Personality disorders

Question 1

1) What does personality refer to?
2) What do people with personality disorder experience difficulties with?
3) In a medical setting, what might personality disorder patients appear to struggle with on presentation?
4) What is personality made up of?
5) Behaviour attributed to a personality disorder must not be attributable to what 2 possibilities?

Answer 1

1) A set of consistent thoughts, feelings and behaviours shown across time in a variety of settings.
2) They experience difficulties in interpersonal relationships.
3) May appear as difficulties in getting their needs met or being labelled as difficult patients.
4) Personality is made up of characteristics or traits.
5) Brain damage/ disease or another psychiatric disorder.

Question 2

Name and describe the ‘3 P’s’ which distinguish personality disorder from traits.

Answer 2

1) Pervasive: occurs in most/ all areas of life.
2) Persistent: evident in adolescence and continues through adulthood.
3) Pathological: causes distress to self or others and impairs functioning.

Question 3

Give the 6 criteria that the ICD-10 requires for a diagnosis of personality disorder to be made.

Answer 3

1) Relationships affected
2) Enduring
3) Pervasive
4) Onset in childhood/ adolescence
5) Result in distress
6) Trouble in occupational/ social performance.

Question 4

Give the 5 broad personality factors and give examples of each.

Answer 4

1) Openness to experience: curiosity, imagination and appreciation of art, adventure and emotion.
2) Conscientiousness: ability to plan and be self-disciplined to achieve goals.
3) Extraversion: predisposition to experience positive (social) events.
4) Agreeableness: tendency to be cooperative, trusting and kind.
5) Neuroticism: predisposition to negative emotions (anger, anxiety or depression).

Question 5

1) What is multiple personality disorder classified within?
2) How many groups/ clusters of personality disorder are there?
3) Who has higher overall rates of personality disorder?
4) Which personality disorders do men have higher rates of?
5) Which personality disorders are more common in females?

Answer 5

1) It is classified within dissociative disorders.
2) 3.
3) Men.
4) cluster A disorders, dissocial or anankastic.
5) Histrionic or borderline personalty disorder.

Question 6

Name and describe the 3 clusters of personality disorder.

Answer 6

1) Cluster A (odd or eccentric): Schizoid and paranoid.
2) Cluster B (dramatic, erratic or emotional): Histrionic, EUPD and dissocial.
3) Cluster C (anxious and fearful): anankastic, anxious (avoidant) and dependent.

Question 7

1) Genetics determine what percentage of our personality?
2) What is the MZ:DZ concordance rate for personality traits?
3) Personality disorder is associated with what 3 factors?
4) Name the 3 categories of aetiology associated with personality disorders.
5) What does ‘temperament’ describe?

Answer 7

1) 50%.
2) 50%:30%
3) family history of PD, history of depression and history of alcohol dependency.
4) genetics, childhood temperament and childhood experience.
5) An infant’s pattern of activity, attention span, response to new situations and intensity of emotional responses.

Question 8

1) The temperament of what can predict personality traits in adulthood?
2) Why do children with ‘difficult’ temperaments have greater problems coping as adults?
3) What type of attachment difficulty is associated with personality disorder development?
4) What childhood experiences are development of personality disorders associated with?
5) Name the 3 theories of personality disorder.

Answer 8

1) The temperament of children as young as 3 can predict personality traits in adulthood.
2) Because they find it harder to develop supportive relationships and are more distressed by negative events.
3) Insecure attachment and early attachment difficulties.
4) PD is associated with insecure attachment and traumatic, neglectful or chaotic upbringing.
5) Cognitive and psychoanalytical theories, psychological defences and neurotransmitter theories.

Question 9

1) What influences a persons expectations about themselves and the world?
2) Behaviour is viewed as being motivated by a combination of what?
3) What aspect of behaviour do cognitive theories favour?
4) What aspect of behaviour do psychoanalytical theories favour?
5) What do both cognitive and psychoanalytical theories agree upon?

Answer 9

1) The quality of early relationships and the nature of the environment that in which someone is raised.
2) Beliefs and desires.
3) They favour beliefs.
4) They emphasise desires.
5) Both agree that our expectations tend to be fulfilled and perpetuated. For example, open and confident people more often receive a friendly response, confirming to them that other are friendly and encouraging them to continue to be confident and open.

Question 10

1) What are defence mechanisms?
2) When do defence mechanisms become pathological?
3) There is evidence of lower levels of what in dissocial personality disorder?
4) Serotonin has been implicated in regulation of what?
5) What patterns of behaviour might Dopamine and Noradrenaline be involved in?

Answer 10

1) Unconscious strategies that are used to manage uncomfortable feelings.
2) They become pathological when people are overly reliant on them, causing conflict with others or never addressing their underlying emotions.
3) Lower serotonin levels.
4) In the regulation of impulsivity and aggression.
5) Dopamine for novelty seeking and noradrenaline for persistence and dependency to rewards.

Question 11

Name the 5 defence mechanisms and link them to the personality disorder that they are associated with.

Answer 11

1) Acting out: borderline personality disorder.
2) Splitting: borderling personality disorder.
3) Projection: paranoid personality disorder.
4) Fantasising: schizoid personality disorder.
5) Reaction formation: anankastic personality disorder.

Question 12

1) As well as the factors in REPORT, what else is required to diagnose a specific personality disorder?
2) What 3 investigations might you want to do for a person with suspected personality disorder?
3) What type of approach is needed for managing a patient with a personality disorder?
4) When managing a patient with personality disorder, what do you need to encourage the patient to do?
5) When managing a patient with personality disorder, what is essential?

Answer 12

1) At least 3 features associated with a particular PD.
2) Second interview, collateral history and psychology/ psychotherapy assessment.
3) A long-term approach is needed.
4) Encourage the patient to take responsibility for their own actions.
5) Boundaries are essential and all staff require a clear understanding of the plan and their respective roles.

Question 13

Name the 7 factors associated with Paranoid PD.

Answer 13

1) Sensitive
2) Unforgiving
3) Suspicious
4) Possessive and jealous of partners.
5) Excessive self-importance
6) Conspirary theories.
7) Tenacious sense of rights.

Question 14

Name 2 differential diagnoses for paranoid PD.

Answer 14

1) Schizophrenia

2) Persistent delusional disorder

Question 15

Name the 8 factors associated with Schizoid PD.

Answer 15

1) Anhedonic
2) Limited emotional range
3) Little sexual interest
4) Apparent indifference to praise/ criticism
5) Lacks close relationships
6) One-player activities
7) Normal social conventions ignored
8) Excessive fantasy world

Question 16

Give 5 differential diagnoses for Schizoid PD.

Answer 16

1) Asperger’s syndrome
2) Agoraphobia
3) Social phobia
4) Psychosis
5) Depression

Question 17

Give 6 features associated with Histrionic PD.

Answer 17

1) Attention seeking
2) Concerned with own appearance.
3) Theatrical
4) Open to suggestion
5) Racy and seductive
6) Shallow affect

Question 18

Give 2 differential diagnoses for Histrionic PD.

Answer 18

1) Hypomanic/manic episode

2) Substance misuse

Question 19

Name the 5 features of both subtypes of emotionally unstable personality disorder.

Answer 19

1) Affective instability
2) Explosive behaviour
3) Impulsive
4) Outbursts of anger
5) Unable to plan or consider consequences

Question 20

Give the 5 features of borderline type EUPD.

Answer 20

1) Self-image unclear
2) Chronic ‘empty’ feelings
3) Abandonment fears
4) Relationships are intense and unstable
5) Suicide attempts and self-harm

Question 21

Give 3 differential diagnoses of borderline type personality disorder.

Answer 21

1) Adjustment disorder
2) Depression
3) Psychosis (patients occasionally experience fleeting psychotic features)

Question 22

Give the 6 features of impulsive type EUPD.

Answer 22

1) Lacks impulse control
2) Outbursts or threats of violence
3) Sensitivity to being thwarted or criticised.
4) Emotional instability
5) Inability to plan ahead
6) Thoughtless of consequences.

Question 23

Give 3 differential diagnoses of impulsive type EUPD.

Answer 23

1) Affective disorder
2) Adjustment disorder
3) Adult ADHD

Question 24

State 6 features of dependent personality disorder.

Answer 24

1) Subordinate
2) Undemanding
3) Feels helpless when alone
4) Fears abandonment
5) Encourages others to make decisions
6) Reassurance needed

Question 25

Give 2 differential diagnoses for dependent personality disorder.

Answer 25

1) Reliance on others because of cognitive impairment.

2) Anxiety disorder

Question 26

Name 6 features of dissocial personality disorder (antisocial personality disorder).

Answer 26

1) Forms but cannot maintain relationships.
2) Irresponsible
3) Guiltless
4) Heartless
5) Temper easily lost
6) Someone else’s fault

Question 27

Give 2 differential diagnoses for dissocial personality disorder.

Answer 27

1) Acute psychotic episode

2) Manic episode

Question 28

State the 6 features of anxious (avoidant) personality disorder.

Answer 28

1) Avoids social contact
2) Fears rejection/ criticism
3) Restricted lifestyle
4) Apprehensive
5) Inferiority
6) Doesn’t get involved unless sure of acceptance

Question 29

Give 4 differential diagnoses of anxious personality disorder.

Answer 29

1) Social phobia
2) ASD
3) Schizophrenia
4) Depression

Question 30

Give the 8 features of anankastic personality disorder.

Answer 30

1) Doubtful
2) Excessive detail
3) Tasks not completed
4) Adheres to rules
5) Inflexible
6) Likes own way
7) Excludes pleasure and relationships
8) Dominated by intrusive thoughts

Question 31

Give 2 differential diagnoses for anankastic personality disorder.

Answer 31

1) OCD

2) Autistic spectrum disorder

Question 32

Give 4 differential diagnoses of anxious personality disorder.

Answer 32

1) Social phobia
2) Autistic spectrum disorder
3) Schizophrenia
4) Depression