18. Personality Disorders Flashcards
What is a personality disorder?
Fixed, rigid pattern of behavior and way of acting in the environment that causes distressess and impaired funcitoning.
In personality disorders,
- Is the person aware of the problem?
- When do they usually present?
- Diagnosing personality disorders in elderly is…
- No
- Early adulthood (not dx until 18 YO): generally not diagnosed in children and adolescents because personality is not fully developed and some traits may go away in adulthood.
- Unreliable: may be due to medical condition/dementia
What are the 3 clusters of personality disorder
- Cluster A (weird; odd or eccentric)
- Cluster B (Bad; dramatic, erratic or emotional behavior)
- Cluster C (anxious or fearful behavior)
Cluster A (Weird; odd or eccentric behavior) PD
- Paranoid PD
- Schizoid PD
- Schizotypal PD
Cluster B (Bad; dramatic, erratic or emotional behavior) PD
- Antisocial PD
- Borderline PD
- Histrionic PD
- Narcisstic PD
Cluster C (Anxious or fearful) PD
- Obsessive Compulsive PD
- Avoidant PD
- Dependent PD
Paranoid Personality Disorder
Suspicious and distrust of thers, even friends and family.
- think others are exploiting/deceiving you
- hidden meanings in comments/events
- hard time building relationships: think spouse or partner is cheating
Person with Paranoid Personality Disorder is at risk for having what?
- Agoraphobia
- Major depression
- OCD
- Substance abuse
Halmark ego defense of someone with Paranoid Personality Disorder
Projection: attribute unacceptable thoughts to others; accue others of being suspcisiou
Schzoid Personality Disorder
- Chooses social isolation; more comfortable alone
- Thinks close relationships are pointless: no close friends
- Flat affect: indifferent to praise or critisism
- No hobbies
Person comes to hospital with uncontrolled illness: lives alone, no kids, same job for 35 years. Goes from work => home, repeat and is COMPLETELY OKAY WITH IT.
Schizoid Personality Disorder
Schizotypal Personality Disorder
Fear of social interaction and few close friends (does not go away with familiarity) + odd beliefs/thinking
- Ideas of reference: think everything is related to them (think they’re center of ATN)
- Superstitions, telepathy, 6th sense
- KEY = open to challenging beliefs (not fixed = diff from delusions)
What makes the odd beliefs in Schizotypal Disorder different from delusions?
- Beliefs are NOT fixed. They are open to challenging them.
CLUSTER B
- Antisocial Personality Disorder
- Disregard for the law and rights of others
- Aggressive, pervasive lying and deception
- NO remorse
- Irresponsible in work and family
In order to be diagnosed with Antisocial Personality Disorder, what criteria must you meet.
- > 18 YO
- Must have had conduct disorder before 15 YO
What is the child form of Antisocial Personality Disorder
Conduct disorder (< 18YO)
Antisocial Personality Disorder
- MC in:
- At risk for developing what?
- M
- At risk for getting
- Anxiety disorders
- Substance abuse
- Somatozation disorder
- Gambling
Borderline Personality Disorder
- Unstable relationships (Attached, fear of abandonment): “all people are very good or bad: boyfiriend is the BEST/devil”
- Mood swings (v bad anger)
- Chronic feeling of emptyiness
- Impulsive in at least 2 areas that are self-damaging (sex, substance abuse, reckless driving)
- Manipulative
- Immature personality traits: teddy bear sign or tweety bird sign
- Paranoia/dissoaciation
Borderline Personality Disorder:
- Patients are at increased risk for:
- BPD is often triggered by what?
- High rate of what comorbidities??
- Suicide (due to fear of abandoment: ill kill myself bc you dont care) or self mutilation
- Sexual/emotional abuse
- Major deppresion
When treating patients with BPD, be sure to do what?
Set rigid boundaries:
- constantly remind them of guidelines and respsonsbilities
- Will often “split” staff members/docs against each other.
Hallmark defense mechanism in Borderline Personality Disorder
Splitting: black and white thinking, cannot hold opposing views, doc is either great/terrible, all things in world are amazing/terrible
What is the gold standard treatment for Borderline Personality Disorder?
-
Dialectical Behavioral Therapy (Type of CBT):
- Treats chronic suicidality by developing coping skills to improve affective stability and impulse.
- Weekly therapy for 1-2 years
Histrionic Personality Disorder
- Examples= celebrities
- Wants to be center of attention (talks loudly, wild stories, hand gestures) and excessive emotions
- Dramatic, sexually provacoative, seductive (wears sexy clothes, touches others alot)
- Very concerned with physical apperance
- La belle indifference: person is unconcerned w sx
Narcissistic Personality Disorder
- Preoccupied with self/ self-inflated and how they’re perceived by others,
- But envious of others
- Entitled
- Lack of empathy for others
- “Me first personality”
Narcisstic Personality Disorder
- MC in: ___.
- At risk for what?
- Male
- At risk for:
- Anorexia
- Substance abuse
- Depression
Avoidant Personality Disorder
- Avoids social interactions/”social inhibition” but wants them because they feel inadequate, ppl wont like them.
- Struggles with intimate relationships
How is Avoidant and Schizoid Personality Disorder different?
- Avoidant = wants social interactions and not odd, but cant;
- Schizoid = prefers to be alone
Dependent Personality Disorder
Dependent on others (always in relationships and hard to make decisions on own)
- Clingy; helpless when alone
- Low self-confidence, making it hard to engage in activities
- Need others to assume responsibility for major life events
- Hard time expressing opinion
Obsessive Compulsive Personality Disorder
- EX. CEO of company “my way or highway”
- Preoccupied with perfection and control“loves to-do lists/always needs a plan”
- Inflexible and stubborn: my way or highway
- Even though focused, interferes with efficiency in tasks
How is OCD different from OCPD?
In OCPD,
- MC in M
- Behaviors help to acheieve goals: obsessions and compulsions help to acheive goals (ego-syntonic)
- Not aware of problem
Dissociative Identity Disorder
- Presence of 2 or more distinct personalities with own thoughts, behaviors and memory.
- May lose track of time
- Reported by others/or self
- Often caused by history of sexual abuse.
What is Psychodynamic Psychotherapy?
How often to you go?
- Looks at how people perceive events and themselves with the assumption that they are shaped by early life.
- Finds more adaptive modes of perception and response using transference.
- Go: several times a week - month
*
What is CBT?
How often to you go?
Deals with how people think about world and their perception of it: turns (-) thoughts into (+).
Go: 1x week for 6-20 weeks.
Can meds cure Personality Disorders?
- No meds cure personality disorder: you can use with psychotherapy so that person engages in therapy.
Which antidepressants should you avoid/prescribe in Personality Disorder?
Avoid: TCAs and MAO-I
Give: SSRI and newer drugs; but rmber drugs will be less effective
Give _____ to control impulse in person with personality disorder.
Valproic acid
Give ______ to reduce transient psychotic symptoms, sometimes een in BPD.
Atypical antipsychotics
Always be concerned about _____ in ppl with Personality Disorders
- Suicide
- Avoid benzos/narcotics
Complications of Personality Disorder
- Suicide
- Substance abuse
- Accidental injury
- Depression
- Homicide (esp high in paranoid and a_ntisocial personality disorder_)
- Cluster ___ PD gets worse later in life
- Clusters _____ PD tend to become less severe and less intense in middle-age/later life.
- Cluster C = worse
- Cluster A/B = gets better
Which cluster has the WORST prognosis?
Cluster B
- Susceptible to substance abuse
- May die early due to: impulse control and suicidal behavior.
