Lecture 20: Personality Disorders Flashcards
What is personality?
Enduring patterns of perceiving, relating to, and thinking about the environment and oneself.
What is a personality disorder?
Personality traits that are inflexible and maladaptive enough to cause significant distress and impairment of functioning.
What sub-groups are personality disorders MC in?
- Psychiatric patients
- Criminals
- Alcohol-dependent
- Drug-dependent (highest)
What are the common comorbidities with personality disorders?
- Reckless/impulsive behaviors
- Psychiatric comorbidities
- Functional impairment
- Non-compliance with treatment
What are the screenings for personality disorders?
- Minnesota multiphasic personality inventory-2 restructured form (MMPI-2-RF)
- Million clinical multiaxial inventory-3 (MCMI-III)
What are common effects on a clinical relationship with personality disorder?
- Challenging to develop provider-patient support
- More likely to see problems with distrust, irritability, etc
- Increased risk of signing out AMA, after-hours calls, etc.
- Patients tend to be very demanding but think their behavior is appropriate.
Describe a cluster A personality disorder.
- Schizotypal (Awkward)
- Schizoid (Aloof)
- Paranoid (Accusatory)
Odd and cynical patients
Describe a cluster B personality disorder.
- Borderline (Borderline)
- Narcissistic (Best)
- Antisocial (Bad)
- Histrionic (flamBoyant)
Emotional, over the top patients.
Describe a cluster C personality disorder.
- Dependant (Clingy)
- Avoidant (Cowardly)
- Obsessive-Compulsive (Compulsive)
What kind of traits would I expect in someone with cluster A disorders?
- Paranoid: suspicious, overly sensitive, mistrustful (Fear)
- Schizoid: shy, introverted, withdrawn, avoids close relationships. (Elsa)
- Schizotypal: superstitious, socially isolated, eccentric (Sheldon)
What etiology increases the risk of cluster A disorders?
Parents who have irrational bursts of anger.
What is the cardinal symptom of a paranoid personality disorder?
Generalized distrust or suspiciousness of others such that their motives are interpreted as malevolent.
On PE, how would someone with a paranoid personality disorder present?
- Formal
- Skeptical
- Mistrustful
- Poor eye contact
How do we treat someone with paranoid personality disorder?
- Antipsychotics (acute decompensation or frank delusions)
- Therapy (often difficult)
Who is schizoid personality disorder most common in? (Elsa)
Men, but it is rare to see since they are avoidant.
What are possible risk factors for schizoid personality disorder?
- Pregnancy during a famine
- Environment devoid of nurturing
- Autism
What are the cardinal symptoms of schizoid personality disorder?
- Detachment from relationships
- Introversion
- Restricted range of emotional expression
- Does not desire/enjoy close relationships
- Preference for solitary pursuits
- Poor social interaction due to impaired interpretations
How do we treat schizoid personality disorder?
- Potentially antidepressants
- Therapy (difficult since they do not feel distressed)
What is schizotypal personality disorder most commonly linked to? (Sheldon)
Genetic link to schizophrenia
What are the cardinal symptoms of schizotypal personality disorder?
- Peculiar thoughts
- Speech and behavior
- Magical beliefs
- Social difficulties
How does someone with schizotypal personality disorder tend to present on PE?
- Constricted affect
- Odd beliefs
- Odd mannerisms
- Tangential
How do we treat schizotypal personality disorder?
- Low-dose antipsychotics (lamotrigine, lithium, etc…)
- Group therapy
- Individual therapy
What are the 4 types of cluster B disorders?
- Antisocial (Jafar) (Bad)
- Borderline (anakin) (Borderline)
- Histrionic (regina george) (flamBoyant)
- Narcissistic (Scar) (Best)
What patient groups is antisocial personality disorder MC in?
- Prisoners
- Alcoholics
Most likely to be serial killers
What etiologies contribute to antisocial personality disorder?
- 5x more common with first-degree relatives that have it, esp. identical twins.
- Abusive or absent parents
- Low socioeconomic status
What are the cardinal symptoms of antisocial personality disorder?
- Recurrent disregard for and violation of the rights and feelings of others
- Poor job performance
- Marital instability
- Often have childhood diagnosis of conduct disorder
- Pathological lying
- LACK of remorse/guilt
- Often manipulative, untrustworthy people.
Similar to conduct disorder
How do we treat antisocial personality disorder?
- Therapy (socially based interventions with others of similar temperaments and problems are tx of choice)
What is the prognosis of antisocial personality disorder?
Terrible ):
Most treatment-refractory personality disorder.
Who is borderline personality disorder MC in? (Anakin)
Women.
What are borderline personality patients most in danger of?
Suicide. 80% have attempted.
What patient groups are borderline personality disorder MC in?
- Psych OP
- Psych IP
- ER patients
What etiologies contribute to borderline personality disorder?
- More common in families with BPD
- Childhood trauma
- Parental neglect
What are the cardinal symptoms of borderline personality disorder?
- Impaired relatedness with others (stormy)
- Labile mood
- Impulsivity
- Self-injurious behavior
- Poor self-image
- Unstable relationships
- Mood changes
- Suicidal
- Negative outlooks
How do we treat borderline personality disorder?
- Lithium (esp if high SI risk)
- Carbamazepine (behavior control)
- Antipsychotics
- SSRIs
What suggests a poor prognosis for borderline personality disorder?
- Self-destructive behavior
- Sabotaging treatment
- Increase towards schizophrenia like symptoms.
What is unique about histrionic personality disorder? (Regina George)
- More likely to seek treatment
- More common in women
What etiologies contribute to histrionic personality disorder?
- Associated with antisocial personality disorder.
- Problematic parent-child relationships
What are the cardinal symptoms of histrionic personality disorder?
- Excessive, superficial emotionality and sexuality
- Attention-seeking
- Evade unpleasant responsibilities
- Control others
- Labile mood
- Seductive
- Overly concerned with physical appearance
- DEPENDENT on provider
How do we treat Histrionic personality disorder?
- MAOIs (maybe)
- SSRIs (tx of comorbidities)
- Therapy (Group, couple/marital, individual)
How is the prognosis for histrionic personality disorder?
Pretty good, generally improves over time.
Who is narcissistic personality disorder MC in?
Men
What are the theories behind narcisstic personality disorder? (Scar)
- Excessive appreciation as a child
- Underappreciation as a child
What are the cardinal symptoms of narcisstic personality disorder?
- Grandiosity
- Notable lack of empathy
- Lack of consideration for others
- Sense of entitlement
- Deserve special treatment
- Hypersensitivity to criticism
- Self-absorbed
- Externalizing problems
- Depressed and withdrawn if self-image is damaged.
How do we treat narcissistic personality disorder?
- Treat comorbidities
- Group therapy (but difficult if they get criticized)
- Couple/marital therapy (avoid criticizing them)
- Individual
How is the prognosis of narcissistic personality disorder?
- Symptoms generally don’t improve over time without treatment
- Depression common in middle-aged and older.
What are the three cluster C disorders?
- Avoidant (Piglet) (Cowardly)
- Dependent (Cinderella) (Clingy)
- Obsessive-Compulsive (Prof Mellert) (Compulsive)
What are the etiologies of avoidant personality disorder?
- Stagnation when going through normal developmental stage of shyness and fear of strangers.
- Caution when diagnosing a young child, because they may outgrow the shyness.
What are the cardinal symptoms of avoidant personality disorder?
- Persistent pattern of avoidance
- Anxiety, leading to restricted lifestyle
- Introversion with limited social interactions
- Awkward and uncomfortable in social situations
- Fears of rejection
- Very passive
- Poor response to criticism
How do we treat avoidant personality disorder?
- SSRIs
- MAOIs
- BBs
- Anxiolytics (buspirone, BZDs)
- Group therapy
- Individual therapy
What suggests a poor prognosis for avoidant personality disorder?
- Other personality disorders
- Poor environments
Normally has one of the best prognosis of the personality disorders
What are the cardinal symptoms of dependent personality disorder? (Cinderella)
- Lifelong interpersonal submissiveness
- Poor self-esteem
- Fear of abandonement
- Lack of self-confidence
- Often seek to be in a new relationship
- Difficulty making decisions alone
- Outwardly agree with others even if they inwardly disagree.
How do you treat dependent personality disorder?
- SSRIs/TCAs can treat associated symptoms.
- Family/couples therapy to reinforce patient autonomy
- Group: Considerable benefit!
- Individual therapy: assertiveness training
How is the prognosis for dependent personality disorder?
- Generally good, especially if no other comorbidities.
- More capacity for empathy or trust
What are the etiologies behind OCPD? (Prof Mellert)
- Overly controlling parenting
- Stagnation in “anal stages” of development
- More common first-degree relatives
What are the cardinal symptoms of OCPD?
- Rigidity
- Constricted affect
- Inflexibility
- Stubbornness
- Need for orderliness and control
- Perfectionist
- Frugal
- Occupational difficulty (poor group work)
- Devoted to work
- Preoccupation with lists
What is the difference between OCPD and OCD?
- OCPD does not act on actual obsessions.
- OCD is much more focused on specific obsessions and generally are distressed from their behaviors.
- OCD spends much more time on their tasks.
How do we treat OCPD?
- SSRIs may help (fluoxetine/prozac, fluvoxamine/luvox)
- Therapy (pts generally don’t feel distressed, so difficult)
How is the prognosis of OCPD?
- Generally good if no comorbidities
- Self-discipline and organization may preclude complications
- Prone to anxiety and depression
