Personality Disorders

Question 1

What are personality disorders?

Answer 1

Definition – conditions in which an individual differs significantly from an average person in terms of how they think perceive, feel or relate to others.

Technical definition – class of mental disorder characterised by enduring maladaptive patterns of behaviour, cognition, and inner experience, exhibited across many contexts and deviating markedly from those accepted by the individual’s culture. These patterns develop early, are inflexible and are associated with significant distress or disability. They are not attributable to brain damage or another psychiatric disorder.

It is a disorder of not fitting into society and so treatment does not tend to be helpful.

Question 2

What causes personality disorders?

Answer 2

Genetic 
Environmental reasons
•	Abusive childhood
•	Neglectful childhood
•	Trauma and loss
Personality disorders are essentially a problem of disrupted attachment

Question 3

What are the key features to many personality disorders?

Answer 3

People with personality disorders (especially cluster B emotionally unstable) have a high tendency to self-harm. Attachment issues

The 3 P’s of personality disorders
Persistent
Problematic
Pervasive – across different contexts

Question 4

What are the 3 clusters of personality disorders?

Answer 4

Cluster A – Odd or eccentric behaviour

Cluster B – Dramatic, emotional or erratic disorders

Cluster C – Anxious or fearful disorders

Question 5

Describe the paranoid personality type

Answer 5

1. Paranoid – suspicious and mistrustful misinterpreting events as persecutory, bearing grudges, constantly questioning loyalty of friends, reluctance to confide in others and strong sense of personal rights – male bias

Question 6

Describe the schizoid personality type

Answer 6

2. Schizoid – present as detached, solitary, aloof, little interest in people and sex, indifferent and lacking close friends – male bias

Question 7

Describe the schizotypal personality type

Answer 7

3. Schizotypal – present as eccentric, odd behaviour and thinking and unconventional beliefs, basically schizophrenia without the hallucinations or true delusions (insight often maintained) – male bias. In ICD10 not listed as a PD.

Question 8

Describe the emotionally unstable personality type

Answer 8

1. Emotionally unstable – two types both female bias
   Impulsive without considerations of the consequences, emotionally unstable including outbursts of emotion and incapacity to control behavioural explosions, often quarrelsome and often in conflicts with others, pseudohallucinations and fear of abandonment
   • Borderline – Impulsive and emotionally unstable, disturbance in self-image and aims, feelings of emptiness, intense and unstable relationships, self-destructive including suicidal and self-harm.
   • Impulsive – characterised predominantly by emotional instability and impulsivity especially difficult to control anger.

Question 9

What is the cause of emotionally unstable PD

Answer 9

Causes include childhood development problems and genetic tendencies.

Question 10

How is emotionally unstable PD managed?

Answer 10

Management – psychological therapy including therapeutic community, dialectical behaviour therapy, cognitive analytic therapy, and psychodynamic therapy

Question 11

Describe the narcissistic personality type

Answer 11

2. Narcissistic – present as grandiose, self-important, degrading of others, obsessed with preoccupation of unlimited success, power or beauty, entitled, lack empathy, envious and arrogant – female bias. Not listed in ICD10 as a PD.

Question 12

Describe the antisocial/dissocial personality type

Answer 12

3. Antisocial (Dissocial) – present with no concern for the feelings of others, deception, disregard for rules, impulsivity, low tolerance to frustration, irritability and aggressiveness, lack of responsibility e.g. cannot keep a job, and failure to take responsibility – male bias. Often diagnosed with conduct disorder in childhood.

Question 13

How is the antisocial personality type managed?

Answer 13

Management
Avoid pharmacological therapy and be aware of drug misuse
Group base CBT especially for impulsivity and interpersonal difficulties
Consider referral for comorbid drug and alcohol misuse
Avoid inpatient admissions

Question 14

Describe the histrionic personality type

Answer 14

4. Histrionic – present as theatrical, dramatic, exhibit superficial emotionality, labile mood, attention seeking, seductiveness and suggestibility – female bias.

Question 15

Describe the anankastic/obsessive compulsive personality type

Answer 15

1. Anakastic/Obsessive compulsive – present as rigid, stubborn, perfectionistic, preoccupied with rules, order and routine and have a higher sense of morality – male bias

Question 16

Describe the dependent personality type

Answer 16

2. Dependant – present as needing others to make decisions for them, fear abandonment, unable to cope alone, cannot express disagreement, always searching for another relationship and need reassurance – equal bias

Question 17

Describe the anxious-avoidant personality type

Answer 17

3. Anxious-avoidant – present with persistent anxiety, sensitive to rejection and preoccupied that they are always being rejected, tend to avoid relationships unless acceptance is guaranteed and avoidance of occupation activities involving significant interpersonal contact due to fears of rejection or criticism – female bias

Question 18

What questionnaire can be used to help diagnose personality disorders?

Answer 18

Questionnaire such as the PDQ4 can be used to help diagnosis.

Question 19

How are personality disorder managed?

Answer 19

Psychotherapy such as psychodynamic, family and group therapies
A type of CBT called Dialectical behaviour therapy is specifically useful for borderline personality disorders.
Mindfulness
Self-help groups
Medication only for comorbid conditions such as mood stabilisers and antidepressants

Question 20

What is psychodynamic psychotherapy?

Answer 20

Psychodynamic therapy allows the presenting problems to be understood in the light of past experience (such as childhood trauma or deficiency) and the dynamics of the internal world. It takes a long time and requires a specific kind of personal relationship between the patient and the psychotherapist. This is based on the theory of transference where your present experience is interpreted in the context of your past experiences. Its important to note that the therapist themself will require their own therapy due to their own transference.

Question 21

When is psychodynamic psychotherapy most useful?

Answer 21

Psychodynamic Psychotherapy is most useful in recurrent and chronic inter-personal difficulties. So, it can help in the management of personality disorders, depression, eating disorders and some presentations of anxiety.