34 - Personality Disorders Flashcards
1
Q
Describe the characteristics of a healthy personality
A
- Flexible (treat mean people differently than really nice people)
- Varied repertoire of coping strategies
- Response in a given situation is primarily driven by current (rather than past) conditions
- Responds more to external reality than internal beliefs
2
Q
Define the DSM-5 definition
A
“An enduring pattern of inner experience and behavior that…
deviates markedly from the expectations of the individual’s culture…
is pervasive and inflexible…
has an onset in adolescence or early adulthood…
is stable over time, and…
leads to distress or impairment.”
If someone is just strange and is NOT in distress, you can’t diagnose it
3
Q
What is the prevalence of personality disorder?
A
- 10-15% of the general population meet criteria for a personality disorder
- 20-30% of patients in a primary care population
- Up to 50% of psychiatric outpatients
4
Q
What are the characteristics of patients with personality disorder?
A
- Interaction is often awkward or uncomfortable
- Clinician may have strong feelings that they do not typically have during patient encounters (can be either negative or positive)
- Patient misperceives the clinician’s intent
- Patient and clinician are having difficulty comprehending the other’s perspective about the clinical encounter or medical issue
- However, not all patients with personality disorders create difficult interactions, and not all difficult or dislikable patients have a personality disorder
5
Q
Describe the general characteristics of all personality disorders
A
- Symptoms appear early in life
- Symptoms appear across a variety of different kinds of interpersonal interactions and are stable across time
- Symptoms feel normal to the patient and are what s/he expects (even if the symptoms do not feel good); they are ego-syntonic (the patent is used to being anxious)
- Maladaptive interpersonal patterns increase under stress (such as when the individual is ill)
- The individual’s maladaptive patterns tend to elicit maladaptive interpersonal behavior from others
- The individual tends to blame others for the problems, and often other people are more distressed by the patient’s behavior than the patient him or herself (always blame someone else)
6
Q
What type of symptoms type to be present in personality disorder?
A
Ego-syntonic
This means the patient perceives the symptoms of personality disorder to just be themselves - they’ve always been anxious, so they don’t think it is a symptom, it is just them.
7
Q
Describe the differential diagnosis for personality disorder
A
- Distinctions amongst the personality disorders are far clearer in theory than in practice
- Among individuals meeting full criteria for one personality disorder, 60% will meet full criteria for at least one additional personality disorder
- Even when the patient does not meet full criteria for a personality disorder, it is often helpful to think about their personality style and adjust your approach accordingly.
8
Q
What are the three “clusters” of personality disorders?
A
Cluster A (Odd, Eccentric)
- Paranoid PD
- Schizoid PD
- Schizotypal PD
Cluster B (Dramatic, Emotional, or Erratic)
- Antisocial PD
- Borderline PD
- Histrionic PD
- Narcissistic PD
Cluster C (Anxious, Fearful)
- Avoidant PD
- Dependent PD
- Obsessive-Compulsive PD
9
Q
Describe paranoid PD?
Cluster A
A
- Pattern of excessive distrust and suspicion of others
- Sees others (including medical providers) as having malevolent intent
- Preoccupied with concerns and fears about others’ trustworthiness
- Reluctance to confide in others; excessive need for self-sufficiency; tend to be rigid and controlling
- Reads hidden derogatory or threatening meanings into neutral comments or events
- Unable to forget and forgive insults or slights
- ***Be very open about what you are doing and why you are doing it. Avoid becoming defensive or dismissive.
- ***Acknowledge patient’s feelings and concerns. May take a slightly more distant stance (overtures of friendliness will likely be met with suspicion).
10
Q
Describe schizoid PD
Cluster A
A
- Neither desires or enjoy close relationships (different from social anxiety)
- Strong preference for solitary activities
- Little interest in sexual activities with another person
- Appears to be insensitive to praise or criticism
- Appears cold, detached, or unemotional
- ***Maintain a professional style and interest in their well-being. Respect patient’s privacy. Make sure to ask questions about all important areas, as they may not volunteer important information. They are unlikely to follow advice just to please you; be particularly careful to explain the reasoning for the advice.
11
Q
Describe schizotypal PD
Cluster A
A
- Discomfort with close relationships, lack of close friends or confidantes, AND
- Odd beliefs or magical thinking (not consistent with individual’s culture)
- Odd perceptual experiences
- Inappropriate affect
- Peculiar behavior or appearance
- Social anxiety that trends toward paranoid fears
- ***If possible, avoid confronting the odd beliefs or behaviors and simply accept their reality. If the beliefs or behaviors are causing the medical problem, confront gently. Screen for more florid forms of psychosis.
12
Q
Antisocial PD
Cluster B
A
- Persistent disregard for the rights of others
- Repeatedly engaging in illegal actions
- Consistent deceitfulness
- Impulsivity and irresponsibility
- Irritability
- Lack of remorse * (they DON’T feel bad about it* –> hallmark)
- *** They are unlikely to follow the rules of a clinician-patient relationship. Set and enforce clear boundaries. Be mindful of the possibility of drug-seeking or malingering.
13
Q
Borderline PD
Cluster B
A
- Desperation to avoid abandonment
Intense, unstable, all-good or all-bad relationships - Significant impulsivity
- Frequent suicidality or self-injury (***completed suicide rate of 8-10%)
- Reactive, unstable mood
- Intense, poorly controlled anger
- *** Relationship with the health care provider is also likely to be intense and either idealizing or devaluing.
- *** Avoid rescuing or abandoning. Instead, be predictable and stable. Establish realistic expectations. Set and enforce clear boundaries.
Most well known PD with a “bad rap” in providers
14
Q
Histrionic PD
Cluster B
A
- Desire to be center of attention at all times
- Often seductive or sexually provocative
- Rapidly shifting emotions
- Theatrical, exaggerated
- Suggestible
- *** Take the dramatic nature of their communication into account when assessing symptoms, but also avoid dismissing concerns due to patient “crying wolf.”
- *** Maintain clear boundaries; neither excessively formal nor too casual. Be mindful and set appropriate limits if patient is sexually provocative.
15
Q
Narcissistic PD
Cluster B
A
- Sees self as superior and expects others to do the same, but self-esteem is very fragile
- Only wants to associate with high-status people or institutions
- Strong sense of entitlement
- Willing to use others to achieve own ends
- Lacks empathy
- Tends to be arrogant and haughty
- *** Avoid confronting the entitlement directly. Instead, frame your suggestions with a statement about the patient deserving the best care possible.
