Psychiatry
Personality Disorders
Personality disorders for MBBS and NEET-PG: clusters A, B and C, antisocial and borderline patterns, dialectical behaviour therapy and the role of medication, mapped to NMC codes PS11.
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Personality Disorders
Personality disorders for MBBS and NEET-PG: clusters A, B and C, antisocial and borderline patterns, dialectical behaviour therapy and the role of medication, mapped to NMC codes PS11.
This chapter covers the personality disorders, defined as enduring, inflexible patterns of experience and behaviour that impair function. It sets out the three clusters and their component disorders, focuses on antisocial and borderline patterns, and explains the leading role of psychological therapy with the limited place of medication.
High-yield: Personality Disorders
- A personality disorder is an enduring, pervasive and inflexible pattern of inner experience and behaviour that deviates from cultural expectation and causes distress or impairment.
- The pattern is stable, begins in adolescence or early adulthood, and affects thinking, emotion, relationships and impulse control.
- Personality disorders are grouped into three clusters, described as odd, dramatic and anxious.
- Cluster A, the odd or eccentric group, includes paranoid, schizoid and schizotypal personality disorders.
- Cluster B, the dramatic or erratic group, includes antisocial, borderline, histrionic and narcissistic personality disorders.
- Cluster C, the anxious or fearful group, includes avoidant, dependent and obsessive-compulsive personality disorders.
- Antisocial personality disorder features disregard for others, deceit, impulsivity and a lack of remorse, and by definition begins before the age of fifteen as conduct disorder.
- Borderline personality disorder features unstable relationships, an unstable self-image, impulsivity, recurrent self-harm and a fear of abandonment.
- Emotional instability and self-harm make borderline personality disorder the pattern most often seen in emergency and self-harm presentations.
- Schizoid personality disorder is marked by detachment and little interest in relationships, distinct from the psychosis of schizophrenia.
- Psychological therapy, especially dialectical behaviour therapy for borderline personality disorder, is the mainstay of treatment.
- Medication has a limited, adjunctive role, targeting comorbid depression, anxiety or brief psychotic symptoms.
- Comorbid depression, anxiety and substance misuse are common and worsen the prognosis.
- A personality disorder is a long-standing trait pattern, unlike an episodic mental illness such as depression, though the two often coexist.
The three clusters
- **Cluster A (odd):** Paranoid, schizoid, schizotypal.
- **Cluster B (dramatic):** Antisocial, borderline, histrionic, narcissistic.
- **Cluster C (anxious):** Avoidant, dependent, obsessive-compulsive.
- **Treatment:** Psychological therapy leads; dialectical behaviour therapy for borderline; medication adjunctive.
NMC competencies in this chapter
- **PS11.1:** Magnitude and aetiology of personality disorders
- **PS11.2:** Clinical features and clusters of personality disorders
- **PS11.3:** Indications and interpretation of investigations
- **PS11.4:** Treatment including behavioural methods
- **PS11.5:** Family education in personality disorders
- **PS11.6:** Pharmacological basis and side effects of therapies
- **PS11.7:** Conditions for specialist referral
Frequently Asked Questions
What are the three clusters of personality disorder?
Cluster A is the odd group (paranoid, schizoid, schizotypal), cluster B is the dramatic group (antisocial, borderline, histrionic, narcissistic), and cluster C is the anxious group (avoidant, dependent, obsessive-compulsive).
What is borderline personality disorder?
It is a cluster B disorder with unstable relationships and self-image, impulsivity, recurrent self-harm and a fear of abandonment, and it is often seen in emergency self-harm presentations.
How is personality disorder treated?
Psychological therapy is the mainstay, with dialectical behaviour therapy well established for borderline personality disorder. Medication has only an adjunctive role for comorbid symptoms.
How does a personality disorder differ from depression?
A personality disorder is a long-standing, pervasive trait pattern present since adolescence, while depression is an episodic illness. The two commonly coexist, which can complicate treatment.
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