Chapter 6: Personality Disorders

Question 1

definition of personality disorder

Answer 1

enduring patterns of inner experience and behavior that deviate markedly from expectations of an individual’s culture.

• pervasive, MALADAPTIVE, and cause impairment in social/ occupational functioning
• often lack insight about problems, symptoms are either ego-syntonic or viewed as immutable.
• vulnerable to developing symptoms of other mental disorders during stress

Question 2

dx and DSM-5 for personality disorder

Answer 2

2 or more of following are deviated:

• cognition
• affect
• interpersonal functioning
• impulse control

Pattern is pervasive and inflexible in a broad range of situations
stable, onset no later than adolescence
leads to significant distress
not accounted for by another mental/ medical illness/ use of a substance

Question 3

mnemonic for personality disorder criteria

Answer 3

CAPRI
Cognition
Affect
Personal relations
Impulse control

Question 4

Cluster A

Answer 4

shizoid, schizotypal, paranoid:

• patients seem eccentric, peculiar, or withdrawn
• familial association with psychotic disorders

Question 5

Cluster B

Answer 5

Antisocial, borderline, histrionic, narcissistic

• patients seem emotional, dramatic, or inconsistent
• familial association with mood disorders

Question 6

Cluster C

Answer 6

avoidant, dependent, obsessive compulsive

• patients seem anxious or fearful
• familial association with anxiety disorders

Question 7

Paranoid Personality Disorder

Answer 7

(Cluster A)
pervasive distrust and suspiciousness of others
often interpret motives as malevolent
blame problems on others
seem angry and hostile
pathologically jealous

Question 8

DX and DSM 5 for paranoid personality disorder

Answer 8

> = 4 of following:
suspicious w ithout evidence of being exploited or deceived
preoccupation with doubting loyalty/ trustworthiness of friends
reluctance to confide in others
interpretation of benign remarks as threatening or demeaning
persistence of grudges
perception of attacks on character; not apparent to others
suspicions regarding fidelity of partner

UNLIKE SCHIZOPHRENIA- no fixed delusions
check for SOCIAL DISENFRANCHISEMENT/ ISOLATION, may be misdiagnosed

Question 9

treatment of paranoid personality disorder

Answer 9

psychotherapy est
avoi group psychotherapy
short course of antipsychotics for transient psychosis?

Question 10

Schizoid personality disorder

Answer 10

have a lifelong pattern of social withdrawal. Often perceived as eccentric and reclusive. Quiet and unsociable and have a constricted afect. NO desire for relationships and prefer to be alone

Question 11

difference between schizoid and avoidant personality

Answer 11

schizoid PREFER to be alone

Question 12

DX and dsm-5 criteria of schizoid personality disorder

Answer 12

pattern of voluntary social withdrawal and restricted range of emotional expression, beginning by early adulthood and present in a variety of contexts.

4 or more of following also:

• neither enjoying nor desiring close relationships (including family)
• generally choosing solitary activities
• little (if any) interest in sexual activity with anotehr person
• taking pleasure in few activities (if any)
• few close friends or confidants (if any)
• indifference to praise or criticism
• emotional coldness, detachment, or flattened affect

Question 13

difference between schizoid and Schizophrenia/ schizotypal

Answer 13

Unlike with schizophrenia, pts with schizoid do not have any fixed DELUSIONS or hallucinations

Schizoid not the same eccentric behavior or magical thinking seen in patients with schizotypal.

Question 14

Treatment of schizoid

Answer 14

group therapy may be threatening; may benefit from day programs or drop-in centers
antidepressants if comorbid major depression dx

Question 15

Schizotypal personality disorder

Answer 15

eccentric behavior, peculiar thought patterns.
often perceived as strange and odd
this disorder developed out of the observation that certain family traits predominate in first-degree relatives of those with schizophrenia

Question 16

DX and DSM-5 of Schizotypal

Answer 16

pattern of social deficits marked by eccentric behavior, cognitive or perceptual distortions, and discomfort with close relationships, beginning by early adulthood and present in a variety of contexts.

5 or more of following:

• ideas of reference (excluding delusions of reference)
• odd beliefs or magical thinking; inconsistent with cultural norms.
• unusual perceptual experiences (bodily illusions, e.g.)
• suspiciousness
• inappropriate or restricted affect
• odd or eccentric appearance or behavior
• few close friends or confidants
• odd thinking or speech (vague, stereotyped, etc.)
• excessive social anxiety

magical thinking may include;

• belief in clairvoyance or telepathy
• bizarre fantasies or preoccuupations
• belief in superstitions

Odd behaviors may include involvement in cults or strange religious practices

Question 17

Schizotypal vs schizophrenia and Schizoid

Answer 17

Unlike schizophrenia, schizotypal not franky psychotic (but can become so transietnly under stress); no fixed delusions

schizoid not same eccentric behavior seen in schizotypal

Question 18

RX for schizotypal

Answer 18

psychotherapy (help develop social skills)
short course of low-dose antipsychotics if necessary for transient psychosis.
may also help decrease social anxiety and suspicion in interpersonal relationships

Question 19

Antisocial personality disorder

Answer 19

exploitative of others
break rules to meet their own needs
lack empathy, compassion, remorse
impulsive, deceitful, often violate the law

frequently skilled at reading social cues and can appear charming and normal to others who meet them for the first time

Question 20

antisocial personality disorder mnemonic

Answer 20

CONDUCT

Capriciousness
Oppressive
Deceitful
Unlawful
Carefree
Temper

Question 21

antisocial personality treatment

Answer 21

psychotherapy is usually ineffective

pharmacotherapy- symptoms of anxiety or depression, but caution– high addictive potential of these patients

Question 22

Borderline personality disorder

Answer 22

unstable moods, behaviors, and interpersonal relationships. Fear abandonment and have poorly formed identity. Relationships begin with intense attachments and end with the slightest conflict. Aggression is common. Impulsive, may have history of repeated suicide attempts/ gestures or episodes of self-mutliation.
Higher rates of childhood abuse.

Question 23

DX and DSM-5 of borderline personality disorder

Answer 23

pervasive pattern of impulsivity, unstable relationships, affects, self-iage, behaviors; present by early adulthood and in a variety of contexts.

At least 5 of following:

• frantic efforts to avoid real or imagined abandonment
• unstable, intense interpersonal relationships
• unstable self-image
• impulsivity in at least 2 potentially harmful ways (spending, sexual activity, substance use, binge eating, etc.)
• recurrent suicidal threats or attempts or self-mutilation
• unstable mood/ affect
• chronic feelings of emptiness
• difficulty controlling anger
• transient, stress-related paranoid ideation or dissociative symptoms

Question 24

Differences between borderline personality and schizophrenia, bipolar II

Answer 24

Unlike pts with schizophrenia, BPD do not have frank psychosis (may have transietn, if decompensate under stress or substances of abuse)

Mood swings experienced in BPD are rapid, brief, moment-to-moment reactions to perceived environmental or psychological triggers

Question 25

treatment of borderline personality

Answer 25

psychotherapy (dialectical behavior therapy, DBT) - RX of choice. Includes CBT, mindfulness, group therapy pharmacotherapy to treat psychotic or depressive symptoms may be helpful

Question 26

histrionic personality disorder

Answer 26

attention-seeking behavior excellsive emotionality dramatic, flamboyant, extroverted, unable to form long-lasting, meaningful relationships often sexualy inappropriate and provocative

Question 27

DX and DSM-5 criteria of histrionic personality disorder

Answer 27

Pattern of excessive emotionality and attention seeking, present by early adulthood in a variety of contexts. At least 5 of: - uncomfortable when not center of attention - inappropriately seductive or provocative behavior

Question 28

mnemonic for borderline personality disorder symptoms

Answer 28

``` IMPULSIVE impulsive moody paranoid under stress unstable self-image labile, intense relationships suicidal inappropriate anger vulnerable to abandonment emptiness ```

Question 29

Wards tip for borderline

Answer 29

commonly use the defense mechanism of splitting- people are all good or all bad.

Question 30

pharmacotherapy has been shown to be more useful in what personality?

Answer 30

BPD-- more than in any other

Question 31

name borderline comes from

Answer 31

patient being on the borderline of neurosis and psychosis

Question 32

DX and DSM 5 of histrionic personality disorder

Answer 32

pattern of excessive emotionality and attention seekeing; present by early adulthood and in a variety of contexts At least 5 of following: - uncomfortable when not the center of attention - inappropriately seductive or provocative behavior - rapidly shifting ut shallow expression of emotion - use physical appearance to draw attention to self - speech that is impressionistic and lacking in detail - theatrical and xaggerated expression of emotion - easily influenced by others or situation - perceive relationships as more intimate than they actual are

Question 33

RX for histrionic personality disorder

Answer 33

psychotherapy (supportive, problem-solving, interpersonal, group)- treatment of choice pharm- to treat associated depressive or anxious symptoms as neessary

Question 34

Histrionic patients often use what defense mechanism?

Answer 34

regression- revert to childlike behaviors

Question 35

Narcissistic personality disorder

Answer 35

have a sense of superiority, a need for admiration, and lack of empathy. Consider themselves "special" and will exploit others for their own gain. Despite their grandiosity however, these patients often have fragile self-esteem.

Question 36

DX and SM-5 of narcissistic personality disorder

Answer 36

Pattern of grandiosity, need for admiration, lack of empathy beginning by early adulthood and present in a variety of contexts. 5 or more of: - exaggerated sense of self-importance - preoccupation with fantasies of unlimited money, success, brilliance, etc. - believes that he or she is "special" or unique and can associate only with other high-status individuals - requires excessive admiration - has sense of entitlement - takes advantage of others for self-gain - lacks empathy - envious of others or believes others are envious of him or her - arrogant or haughty

Question 37

antisocial vs narcissistic

Answer 37

both types exploit others, but NPD want status and recognition antisocial- want material gain or subjugation of others. narcissistic become depressed when they dont' get hte recognition they think they deserve

Question 38

treatment of narcissistic

Answer 38

psychotherapy - treatment of choice | antidepressants may be used if a comorbid mood disorder dxed

Question 39

Avoidant personality disorder

Answer 39

(cluster c) pervasive pattern of social inhibition intense fear of rejection avoid situations where thy may be rejected. fear of rejection so overwhelming that affects all aspects of lives. avoid social interactions and seek jobs in which there is little interpersonal contact. Desire companionship but are extremely shy and easily injured.

Question 40

DX and DSM-5: avoidant

Answer 40

pattern of social inhibition, hypersensitivity, feelings of inadequacy since early adulthood at least four: - avoids occupation that involves interpersonal contact due to fear of criticism and rejection unwilling to interact unless certain of being liked cautious of interpersonal relationships preoccupied with being criticized or rejected in social situations inhibited in new social situations because feels inadequate believes he or she is socially inept and inferior reluctant to engage in new activities for fear of embarrassment

Question 41

difference between avoidant and schizoid

Answer 41

avoidant desire companionship but are shy schizoid have little desire for it

Question 42

difference between avoidant and social anxiety disorder (social phobia)

Answer 42

if part of personality- evident since before adulthood- personality disorder more likely . anxiety- fear of embarassment avoidant- fear of rejection

Question 43

difference between avoidant and dependent

Answer 43

avoidant- cling to relationships but are slow to get involved dependent- actively and aggressively seek relationships

Question 44

treatment of avoidant personality disorder

Answer 44

psychotherapy- assertiveness and social skills training- most effective group therapy also SSRIs- for comorbid social anxiety disorder or major depression

Question 45

Dependent Personality Disorder

Answer 45

poor self-confidence fear separation excessive need to be taken care of and allow others to make decisions for them they helpless when left alone

Question 46

DX/ DSM-5 criteria of dependent personality disorder

Answer 46

pattern of excessive need to be taken care of--> submissive and clinging behavior 5 of following - difficulty making everyday decisions without reassurance from others - need others to assume responsibilities for most areas of life - difficulty expressing disagreement because of fear of loss of approval - difficulty initiating projects because of lack of self-confidence - goes to excessive lengths to obtain support from others - feels hellpless when alone - urgently seeks another relationship when one ends - preoccupied wit fears of being left to take care of self

Question 47

difference between dependent and borderline/ histrionic

Answer 47

dependent personality disorder- usualy have a long-lasting relatioinship with one person on whom they are dependent.

Question 48

Obsessive compulsive PERSONALITY Disorder

Answer 48

pervasive pattern of perfectionism, inflexibility, and orderliness. So preoccupied with unimportant details that they are often unable to complete simple tasks in a timelly fashion. They appear stiff, serious and formal, with constricted affect. They are often successful professionally but have poor interpersonal skills.

Question 49

DX and DSM-5: OCPD

Answer 49

pattern of preoccupation with orderliness, control, and perfectionism at the expense of efficiency and flexibility, present by early adulthood and in a variety of contexts. At least 4: - preoccupation with details, rules, lists, and organization such that the major point of the activity is lost - perfectionism that is detrimental to completion of the task - excessive devotion to work - excessive conscientiousness and scrupulousness about morals and ethics - will not delegate tasks - unable to discard worthless objects - miserly spending style - rigid and stubborn

Question 50

difference between OCPD and OCD

Answer 50

OCPD do no have the obsessions or compulsions in OCD; symptoms of OCPD are EGo_SYNTONIC rather than ego dystonic (as in OCD) OCD pts usually aware of problem and wish their thoughts/ behaviors would go away

Question 51

difference between OCPD and narcissistic

Answer 51

both involve assertiveness and achievement; NPD patients motivated by status, OCPD by the work itself

Question 52

RX of OCPD

Answer 52

psychotherapy CBT particularly useful pharm can treat associated symptoms as necessary

Question 53

RX for OCD

Answer 53

SSRIs often decrease the intrusive thoughts associated with OCD

Question 54

Personality change due to another medical condition

Answer 54

persistent personality change from previous pattern due to the direct pathophysiological result of a medical condition (e.g. head trauma, strokes, epilepsy, CNS infections, neoplasms). Subtypes: labile, disinhibited, aggressive, apathetic, paranoid.

Question 55

Other specified personality disorder

Answer 55

reserved for a personality disorder that does not meet the full criteria for any of the disorders, but where the clinician chooses to communicate the specific reason that the presentation does not meet the criteria for any specific one. (e.g. "mixed personality disorder)

Question 56

Unspecified personality disorder

Answer 56

used for one that does not meet the full criteria for any of the disorders, but where the clinician chooses NOT to specify the reason that the criteria are not met for any specific personality disorder (e.g. not enough information to make a more specific dx)