W8: Personality Disorders

Question 1

When is the typical onset of personality disorders

Answer 1

adolescence or early adult hood

to diagnose before the age of 18 the symptoms need to be present for at least 12 months

Except for antisocial personality disorderThat can only be diagnosed and individuals who are older than 18

Question 2

Personality disorders can be

Answer 2

Difficult to diagnose it often takes multiple sessions together the information needed to assist the diagnosis

Question 3

Individuals with personality disorders tend to

Answer 3

Use mental health services at a much higher rate than individuals without personality disorders 

Question 4

What are the two sections in the DSM that personality disorders can be coded as

Answer 4

Categorical (present/absent)

Dimensional (traits on a continuum)

Question 5

What is the dimensional approach to personality disorder diagnosis

Answer 5

It involves diagnosing a personality disorder based on pathological personality traits – these personality traits are considered to be a disorder when they are in flexible, maladaptive and cause significant distress or impairment in functioning

Question 6

What is the level of personality functioning scale used for

Answer 6

Used to provide a global score ranging from no impairment to extreme impairment

Question 7

What are the pathological personality traits in the dimensional approach to personality disorders (5)

Answer 7

1. Negative affectivity (anxiousness, hostility, separation insecurity, submissiveness, restricted/lack of affectivity)
2. Detachment (anhedonia, depressive therapy, intimacy avoidance, suspiciousness, withdrawal)
3. Antagonism (attention seeking, callousness, deceitfulness, manipulativeness)
4. Disinhibition (distractibility, impulsivity, risk taking, irresponsibility)
5. Psychoticism (eccentricity, perceptual dysregulation, unusual beliefs and experiences)

Question 8

What does the dimensional approach of personality disorders say in the DSM

Answer 8

Moderate or greater impairment in personality functioning

One or more pathological personality traits

The impairment in personality functioning and the individuals personality trait expression are:

• relatively inflexible and pervasive across a range of personal and social situations
• relatively stable across time with onset that can be traced back to at least adolescence or early adult hood

Not better explained by another mental disorder, substance or a medical condition and they are not better understood as normal for an individual‘s developmental stage or sociocultural environment

Question 9

In the categorical approach to personality disorders DSM divides the disorders into three clusters what are these three clusters?

Answer 9

A: odd, eccentric cluster
B: dramatic, emotional, erratic cluster
C: anxious, fearful cluster

Question 10

What personality disorders are part of a cluster A

Answer 10

Paranoid personality disorder
• Characterized by excessive distrust and suspiciousness

Schizoid personality disorder
• Characterized by severe disinterest in social relationships and restricted range of emotional expression

Schizotypal personality disorder
• Characterized by extreme discomfort in relationships and odd/eccentric behaviour

Question 11

What personality disorders are a part of cluster B 

Answer 11

Antisocial personality disorder
• Characterized by significant disregard for and violation of the rights of others

Borderline personality disorder
• Characterized by extreme impulsivity, unstable sense of self and instability in interpersonal relationships

Histrionic personality disorder
• Characterized by patterns of intense emotionality and attention seeking

Narcissistic personality disorder
• Characterized by grandiosity and need for admiration

Question 12

What personality disorders are part of cluster C

Answer 12

Avoidant personality disorder
• Characterized by extreme feelings of inadequacy, hypersensitivity to
negative evaluation and social avoidance

Dependent personality disorder
• Characterized by clingy and submissive behaviour and an excessive need to be taken care of

Obsessive compulsive personality disorder
• Characterized by preoccupation with orderliness, perfectionism and
control

Question 13

What are the advantages of using the categorical approach

Answer 13

Used for decades

Easy transmission of information between clinicians

Helpful for devising evidence based treatment

Question 14

What are the disadvantages of using the categorical approach

Answer 14

Diagnoses are not stable they may meet diagnostic criteria only at certain points in life for example severity decreasing with age

Do you not have great interrater reliability

Stigmatising

Question 15

What are the advantages to using the dimensional approach

Answer 15

Trait descriptions are more stable overtime

Provides more descriptive information for clinicians

Avoids patient getting multiple personality disorder diagnoses

Question 16

What is a disadvantage to using the dimensional approach to personality disorders

Answer 16

It is not clear when a dimension becomes pathological

Traits vs. clinical significance 

Question 17

What does the DSM say about Schizotypal personality disorder

Answer 17

Pervasive patterns of social and interpersonal deficits marked by:
– Acute discomfort with and reduced capacity for close relationships
– Cognitive or perceptual distortion and eccentricities of behaviour

Beginning by early adult hood and present in a variety of contexts, 5 or more of the following:
– Ideas of reference – the person often interpret external events has been relevant to them
– Odd beliefs – magical thinking that influences behaviour and is inconsistent with cultural norms for example superstitious 
– Unusual perceptual experiences-sensing that events will occur in the future
- odd thinking and speech
- suspiciousness or paranoid ideation
- inappropriate or constructed affect
- behaviour or appearance that is odd, eccentric or peculiar
- lack of Close friends or confidants other than first degree relatives
-Excessive social anxiety that does not diminish with familiarity and tends to be associated with paranoid fears rather than negative judgements about yourself

This does not occur exclusively during the course of schizophrenia or bipolar disorder or depressive disorder with psychotic features or autism spectrum disorder

Question 18

What treatment is there for schizotypal personality disorder

Answer 18

Treatment includes medical and psychological treatments

A combination of antipsychotic medication, community treatment and therapy including social skills training

CBT can be used for psychosis to have the thought patterns changed

Early intervention is preferred 

Question 19

What is social skills training

Answer 19

It can form a part of cognitive behavioural therapy programs and it is a structured and therapeutic approach to teaching clients how to interact with others

It involves teaching the rules of social interaction through psychoeducation modelling role-play and behavioural experiments 

Question 20

What does the DSM say about borderline personality disorder

Answer 20

Instability of interpersonal relationships, self image, affect, and marked impulsivity

Early adulthood

– Frantic efforts to avoid real or imagined abandonment 
- alternating between extremes of idealisation and evaluation partner
– Identity disturbance through unstable self image or sense of self
– An impulsivity in at least two areas that are potentially self-damaging e.g. substance use reckless driving
– Recurrent suicidal behaviour, gestures or threats
-Effective instability due to marked reactivity in mood (eg. Intense episodic dysphoria, irritability or anxiety usually lasting hours and only rarely more than a few days)
– Chronic feelings of emptiness
-Inappropriate, intense anger or difficulty controlling anger
– Transient, stress related paranoid ideation or severe Dissociative symptoms

Question 21

Borderline personality disorder and abuse

Answer 21

People with this personality disorder are more likely than individuals with other personality disorders to report and abusive history

Question 22

What is linehan’s diathesis-stress theory? 

Answer 22

People with borderline personality disorder have a biological diathesis 

They are then raised in an environment that is invalidating and the person‘s feelings are discounted and disrespected

Question 23

How do you know if it’s borderline personality disorder or complex PTSD

Answer 23

They share things like emotional dysregulation, self-destructive behaviours, suicidal tendencies, dissociation and paranoia, negative self image, feelings of emptiness and sense of numbness

However Borderline personality disorder include things such as impulsivity, fear of abandonment, and inappropriate anger, extreme mood swings and unstable relationships

In complex PTSD they have nightmares, somatic distress, hypervigilance, sense of threat, avoidance, flashbacks and unwanted memories


Question 24

What is the treatment for borderline personality disorder

Answer 24

A variant of cognitive behavioural therapy called dialectal behavioural therapy – it involves helping the client regulate emotions and cope with stresses that might trigger self-destructive behaviours

It involves for skills that are taught in a rotating fashion:
Mindfulness skills (calm physiological arousal and dampen the sympathetic nervous system)
Interpersonal skills (how to interact with others)
Emotional regulation
Distress tolerance skills (help tolerate stressful life situations so they are less likely to engage in self destructive behaviours) 

Question 25

What does the DSM say about avoidant personality disorder

Answer 25

A pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation, beginning by early adult hood and present in a variety of context as indicated by four or more of the following:
– Avoids occupational activities that involve significant interpersonal contact because of fears of criticism, disapproval or rejection
– Is unwilling to get involved with people unless certain of being liked
– Shows restraint with intimate relationships because of the fear of being shamed or ridiculed
-Is preoccupied with being criticised or rejected in social situations
-Is inhibited in new interpersonal situations because of feelings of inadequacy
– Views self as socially inept, personally and appealing, or inferior to others
– Is unusually reluctant to take personal risks or engage in any new activity because they may prove embarrassing


Question 26

Avoidant personality disorder has been considered

Answer 26

An extreme and pervasive form of social anxiety disorder

Question 27

What treatment is there for avoidant personality disorder

Answer 27

CBT focusing on behavioural activation, behavioural experiments and social skills training is indicated

A therapeutic alliance is vital for all clients but is particularly important for treatment success with this client group – you may need to take it slower and build up a secure base you may begin with phone calls prior to meeting in person

Question 28

What is the gold standard in assessment for personality disorders

Answer 28

Structured clinical interview for DSM-5 personality (book)

It’s a semistructured interview where you gather information as to whether they make criteria or not

Question 29

Many people with personality disorders enter treatment for

Answer 29

Reasons other than their personality disorder such as depression anxiety or a crisis