Personality Disorders

Question 1

1. what is the definition of personality?

2. What is the definition of personality disorder?

Answer 1

1. the innate and enduring characteristics of an individual which shape their attitudes, thoughts and behaviours in response to situations
2. enduring, persistent and pervasive disorders of inner experience and behaviour that cause distress or significant impairment in social functioning

Question 2

What are the 5 trait domains of personality disorders?

Answer 2

1. negative affectivity (tendency to manifest distressing emotions)
2. dissociality (tendency to disregard social conventions and the rights of others)
3. Disinhibition (tendency to act impulsively)
4. anankastia (tendency to control one’s own and other’s behaviour)
5. detachment (tendency to maintain emotional and interpersonal distance)

Question 3

What are the general diagnostic criteria for personality disorders?

Answer 3

• severe disturbance in behaviour and personality, not attributed to another organic disease, brain damage or psychiatric disorder
• marked disharmonious attitudes and behaviour affecting cognition, affectivity, impulse control, interpertional relations
• deviation/disturbance mist be enduring and pervasive
• must be evidence that the deviation is stable and of long duration

Question 4

Describe the main clinical features of the following personality disorders:

1. paranoid
2. schizoid
3. schizotypal
4. antisocial
5. EUPD - impulsive
6. EUPD - borderline
7. histronic
8. narcisstic
9. avoidant
10. dependent

Answer 4

1. sensitive; suspicious; distrust of others; preoccupoed with conspiratorial explanations
2. emotionally cold and detached; lack of interest in others; fantasy
3. interpersonal discomfort; peculiar ideas, perceptions and behaviour
4. callous unconcern for the feelings of others; gross and persistent attitude of irresponsibility and disregard for social norms, rules and obligations; very low threshold for discharge of aggression
5. tendency to act unexpectedly and without consideration of consequences; conflicts with others; outbursts of anger and violence; unstable mood
6. Liability to become involved in intense and unstable relationships, often leading to emotional abandonment; Excessive efforts to avoid abandonment; Recurrent threats or acts of self harm
7. self dramatisation, shallow effect; egocentricity; manipulative
8. gradiosity; lack of empathy; need for admiration
9. tension, self consciousness, fear of negative evaluation by others, timid, insecure
10. clingy, submissive, excessive need for care, feels helpless when not in a relationship

Question 5

What are the 3 clusters of PD categories?

Answer 5

1. CLUSTER A (odd/eccentric) - paranoid, schizoid, schizotypal
2. CLUSTER B (emotional/dramatic) - antisocial; histrionic; narcissistic; borderline
3. CLUSTER C (fearful/anxious) - avoidant, dependent, obsessive-compulsive

Question 6

Name the 4 main areas for which people with BPD tend to have dysfunctions in:

Answer 6

1. emotional instability
2. disturbed patterns of thinking/perception
3. impulsive behaviour
4. intense but unstable relationships with others

Question 7

Name environmental risk factors associated with the development of BPD

Answer 7

• emotional/phyiscal/sexual abuse
• long term fear/distress as a child
• childhood neglect
• growing up with a family member who has a serious psychiatric condition

Question 8

1. Name some emotional and interpersonal traits associated with psychopathy
2. name some behavioural manifestations of psychopathy

Answer 8

1. superficial charm
   grandiose sense of self worth
   pathological lying
   manipulation
   lack of remosrse or guily
   shallow affect

2. need for stimulation
    lack of realistic long term goals
    impulsivity
    irresponsibility
    criminal versitality

Question 9

Name 4 controversial issues surrounding personality disorders

Answer 9

1. TAUTOLOGY - i.e. the same features displayed by a patient, which suggest a diagnosis of PD, are then ‘explained’ by the presence of that diagnosis.
2. Some argue that psychiatry has no role in the treatment of people with personality disorders, because they argue that personality is by definition unchangeable
   (however others argue that psychiatry does have a role in the treatment of PD because people suffer symptoms related to their disorder, which warrants care and treatment)
3. personality is who we are - does that make it an illness?
4. Personality develops as our brain’s way of surviving as a result of life experiences. Does the way your brain adjusts to a hostile environment justify being considered personality disordered?

Question 10

1. What other psychiatric conditions have a familial link with personality disorders?
2. Describe the role of childhood development in the aetiology of personality disorders
3. Which neurophysiological changes are demonstrated in Personality Disorders?
4. Describe a psychodynamic theory of personality disorders

Answer 10

1. schizotypal PD and schizophrenia
   BPD and affective disorders
2. severe trauma in childhood, attachment disorder and early life adversity are all associated with children developing ways of coping that are later associated with risk of personality disorder
   - responsive to threats
   - keeps people distant to protect from pain of future rejection
3. decreased activity in amygdala
   reduced expression of oxytoxcin and dopamine receptors in the nucleus accumbens (reward centre) - dont experience relationships in a pleasurable way
4. arrested development at oral, anal and genital stages leading to dependent, obsessional and histrionic personalities

Question 11

What is the impact of a co-morbid personality disorder on other mental disorders (2)

Answer 11

• presentation may be masked or exaggerated

- usually makes treatment more difficult and worsens outcome

Question 12

Which type of psychotherapy is particularly useful in the management of borderline personality disorder?

Answer 12

Dialectical Behavioural Therapy