B3.062 Personality Disorders in Psychiatry Flashcards
what is personality
way of understanding normal human behavior and information processing
affects cognition, emotion, and behavioral responses
provides stability and tendencies across setting and contexts
nature
emphasis on biological factors to predispose people to certain traits or personality features
nurture
emphasis on psychological, social, and environmental factors to help express, inhibit, or reinforce underlying predispositions toward tendencies of thinking, feeling and behaving
what evidence is there for personality disorders having a strong genetic influence
higher concordances between monozygotic twins than dizygotic twins
what is a personality disorder
when personality features are extreme or skewed they can be maladaptive and represent a disorder that requires treatment
APA definition of personality disorder
enduring patterns of perceiving, relating to, and thinking about the environment and oneself that are exhibited in a wide range of important social and personal contexts, and are inflexible and maladaptive, and cause either significant functional impairment or subjective distress
general symptoms of a personality disorder
frequent mood swings stormy relationships social isolation angry outburst suspicion and mistrust of others difficulty making friends a need for instant gratification poor impulse control alcohol or substance abuse
what types of problems are personality disorders frequently comorbid with
mood disorders anxiety disorders adjustment problems substance abuse frequent ER visits social problems illegal activities poor, inflexible coping strategies
core features of personality disorders
present by adolescence (age 15)
pervasive and inflexible
associated with impaired functioning (social, occupational, or other important area)
cluster A disorders
“odd or eccentric”
paranoid
schizoid
schizotypal
cluster B disorders
"dramatic, emotional, and erratic" borderline narcissistic histrionic antisocial
cluster c disorders
“anxious, avoidant, fearful”
obsessive-compulsive personality disorder
dependent personality disorder
avoidant personality disorder
paranoid personality disorder
characterized by a pattern of irrational suspicion and mistrust of others, interpreting motivations as malevolent
schizoid personality disorder
lack of interest and detachment from social relationships, and restricted emotional expression
“autistic thinking”
schizotypal personality disorder
a pattern of extreme discomfort interacting socially, distorted cognitions and perceptions, behavioral eccentricities
“magical thinking”
thought to be “akin” to schizophrenia-spectrum disorders
what are some common themes among cluster B disorders
commonly seen in emergency settings
externalizing
individuals get in trouble and physical harm due to their choices
borderline personality disorder
pervasive pattern of instability in relationships, self-image, identity, behavior and affect often leading to self harm and impulsivity
often mistaken for bipolar mood disorder
narcissistic personality disorder
a pervasive pattern of grandiosity, need for admiration, and lack of empathy
histrionic personality disorder
a pervasive pattern of attention-seeking behavior and excessive emotions
seduction/manipulation of others
antisocial personality disorder
a pervasive pattern of disregard for and violation of the rights of others, lack of empathy
must have history of conduct disorder during childhood (longstanding)
obsessive compulsive personality disorder
characterized by rigid conformity to rules, perfectionism and control
dependent personality disorder
pervasive psychological need to be cared for by other people
avoidant personality disorder
pervasive feelings of social inhibition and inadequacy, extreme sensitivity to negative evaluation
strong social anxiety
personality disorder due to a general medical condition
must be attributable to medical condition
head/brain trauma most common
risk factors for personality disturbance
temperament problems in childhood adverse environmental events parents with personality disorders low socioeconomic status physical or sexual abuse in childhood psychological and physical neglect chaotic family life conduct problems loss of parents
% of people w BPD who experienced childhood sexual abuse
40-71%
% of people w antisocial personality disorder who have a history of risk factors
childhood physical abuse 42%
parental marital abuse 49%
poverty 42%
foster care 40%
discuss the relationship between trauma and childhood brain development
traumatic events have been shown in animal models to sensitize the HPA system
sensitization by stress hormones result in altered functioning of the amygdala and limbic connection with the prefrontal lobes in animal models and post-mortem studies
repetitious brain exposure to higher levels of neurotransmitters such as noradrenaline affect development of hippocampus (decreased size)
function of cortisol
increases excitatory neurotransmission
sympathetic nervous system
contributes to arousal
exaggerated startle response
limbic system
hippocampus: involved in memory formation, retrieval
anterior cingulate: initial emotional regulation
frontal lobe
prefrontal cortex and orbitofrontal cortex
- involved in short term memory
- problem solving
- executive functioning, decision making
- automatic and controlled emotional regulation
discuss the neuroimaging and anatomical findings associated with BPD and antisocial personality disorder
dysfunction of prefrontal-limbic circuits
lower volume of hippocampus, LPFC, cingulate in BPD
discuss the neuroimaging and anatomical findings associated with schizotypal
compromise of the temporal lobe and basal striato-thalamic structures
what type of attachments in infancy and childhood lead to more emotional and physical health
secure
how do you assess a personality disorder?
clinical interview
psychological testing
what are components of a clinical interview when assessing personality disorders
comprehensive history
functioning back to childhood and adolescence
functioning in multiple domains
corroboration from family
different types of psychological testing
DSM SCID-II MMPI-2 MCMI-III PAI
how do you treat a personality disorder?
no pharma treatment for personality disorders treatment typically symptomatic in nature -antidepressants -anxiolytics -mood stabilizers -atypical antipsychotics reduction in comorbid symptoms psychotherapy
how is psychotherapy utilized in PDs
primary treatment modality
patients respond to structured therapies as well as less structured therapies
counseling directed towards problem areas–supportive therapy
disorders with greater treatment response to CBT spectrum counseling
BPD
OCPD
avoidant
dependent
disorders with less response to therapy
cluster A
antisocial
