Personality Disorders

Question 1

what is a personality disorder?

Answer 1

A person with a personality disorder thinks, feels, behaves or relates to others very differently from the average person.

There are several different types of personality disorder.

Question 2

how does someones personality develop?

Answer 2

Develop in a network of relationships in a culture

Personality is the characteristics of the way someone relates to others, understands and manages their feelings, understands and manages their time, movements, habits and preferences. Somehow seems to determine to others who they are

Personality is who you are to others and to yourself. What makes this person different form the next person

Makes someone predictable to a situation you know well

Some of this will be genetic

The environment around a baby has a big impact on the child

Siblings

Culture and subculture they grow up in

Question 3

The idea of personality disorder:

• People can have habitual ways of relating to others, and managing their feelings, that wind up being very __________, and the focus of clinical concern
• While personalities are complex and multifaceted, there can be _________ patterns
• Defining those ________ can be helpful

Answer 3

problematic

predictable

patterns

Question 4

what do you need to think about when dealing with someone with a personality disorder?

Answer 4

Got to think about what the person is, what specific traits of someone’s personality get in the way for them, what they specifically want to be different, what specific problems in their back ground have lead into them having these particular traits of their personality disorder being eventuated

Question 5

what classifys persoanlity dissorders?

Answer 5

• ICD-10 shows a description of the disorder
• DSM-5 gives specific operationalised diagnosis (4 or more of the following things etc..)
• ICD-11 will adopt a dimensional approach with specifiers for specific traits (mild, moderate, severe personality disorder or less that mild which is personality dysfunction)

Question 6

what is the most commonly recognised persoanlity disorder?

Answer 6

borderline persoanlity disorder

Question 7

what is Borderline Personality Disorder?

Answer 7

When relationships are strained, real distress, with frantic efforts to avoid abandonment; self-injury sometimes to regulate feelings; transient stress-related mood and psychotic-like disturbances

They have had serious problems with attachment relationships early in life in where they’ve had real reason not to trust people or not to feel safe

would often co-occurrence with mental illnesses like depressive illnesses in

disturbed ways of thinking, impulsive behaviour and problems controlling their emotions

They may have intense but unstable relationships and worry about people abandoning them

Question 8

what are the Symptoms of borderline personality disorder (BPD)?

Answer 8

The symptoms of BPD can be grouped into 4 main areas:

emotional instability – the psychological term for this is affective dysregulation

disturbed patterns of thinking or perception – cognitive distortions or perceptual distortions

impulsive behaviour

intense but unstable relationships with others

Question 9

what causes BPD?

Answer 9

BPD appears to result from a combination of genetic and environmental factors.

Traumatic events that occur during childhood are associated with developing BPD.

Many people with BPD will have experienced parental neglect or physical, sexual or emotional abuse during their childhood.

Question 10

what is the management of BPD?

Answer 10

• Work may be on improving capacity to keep reflective function at times of distress—Mentalization-Based Treatment
• Or it could be on improving skills for distress tolerance and helping make emotions more predictable—Dialectical Behaviour Therapy

psychotherapy

Question 11

what is Antisocial Personality Disorder?

Answer 11

A person with antisocial personality disorder will typically get easily frustrated and have difficulty controlling their anger

They may blame other people for problems in their life, and be aggressive and violent, upsetting others with their behaviour.

characterised by impulsive, irresponsible and often criminal behaviour

• Tendency towards offending behaviour, difficulties with impulse control and anger, often difficulty with empathic concern for others

Question 12

what is a severe form os antisocial persoanlity disorder?

Answer 12

Psychopaths are considered to have a severe form of antisocial personality disorder

Question 13

what are the signs of antisocial persoanlity disorder?

Answer 13

exploit, manipulate or violate the rights of others

lack concern, regret or remorse about other people’s distress

behave irresponsibly and show disregard for normal social behaviour

have difficulty sustaining long-term relationships

be unable to control their anger

lack guilt, or not learn from their mistakes

blame others for problems in their lives

repeatedly break the law

Question 14

Who develops antisocial personality disorder?

Answer 14

Antisocial personality disorder affects more men than women.

It’s not known why some people develop antisocial personality disorder, but both genetics and traumatic childhood experiences, such as child abuse or neglect, are thought to play a role.

A person with antisocial personality disorder will have often grown up in difficult family circumstances

Question 15

what is the management of antisocial persoanlity disorder?

Answer 15

antisocial personality disorder is one of the most difficult types of personality disorders to treat

may also be reluctant to seek treatment and may only start therapy when ordered to do so by a court

recommended treatment will depend on their circumstances, taking into account factors such as age, offending history and whether there are any associated problems, such as alcohol or drug misuse

The person’s family and friends will often play an active role in making decisions about their treatment and care

Question 16

Other Personality Disorders: Specific Personality Disorders

what is cluster A?

Answer 16

Paranoid, Schizoid, Schizotypal

Question 17

Other Personality Disorders: Specific Personality Disorders

what is cluster B?

Answer 17

Narcissistic, Histrionic

Question 18

Other Personality Disorders: Specific Personality Disorders

what is cluster C?

Answer 18

Avoidant, Dependent, Obsessive-Compulsive/Anankastic

Question 19

summary of the different specific persoanlity disorders:

Answer 19

Question 20

cluster A:

what is paranoid persoanlity disorder?

Answer 20

This is characterised by a general distrust of others that markedly gets in the way of any ordinary relating. The distrust can be seen directly as distrust, or by its effect, such as a tendency to anger and to feel slighted. This is rarely of significant clinical concern, because the patients do not seek treatment. Sufferers may had important reasons to feel like their boundaries, including those relating to their bodily integrity, are at threat—often because they have been in the past

Question 21

cluster A:

what is Schizoid Personality Disorder?

Answer 21

This is characterised by, outwardly, an indifference to social contact with others. Patients often are strikingly unbothered by their lack of sociality. However, there is often a rich fantasy life, and analytically-inclined psychiatrists can think that these patients have a deep yearning for relatedness. The small number of patients who recognise that they have a problem and want it to be different probably can improve in long-term psychodynamic psychotherapy

Question 22

cluster A:

what is Schizotypal Personality Disorder?

Answer 22

In the ICD-10, this is considered not as a personality disorder but as a Schizophrenia-spectrum condition. These are patients who come across as markedly odd—eccentric beyond eccentric. They often have psychotic-like experiences, like intuitions, magical thoughts, and so on. This is not a good prognostic sign for work in psychotherapy

Question 23

cluster B:

what is Narcissistic Personality Disorder?

Answer 23

People with Narcissistic Personality Disorder outwardly have a very high opinion of themselves, and very little sense of what matters to others. However, most psychotherapists find these patients in fact to have a deep sense of their inadequacy that is very painful for them to get close to, so they deny it. It is not a disorder of particular clinical concern because people would only be likely to present obliquely—why would someone with little wrong with them want treatment? In some offender-patients, narcissistic traits can be relevant to the formulation of their offending and way of approaching treatment, but even in them it is very rare that they would meet the DSM-5 criteria for NPD. It could not be agreed upon for the ICD-10

Question 24

cluster B:

what is historic personality disorder?

Answer 24

This is rarely a disorder of particular clinical interest. A small number of patients have a tendency to dramatic displays of emotion that seem to ring hollow, and may be openly flirtatious and continuously seeking appreciation. While people may have histrionic traits that they may work on in therapy—thinking about why their experience has led them to relate in this way rather than more directly—patients do not come for treatment with this as a diagnosis in my experience

Question 25

cluster C:

what is - Obsessive-Compulsive Personality Disorder (Anankastic Personality Disorder in ICD-10)?

Answer 25

This is very different from the mental illness, Obsessive Compulsive Disorder, where someone has strong intrusive thoughts that are calmed by rituals

It is about a tendency towards obstinateness, rigidity, and significant anxiety at anything that is disorderly. It is not often directly a presenting complaint: the presentation may be with the associated anxiety, which on closer history-taking turns out not to be episodic but lifelong. People with OCPD can improve in psychodynamic psychotherapy, but it is rarely that someone comes with a single OCPD diagnosis. Someone may have OCPD and have had something happen that leads them into a symptomatic anxiety disorder, say a Panic Disorder with Agoraphobia, and improve with treatment of that but still have the OCPD

Question 26

clyster C:

what is Dependent Personality Disorder?

Answer 26

This is a somewhat problematic idea of limited clinical relevance. This is where a person has a marked difficulty with assuming appropriate adult responsibilities, and defers to others in all areas, rarely seeing any way in which they can manage things themselves. This is not a problem of significant clinical concern. If someone’s mental illness is complicated by dependent traits, then usual clinical management of the co-occurring disorder would probably be augmented by an approach that gently encourages the patient to see their own strengths

Question 27

cluster C:

what is Avoidant Personality Disorder?

Answer 27

This is also slightly problematic. Someone can have strong avoidant traits—tend not to allow conflict, tend to put off their problems—but in my opinion it rarely would be of the degree that leads to clinically-significant impairment as a single diagnosis. A highly avoidant personality type may make difficulties understandable or help with the formulation. For example, someone with very avoidant traits may keep away from all conflict and anxiety-provoking things, and build up a large number of problems over which they feel powerless as they become progressively more depressed. The Depressive Episode’s origins might be formulated with this in mind, but it would still need treated, albeit with the traits considered