106/107b - Personality Disorders I and II

Question 1

What is the major risk factor for the development of borderline personality disorder?

Answer 1

Affective instability

• Borderline Personality Disorder – instability in interpersonal relationships, instability in self-image (not knowing who they are as a person), affective lability (experience strong and variable emotions that can disrupt functioning), and marked impulsivity
  
  • need 5/9 symptoms (Mnemonic – AM SUICIDE): Abandonment fears, mood instability, suicide/self-injurious behaviors, unstable + intense relationships, impulsivity, control of anger is poor, identity disturbance, dissociative/paranoid symptoms, emptiness

Question 2

Which cluster and specific personality disorder is most likely?

“Need for companionship, reassurance, often indecisive (looking to others to decide for them or affirm their decision), fear of being left alone to care for self, often submissive”

Answer 2

Cluster C

Dependent

• Dependent Personality Disorder – very submissive, clingy behavior, and excessive need to be taken care of
  
  • need 5/8 symptoms (Mnemonic – RELIANCE): reassurance, expressing disagreement is difficult, life responsibilities need to be taken care of by someone else, initiating projects is difficult, alone feeling, nurturance is needed, companionship is sought urgently, exaggerated fears of being left to care for oneself

Question 3

When do personality disorders usually present?

What is their course?

Answer 3

Begin in childhood, persist throughout life

• Exception: Antisocial PD cannot be diagnosed <18 y/o
  
  • If present earlier, either adolescence-limited conduct disorder or oppositional defiant disorder

Question 4

Which cluster and specific personality disorder is most likely?

“Values productivity, orderliness, perfection. Often puts work or school tasks before friendships/relationships. Stubborn, doesn’t adapt well to other’s ways of doing things”

Answer 4

Cluster C

Obsessive compulsive personality disorder

• Obsessive Compulsive Personality Disorder – preoccupation w/ orderliness, perfectionistic, controlling
  
  • able to separate from obsessive compulsive disorder b/c in the personality disorder, they are comfortable w/ their personality and not distressed by their symptoms while ppl w/ OCD want to get rid of their symptoms

Question 5

Which cluster and specific personality disorder is most likely?

“Needs to be admired, desire for success and power, lack of empathy, fantastical ideas about self”

Answer 5

Cluster B

Narcissistic

• Narcissistic Personality Disorder – grandiosity, need for admiration, lack of empathy
  
  • need 5/9 symptoms (Mnemonic – SPEEECIAL): special, preoccupied w/ fantasies, envious, entitlement, excess admiration is required, conceited, interpersonal exploitation, arrogant, lacks empathy

Question 6

What is the prevalence of personality disorders altogether?

Answer 6

10% of the population

Cluster A and Cluster C are most common

Question 7

Which personality disorder carries the highest risk of suicide and self-harm?

Answer 7

Borderline personality disorder

Question 8

Which personality disorders are included in cluster C?

Answer 8

• Avoidant
• Obsessive-compulsive PD
• Dependent

“Anxious, fearful”

Question 9

Which cluster and specific personality disorder is most likely?

“Fears confiding in others, suspicious of others, unforgiving, does not trust motives of friends”

Answer 9

Cluster A

Paranoid personality disorder

**Paranoia must be pervasive accross many situations, relationships; if it’s just directed at one person, their paranoia is likely real!!

Question 10

Which cluster and specific personality disorder is most likely?

Which personality disorder is most likely?

“Difficulty in close relationships, few close friends, unusual perceptions/thinking/speech, interest in witchcraft”

Answer 10

Cluster A

Schizotypal personality disorder

• Schizotypal Personality Disorder – acute discomfort in close relationships, cognitive or perceptual distortions, and eccentricities of behavior ® individual feels like fireworks
  
  • need 5/9 symptoms (mnemonic – ME PECULIAR): Magical thinking or odd beliefs, experiences unusual perceptions, paranoid ideation, eccentric behavior/appearance, constricted/inappropriate affect, unusual thinking and speech, lacks close friends, ideas of reference, anxiety in social situations, rule out psychotic disorders

Question 11

Which cluster and specific personality disorder is most likely?

“Unsure of identity/self image, fear of abandonment, mood instability, impulsivity, history of unstable interpersonal relationships”

Answer 11

Cluster B

Borderline

• Borderline Personality Disorder – instability in interpersonal relationships, instability in self-image (not knowing who they are as a person), affective lability (experience strong and variable emotions that can disrupt functioning), and marked impulsivity
  
  • need 5/9 symptoms (Mnemonic – AM SUICIDE): Abandonment fears, mood instability, suicide/self-injurious behaviors, unstable + intense relationships, impulsivity, control of anger is poor, identity disturbance, dissociative/paranoid symptoms, emptiness

Question 12

Which personality disorders are included in cluster B?

Answer 12

• Borderline
• Narcissistic
• Antisocial
• Histrionic

“Dramatic, emotional, erratic”

Question 13

Which cluster and specific personality disorder is most likely?

“Provocative/sexually seductive style of speech and dress, history of intensely intimite relationships, wants attention (and influenced by others in order to get their attention), theatrical”

Answer 13

Cluster B

Histroinic

• Histrionic Personality Disorder – excessive emotionality, attention seeking, provocative behavior, often seen as a female disorder
  
  • need 5/8 symptoms (Mnemonic – PRAISE ME): provocative behavior, relationships considered more intimate than they really are, attention seeking, influenced easily, style of speech is impressionistic and lacks detail, emotions are rapidly shifting and shallow, “made up” appearance to draw attention to oneself, emotions are exaggerated and theatrical

Question 14

A 15 year old girl is referred to a psychiatrist for the following behaviors that have concerned her parents and PCP

She is often deceitful and manipulative, with little regard for the feelings of others. She has been in trouble multiple times in school and does not complete chores at home, and is often aggressive when these transgressions are brought to attention. This causes significant distress to her parents, teachers, and peers

If a personality disorder is present, which one is most likely?

Answer 14

Personality disorder is NOT present

• These signs are consistent with antisocial personality disorder (cluster B), but cannot diagnose in anyone <18 y/p
• This may be either adolecent-limited conduct disorder or oppositional defiant disorder
• If persisting to and past age 18, can be diagnosed as antisocial personality disorder

Question 15

Which cluster and specific personality disorder is most likely?

“Difficulty in new relationships, feelings of inadequacy, socially isolated, fear of rejection”

Answer 15

Cluster C

Avoidant

Isolated due to fear of rejection/fear that new people will enforce inferiority vs. schizoid just wants to be left alone, indifferent to rejection or criticism

Question 16

Describe the alernative model of personality disorders

Answer 16

• Personality disorders are variants of normal personality, rather than disease entities
• If 1 or more pathological personality traits are present, suspect “a personality disorder,” rather than a specific PD
  
  • Pathologic = extreme of normal that is distressing/impairing

Allows clinicians to be more dimensional in their diagnosis and management

Question 17

What are the key differences between borderline and dependent PD?

Answer 17

Both may have signs of clinginess/fear of abandonment

• Borderline
  
  • More mood instablity
  • More impulsive
  • No core sense of self-image
• Dependent
  
  • Fear of needing to care for self
  • More indecisive (vs impulsive)
  • Has sense of self image, but changes behavior to appease others so they won’t be left alone

Question 18

Which cluster and specific personality disorder is most likely?

“Blunted affect, lack of interest in relationships, indifferent to criticism or praise, very introverted”

Answer 18

Cluster A

Schizoid personality disorder

Question 19

Which cluster and specific personality disorder is most likely?

“Disregard for and violation of the rights of others, often deceitful or manipulative. Angry, unempathetic”

Answer 19

Cluster B

Antisocial personality disorder

• Antisocial Personality Disorder – deceit, disregard and violation of the rights of others (can be criminal), and manipulation of others
  
  • need 3/7 symptoms (mnemonic – CORRUPT): conformity to law is lacking, obligations are ignored, reckless disregard for safety of self or others, remorse is lacking, underhanded (deceitful, lies), planning is insufficient (impulsive), temper (irritable and aggressive)

Question 20

Which personality disorders are included in cluster A?

Answer 20

• Schizoid
• Schizotypal
• Paranoid

“Odd, eccectric”