Personality disorders

Question 1

What is a personality disorder?

Answer 1

Enduring pattern of behaviour that manifests itself as inflexible responses to personal and social situations

Question 2

What are the different types of personality disorder?

Answer 2

EUPD
Paranoid
Schizoid
Antisocial
Narcissistic
Histrionic
Anankastic (obsessional)
Dependent

Question 3

What is EUPD?

Answer 3

Impulsive actions
Intense, short-lived emotional attachments
Chronic internal emptiness
Frequent self-harm
Transient pseudo-psychotic features
Strong family history of mood disorders
A disorder of mood and how a person interacts with others
Differs significantly from an average person in terms of how he/she thinks, perceives, feels, or relates to others
Emotionally unstable, anxiety, and pattern of self-destructive behaviour

Question 4

What is paranoid PD?

Answer 4

Extreme sensitivity
Suspicion
Litgiousness
Self-importance
Preoccupations with conspiracy theories

Question 5

What is schizoid PD?

Answer 5

Emotional coldness and detachment
Limited capacity to express emotions
Indifference to praise or criticism
Preference for solitary activities
Lack of close friendships
Marked insensitivity to social norms

Question 6

What is antisocial PD?

Answer 6

Callous unconcern for the feelings of others
Incapacity to maintain enduring relationships
Very low tolerance of frustration
Incapacity to experience guilt and to learn from experience
Tendency to blame others

Question 7

What is narcissistic PD?

Answer 7

Inflated sense of self-importance
Need to be admired
Self-referential nature
Arrogance

Question 8

What is histrionic PD?

Answer 8

Self-dramatization, theatrically, suggestibility
Shallow and labile emotions
Continual seeking for excitement and appreciation
Inappropriately seductive appearance and behaviour

Question 9

What is anankastic PD?

Answer 9

Feelings of excessive doubt and caution
Preoccupation with details, rules and order
Perfectionism
Excessive conscientiousness, scrupulousness, pedantry, and rigidity

Question 10

What is dependent PD?

Answer 10

Encouragement of others to make their personal decisions
Subordination of their needs to others
Unwillingness to make demands on others
Feelings of inability to care for themselves
Preoccupation with fears of being abandoned

Question 11

What are the different types of EUPD?

Answer 11

Borderline - more difficulties with relationships, self-harming, and feelings of emptiness
Impulsive - more difficulties with impulse behaviour and angry feelings

Question 12

What important questions should you ask in a history?

Answer 12

What are your relationships like?
Do you change your emotions a lot?
Have you ever self-harmed?
Have you ever had any suicidal thoughts?
Have you ever heard voices?
How quickly do their emotions change?
Do you make impulsive decisions?

Question 13

What are the risk factors for EUPD?

Answer 13

Abandonment in childhood/adolescence
Disrupted family life
Poor communication in family
Sexual, physical, and emotional abuse
Female
Hospitalised psychiatric patients

Question 14

How common is EUPD?

Answer 14

Most often seen in women
0.7-2%
20% of patients in psychiatric wards
High in prison population

Question 15

What are the differential diagnoses of EUPD?

Answer 15

Bipolar disorder
Major depression
Schizophrenia
ADD
PTSD

Question 16

How does EUPD present?

Answer 16

Emotional instability
- Severe mood swings over a short space of time
- Repeated crises and acts of self-injury
- Frequent displays of inappropriate anger
Disturbed patterns of thinking or perception
- Upsetting thought
- Brief episodes of strange experiences - hallucinations
- Prolonged episodes of abnormal experiences
Impulsive behaviour
- Impulse to self-harm
- Impulsiveness such as substance abuse or sexual relationships
- Spending sprees, binge drinking, drug misuse, gambling
Intense but unstable relationships with others
- Intense fear of being abandoned
- May also feel smothered leading to a love-hate relationship
- Cannot tolerate being alone
- Views of other people changing quickly
Uncertainty about identity
Interests and values change rapidly
Frequent feelings of emptiness and boredom

Question 17

What is the pathology of EUPD?

Answer 17

Genetics
Altered levels of serotonin in brain
Smaller amygdala, hippocampus, and orbitofrontal cortex
Environmental factors - emotional, physical, or sexual abuse, neglect, growing up with family member with severe mental health conditions

Question 18

What investigations should you do for EUPD?

Answer 18

Answering yes to 5/more of following questions

• Do you have an intense fear of being alone, causing you to act in ways that, on reflection, seem out of the ordinary or extreme such as constantly phoning someone?
• Do you have a pattern of intense and unstable relationships with other people switching between thinking you long someone to hating them?
• Do you ever feel you don’t have a strong sense of your own self and are unclear about you self-image?
• Do you engage in impulsive activities in 2 areas that are potentially damaging?
• Have you made repeated suicide threats/attempts in your past and engaged in self-harming?
• Do you have mood swings?
• Do you have long-term feelings of emptiness and loneliness?
• Do you have sudden and intense feelings of anger and aggression?
• When you find yourself in stressful situations, do you have feelings of paranoia or do you feel you are disconnected from the world or from your own body?

Question 19

How is EUPD managed?

Answer 19

CPA
- Assessment of health and social needs
- Care plan
- Appointments of care co-ordinator
- Reviews
Psychotherapy
DBT/MBT
Therapeutic communities
Art therapies
Numbers to contact if you're experiencing a crisis

Question 20

What is the prognosis of EUPD?

Answer 20

With treatment, many learn to manage symptoms and improve quality of life
Without treatment, often have increased risk of drug and alcohol abuse, depression, self-harm and suicide