Psych - Personality Disorders

Question 1

What is the definition of personality disorder?

Answer 1

• Deeply ingrained and enduring patterns of behaviour that are abnormal in a particular culture
• They lead to subjective distress and sometimes cause distress to others
• These traits can normally be seen from adolescence but cannot be diagnosed as PD before the patient is an adult (>18)

Question 2

What are the important management principles for patients with PD?

Answer 2

• Need active work to engage them and to reverse past exclusion
• Structure, consistency and clear boundaries - especially when coming up to a discharge
• Need to make them be responsible for their own actions
• Provide support: housing, care
• Treatment: adapted CBT, dialectical behaviour and mentalisation based treatments, parent-training education programs targeting children with conduct disorder

Question 3

What are the cluster A types of PD?

Answer 3

‘Odd/eccentric’

• Paranoid
• Schizoid
• Schizotypal

Question 4

Describe the features of paranoid personality disorder

Answer 4

• Hypersensitivity and unforgiving attitude when insulted
• Unwarranted tendency to question the loyalty of friends
• Reluctance to confide in others
• Preoccupation with conspiratorial beliefs/hidden meaning
• Unwarranted tendency to perceive attacks on their character

Question 5

Outline the features of Schizoid personality disorder

Answer 5

• Indifference to praise and criticism
• Preference for solitary activities
• Lack of interest in sexual interactions
• Lack of desire for companionship
• Emotional coldness
• Few interests
• Few friends/confidants other than family

Question 6

Outline the features of schizotypal personality disorder

Answer 6

• Ideas of reference (differ from delusions - some insight is retained)
• Odd beliefs/magical thinking
• Unusual perceptual disturbances
• paranoid ideation/suspiciousness
• Odd/eccentric behaviour
• Lack of close friends other than close family members
• Inappropriate affect

Question 7

What are the cluster B types of PD?

Answer 7

‘Flamboyant/dramatic’

• Borderline/Emotionally unstable
• Histrionic
• Narcissistic (DSM)
• Antisocial (DSM)/dis-social (ICD)

Question 8

Describe the features of borderline personality disorder

Answer 8

• Efforts to avoid real or imagined abandonment
• Unstable interpersonal relationships which alternate between idealisation and devaluation
• Unstable self image
• Impulsivity in potentially self damaging area (spending, sex, substances)
• Recurrent suicidal behaviour
• Affective instability
• Chronic feelings of emptiness
• Difficulty controlling temper

Question 9

Describe the features of histrionic personality disorder

Answer 9

• Inappropriate sexual seductiveness
• Need to be the centre of attention
• Rapidly shift and shallow expressions of emotions
• Physical attention used for attention seeking purposes
• Self dramatisation

Question 10

Describe the features of narcissistic personality disorder

Answer 10

• Grandiose sense of self importance
• Preoccupation with fantasies of unlimited success, power and beauty
• Sense of entitlement
• Taking advantage of others to achieve own needs
• Lack of empathy
• Excessive need for admiration
• Chronic envy
• Arrogant and haughty attitude

Question 11

Describe the features of antisocial personality disorder

Answer 11

• Failure to conform to social normals wrt lawful behaviours (repeatedly perform acts that are grounds for arrest)
• More common in men
• Deception: repeated lying, use of aliases, conning others for profit or pleasure
• Impulsiveness or failure to plan ahead
• Irritability and aggressiveness (physical fights/assaults)
• Reckless disregard for safety of others
• Consistent irresponsibility (failure to sustain work/honour financial obligations)
• Lack of remorse: indifferent to or rationalising having hurt/mistreated or stolen from another

Question 12

What are the cluster C types of PD?

Answer 12

‘Fearful/anxious’

• Avoidant (DSM)/Anxious (ICD)
• Dependent
• Obsessive compulsive (ICD)/Anankastic (DSM)

Question 13

Describe the features of avoidant personality disorder

Answer 13

• Avoidance of occupational activities which involve significant interpersonal contact due to features of criticism or rejection
• Unwilling to be involved unless certain of being liked
• Preoccupied with ideas that they are being critiqued or rejected in social situations
• Reluctance to take personal risks due to features of embarrassment
• Social isolation accompanied by a craving for social contact

Question 14

Describe the features of dependent personality disorder

Answer 14

• Difficulty making every day decisions without excessive reassurance from others
• Need for others to assume responsibility for major areas of their life
• Difficulty expressing disagreement with others due to fears of losing support
• Lack of initiative
• Unrealistic fears of being left to care for themselves

Question 15

Describe the features of obsessive-compulsive personality disorder

Answer 15

• Occupied with details, rules, lists, order, organisation or agenda to the point that the key part of the activity is gone
• Demonstrates perfectionism that hampers with completing tasks
• Not capable of disposing worn out or insignificant things even if they have no sentimental meaning
• Stingy spending style towards self and others