9B. Personality disorders: diagnostic criteria (clusters a-b-c) and clinical management Flashcards
Personality disorders DEFINITION
are pervasive, inflexible, and maladaptive personality patterns
that lead to significant distress and/or functional impairment.
Deviates from exprectations of an individuals culture
Age of onset of personality disorders
late childhood or adolescence
personality disorders and which gender they are most common in
Male individuals:
* antisocial (Severe, impairing)
* narcissistic personality disorders
* paranoid
* schizoid
* avoidant
* OCPD
Female individuals:
* borderline personality disorders (Severe, impairing)
* histrionic
* dependent PD
which personality disorders are severely impairing
- Antisocial PD (male) - incarcerated or hospitalized
- Borderline personality disorder (common in females) - unemployed, socially isolated
which personality disorders are less impairing, patient can maintain job
- Histrionic
- Narcissistic PD
patients have difficulty maintaining social relationship
Etiology of Personality disorder
- Multifactorial
- Combination of
1. hereditary
2. psychosocial factors (e.g., child neglect, abuse
DSM 5 criteria of personality disorders
cluster A personality disorders
- Paranoid
- schizoid
- schizotypal PD
Cluster A personality disorders characteristic behavior
“Weird”
- odd
- eccentric
- unable to form close interpersonal relationships
- typically: no psychosis
cluster A PD are commonly associated with which condition
psychotic disorders ( eg schizophrenia)
PaSS
Cluster B personality disorders
Antisocial
Borderline
Histrionic
Narcissistic
BANHed
Cluster B personality disorders characteristic behavior
“wild”
- Dramatic
- emotional
- Unpredictable/ inconsistent
cluster b commonly associated with
- mood disorders
- recreational drug use
Cluster C personality disorders
- Avoidant
- Dependent
- Obsessive-compulsive PD
DOA
Cluster C personality disorders characteristic behavior
- fearful
- avoidant
- anxious
Cluster C personality disorders associated with
anxiety disorders
Clinical features common to all personality disorders
*Affected individuals consider their symptoms normal and nonproblematic
*Thinking and behavior that significantly differ from cultural expectations
Treatment of personality disorders
- Psychotherapy, dialectical behavior therapy, group therapy, and/or cognitive therapy
- Medical therapy (for symptomatic relief)
o Mood stabilizers: valproate, topamirate, and lamotrigine
▪Decrease symptoms such as affective dysregulation, impulsivity, and aggression
o Antipsychotics: for symptoms of delusion
o Antidepressants: SSRIs
Paranoid personality disorder diagnostic criteria
▪At least 4 of the following criteria must be met
*Pervasive distrust of others
*Unjustified fear that others will use information against them
*Unjustified suspicion about the loyalty of friends and family
*Unjustified suspicion that others are deceiving or harming them
*Suspicions of infidelity in sexual partners/spouse
*Disproportionate reactions to perceived attacks
*Perceives benign remarks as hidden humiliations
*Holding grudges
Schizoid personality disorder
o Diagnostics: according to the DSM-5
At least 4 of the following criteria must be met
* Voluntary social withdrawal (e.g., family)
* Enjoys few activities
* Prefers solitary activities
* Lack of interest for close relationships
* Lacks people to trust or close friends
* Indifferent to praise or criticism
* Restricted emotional expression, flattened affect
Other features: comfortable with social isolation (unlike in avoidant personality disorder)
schizoid PD vs avoidant
schizoid PD is comfortable with social isolation (unlike in avoidant personality disorder)
Schizotypal personality disorder diagnostic
At least 5 of the following criteria must be met
* Odd and eccentric behavior or physical appearance
* Magical thinking
* Social awkwardness
* Excessive social anxiety
* Ideas of reference
* Unusual perceptual experiences (e.g., body illusions)
* Bizarre thinking/speech
* Paranoia and suspicion of others
* Constricted affect
* Few or no close friends
* Social anxiety and preference for social isolation because of paranoia that they cant connect with others
Antisocial personality disorder diagnostic criteria
Adult
Criminal
Impulsive
Disregard for safety
Lying/cheating
Irresponsible
Aggression
Remorselessness
▪ The patient is at least 18 years of age
▪ 3 or more of the following symptoms of conduct disorder are present from at least 15 years of age
* Deceiving, manipulation
* A history of hostility and repeated aggression
* Repeatedly engaging in criminal activity
* Impulsivity/failure to plan ahead
* A reckless disregard for one’s own safety and/or the safety of others
* A failure to fulfill work-related or financial obligations
* A lack of empathy, remorse for their actions
▪ Antisocial behavior that is not only due to manifestations of bipolar disorder or schizophrenia
treatment is very difficult
Borderline personality disorder diagnostic crit
▪ At least 5 of the following criteria must be met
- Unstable mood (e.g., irritability, anxiety)
- Intense anger that can be difficult to control
- Feelings of emptiness
- Self-damaging acts (e.g., unsafe sex, substance abuse, reckless behavior)
- Self-harm, suicidal behavior
- Unstable self-image
- Suspicion about what others think of them, even paranoid ideation and/or dissociative episodes
- Unstable personal relationships
- Fear of abandonment
Other features: splitting; a defense mechanism in which relationships are all good or all bad
treatment of borderline PD
Treatment: dialectical behavior therapy
Histrionic personality disorder
o Diagnostics: according to the DSM-5
▪ At least 5 of the following criteria must be met
* Attention-seeking: drawing attention to oneself by way of physical appearance
* Uses dramatic speech
* Exaggerated emotional expression
* Not being the center of attention causes discomfort
* Feelings are often shallow and unstable
* Exhibiting inappropriate, sexually provocative, and/or seductive behavior during interactions with others
* Easily influenced by others or circumstances
* Overestimating the degree of intimacy in relationships
Narcissistic personality disorder
o Diagnostics: according to the DSM-5
▪ At least 5 of the following must be met
* Excessive sense of self-importance
* Fantasizes disproportionately about success, power, etc.
* Believe in being special and a feeling of superiority
* Great need for admiration
* Expecting favorable treatment from others
* Exploitation of others to achieve their own goals
* Lack of empathy
* Often envious of others
* Often behaves arrogant and/or snobbish
o Other features: difficulty dealing with criticism, fragile self-esteem
Classification: 3 subtypes Narcissistic personality disorder
Grandiose, overt
High-functioning
Vulnerable/covert
Avoidant personality disorder
o Diagnostics: according to the DSM-5
▪ At least 4 of the following criteria must be met
* Avoidance of interpersonal contact due to fear of criticism or rejection
* Only interacts with people if certain of being liked by them
* Restrained in intimate relationships due to fear of being ashamed
* Preoccupation with and hypersensitivity to criticism
* Feelings of inadequacy resulting in involuntary social withdrawal
* Low self-esteem
* Avoids taking risks and seldomly engages in new activities
▪ Strong desire for social relationships (unlike schizoid personalities), but limited by extreme shyness and social anxiety
Dependent personality disorder
o Diagnostics: according to DSM5
▪ At least 5 of the following must be met
- Disproportionate need for support
- Difficulty making everyday decisions (requiring others to assume responsibility)
- Avoids disagreeing with others due to fear of losing their support
- Difficulty initiating projects because of a lack of self-confidence
- Makes extreme efforts to obtain support from others even if these efforts are unpleasant
- Feelings of helplessness when alone
- Urgently seeking new relationships when one fails
- Both afraid of being abandoned and afraid to abandon their partner
o Other features: often stuck in abusive relationships; associated with increased risk of suicide
Obsessive-compulsive personality disorder
o Diagnostics: according to DSM-5
▪ At least 4 of the following must be met
* Excessive preoccupation with rules, lists, details, etc.
* Obsession with work and productivity that often occurs at the expense of occupational success (e.g., missing deadlines), social relationships (e.g., excluding social activities to complete tasks), and pleasurable activities
* Perfectionism that often interferes with task completion
* Unwillingness to delegate work or to collaborate with other people
* Great conscientiousness and fastidiousness, inflexible about matters of morality or ethics
* Cling to worn-out/worthless items (even if they have no sentimental value)
* Often show miserliness (e.g., obsessed with saving money for future disasters)
* Rigid routines
OCPD VS OCD
▪ In contrast to OCS, intrusive thoughts and repetitive behaviors are not present
