Lecture 5: Personality, Impulse Control, OCD

Question 1

Personality Disorders

Answer 1

1. enduring patterns of perceiving, relating to, and thinking about the environment and oneself
2. exhibited in a wide range of social and personal contexts, deviate markedly from cultural standards
3. Traits are inflexible, maladaptive, and cause significant functional impairment or subjective feelings of distress
4. traits develop by early adulthood and are stable over time

Question 2

General Criteria Mood Disorders (5)

Answer 2

1. enduring pattern of experience and behavior manifested in
   a. cognition (self, people, events)
   b. affectivity (range, appropriateness, intensity)
   c. interpersonal functioning
   d. impulse control
2. pattern is enduring and pervasive across a broad range of personal and social situtations
3. leads to clinically significant distress of impairment
4. begins by adolescence and is durable
5. r/o other mental disorders and medical causes

Question 3

Course and Prognosis PDO

Answer 3

1. generally persistent, some types tend to decrease in symptom severity with age
2. personality changes in middle age or after should prompt evaluation for medical cause

Question 4

clusters of personality disorders (3)

Answer 4

A. Cluster A: odd or eccentric

B. Cluster B: dramatic, emotional, erratic

C. Cluster C: anxious or fearful

Question 5

Paranoid PDO (7)

Answer 5

1. pervasive mistrust and suspiciousness as represented by at least 4 of the following
   a. suspects, without sufficient basis, of others exploiting, harming, or deceiving them
   b. preoccupied with unjustified doubts about the loyalty of others
   c. reluctant to confide in others for fear of betrayal
   d. reads demeaning or threatening messages into benign statements or events
   e. persistently bears grudges
   f. perceives hidden attacks and reacts angrily
   g. recurrent, unjustified suspicions of infidelity

Question 6

Pschizoid PDO

Answer 6

1. Detachment from from social and emotional relationships, as evidenced by four of the following:
   a. lack of interest in close relationsips
   b. chooses solitary activities
   c. little interest in sexuality
   d. few pleasurable activities
   e. lacks close friends or confidants other than family
   f. Indifferent to praise or criticism
   g. emotional detachment, coldness, or flattened affect

Question 7

Schizotypical PDO

Answer 7

1. Discomfort with personal relationships combined with eccentricities of thought or behavior, as evidenced by 5 or more

a. ideas of reference
b. magical thinking
c. unusal perceptive process
d. odd thinking of speech patterns
e. suspiciousness or paranoia
f. inappropriate or constricted affect
g. eccentric behaviors
h. lack of close friendships
i. excessive social anxiety despite familiarity

Question 8

Antisocial PDO

Answer 8

1. Disregard for and violation of the rights of others, evidenced by three or more:

a. frequent illegal acts
b. chronic deceitfulness
c. impulsivity and failure to plan ahead
d. frequent physical aggressiveness
e. reckless disregards for safety of self or others
f. irrespnsibilty
g. lack of remorse

Question 9

ASPD vs. Psychopathy

Answer 9

1. psychopathy overlaps with DSM ASPDO
2. callous, charming, manipulative
3. frequently violent and impulsive
4. associated with serial violence or sexual violenc
5. may disguise traits with significant social success

Question 10

Borderline PDO

Answer 10

1. instability in relationships, self-image, affect, impulsivity, requiring 5 of the following
   a. frantic efforts to avoid relationships of imagined abandonment
   b. unstable and intense relationships
   c. unstable self-image
   d. impulsivity and high-risk activities
   e. recurrent suicidal threats, gestures, or self mutilating behaviors
   f. marked mood and affect reactivity and instability
   g. chronic feelings of emptiness
   h. inappropriate and intense anger
   i. transient stress related paranoia or dissociative symptoms

Question 11

Histrionic PDO

Answer 11

1. pattern of excessive emotionality and attention seeking, req. 5 of the following:
   a. need to be center of attention in all settings
   b. interactions tend to be sexualized or provocative
   c. rapidly shifting and shallow emotions
   d. draws attention by psychical appearance
   e. impressionistic but non-detailed speech
   f. emotions are dramatically, theatrical, and exaggerated
   g. easily influenced by others or by situations
   h. exaggerated intimacy of relationships

Question 12

Narcissistic PDO

Answer 12

1. pattern of grandiosity, need for admiration, and lack of empathy, req. 5 of
   a. exaggerates sense of self importance
   b. preoccupied with fantasies of success, power, ideal love, brilliance, or beauty
   c. belief in “specialness” and only wants to assoc. with those who are other “special” people
   d. requires excessive admiration
   e. exploitative in relationships
   f. fails to recognize the feelings of others
   g. often envious of others, and believe others envy them
   h. arrogant, haughty behaviors or attitudes

Question 13

Avoidant PDO

Answer 13

1. pattern of social inhibition, inadequacy, and hypersensitivity to negative evaluations, requiring four of the following:
   a. avoids jobs with potential for criticism or rejection
   b. avoids friendships unless certain of being liked
   c. avoids relationships with potential for shame or ridicule
   d. preoccupied with fear of criticism in social situations
   e. inhibited in new relationships due to feeling of inadequacy
   f. views self as unappealing, socially inept, or inferior
   g. reluctant to take rx or do new things due to fears of embarassment

Question 14

Dependent PDO

Answer 14

1. pervasive and excessive need to be take care of leading to submissive and clinging behaviors by 5 of the following:
   a. needs excessive advice or encouragement for everyday decisions
   b. needs others to take responsibility for most major areas of life
   c. difficulty disagreeing with others due to fear of losing their support
   d. difficulty imitating projects on their own
   e. goes to excessive lengths to obtain nurturance and support
   f. uncomfortable or helpless when alone
   g. urgently seeks new relationships with old ones end
   g. precoccupied with fears of being left to take of seld

Question 15

Obsessive compulsive PDO

Answer 15

1. pattern of preoccupation with orderliness, perfectionism, and interpersonal control, as evidence by 4 of the following:
   a. preccupied with details, rules, list, order etc. to the point where major point of activity is lost
   b. excessively devoted to work and productivity
   c. perfectionism that interferes with task completion
   d. overconscientious, scrupulous, and inflexible about moral and ethical values
   e. reluctant to delegate tasks to others
   f. adopts miserly spending styles
   g. shows righty and stubornness

Question 16

Impulsive Control Disorders

Answer 16

1. related to problems in self-control and behavior

2. Occur in children, adolescents and adults

Question 17

Intermittent explosive DO (impulse control do)

Answer 17

1. recurrent behavioral outbursts representing a failure to control aggressive impulses by either
   a. verbal aggression like temper tantrums, arguments, or fighting 2x weekly on avg. for a 3 month period
   b. 3 behavioral outburst involving damage or destruction of property or physical injury to others within a 12 month period
   c. magnitude of aggression is out of proportion to provocation
   d. not premeditated or committed to a tangible outcome
   e. cause marked distress, functional impairment, or legal consequences
   f. must be 6 or older
   g. not better explained by another disorder

Question 18

Pyromania

Answer 18

1. deliberate and purposeful fire setting more than once
2. tension of affected arousal before the act
3. fascination with fire and its situations
4. pleasure gratification, or relief when setting or witnessing fires
5. not done for monetary gain, political expression, of in response to delusion
6. not assoc. with conduct disorder, mania, or ASPDO

Question 19

Kelptomania

Answer 19

1. recurrent failure to resist impulses to steal objects not needed for personal use or monetary value
2. increase sense of tension immediately before committing theft
3. pleasure, gratification, or relief afterwards
4. not committed to express anger vengeance, not in response to delusion ro hallucination
5. not explained by conduct disorder, mania, or ASPDO

Question 20

Obsessive-Compulsive Disorder (NOT* personality disorder)

Answer 20

1. presence of obsessions, compulsions, or both
2. time-consuming or cause significant functional impairment
3. not attributable to effects of a substance of medical condition
4. not better explained by another mental disorder
5. specify level of insight: poor, fair, food
6. specify related to TIC disorder

Question 21

Obsessions

Answer 21

1. recurrent and persistent thoughts, urges, or images that are experienced as intrusive and unwanted, and cause marked anxiety or distress
2. individual attempts to ignore or suppress such thoughts, or tries to neutralized them with some other thought or action

Question 22

Common Obsessive themes (5)

Answer 22

1. contamination
2. symmetry
3. forbidden or taboo thoughts
4. harm to self or others
5. hoarding behaviors

Question 23

Compulsions

Answer 23

1. repetitive behaviors (hand washing, ordering, checking) or mental acts (counting, praying, repeating) that the individual feels driven to perform in response to an obsession or rigid, arbitrary rules
2. actions are aimed at preventing or reducing anxiety, or preventing some dressed event.
   - actions may not be logical connected to what they are designed to prevent

Question 24

Body Dysmorphic DO

Answer 24

1. preoccupation with one or more perceived defects in physical appearance that are not perceived or appear slight to others
2. at some point, individual has performed repetitive thoughts are behaviors in response to this belief
3. causes significant distress or functional impairment
4. no better explained as an eating disorders

Question 25

Hoarding disorder

Answer 25

1. persistent difficulty discarding objects regardless of their actuual value
2. due to perceived need to save items and distress associated with discarding them
3. living areas become cluttered and their functioncompromised
4. causes significant distress or impairment
5. not assoc. with other psychiatric medical disorders
6. specify: excessive acquisition of unneeded items
7. specify: level of insight (absent, poor, fair, good)