Chapter 6_Personality Disorders Flashcards
DSM criteria for personality disorder
CAPRI (Cognition, affect, personal relations, impulse control)
- Enduring pattern of behavior that deviates from norm, and manifested in two CAPRI areas
- stable; presents no later than adolescence or early adulthood
- must cause significant impairment, not due to other disorder
What are the three “clusters” of personality disorders
Cluster A WEIRD (schizoid, schizotypal, paranoid)
Cluster B WANTING (antisocial, borderline, narcissistic, histrionic
Cluster C WORRIED (obsessive compulsive, avoidant, dependent)
can have other specified/unspecified personality disorder for a disorder that doesn’t meet full criteria for any other disorders
What familial associations does each cluster have?
A - psychotic disorders
B - mood disorders
C - anxiety disorders
T/F: Many personality disorder symptoms can be treated with medication
False. Very difficult to to treat. Chronic and lifelong
What is the most effective treatment for personality disorders?
PSYCHOTHERAPY
- pervasive distrust of others; suspicious, interpret motives of others as malevolent
- blame their own problems on others; angry and hostile
- jealous; suspects partner cheats on them
paranoid personality disorder (PPD)
Cluster A
30 year old man says his wife has been cheating on him because he doesn’t have a good enough job to provide for her needs, He also claims that on his previous job, his boss laid him off because he did a better job than his boss. He has initiated several lawsuits; refuees couples therapy because he believes the therapist will side with his wife
paranoid personality disorder (PPD)
Cluster A
How to differentiate between PPD and schizophrenia?
Patients with schizophrenia don’t have fixed delusions or are frankly psychotic; they may become psychotic transiently under stress though
How to differentiate between PPD and social disenfranchisment/social isolation?
Ask people who are close to them. People without social support can often act suspicious toward others
Treatment for PPD
psychotherapy
short course of antipsychotics for transient psychosis
What to avoid in treatment of PPD
Group therapy; they may misinterpret others and mistrust them
Lifelong pattern of social withdrawal; often perceived as eccentric and reclusive; quiet and unsociable; constricted affect; no desire for close relationships and prefer to be alone
schizoid personality disorder
45 year old scientist works in the lab most of the day and has no friends, according to coworkers. Has not been able to keep his job because of failure to collaborate with others. Expresses no desire to make friends and is content with single life. No evidence of thought disorder
schizoid personality disorder
How to differentiate schizoid from schizotypal
Schizoids don’t have the same magical thinking or eccentric behavior as schizotypal. Schizotypal are more similar to schizophrenics in terms of odd behavior and perceptions
How to treat schizoid
day programs or drop in centers; lack of insight so won’t benefit from psychotherapy
SSRIs to treat possible comorbid depression
Pervasive pattern of eccentric behavior and peculiar thought patterns. Perceived as strange and odd. Ideas of reference, odd beliefs or magical thinking (clairvoyance/telepathy/fantasies/superstitions) inconsistent with cultural norms, inappropriate restricted affect, strange religious practices, excessive social anxiety, suspiciousness
schizotypal (cluster A)
35 year old man dresses in wizard costume every weekend for LARP. Great deal of time on computers set up in basement in order to “detect the presence of extraterrestrial communications in space”; no AVH
schizotypal (Cluster A)
How to treat schizotypal
psychotherapy to help develop social skills training; short course low dose antipsychotics may help decrease social anxiety and suspicion in interpersonal relationships
Exploitive of others and breaks rules to meet their own needs. Lack empathy, compassion, remorse for actions. Impulsive, deceitful, and often violate the law. Skilled at reading social cues and can appear charming and normal to others who meet them for the first time and do not know their history
antisocial (cluster B)
26 year old man has a history of multiple criminal arrests and is the son of two alcoholic parents. Brother recalls him setting their pet dog on fire as a kid.
antisocial (cluster B)
How old must patient be to receive dx of antisocial?
at least 18; but needs to have had disregards and violation for others rights since age 15
before 18; behavior must be consistent with conduct disorder
How to distinguish antisocial and drug abuse?
Ask what came first; drugs or personality disorder…if drugs came first; addiction may be contributing to behavior
Treatment for antisocial
- psychotherapy usually ineffective
- may try meds to treat anxiety or depression; but caution since patients may have high addictive potential
Name some childhood events that may lead to antisocial
abuse (physical or sexual); history of hurting animals or starting fires
Unstable moods, behaviors, and interpersonal relationships. Fear abandonment and have poorly formed identity. Relationships begin with intense attachements and end at slightest conflict. Aggression is common. Impulsive and may have a history of repeated sicide attempts/gestures or episodes of self mutilation. Higher rates of childhood physical, emotional, and sexual abuse than regular population
borderline personality disorder (BPD)
cluster B
23 year old medical student attempted to cut her wrist because things didn’t work out with a man she had been dating over the past 3 weeks. She states that guys are jerks and “not worth her time” She often feels she is “alone in the world”
BPD
cluster B
how to differentiate BPD and bipolar II
BPD mood swings are moment to moment in reaction to environmental/psychological triggers
What psych comorbidities are often seen in BPD
substance use, depression, increased risk of suicide
Treatment for BPD
DBT!; pharmacotherapy to treat comorbid psychotic or depression
Attention seeking behavior and excessive emotionality. Dramatic, flamboyant, extroverted, unable to form long lasting meaningful relationships. Sexually inappropriate and provacative; uncomfortable when not center of attention easily influenced by others or situation, shallow expression of emotion
histrionic personality disorder HPD
cluster B
33 year old scantily clad woman comes to your office complaining that her fever feels like “she is burning in hell” Vividly describes how the fever has affected her work as a teacher
HPD
cluster B
What defense mechanism do patients with HPD usually use?
Regression (to childlike behaviors)
Treatment for HPD
psychitherapy (supportive problem solving, interpersonal)
how to differentiate HPD and BPD
HPD patients tend to be more functional. They are less prone to depression, brief psychotic episodes, and suicide attempts
Sense of superiority; need for admiration and a lack of empathy. COnsider themselves “special” AND WILL EXPLOIT OTHERS for their own gain. Still may have fragile self esteem. Arrogant or haughty, preoccupation with unlimited money, success, brilliance. Advantage of tohers. Envious of others and believes others are envious of him
narcissistic personality disorder (NPD)
cluster B
How to differentiate between NPD and BPD
NPD and BPD both exploit others but NPD does it for status and recognition while BPD want more material gain or simply just to see the world burn. NPD will become depressed if they don’t get the attention they think they deserve
Avoidant personality disorder has large overlap with what other disorder?
social anxiety disorder
Fear of being rejected; social inhibition for fear of being rejected, avoid social interactions and seek jobs in which there is little personal contact. Desire companionship but are extremely shy and easily injured. Unwilling to act unless certain of being liked. Believes themselves to be socially inept or inferior
avoidant personality disorder (cluster C)
How to differentiate schizoid and avoidant?
Avoidant wants companionship, schizoid doesn’t
How to differentiate avoidant and social phobia?
If symptoms are integral part of persons personality before adulthood, more likely to be avoidant….fear of rejection and inadequacy in avoidant vs fear of embarassment in social phobia. Often they coexist together
Treatment for avoidant
psychotherapy (assertiveness and social skills training); group therapy
SSRIs for comorbid social anxiety or major depression
How to differentiate avoidant and dependent?
Avoidant and dependent both want relationships but avoidant will be slow to start relationships whereas dependent will aggressively seek out relationships
Poor self confidence and fear of separation; excessive need to be taken care of and allow others to decide for them. Helpless when alone; urgently seeks another relationship when one ends; goes to excessive lengths to get support form others; difficulty expresssing disagreement because of fear of loss of approval; difficulties with employment since they cannot act independently or without close supervision
dependent personality disoder (DPD)
cluster C
how to differentiate between DPD and BPD/HPD?
DPD will be able to form long lasting relationships that they cling to; whereas BPD/HPD have trouble maintaining relationships
Pervasive preoccupation with perfection, inflexibility, and orderliness; Preoccupation with unimportant details; unable to complete simple tasks on time. Stiff serious, formal, with constricted affect. Can be successful professionaly but often have poor interpersonal skills. Will not delegate tasks, unable to discard worthless objects
OCPD (cluster C)
How to differentiate between OCPD and OCD
OCD - ego dystonic
OCPD - ego syntonic
How to differentiate between narcissistic and OCPD
NPD- motivated by status
OCPD - motivated by work itself
