Personality Problems

Question 1

Personality traits vs Personality disorder

Answer 1

Traits = enduring patterns of perceiving, thinking about, and relating to both self and the environment, exhibited in a wide range of social and personal contexts

Disorder = individual traits are persistently inflexible and maladaptive, stable over time, which cause significant personal distress or functional impairment

Question 2

Classification of personality disorders by aetiology - acquired vs specific

Answer 2

Acquired
- develops after, or directly related to, recognisable insult

Specific

• difficult to find direct causal relationship, but genetic and environmental factors are implicated; adolescence or early adult onset
• -> dimensional approach: disorders exist on a continuum from normal to severely ill; used in research
• -> categorical approach: distinct types of personality disorder (seldom accurate representation of reality as there is considerable overlap of traits and most individuals don’t fit perfectly)

Question 3

Diagnostic criteria for general personality disorder

Answer 3

1. Enduring pattern of inner experience and behaviour that deviates markedly from the expectations of the individual’s culture in >2 of the following:
   - cognition (way of perceiving and interpreting)
   - affectivity
   - interpersonal functioning
   - impulse control
2. Inflexible and pervasive pattern across a broad range of personal and social situations
3. Clinically significant distress or impairment in functioning
4. Stable and long duration, onset traced back to adolescent or early adulthood
5. Not better explained by another mental disorder and not attributable to substance or medical condition

Question 4

Cluster A personalities - “odd or eccentric”

Answer 4

Paranoid

• suspects others are harming, exploiting, or deceiving them
• doubts spouse’s fidelity
• bears grudges
• tenacious sense of personal rights, litigious

Schizoid

• emotional coldness
• prefers solitary activities, takes pleasure in few activities
• indifferent to praise or criticism

Schizotypal

• eccentric, odd beliefs or magical thinking
• unusual perceptual experiences; ideas of reference, suspicious or paranoid ideas
• circumstantial thinking
• socially withdrawn

Question 5

Cluster B personalities - “dramatic, emotional, erratic”

Answer 5

Borderline

• unstable, intense relationships
• unstable self-image, mood fluctuations
• impulsivity (binge eating, sex, spending money, substance abuse)
• chronic feelings of emptiness, repetitive suicidal or self-harm behaviour
• frantic efforts to avoid abandonment

Antisocial

• repeated unlawful or aggressive behaviour, lying, deceitfulness, reckless irresponsibility
• lack of remorse or incapacity to feel guilt
• often have conduct disorder in childhood

Histrionic

• dramatic, exaggerated expressions of emotion, attention seeking
• seductive behaviour

Narcissistic
- grandiose sense of self-importance, need for admiration

Question 6

Cluster C personalities - “anxious or fearful”

Answer 6

Dependent

• excessive need to be cared for
• submissive, clinging, fear of separation

Avoidant

• hypersensitivity to critical remarks or rejection
• fears of inadequacy, inhibited in social situations

Obsessive compulsive

• preoccupation with orderliness, perfectionism and control
• devoted to work at expense of leisure
• pedantic, rigid, stubborn

Question 7

Aetiology and associations of personality disorders

Answer 7

GENETIC
Disordered attachment leads to difficult relationships –> may manifest as personality disorders

Cluster A more common in FHx of schizophrenia
Schizoid and schizotypal neurodevelopment disorders?

Borderline personality disorder –> depression more common
Early adverse social circumstances a/w cluster B personality disorders

Question 8

Management of borderline personality disorder

Answer 8

Careful planning, structure; autonomy and choice encouraged
Multidisciplinary approach

Crisis management

• self-management strategies, sources of support
• short term drugs to alleviate distress
• crisis resolution or home tx considered before admission

Pharmacological

• treat comorbid mental illness
• antidepressants may be used in depressive symptoms
• SSRI may have OC or impulsive behaviour
• mood stabilisers in aggression, impulsivity

Psychosocial

• psychoeducation
• coping strategies, relaxation, distraction, skills/hobbies
• social services: housing, finances, employment

Long term management

• CBT
• psychodynamic psychotherapy
• cognitive analytic therapy
• mentalisation based therapy - understand what is going on in their minds and minds of others
• dialectical behaviour therapy