Personality Disorders

Question 1

What is a personality disorder?

Answer 1

Personality – i.e. enduring traits – which causes distress to self/others and/or impairs social functioning.
3 DSM-5 clusters: odd/eccentric (A), dramatic/emotional (B), and anxious/avoidant (C).

Question 2

What is cluster A of personaility disorders?

Answer 2

Odd or eccentric personality disorders
Cluster A in DSM-5.

Paranoid
Resentful and self-important.
Suspicious and distrustful.
Bears grudges and may counter-attack.
Schizoid
Cold, aloof, introspective, and misanthropic.
Lacks enjoyment.
Schizotypal
Social anxiety.
Odd behaviours and beliefs.

Question 3

What is cluster B of personality disorders?

Answer 3

Dramatic or emotional personality disorders
Cluster B in DSM-5.

Antisocial
Aka dissocial PD, psychopathy, dangerous and severe personality disorder.
Disregard for rights of others.
Little remorse for actions.
Borderline
Aka emotionally-unstable PD.
Rapid-fluctuating mood and strong emotions.
Impulsive. Often self-harm and misuse substances.
Intense unstable relationships.
Commonest in young women.
Histrionic
Shallow and labile affect.
Dramatic and suggestible.
Concern with physical attractiveness.
Narcicisstic
Preoccupied with prestige and appearance. Attention-seeking.
Think they’re superior and have a strong sense of entitlement.
Lack empathy or true intimacy in relationships.
Critical of others but cannot handle criticism.

Question 4

What is cluster C of personality disorders?

Answer 4

Anxious or avoidant personality disorders
Cluster C in DSM-5.

Avoidant
Aka anxious PD.
Want acceptance but expect rejection and fear embarrassment.
Severely hurt by criticism.
Consequently, avoid others.
Dependant
Submissive.
Feel they can’t look after themselves and allow others to make decisions for them.
Obsessive-compulsive
Aka anankastic PD.
Perfectionist, pedantic, and inflexible. Like routines, lists, and organisation. May be obsessed with work. Morally rigid.
Unlike OCD, they derive contentment and enjoyment from perfection and rituals. Tend to seek help when friends/relatives tell them to, unlike in OCD where people seek help for their distress.

Question 5

How can personality disorders be managed?

Answer 5

There are few specific therapies for personality disorders. Often, providing psychoeducation and support is the most effective intervention.

Biological:

Little evidence of direct benefit for personality disorders.
More likely to be used for treatment of psychiatric co-morbidities, which is key.
Psychosocial:

Psychotherapy may focus on problem-solving for difficult emotions and behaviours, and negotiating the interpersonal problems they face.
Approaches include CBT and dialectical behavioural therapy (DBT). DBT involves individual and group sessions, and combines elements of mindfulness and CBT, as well as building self-esteem.
Where relevant, involve family in treatment, including for crisis management.