Week 3 Topic 1

Question 1

What is personality?

Answer 1

There is no agreed definition, but it is someones enduring features, made up of traits and can influence situations

Question 2

What is personality disorder?

Answer 2

Variations or Exaggerations of normal personality attributes

Question 3

What does personality disorder impair?

Answer 3

Well-being and social functioning, and can reduce effectiveness of usual treatments

Question 4

Give 4 reasons why there was a shift from Categorical models to Dimensional Models?

Answer 4

1) Few people fit neatly into one box
2) Reliability of diagnosis is poor between different practitioners
3) Only a few of the categories are used in clinical practice
4) Dimensional models identify different traits or domains which represent the more pathological end of the OCEAN personality factors

Question 5

What are the BIG 5 (OCEAN) ?

Answer 5

Openness, Conscientiousness, Extraversion, Agreeableness, Neuroticism

Question 6

What is Borderline Personality Disorder?

Answer 6

A significant instability of interpersonal relationships, self image and mood

Question 7

Name 3 symptoms that may lead to a diagnosis of Borderline Personality Disorder?

Answer 7

Impulsive behaviour, Rapid fluctuations of mood, Fear of rejection

Question 8

Name 3 issues around diagnosis of Personality Disorder

Answer 8

Validity of diagnosis and low reliability, Atheoretical basis (less for new models), Stigma of “bad person”

Question 9

What can Personality Disorder overlap with?

Answer 9

Complex PTSD

Question 10

Name 3 benefits of retaining concept of Personality Disorder?

Answer 10

1) Pragmatism
2) Communication between staff
3) Choice of treatments with better outcomes

Question 11

Personality Disorder affects ___% of the general population

Answer 11

10

Question 12

Where is there a higher prevalence of Personality Disorder?

Answer 12

In mental health population

Question 13

__% - __% of adult prisoners have Personality Disorder

Answer 13

50-70

Question 14

There are differences in which _____ diagnosed more frequently in men and women

Answer 14

Categories

Question 15

How can biology explain Personality Disorders?

Answer 15

Dimensions have variable heritability, and genetic differences impact on resilience e.g. some people need less of a setback to go unstable

Question 16

What is the biggest risk factor for Personality Disorder?

Answer 16

Emotional neglect

Question 17

What family factors can explain Personality Disorders?

Answer 17

Insecure attachments (disorganised is the worst), Dysfunction in family mediated by attachment e.g. substance users, domestic violence, makes parents less reliable, Childhood trauma

Question 18

What is Disorganised attachment? (others are avoidant and ambivalent)

Answer 18

When there is a frightened or frightening caregiver, and the child experiences fear without a solution so alternates between flight, freezing, fighting

Question 19

What does the Model of Disorganised attachment say?

Answer 19

That Distress/Fear leads to Activation of an Attachment System, which then leads to Seeking proximity, which then leads to Exposure to Maltreatment

Question 20

What are the 5 Models of Therapy for BDP?

Answer 20

1) Mentalisation Based Therapy
2) Dialectical Behaviour Therapy
3) Schema Based Therapy
4) STEPPS programme
5) Structured Clinical Management

Question 21

What is Mentalisation? And why is it important?

Answer 21

Working out what is going on in your mind and the minds of others. Because the patient won’t know why they feel the way they do, they will just feel bad

Question 22

How can developing a disorganised attachment affect Mentalisation?

Answer 22

Because we internalise representations of ourselves from responses of an attachment figure, so therefore if this attachment is disorganised, our capacity to mentalise fails to develop sufficiently and our attachment system is triggered too easily

Question 23

So, what is the purpose of Mentalisation Based Therapy?

Answer 23

To focus on promotiong mentalisation about the self, others and relationships, focusing on keeping emotional arousal at an optimum level, delivered via a weekly group and 1:1 therapy

Question 24

What does Dialectical Behaviour Therapy aim to teach?

Answer 24

Skills to improve emotion regulation, as it views this as the primary dysfunction, as well as aims to improve distress tolerance and interpersonal functioning

Question 25

What 2 things does Dialectical Behaviour Therapy combine?

Answer 25

CBT and Mindfulness e.g. balancing opposites

Question 26

How is Dialectical Behaviour Therapy delivered?

Answer 26

Via weekly skills group and 1:1 therapy

Question 27

What does Schema Based Therapy say about Personality Disorder?

Answer 27

That it involves Early Maladaptive Schemas (EMS), which interfere with self expression, autonomy and social validation

Question 28

What does Schema Based Therapy focus on?

Answer 28

EMS are explored and related to developmental origins,

Question 29

What does the STEPPS programme focus on?

Answer 29

This is a highly structured psycho-educational 20 week group programme, with 1:1 reinforcement and teaching about schemas, as well as other CBT techniques

Question 30

What does the Structured Clinical Management focus on?

Answer 30

Draws on MBT and DBT, delivered by generalist mental health professionals and there is an emphasis on clear structure to treatment and active and collaborative, focus on learning to tolerate emotions

Question 31

Is there one Therapy that’s considered better for treating BPD?

Answer 31

No, no clear evidence