Behavioral science - personality disorders Flashcards
What is the definition of a personality disorder according to DSM criteria?
an ENDURING pattern of experience and behavior that has
1) Cognitive, emotional, interpersonal, and behavioral components
2) Leads to distress or impairment
3) Pervasive and inflexible
4) Onset in adolescence or early adulthood and stable over time
What are the 4 personality types defined by hyppocrates?
What was the cause of the different types?
What was ignored by this model?
What was used as treatments?
Who’s model changed this?
essentially cheerful,
depressed,
lazy,
angry
alterations in balance of bodily fluids/humors
role of environment and genetics
Diet purging or bleeding
Freuds model introduced heredity as a cause of personality disorder
Who provided the first attempt at modern classification of personality disorders?
What defined the different subtypes?
Wilhelm Reich
predominant ego defenses (“character armor”
What are Reic’s 4 classes?
Hysterical
Compulsive
Narcissistic
Masochistic
Which classifcation from Reich?
seductive, anxious, and dramatic, displaying under control over their instincts, emotions, and behaviors
hysterical
Which classification from Reich?
long-suffering, complaining, self-deprecatory, and dependent, undervaluing themselves relative to other persons.
masochistic
Which classification from Reich?
contemptuous, grandiose, essentially describing persons who overvalue themselves relative to other people
Narcissistic
Which classification from Reich?
controlled, decisive, and distrustful, essentially displaying an over control of their instincts, emotions, and behaviors, and a need for perfection
Compulsive
In today’s DSM what is Reich’s compulsive personality type called?
obsessive compulsive personality disorder
What is hysterical disorder now called?
Histrionic personality disorder
What is DSM correlation to masochistic personality?
Depressive personality disorder
Dependent personality disorder
What are the Cluster A personality disorders?
Paranoid, Schizoid, Schizotypal
What are the Cluster B personality disorders?
Antisocial, Histrionic, Narcissistic, Borderline
What does it mean if you feel as though you meet the criteria for every type of personality disorder?
Sign of health and personal reflection ability
What characterizes Cluster A disorders?
psychotic-like thinking and mannerisms (NOT psychotic)
What characterizes Cluster B disorders?
poorly controlled, impulsive behaviors and unstable mood
engender dread among physicians
What characterizes Cluster C disorders?
anxiety
What are the Cluster C personality disorders?
Avoidant, Dependent, Obsessive-Compulsive
unduly suspicious and distrustful of others, but this does not reach delusional intensity in that they can usually be persuaded otherwise. These are the patients who will accuse you of treating them like a guinea pig.
paranoid personality disorder
display a pervasive pattern of detachment from social relationships and emotional flattening, similar to schizophrenia, but not to the same extent. They really prefer to be by themselves and choose solitary profession, like computer programming. (AS3 ck exist
)schizoid personality disorder
odd and eccentric, and may have cognitive and perceptual disturbances. For instance, many believe in ESP, may be very superstitious, or display magical thinking, such as believing that their dreams predict future events. They may have an unusual choice of clothing that does not…quite fit together and are inattentive to usual social conventions.
schizotypal personality disorder
Pervasive pattern of disregard for and violation of the rights of others occurring since age 15 years
Evidence of a Conduct Disorder with onset before age 15 years
Antisocial personality disorder
Antisocial behavior is not exclusively during schizophrenia or a manic episode
Expect others to be manipulated
also called psychopathy and sociopathy. Interactions with physicians may involve deceit, manipulation, and malingering.
Antisocial personality disorder
expect that others will reject them
Histrionic personality disorder
expect other to be manipulated
antisocial personality disorder
Pervasive pattern of excessive emotionality and attention seeking, beginning by early adulthood, such as:
Sexually seductive or provocative behavior
Self-dramatization, theatricality, exaggerated emotional expression
Is easily influenced by others
Considers relationships to be more intimate than they actually are
histrionic personality disorder
tend to be excessively emotional and dramatic. They may initially charm us by their enthusiasm, apparent openness, or flirtatiousness. These charms quickly wear thin, however, as they continually demand to be the center of attention.
histrionic personality disorder
A pervasive pattern of grandiosity (in fantasy and behavior) beginning by early adulthood
Need for admiration
Lack of empathy
Sense of entitlement
Narcissistic personality disorder
expect others will be manipulated
antisocial personality disorder
Expect others will humiliate them
Narcissistic personality disorder
instability in mood, cognition, behavior, relationships, and sense of self.
borderline personality disorder
What is the DSM criteria for borderline personality disorder?
A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood. > 5/9 characteristic behaviors are needed
What are the 9 characteristic behaviors of borderline personality disorder?
- Frantic efforts to avoid real or imagined abandonment
- Unstable and intense interpersonal relationships, alternating idealization and devaluation
- Persistently unstable self-image or sense of self
- Impulsivity that is potentially self-damaging
- Recurrent suicidal behavior or threats, or self-mutilation
- Mood lability and reactivity
- Chronic feelings of emptiness
- Frequent or intense anger outbursts
- Transient paranoid ideation or severe dissociative symptoms
What is the interpersonal drama triangle? What PD does it define?
evil perpetrator, innocent victim, or heroic rescuer
perception of the behavior of those around them
borderline PD
Which cluster of personality disorders are anxiety-ridden, but generally higher functioning?
Cluster C - disorders have an anxious component, but not enough to qualify for an anxiety disorder.
Avoidant
Obsessive-Compulsive
Dependent
are sub-types of which cluster of PDs?
Cluster C
Pervasive pattern of social inhibition beginning by early adulthood
Inhibited in social situations because of feelings of inadequacy
Hypersensitive to criticism or rejection
Avoidant PD
____ PD essentially represents an exaggerated shyness
avoidant
_____ personality disorder - generally want relationships, but are afraid of rejection or humiliation. _____ personality disorder - don’t care about relationships or opinions of others
Avoidant
Schizoid
preoccupied with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, spontaneity, and openness
Obsessive compulsive PD
How does OCD differ from OCPD?
OCD is characterized by obsessions and compulsions, such as counting, checking, and hand-washing. More severe manifestation of symptoms OCPD symptoms
By early adulthood:
Preoccupied with details, rules, lists, schedules
Perfectionism interferes with task completion
Excessively devoted to work and productivity
Scrupulous about morality, ethics, and values
Unable to discard worn-out objects
Micro-manages tasks
Miserly spending style
Rigid and stubborn
Obsessive compulsive personality disorder
Pervasive and excessive need to be taken care of beginning by early adulthood
Indecisive
Submissive and clingy
Difficulty expressing disagreement
Lack of self-confidence, feeling of helplessness
Goes to excessive lengths to obtain nurturance and support from others
Dependent personality disorder
craves to be taken care of and told what to do. Behavior tends to be submissive, indecisive, and clingy, with fears of separation.
Dependent personality disorder
What distinguishes borderline and dependent personality disorder?
BPD alternates from clingy and dependent behavior to periods of angry and defiant behavior
What is the 5 factor mordel? What are the factors?
system of classification of personality types rather than method to diagnose a disorder
Extraversion Neuroticism Openness to experience Conscientiousness Agreeableness
Which personality disorders are more common in women? men?
Women: Paranoid, avoidant, and dependent PDs
Men: Antisocial PD
What are the risk factors for developing a PD
not married, impoverished, poorly educated
Prevalence rates vary by country, setting, and gender
What factors should be considered in a differential diagnosis of a PD/might exacerbate PD symptoms
Substances
Medical/psychiatric disorders
Stress
Close relationships
Are biomarkers (e.g. neuoimaging) useful?
No. Can’t distinguish between cause and effect.
Low CSF serotonin levels are associated with what behavior?
impulsive agression
Genetic factors can predispose:
mood instability
impulsive aggression
social inhibition
What environmental factor can significantly associate with development of PDs?
parenting behaviors
Treatments for Cluster A disorders
Antipsychotics and psychotherapy may have modest benefit although generally understudied
Treatments for Cluster B disorders
Psychopharmacology:
Modest efficacy, especially mood stabilizers, antipsychotics.
Benzodiazepines may exacerbate condition
Co-occurring conditions (depression, anxiety, etc.) may also respond poorly to medications
Psychotherapy is most effective for what PDs? Specifically what type of therapy?
Borderline, histrionic, narcissistic - RCTs show responsiveness to PSYCHODYNAMIC psychotherapy - although high remission rates after treatment
Dialectic behavioral therapy (type of CBT) is no better than psychodynamic therapy
antisocial PD is less amenable to psychotherapy treatment
What is the only personality disorder for which parmacotherapy has shown significant benefit?
Avoidant personality disorder - benefit from both benzos and SSRIs
T/F dependent and obsessive compulsive personality disorders can be effectively treated with medications
False
T/F there is good evidence that Cluster C disorders are effectively treated with psychotherapy
True - both cognitive behavioral and psychodynamic approaches are helpful
