Lec 79 Personality Disorders

Question 1

Is there FDA approved treatment for personality disorders?

Answer 1

nope! just do psychotherapy

Question 2

What is the core feature of all personality disorders?

Answer 2

difficulty in interpersonal functioning

Question 3

What is the DSM-5 definition of personality disorder?

Answer 3

• enduring pattern of inner experience and behavior that deviates from expectations of one’s culture. pattern manifests in 2 or more of the following: cognition, affectivity, interpersonal functioning, impulse control
• inflexible and pervasive pattern
• leads to clinically significant distress or impairment
• stable pattern of long duration, onset traced back at least to adolescence or early adulthood

person is not usually aware of the problem

Question 4

What is development and course of personality disorder?

Answer 4

• person is not usually aware of the problem
• evident during adolescence or early adult life
• relatively stable over time
• hard to diagnose under age 18
• may be exacerbated by loss of significant support or previously stabilizing social situations

Question 5

Is personality disorder dimensional or categorical?

Answer 5

currently in DSM 5 = categorical = not on a continuum with normal personality

Question 6

What is difference axis 1 vs axis 2 disorders DSM4?

Answer 6

axis 1 = symptoms, episodic, pt suffers most, biologic, genetic, treat with meds
axis 2 = traits, stable, those around pt suffer most, psychological, development, treat with therapy

Question 7

What are the 3 clusters of personality disorders?

Answer 7

cluster A = odd or eccentric [weird]
cluster B = dramatic, emotional, erratic [wild]
cluster C = anxious/fearful [worried]

Question 8

What are the cluster A personality disorders? 3 types?

Answer 8

odd/eccentric, inability to develop meaningful social relationships, no psychosis, genetic association with schizophrenia
= Accusatory, Aloof, Awkward

3 types: paranoid, schizoid, schizotypal

Question 9

WHat are the 3 personality clusters and their major characteristics [ABCs]?

Answer 9

cluster A = weird [accusatory, aloof, awkward]
cluster B = wild [bad to the bone]
cluster C = worried [cowardly, compulsive, clingy]

Question 10

What is paranoid personality disorder?

Answer 10

• cluster A
• irrational suspicions and mistrust of others
• projection is major defense mech

Question 11

What is schizoid personality disorder?

Answer 11

• cluster A
• voluntary social withdrawal, limited emotional expression,, content with social isolation
• schizoiD = Distant

Question 12

What is schizotypal personality disorder?

Answer 12

• cluster A
• commonly co-occurs with paranoid PD = high rate of aggression often leading to criminal violence
• classic schizotypal: eccentric appearance, odd beliefs or magical thinking, interpersonal awkwardness, difficulty with working memory, lack of close friends, emotionally reserved
• schizoTypal = magical Thinking

don’t look obviously mentally ill, could be misdiagnosed as depression, ADHD

Question 13

What are characteristics of cluster B personality disorders? 4 types?

Answer 13

dramatic, emotional, erratic
- genetic association with mood disorders and substance abuse

• antisocial, borderlines, histrionic, narcissistic

Question 14

What are characteristics of cluster C personality disorders? 3 types?

Answer 14

anxious or fearful; genetic association with anxiety disorders

avoidant, obsessive compulsive, dependent

Question 15

Match the personality disorder cluster and which diseases it has genetic association with:

1. cluster A
2. cluster B
3. cluster C

A. mood disorders/substance abuse
B. anxiety disorders
C. schizophrenia

Answer 15

cluster A = schizophrenia
cluster B = mood disorders/substance abuse
cluster C = anxiety disorders

Question 16

What is antisocial personality disorder?

Answer 16

• cluster B
• disregard for violation of rights of others
• criminality, impulsivity
• males > females; > 18yo and have conduct disorder before age 15
• if under age 18 its conduct disorder not personality disorder

Question 17

What is borderline personality disorder?

Answer 17

• cluster B
• emotional instability [esp anger], hypersensitivity to interperonsal interactions esp. rejection, self-injury [to relieve pain], dissociatve symptoms, impulsivity esp aggression, intense unstable mood and interpersonal relationships, extreme “black and white” thinking, boredom, sense of emptiness
• female > male
• high suicide rate [distinct from self-injury]
• onset = adolescence but symptoms evident in child
• childhood trauma increases risk

Question 18

What is histrionic personality disorder?

Answer 18

• cluster B
• pervasive attention-seeking, sexually provocative, overly concerned with appearance, excessive emotionality and excitablity

Question 19

What is narcissistic personality disorder?

Answer 19

• cluster B
• grandiosity, sense of entitlement, lacks empathy and requires excessive admiration, often demands the “best” and reacts to criticism with rage

Question 20

What is avoidant personality disorder?

Answer 20

• cluster C
• hypersensitive to rejection, socially inhibited, avoidance of social interactions, timid, feelings of inadequacy, desires relationships with others
• closely tied to social anxiety disorder
• pt desires affection/acceptance/relationships

Question 21

What is obsessive-compulsive personality disorder?

Answer 21

• cluster C
• preoccupation with order, perfectionism, control
• rigid conformity to rules
• behavior consistent with one’s own beliefs and attitudes [vs OCD has intuition]

Question 22

What is dependent personality disorder?

Answer 22

• cluster C
• psychological dependence on others
• submissive and clinging
• excessive need to be taken care of
• low self-confidence

Question 23

What 3 personality disorders most seen in clinic?

Answer 23

• schizotypal
• borderline
• avoidant

Question 24

Which personality disorders more seen in men?

Answer 24

• antisocial personality disorder

Question 25

Which personality disorders more seen in women?

Answer 25

• dependent
• histrionic
• borderline

Question 26

What is neurobiology of schizotypal personality disorder? treat?

Answer 26

eye tracking abnormalities, temporal lobe volume loss, reduced striatal DA

treat = social skills training, low dose antipsychotics

Question 27

What are neuro models of borderline personality disorder?

Answer 27

• amygdala-OFC disconnection –> emotional dysregulation = made worse by benzos/alc
• fialure in habituation to negative emotional stimuli –> reviewing painful memories worsens symptoms + increases self-injury
• social cognition dysfunction –> decreased activity in insula during social interaction, difficult identifying feels in self and others = lack of gut feeling that there is a problem with a relationship

Question 28

What is course of borderline personality disorder?

Answer 28

• impairment and suicide risk decrease with age + relationships stabilize
• if therapy –> benefit w/in 1 yr
• after 10 yrs up to 50% no longer have pattern of behavior that meets full criteria for borderline personality disorder
• 10% commit suicide

Question 29

What is neurobiology of avoidant PD?

Answer 29

inhibited temperament evident prenatally + infancy predicts

high amygdala activity similar to BPD

Question 30

What is treatment for avoidant PD?

Answer 30

psychoanalytic psychotherapy, social skills training, antidepressant