Exam 2 Personality disorders Flashcards
define personality
person’s unique emotional and behavioral traits used to RESPOND to the environment and INTERPERSONAL relationships, which are APPARENT in ordinary life and are usually STABLE and PREDICTABLE
How does personality influence neural processing
sensation –> perception* –> cognition* –> behavior* or emotions*
*personality influences
General description of PDs
A. subjective experiences and behaviors that
- Deviate from cultural standards
- Traits are pervasive, inflexible, maladaptive
- Have onset in late adolescence or early adulthood
- Are stable from late adolescence through time
- Can lead to unhappiness and impairment
B. Characteristics
- Deny they have problems
- Sx are alloplastic; attempt to alter the external environment (not themselves)
- Ego-syntonic: believe behaviors are normal to suit their self0image
- Do not feel anxious about their maladaptive behavior
- Disinterested in tx: refuse psych tx
- Impervious to recovery
What are the different clusters of PDs
Cluster A (odd/eccentric) Cluster B (dramatic/emotional) Cluster C (anxious/fearful)
What is included under Cluster A of PDs
“Odd/eccentric” - acts peculiar or avoids social relationships
- Paranoid
- Schizoid
- Schizotypal
What is included under cluster B (dramatic/emotional)
“dramatic/emotional”
- Antisocial
- Borderline
- Histrionic
- Narcissistic
What is included under Cluster C (anxious, fearful)
“anxious, fearful”
- Avoidant
- Dependent
- Obsessive compulsive (PD)
Etiology of PDs
- Developmental hx may reveal individual difficulties - family problems/abuse/incest
- Biological determinants may be evident (genetics) - perinatal injury, encephalitis, head trauma
DSM dx of Paranoid Personality disorder
suspicious, mistrusting, 4/7
A pervasive distrust and suspiciousness of others present w/o justification, Begins by early adulthood at least 4 of the following:
- Suspicious others are exploiting, harming or deceiving
- Doubts loyalty or trust-worthiness of others
- Fears that info given to others will be used maliciously against them
- Mistrust other “out to get them”
- Bears grudges
- Perceives attacks that are not apparent to others and is quick to react angrily or to counterattack
- Repeatedly questions the fidelity of the spouse or sexual partner
DSM criteria of Schizoid personality disorder
Schizoid, devoid 4/7
Pervasive pattern of social detachment with a restricted affect, beginning by early adulthood and indicated by at least FOUR of the following:
- Neither desires nor enjoys close relationships
- Chooses solitary activities
- Little interest in having sexual experiences
- Takes pleasure in few, if any, activities
- No close friends or confidants except first degree relatives
- Indifferent to the praise or criticism of others
- Emotional detachment (restricted range of emotions( cold and aloof
DSM dx cx Schizotypal PD
*no close relationships, eccentric, 5/9
pervasive pattern of interpersonal deficits marked by discomfort and REDUCED CAPACITY FOR CLOSE RELATIONSHIPS as well as perceptual distortions and ECCENTRICITIES of behavior, beginning in early adulthood. at least FIVE of the following:
- Ideas of REFERENCE
- NO close relationships outside first degree relatives
- Behavior or appearance is odd, eccentric or peculiar
- Odd thinking and speech
- Suspiciousness or paranoid ideations
- Inappropriate or constricted affect
- Excessive social anxiety that does not diminish with familiarity
- Odd beliefs or magical thinking
- Unusual perceptions/body illusions
Cluster B of PDs includes
“emotional, inconsistent, dramatic”
- Antisocial “man slaughterers 3/8”
- Borderline “unstable clingy, paranoids 5/9”
- Histrionic “drama queen 5/8”
- Narcissistic
Dx criteria for antisocial personality do
disregard, deadly 3/8
A. Pt displays disregard for, and violation of the rights of others and is indicated by at least THREE:
- disregard for social norms with respect to lawful behaviors
- Deceitfulness: repeated lying, conning others for personal profit or pleasure
- Impulsivity or failure to plan ahead
- Irritability and aggressiveness
- Reckless disregard for the safety of self or others
- Irresponsibility in employment or finances
- Lack of remorse/guilt/shame
- Lack of empathy
Disregard lawful behavior, Deceitful, impulsive, irritable, reckless, irresponsible, unremorseful, apathetic
DDIIRIUA (at least 3)
Antisocial personality d/o background
hx of sx of conduct disorder before age 15 ie
- Aggression against people and animals
- Destruction of property
- Deceitfulness
- Serious violation or rules
predisposing: ADHD, oppositional defiant disorder, conduct disorder
How does dysfunction of paralimbic structures relate to antisocial personality d/o (prefrontal cortex, anterior cingulate, amygdala, insular damage)
Prefrontal cortex damage = impulsive, lacks insight, recidivism
Anterior cingulate damage = lack of empathy and affect
amygdala damage = fearlessness; misperceptions of threat
Insular damage = can’t recognize violation of social norms; high disgust threshold
DSM dx of Borderline Personality disorder (unstable/clingy/paranoid 5/9)
A pervasive pattern of UNSTABLE INTERPERSONAL RELATIONSHIPS, unstable SELF IMAGE, and poor IMPULSE CONTROL beginning by early adulthood. at least FIVE:
- Frantic efforts to avoid real or imagined ABANDONMENT
- Unstable and intense interpersonal relationships
- Identity disturbance: unstable self image or sense of self
- Impulsivity in at least TWO areas that are potentially self damaging (spending, promiscuity, substance abuse, reckless driving, binge eating)
- Recurrent suicidal behavior, gestures or threats or self-mutilating behavior
- Affect instability (sudden intense dysphoria, irritability or anxiety of short duration)
- Chronic feelings of emptiness
- Intense anger or difficulty controlling anger
- Transient stress related paranoid ideation, dissociative sx or brief psychotic episodes
fear abandonment, unstable relationships, identity disturbance, self-damaging impulsivity, suicidal, affect instability, empty, anger, brief psychosis/ideation
*BORDERline = unstable
Characteristics of attention and emotional imbalances
better name = “emotional dysregulation disorder”
- no emotional skin
-worship then detest partners
DEPAKOTE (VALPROATE) may help alleviate emotional and interpersonal volatility
-hypersensitivity to facial expressions
- difficulty distancing from emotionally charged situations due to: less emotional regulation by anterior cingulate cortex and difficulty turning attention away due to dysfunction in intraparietal sulcus
DSM dx Histrionic Personality Disorder
*drama queen, 5/8
Pervasive Pattern of excessive EMOTIONALITY and ATTENTION SEEKING beginning early adult. FIVE or more:
- Not comfortable unless center of attention
- Sexually seductive or provocative
- Rapid shifting and shallow expression of emotions
- Uses physical appearance to attract attention
- Style of speech excessively impressionistic, lacking detail
- Dramatic and exaggerated expression of emotion
- Suggestible, easily influenced by others
- Considers relationships more intimate than they are
DSM dx Narcissistic Personality d/o
*Voldemort 5/9
Pervasive pattern of GRANDIOSITY (in fantasy or behavior), NEED for ADMIRATION, LACK EMPATHY, beginning early adulthood; FIVE of the following:
- Grandiose sense of self importance
- Preoccupation with fantasies of unlimited success, power, brilliance, beauty or ideal love
- Associates only with others who are perceived as unique or exceptional
- Needs excessive admiration
- Has a sense of entitlement
- Takes advantage of others to achieve his/her own ends
- Lacks empathy - unwilling to recognize or identify with feelings or needs of others
- Envious of others, believe others envious of them
- Shows arrogant, haughty behaviors or attitudes
Cluster C personality d/o include
“Fearful and anxious”
a) avoidant PD
b) Dependent PD
c) Obsessive Compulsive PD
DSM dx Avoidant PD
*no relationship bc fear rejection, 4/7
Pervasive pattern of SOCIAL INHIBITION, feelings of INADEQUACY, and HYPERSENSITIVITY beginning by early adulthood. At least FOUR
- Avoids occupations with sig interpersonal contact due to fear of criticism, disapproval or rejection
- Restrained in intimate relationships due to fear of being shamed or ridiculed
- Preoccupied with being criticized or rejected in social situations
- Inhibited in new interpersonal situations due to feelings of inadequacy
- Pt views himself as socially inept, unappealing or inferior to others
- Reluctant towards personal risks or new activities - fear of embarrassment
- Unwilling to get involved with people unless certain of being liked
*they do desire to have attachments with others
DSM dx Dependent Personality disorder
*always need confirmation 5/9
Pervasive and excessive need to be cared for - subemissive, behavior and fears of separation. At least FIVE:
- Unable to make their own decisions
- Need to be taken care of and others assume responsibility for them
- Difficulty expressing disagreement with others
- Difficulty initiating projects - pessimistic about abilities
- Goes to excessive lengths to be dependent on others regardless of cost to self
- helpless when alone. Fears being unable to care for himself/herself
- Urgently seeks another relationship when one ends
- Preoccupied with fears of being left to take care of themselves
OCPD DSM dx
Preoccupation with ORDERliness, PERFECTIONISM and CONTROL, at the expense of flexibility, openness and efficiency beginning by early adulthood. At least FOUR:
- Preoccupied with details, rules, lists, organization or schedules
- Perfectionism interferes with task completion
- Excessively devoted to work and productivity to the exclusion of leisure activities and friendships
- Over conscientious, scrupulous and inflexible about morality, ethics or values (not accounted for by cultural or religion)
- Unable to discard worn out or worthless objects even if they have no sentimental value
- Reluctant to delegate tasks to others
- Miserly spending toward self and others
- Rigid and stubborn
In response to medical illness, any aberrant sx will..
become more exaggerated
