Important Questions for IGNOU PGDCFT MSCCFT MCFT002 Exam with Main Points for Answer - Unit 12

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Unit 12 Personality Disorders

1. How is ‘personality’ defined?

Personality can be defined as the dynamic organisation of temperamental and character traits within an individual that determines her or his unique adjustment with her or his environment.

2. How are personality disorders classified by DSM-IV?

Depending on the predominating characteristics, the DSM-IV describes three clusters of personality disorders. Cluster A personalities are characterised by behavioural oddities or eccentric features (paranoid, schizoid, and schizotypal); Cluster B personalities show dramatic, impulsive and erratic features (borderline, antisocial, narcissistic and histrionic); and Cluster C personality disorders are characterised by anxious and fearful features (avoidant, dependent and obsessive-compulsive).

3. What are the characteristic features of Cluster A personality disorders?

The characteristic features of Cluster A personality disorders are odd and eccentric features.

4. What are the characteristic features of Cluster B personality disorders?

The characteristic features of Cluster B personality disorders are dramatic, impulsive and erratic features.

5. What are the characteristic features of Cluster C personality disorders?

The characteristic features of Cluster C personality disorders are anxious and fearful features.

6. What are the predominant symptoms of various personality disorders?

a) Paranoid personality - Suspicious and distrustful

b) Borderline personality - Unstable emotionality and interpersonal relationships

c) Anankastic personality - Preoccupied with perfectionism and rules

d) Schizotypal personality - Odd and eccentric; with referential thinking.

e) Schizoid personality - Aloof and emotionally cold.

f) Histrionic personality - Dramatic and attention seeking.

g) Anxious-avoidant personality - Persistent anxiety and feelings of inferiority.

7. Enumerate the psychosocial factors that are responsible for the development of personality disorders.

Following are the phychosocial factors that are responsible for the development of personality disorders:

i) Early childhood experiences like child physical abuse, child sexual abuse or childhood neglect;

ii) Family factors like lack of parental affection, overprotective parenting, parental unavailability, insensitivity or instrusiveness etc.; and

iii) Phychological factors.

8. Describe some of the maladaptive defense mechanisms used by personality-disordered individuals.

Some of the maladaptive defense mechanisms used by personality disordered individuals are like paranoid personalities, for instance, use projection, a process of projecting one’s feelings on to others resulting in the faultfinding behaviour and excessive sensitivity to criticism.

Schizoid personalities use withdrawal and excessive fantasy thinking, wherein they seek satisfaction by creating imaginary friends and lives, thereby becoming aloof and asocial.

Histrionic personalities, who are often seen as dramatising and emotionally shallow use denial as a major defense mechanism whereby the individual ‘denies’ the existence of unpleasant feelings by substituting them with pleasant ones.

Splitting is a defense mechanism used primarily by borderline personalities who tend to classify people as all good or all bad, leading to their vacillating between idealising people and hating them.

9. Who proposed the Temperament and Character Inventory for assessment of the 7 dimensions of personality?

Robert Cloninger

10. What are the two common diagnostic interviews used for formal assessment of personality disorders?

International Personality Disorders Examination (IPDE) and
Diagnostic Interview for DSM-IV Personality Disorders (DIPD-IV)

11. What are the two common self-administered questionnaires for assessment of personality dimensions?

Temperament and Character Inventory (TCI) and
Revised NEO Personality Inventory

12. Describe the principles of management of personality disorders.

Managing personality disorders requires a multifaceted approach involving a collaborative team of mental health professionals and a combination of tailored interventions. The goal is to improve functionality and quality of life, though a complete "cure" may not always be possible.

Collaborative and Individualised Care: Treatment necessitates collaboration between psychiatrists, psychologists, social workers, and family therapists to create an individualised plan addressing the patient's unique needs. No single treatment works for everyone, and plans must be adapted to each patient's specific diagnosis, symptom severity, co-occurring conditions, and personal preferences.
Combined Approach: Treatment typically involves a combination of medication and therapy.

Pharmacological interventions aim to alleviate specific symptoms such as mood swings, anxiety, and impulsivity. Medications might include antidepressants, anxiolytics, mood stabilisers, and antipsychotics, chosen based on individual needs.
Non-pharmacological interventions, mainly psychotherapy, address the underlying maladaptive thoughts, feelings, and behaviours that contribute to the personality disorder.

Addressing Underlying Beliefs and Behaviours: Therapies, especially cognitive-behavioural therapies (CBT), are crucial in helping patients identify and modify unhelpful thought patterns and schemas, develop coping mechanisms, and learn more effective interpersonal skills.
Specific Therapeutic Approaches: The sources outline various therapy approaches tailored to each personality disorder. For example, therapy for paranoid personality disorder focuses on building trust and addressing threat perception, while dialectical behaviour therapy (DBT) is commonly used for borderline personality disorder, focusing on emotional regulation and interpersonal effectiveness.
Family Involvement: Family involvement is crucial. Families can provide support, encouragement, and help with medication adherence. Family therapy can address dysfunctional family dynamics, and psychoeducation helps families understand the disorder and develop coping strategies.
Long-Term Management and Addressing Co-Occurring Disorders: As personality disorders involve enduring behaviour patterns, long-term management is often necessary. Continuous monitoring, relapse prevention, and ongoing support are important. It's also vital to assess and treat any co-occurring mental health disorders like depression or anxiety, as they can worsen symptoms and complicate treatment.
Ethical considerations like confidentiality, informed consent, and respecting the individual's autonomy must be kept in mind throughout the management process.

13. Describe the course and outcome of any three personality disorders.

Both classificatory systems (DSM and ICD) emphasise the idea that personality disorders are stable.
All personality disorders usually emerge in mid to late adolescence, with the behavioural disturbance in adolescence continuing into adulthood.
Personality disorders usually last very long, but not necessarily for life, and in some, like antisocial personality, the symptoms improve as the person grows older.
Paranoid personalities sometimes go on to suffer from schizophrenia. They usually have lifelong
problems with work and interpersonal relations. It has been reported that 10 per cent of those with schizotypal personalities eventually committed suicide, though some people still manage to live normal lives, work and run a family.
Antisocial and histrionic personalities commonly develop substance use disorders.
Borderline personalities usually suffer from comorbid depressive disorders.
Narcissistic personalities are very difficult to treat. They often have to suffer due to experiences which do not reinforce their beliefs about themselves.
Dependent personalities find it difficult to work as they require constant supervision and they tend to relate only to people on whom they can depend.
Some individuals with obsessive-compulsive disorder go on to live normal lives while in others it is the harbinger of schizophrenia or major depressive disorder.
Longitudinal studies have suggested that Cluster B personality disorders have the highest diagnostic stability while Cluster A personality disorders have the lowest.
A recent study has reported that symptomatic improvement in patients with borderline personality disorder may be more than what is generally believed.
The Collaborative Longitudinal Personality Disorders Study (of schizotypal, obsessive-compulsive, borderline and avoidant personality disorders) observed that, at 12 months, remission rates ranged from 23 per cent (in the case of schizotypal personality disorder) to 38 per cent (in the case of obsessive-compulsive personality disorder) with all the 4 personality disorders showing improvements over a 2 year period. However, in contrast to symptomatic improvement, these patients showed less significant and more gradual improvement in their social and ‘real life’ functioning.

14. What are the principles underlying Dialectical Behaviour Therapy in borderline personality disorder?

The dialectic approach assumes that the patients are doing their best, that they are not responsible for all their problems, and that it is only the therapy (and not the patient) which can fail. DBT draws heavily from dialectic philosophy, learning principles and mindfulness techniques in Zen. The learning element involves removal of reinforcers for maladaptive behaviours, and reinforcement of adaptive behaviours.

15. Describe the role of early childhood experiences and family environment in the development of personality disorders.

Role of Early Childhood Experiences

Early childhood experiences play a significant role in the development of personality disorders. Research on patients with various personality disorders has shown that early adversities like neglect, childhood physical and sexual abuse make a person more susceptible to personality disorders in later life.
It is more often the cumulative effect of multiple events and experiences which put an individual at higher risk. However, resilience to childhood adversity varies among individuals; in fact some individuals go on to live normal lives despite severe emotional trauma during early development.
Amongst the developmental antecedents that increase the risk of personality disorders, childhood physical, sexual and emotional abuse, and neglect constitute the most important factors.

Role of Family Environment

Family plays a key role in personality disorders.
The developing personality may be adversely affected by parents who do not show warmth and affection, spend time or communicate adequately with the child.
More specifically, lack of parental affection has been shown to be associated with the development of antisocial personality symptoms, while overprotective parenting could be associated with schizoid personality.
Parental unavailability, insensitivity and intrusiveness in early childhood might interfere with the establishment of a stable sense of self leading on to the development of borderline personality disorder.

16. What is the role of marital and family interventions in the management of personality disorders?

There is a need for family interventions as a preventive means of reducing personality disorder.

Parents should also be taught more effective child rearing practices. Presence of parental psychiatric disorder and marital discord need to be looked into and treated to ensure better care and social support for the children.

Important Points

i) Psychoanalysis is not useful for treatment of all personality disorders.

ii) Low dose antipsychotic medications are useful for treatment of Cluster A personality disorders.

iii) Dialectical Behaviour Therapy is used primarily for treatment of borderline personality disorder.

iv) Jacobsen’s Progressive Muscle Relaxation is not used in the treatment of schizoid personality disorder.

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