Personality D/o Flashcards
When is the onset of personality d/o?
early adolescence or early adulthood
Behavior/traits in a pt with personality d/o are considered ____ and ____
pervasive and inflexible
Patients with personality d/o are usually (unstable/stable) over time
stable
There are 3 clusters of personality d/o, A B and C. What are they? What are they characterized by?
A – Eccentric d/o “the weirds”
B – Dramatic D/o “the wilds”
C – Anxious d/o “the wimps”
Personality d/o lay on a continuum ranging from no ______ to severe ______
no dysfunction to severe dysfunction
Personality theory presents that personalities can be defined/described by a combo of 4-5 different traits:
Extraversion, Agreeableness, Conscientiousness, Neuroticism, Openness to experience
How common is personality d/o?
very common, 9-16% US pop and 30-50% in psych outpatient pop
What are some common comorbid conditions in a pt with personality d/o?
MDD (51%), GAD (64%), and Panic d/o (56%)
What personality d/o are more common in males?
Antisocial personality d/o
What personality d/o are more common in females?
Borderline personality d/o
Histrionic personality d/o
Dependent personality d/o
What personality d/o are equal between sexes?
Schizoid, schizotypal, obsessive compulsive
Personality d/o is more common in (younger/older) pop, and prevalence (increases/decreases) with age
younger, decreases
Rates of unemployment, divorce, homelessness, drug abuse, and domestic violence are (lower/higher) in pts with personality d/o
higher
The dx of antisocial personality d/o requires a minimum age of ____ y/o, and is considered ______ d/o in younger individuals
18 y/o
conduct d/o
Personality changes later in life are more indicative of ______, such as ____ and ______
other mental illnesses, such as early schizophrenia or neurocognitive d/o
Early traumatic experiences and failing to progress through the normal stages of sexual development are common in pts with personality d/o, but early childhood _____ and ____ is associated w/ these d/o–> particularly _______ and ______ d/o
trauma and abuse
borderline
antisocial
______ personality d/o has a genetic component and is most likely related to/a variant of schizophrenia. Only ______ and _____ d/o have shown a clear genetic component.
schizotypal
borderline and antisocial
There is some physiological functional differences in the brain and its anatomy in pts with personality d/o, three examples include…
Altered metabolism in the prefrontal cortex
Reduced prefrontal grey matter
Less affect-related activity in limbic regions
Pts w/ personality d/o generally have (very little/a lot) of insight into their maladaptive behaviors
very little–often blame others for their troubles, more often do not seek help
Usually, pts w/ personality d/o will seek help for ____, not their actual d/o
consequences of their behaviors (depression, marital/work issues, anxiety/anger)
T/F: A dx of a personality d/o should be given ASAP to ensure early intervention
F: Do not be quick to give out these dx→ many need long term observation/interview to reach a conclusion
Before a dx of a personality d/o is given, you should r/o other mental d/o and medical conditions that could be causing similar sx, such as…
depression, anxiety, medical illness
A personality d/o is characterized by having certain (persistent/fluctuating) behaviors, being (flexible/inflexible), (adaptive/maladaptive) with their behaviors having a clear ______ impact on their lives
persistent, inflexible, maladaptive, negative
As part of the interview of a pt w/ a personality d/o, the provider should focus on how the following domains have been affected in the pt’s life: (x6)
Sense of self
Interpersonal relationships
Work
Affect
Reality testing
Impulse Control
(SI, WARI)
Is there a general tx available for pts with a personality d/o?
No, these d/o are very different
No FDA approved pharmaceutical tx for any of the personality d/o
Tx the sx
What is an example of a medical condition that could cause a personality change?
Frontal lobe lesion
What cluster of personality d/o is described by the following:
Pervasive pattern of abnml cognition self expression or relating to others
Cluster A “the weirds”
What cluster of personality d/o is described by the following:
Pervasive pattern of abnormal fears involving social relationships, separation, or need for control
Cluster C “the wimps”
What cluster of personality d/o is described by the following:
Pervasive pattern of violating social norms of the rights of others, impulsivity, excessive emotionality, grandiosity, or acting out
Cluster B “the wilds”
What are the personality d/o categorized under Cluster A “the weirds” (eccentric d/o)?
Paranoid, schizoid, schizotypal
What are the personality d/o categorized under Cluster B “the wilds” (dramatic d/o)?
Antisocial, borderline, histrionic, narcissistic
What are the personality d/o categorized under Cluster C “the wimps” (anxious d/o)?
Avoidant, dependent, obsessive compulsive
What is the prevalence of paranoid personality d/o (%)?
~1-4%
Pts with paranoid personality d/o (can/cannot) have frank delusions, (often/rarely) seek tx, and have a pattern of ____ and ____ such that other’s motives are interpreted as malevolent
cannot
rarely
distrust and suspiciousness
What is the tx for a pt with paranoid personality d/o?
Is group therapy an option?
What medications are options?
Mostly supportive
Group therapy is NOT an option!
Antipsychotic medications for mild psychotic sx, depression
What is the prevalence of schizoid personality d/o (%)?
3-5%
Patients with schizoid personality d/o have a profound defect in their ability to form ______, which they are (not okay/okay) and see (no problem/a problem) with.
personal relationships
okay with, no problem
In pts with schizoid personality d/o there is a clear pattern of detachment from social relationships and a restricted range of ______
emotional expression
Tx for pts w/ schizoid personality d/o includes
tx of whatever sx they will allow
T/F: Pts with schizoid personality d/o have some motivation for therapy
F, they lack insight/motivation for any kind of therapy, including group
What is the prevalence of schizotypal personality d/o (%)? Is it more common in males or females?
4-5%, there is no gender difference
Pts with schizotypal personality d/o show a pattern of peculiar/odd/unusual ____, ____, _____, and ____
behavior, speech, thinking, and perceptual experiences
Pts with schizotypal personality d/o have “____” beliefs, and mild _____. They also exhibit a(n) _____/_____ affect, and social _____.
magical
paranoia
inappropriate/constricted
anxiety
Do pts with schizotypal personality d/o have delusions?
No, they have magical beliefs, delusions are “fixed beliefs”
What are three common comorbid conditions in pts with schizotypal personality d/o?
substance abuse, depression, and anxiety
Are support groups an option for tx of pts w/ schizotypal personality d/o?
Yes, if possible should utilize
What are medications that can be helpful in the tx of pts w/ schizotypal personality d/o?
2nd generation antipsychotics such as risperidone and olanzipine
What is the prevalence of antisocial d/o in males vs females (%)?
2-5% males
0.5-1% females
Patients with antisocial d/o usually have a hx of _______
childhood behavior problems (conduct d/o)
Upon young adulthood, pts w/ antisocial d/o have problems with _______, and are thus unable to ______
age-appropriate responsibilities
keep a job
Often, pts with antisocial d/o are found to have committed _____ and _____ and have used ______
domestic abuse, criminal behavior, and have used aliases
What populations of persons is antisocial d/o most common in?
Homeless, incarcerated, psychiatric inpatient, and substance abusers
Are sx of antisocial d/o worse or better early on? Do they recede or progress as the pt ages?
worse early on in course
recede as pt ages
What medications are options for tx of pts with antisocial d/o?
Lithium and valproic acid to tx aggression
Meds for comorbid anxiety, depression, ADHD
Is CBT an option for tx of a pt with antisocial d/o?
Possibly
What is the prevalence of borderline personality d/o?
6%
In pts with borderline personality d/o, pts have a pervasive pattern of mood _____, ___/___ interpersonal relationships, and chronic “______”
instability
unstable/intense
“emptiness”
____% of pts with borderline personality d/o will perform self-harm/mutilation, and there is a ____% suicide rate
75%
~10%
Pts with borderline personality d/o fear _____
abandonment
Pts with borderline personality d/o have marked _____
impulsivity
______ has shown the most benefit in tx of borderline personality d/o
Therapy
The 20 week STEPPS program has shown benefit for tx of pts with borderline personality d/o. What does STEPPS stand for?
Systems Training for Emotional Predictability and Problem Solving
What are medications that can be used in the tx of a pt with borderline personality d/o?
SSRIs for comorbid depression and antipsychotics for perceptual disturbances, anger, and agitation (risperidone, valproic acid)
What is the prevalence of histrionic personality d/o?
2%
In pts with histrionic personality d/o, there is a pattern of excessive _____ and ______ behavior
emotionality and attention-seeking behavior
In pts with histrionic personality d/o, there is an excessive concern w/ _____ and wanting to be _______
appearance, center of attention
Often, pts with histrionic personality d/o are initially ____ and _____, but then ____ and _____
charming and gregarious
demanding and vain
Do patients with histrionic personality d/o seek medical attention rarely or often?
Often!
What is believed to be the cause of histrionic personality d/o?
unknown, but there is shown linkage to somatic sx and antisocial d/o
What is the best option for tx of a pt with histrionic personality d/o?
Therapy, if agreeable
Is group therapy useful for pts with histrionic personality d/o?
Yes, when tackling provocative or attention seeking behaviors
What is the prevalence of narcissistic d/o?
6%
Narcissistic d/o is characterized by _____, a lack of ____, and hypersensitivity to _____
grandiosity
empathy
evaluation by others
Pts with narcissistic d/o inflate their _____, and exploit/manipulate those around them for ____
accomplishments
personal gain
Pts with narcissistic d/o have an exaggerated sense of _____
entitlement
Pts with narcissistic d/o may initially be very _____ and _____ to be around, but ultimately very difficult, haughty and temperamental
charming and exciting
What is the mainstay of therapy for a pt with narcissistic d/o?
Therapy (CBT, psychodynamic, interpersonal therapies)
Pts with narcissistic d/o usually seek tx for other sx such as ____ and ____, usually in combination with not receiving something they feel they deserved (_____, _____)
depression and anger
Job, promotion
Pts with avoidant personality d/o usually are described as ____, _____, and _____
inhibited, introverted, and anxious
Patients with avoidant personality d/o have a (low/high) self esteem, are hypersensitive to ____, and are socially awkward
low, rejection
What is the mainstay of tx for pts with avoidant personality d/o?
Therapy
Is group therapy beneficial for pts with avoidant personality d/o?
Yes
What are medication options for pts with avoidant personality d/o?
BZD, SSRIs
What is the prevalence of dependent personality d/o
0.5%
Pts with dependent personality d/o rely on others/someone excessively for ______
emotional support
They exhibit submissive/clinging behavior related to excessive need to be taken care of
What do some believe dependent personality d/o to be due to?
Disruption of early attachments or from over-protectiveness/parental authoritarianism in childhood
Pts with dependent personality d/o commonly have _____ and _____
other personality d/o and other chronic medical conditions
What is the best option for tx of pts with dependent personality d/o?
Therapy (CBT)
Focused assertiveness training, social skills training, tx comorbid conditions
What prevalence does obsessive compulsive personality d/o have?
1-2%
T/F: Obsessive compulsive personality d/o and obsessive compulsive d/o are different
True
Obsessive compulsive personality d/o is characterized by _____ and _____
Perfectionism and over-conscientiousness
Pts with obsessive compulsive personality d/o are preoccupied with ____, ____, and ____.
orderliness, perfectionism, and control
What is the best option for therapy in a pt with obsessive compulsive personality d/o?
CBT
Obsessive compulsive personality d/o is more common in patients with (low/high) level of education and SES
high
What are two common comorbidities in pts with obsessive compulsive personality d/o?
mood and anxiety d/o
Does obsessive compulsive personality d/o lead to OCD?
NO
______ (medication) have been shown to be helpful w/ ritualistic tendencies and a decreased need for perfectionism in pts with obsessive compulsive personality d/o
SSRIs
