The DSM-5 groups personality disorders into three clusters. Which cluster includes Paranoid, Schizoid, and Schizotypal Personality Disorders?

A: Cluster A — odd/eccentric

B: Cluster B — dramatic/emotional/erratic

C: Cluster C — anxious/fearful

D: Cluster D — impulsive/aggressive

Correct: Cluster A — odd/eccentric

Cluster A personality disorders are characterised by odd or eccentric thinking and behaviour and include Paranoid PD (pervasive distrust), Schizoid PD (detachment from social relationships, restricted affect), and Schizotypal PD (social deficits, cognitive/perceptual distortions, eccentricities). They are sometimes referred to as the "odd cluster" and share some genetic overlap with schizophrenia spectrum conditions.

Borderline Personality Disorder (BPD) is characterised by all of the following EXCEPT:

A: Intense fear of abandonment

B: Unstable self-image and identity disturbance

C: Persistent grandiosity and lack of empathy

D: Impulsive behaviour and recurrent self-harm

Correct: Persistent grandiosity and lack of empathy

Persistent grandiosity and lack of empathy are hallmarks of Narcissistic Personality Disorder, not BPD. BPD is characterised by instability in interpersonal relationships, self-image, and affect, along with marked impulsivity. The nine DSM-5 criteria include frantic efforts to avoid abandonment, unstable intense relationships, identity disturbance, impulsivity, recurrent suicidal or self-mutilating behaviour, affective instability, chronic emptiness, intense anger, and transient dissociation or paranoid ideation.

Dialectical Behaviour Therapy (DBT), developed by Marsha Linehan, was specifically designed for the treatment of Borderline Personality Disorder.

Answer: True

DBT was developed by Marsha Linehan in the late 1980s specifically for chronically suicidal women, most of whom met criteria for BPD. It combines individual therapy, skills training (in mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness), phone coaching, and therapist consultation teams. DBT is the best-evidenced treatment for BPD, with multiple RCTs demonstrating reductions in suicidal behaviour, self-harm, hospitalisation, and dropout.

Antisocial Personality Disorder (ASPD) requires evidence of conduct disorder with onset before age 15. Which feature best distinguishes ASPD from psychopathy as described by Hare?

A: ASPD includes callous-unemotional traits whereas psychopathy does not

B: Psychopathy additionally captures affective and interpersonal traits (e.g., shallow affect, grandiosity, lack of remorse) not fully covered by ASPD criteria

C: They are identical constructs measured by different instruments

D: ASPD is a broader dimensional concept; psychopathy is a categorical diagnosis

Correct: Psychopathy additionally captures affective and interpersonal traits (e.g., shallow affect, grandiosity, lack of remorse) not fully covered by ASPD criteria

ASPD in the DSM-5 focuses primarily on behavioural features (criminal behaviour, deceitfulness, impulsivity, aggression). Hare's psychopathy construct, measured by the PCL-R, additionally captures an interpersonal/affective dimension: grandiosity, pathological lying, shallow affect, lack of remorse, and failure to accept responsibility. Most individuals with ASPD do not meet criteria for psychopathy, but most psychopaths meet criteria for ASPD. Psychopathy is associated with worse outcomes and higher recidivism.

Which cluster of personality disorders is characterised by anxious and fearful features, and includes Avoidant, Dependent, and Obsessive-Compulsive Personality Disorders?

A: Cluster A

B: Cluster B

C: Cluster C

D: Cluster D

Correct: Cluster C

Cluster C personality disorders — Avoidant, Dependent, and Obsessive-Compulsive PD — share an anxious or fearful quality. Avoidant PD involves social inhibition and hypersensitivity to negative evaluation; Dependent PD involves excessive need to be taken care of; OCPD involves preoccupation with orderliness, perfectionism, and control. Note that OCPD is distinct from OCD — OCPD traits are ego-syntonic (experienced as part of oneself), whereas OCD symptoms are typically ego-dystonic.

Personality disorders were traditionally considered untreatable, but evidence now supports psychological interventions, particularly for BPD.

Answer: True

Historically, personality disorders — especially BPD — were considered resistant to treatment. This view has been substantially revised. DBT, Mentalisation-Based Treatment (MBT), Schema Therapy, and Transference-Focused Psychotherapy all have RCT support for BPD. Long-term follow-up studies show that many patients with BPD show meaningful improvement over time. The evidence base for treating other personality disorders (e.g., ASPD, Cluster A) is less developed but growing.