without excessive reassurance
needs others to assume responsibility for major areas or their life
difficulty expressing disagreement with others due to fear
difficulty initiating projects or doing things on own (lack of self confidence)
excessive lengths to obtain nurturance and support from others
feels uncomfortable or helpless when alone
urgently seeks another relationship when one ends
unrealistically preoccupied with fears of being left to take care or their self

Question 22

what is obsessive-compulsive PD (1.9% prevalence)?

Answer 22

preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness and efficiency, beginning by early adulthood

Question 23

obsessive-compulsive PD is indicated by four (or more) of what 8 symptoms?

Answer 23

preoccupied with details, rules, lists, order and organisation
perfectionism that interferes with task completion
excessively devoted to work and productivity to exclusion of leisure
overconscientious and inflexible about matters of morality, ethics or values (not accounted for by religion)
unable to discard worthless objects even when no sentimental value
is reluctant to delegate tasks or work with others unless conform to their way of doing things
adopts miserly spending style - money hoarded
rigidity and stubbornness

Question 24

what is the difference between antisocial PD and psychopathy?

Answer 24

antisocial PD is largely based on behaviour, whilst psychopathy describes a set of deficits in emotional and cognitive functioning

Question 25

what should be the focus of treatment of personality disorders?

Answer 25

treatment of comorbidity (eg depression, anxiety)

generally, not good evidence for treatment of PD itself

Question 26

what may be helpful in treatment of avoidant PD?

Answer 26

social skills training

antidepressants

Question 27

what is main treatment for emotionally unstable PD (BPD)?

Answer 27

dialectical behavioural therapy (DBT)

complex package of groups, firm boundaries and managing interpersonal issues

Question 28

what treatment for BPD has became increasingly popular in recent years?

Answer 28

mentalisation - process by which we interpret our own actions as being meaningful, based on our own internal mental states

Question 29

what drug treatment can be used for BPD?

Answer 29

focused on comorbid - none licenced for BPD

MAOIs may be effective (phenelzine for hostility)

antipsychotics may have role to play (olanzapine - weight gain, haloperidol)

mood stabilisers eg lamotrigine may have role

topiramate has some evidence for anger and aggression

Question 30

what can be used for treatment of antisocial PD?

Answer 30

group based cognitive and behavioural interventions, in order to address problems such as impulsivity, interpersonal difficulties and antisocial behaviour