Personality Disorder - collins

Question 1

how are personality disorder described

Answer 1

deeply ingrained way of thinking, feeling and behavior that:
-begin in adolescence or early adulthood
-deviates significantly from societal/cultural norms
- pervasive and inflexible/maladaptive
-stable over time
-produces distress, impairment in mood or functioning

Question 2

what are the domains of personality disorders

Answer 2

cognition, affectivity, interpersonal function, impulse control

impairments must be present in two of four of these domains

Question 3

what are personality disordersclassified into

Answer 3

three clusters:
Cluster A
Cluster B
Cluster C

Question 4

what are Cluster A disorders

Answer 4

“mad”
abnormal thinking, psychotic symptoms
disordered self-expression(eccentric), interpersonal relationships (reclusiveness)
ex. paranoid, schizoid, schizotypal

Question 5

what are cluster B disorders

Answer 5

“bad”
dramatic, violation of social norms or others rights, impulsivity
hyper emotional, grandiose, acting out
ex. antisocial, boarderline, histrionic, narcissistic

Question 6

what are cluster C disorders

Answer 6

“sad”
anxious, need for control, fear, isolation
ex. avoidant, dependent, obesessive-compulsive

Question 7

what is paranoid PD

Answer 7

M>F
often with a hx of childhood trauma/abuse
some genetic etiology, rarely sole diagnosis
pervasive distrust, suspiciousness, skepticism

Question 8

what is the typical presentation of Paranoid PD

Answer 8

significant distrust of others
no true paranoid delusions/hallucinations
defensive or hostile
fell they have been treated unfairly
unforgiving of mistakes/holds grudges
failed intimate relationships
react poorly to ‘control’ or authority

Question 9

what is the treatment of paranoid PD

Answer 9

first line = psychotherapy (avoid group therapy)
+/- antipsychotics for agitation (Olanzapine or Haloperidol)
+/- BZDs for anxiety (valium or Clonazepam)

Question 10

what is the etiology of Schizoid PD

Answer 10

M>W
men have more severe disease
often hx of childhood trauma, esp neglect
some evidence of genetic etiology
may develop delusional disorder, schizophrenia, psychosis, depression
prevasive detachment from social relationships and restricted range of emotions

Question 11

what is the clinical presentation of schizoid PD

Answer 11

self-absorbed
‘loners’
failed intimate relationships AND no interest in making them work
difficulty expressing/showing emotions
may appear depressive

ex. Sheldon Cooper

Question 12

what is the treatment of schizoid PD

Answer 12

psychotherapy - may be difficult to elicit participation in group therapy
+/- antipsychotics, SSRI and BZDs for negative symptoms

Question 13

What is the etiology of Schizotypal PD

Answer 13

?more common M or W -> does have association with women with fragile X syndrome
some evidence of genetic etiology
may progress to schizophrenia
10% will attempt suicide

pervasive social and interpersonal deficits
discomfort with and/or reduced capacity for close relationships secondary to behavior

Question 14

what is the presentation of schizotypal PD

Answer 14

odd thinking or speech - flight of ideas, non-sensical, tangential thinking
odd behavior, appearance
oddities may make it hard to communicate with them
may claim to be superstitious, clairvoyant, have other special powers
failed interpersonal relationshipos
flat affect
may have frank psychotic symptoms (delusions/hallucinations)
ex. willy wonka

Question 15

what is the treatment of schizotypal PD

Answer 15

psychotherapy
+/- antipsychotic for anxiety, perceptual disturbances, paranoia (Risperidone or Olanzapine)

Question 16

what disorders fall under Cluster A disorders

Answer 16

Paranoid PD
Schizoid PD
Schizotypal

Question 17

What is antisocial PD etiologies

Answer 17

M>W
+FH increases risk 5x
higher risk if low SES, history of ADD/ADHD
have a prior hx of ODD/conduct disorder
often co-morbid SUD, anxiety disorder

pervasive disregard for others or violation of others’ rights SINCE AGE 15
individual MUST BE age 18+
EVIDENCE OF CONDUCT DISORDER before 15

Question 18

how does antisocial PD present

Answer 18

repeated conflicts - impaired in inability to maintain relationships
arrests, fines, other legal issues
substance misuse or promiscuity
repeated physical altercations, perpetration of physical abuse
disregard for authority (rebellious)
devoid of emotions - flat affect, no empathy/sympathy, no remorse
difficulty communicating due to rage, hostility
ex. joker

Question 19

what are the treatment options for antisocial PD

Answer 19

psychotherapy - CBT
treat any co-occuring mood or anxiety disorders, ADD or ADHD
+/- medications for aggression (lithium, valproate, antipsychotics) - compliance is an issue, not routinely prescribed

Question 20

what is the etiology of BPD (borderline)

Answer 20

W>M
MOST COMMON
rarely sole diagnosis
+FH increases risk 5x
co-morbid mood DO, anxiety DO or SUD common
75% will participate in self harm
10% will attempt suicide

pervasive pattern of unstable personal relationships, self-image and/or affect, with marked impulsivity

Question 21

what is the clinical presentation of BPD

Answer 21

lability in various facets
mood swings
persistent sense of ‘crisis’ in their lives
intense, unstable relationships (“hot and cold”) ->multiple failed relationships (co-dependency)
self-destructive behavior, including SI/self-harm or threats
impulsivity -> promiscuity, SU, financial, driving, eating
separation anxiety -> quick intimate relationships or preemptive termination

Question 22

what is the treatment of BPD

Answer 22

psychotherapy (Dialectical behavior therapy(DBT) = coping skills, emotional regulation, or CBT)
+/- SSRIs for depressive sx
+/- antipsychotics for perceptual changes, anger, SI
+/- BZDs for anxiety (high risk for misuse)

Question 23

What is the etiology of Histrionic PD

Answer 23

exaggerated, uncontrollable emotion or excitement.
conversion, somatization, dissociation, lability of emotion
W>M
co-morbid mood DO, somatization DO, SUDs
frequent utilization of healthcare services

pattern of excessive emotionality and attention seeking

Question 24

what is the presentation of histrionic PD

Answer 24

overly dramatic
emotional expression seems insincere
may make inappropriate advances/comments
attention seeking behaviors (temper tantrums, tears, accusations)
seeking reassurance/validation from others
bright colored or revealing clothing
may seem embarrassing to those around them

Question 25

what is the treatment of histrionic PD

Answer 25

psychotherapy (CBT, talk therapy, group therapy)
+/- antidepressants for affect/mood distrubances (fluoxetine, amitriptyline, fluvoxamine)
+/- antipsychotic for derealization (haloperidol or SGA)
+/- BZDs for anxiety (High risk for abuse)

Question 26

What is the etiology of narcissistic PD

Answer 26

M>F
+FH increases risk
high rates of other co-occuring PD or SUDs
grandiose vs. vulnerable types

pattern of grandiosity, need for admiration and lack of empathy

Question 27

what is grandiose

Answer 27

more aaggressive

Question 28

what is vulnerability

Answer 28

overly sensitive

Question 29

what is the presentation of narcissistic PD

Answer 29

overly aggressive or sensitive
arrogant behavior
resist admitting fault
sense of entitlement - that the world owes them something
‘picky’ with their social circles/friends
make unreasonable demands, have ‘high standards’
fragile self-esteem, reflected in impaired interpersonal relationships
workplace difficulties
unable to tolerate rejection/criticism
subject to anger/hostility or depression

Question 30

what is the treatment of Narcissistic PD

Answer 30

psychotherapy - group therapy if agreeable can help develop empathy
+/- Lithium for mood lability
+/- SSRI for associated depression

Question 31

what are Cluster B disorders

Answer 31

antisocial PD
Borderline PD
Histrionic PD
Narcissistic PD

Question 32

what is avoidant PD etiology

Answer 32

W> or = M
often some hx of childhood trauma
other co-morbid PD, SUD, SI or suicide attempts common
social inhibition, sense of inadequacy, hypersensitivity and negative disposition

*Desperately WANT to be in relationship and seek reassurance

Question 33

what is the presentation of avoidant PD

Answer 33

anxiety within relationships and/or with clinician
anxiety abates if they perceived they are liked or received reassurance
anxiety intensifies if they perceive being disliked, criticized or feel embarrassed
overly sensitive to feedback
intense fear of rejection
self-defeating, self-depreciating disposition
repeatedly seeking reassurance
avoidance of vulnerable situations
ex. Charlie brown

Question 34

what is the treatment of Avoidant PD

Answer 34

psychotherapy - assertiveness or social skills training most helpful
+/- Beta-blockers (atenolol) for associated fear/anxiety
+/- SSRI for anxiety surrounding rejection

Question 35

what is dependent PD etiology

Answer 35

W>M
not extensively studied independently
often co-occurs with other PDs, other psychiatric disorders or medical dx

need to be taken care of, leading to submissiveness, ‘clingy’ behavior and/or separation anxiety

Question 36

what is the presentation of dependent PD

Answer 36

co=dependency
poor self-esteem, lack of self-confidence
difficulty building/maintaining relationships due to low self-esteem
constant need for approval, reassurance
frequently seek help
‘people pleasers’ - overly compliant even if its undesirable
passive/submissive, with difficulty expressing negative emotions
avoids/fears confrontation
‘rule followers’
ex. cinderella

Question 37

what is the treatment of dependent PD

Answer 37

psychotherapy - CBT, social skills or assertiveness training
+/- BZDs for anxiety

Question 38

what is obsessive-compulsive PD

Answer 38

M>F
higher risk if +FH
oldest child at highest risk
more common in higher SES and higher education levels
co-morbid mood and anxiety disorders common
not linked to development OCD (OCPD less likely to have insight to their illness)

preoccupation with perfection, orderliness and control at the expense of flexibility, openness and efficiency

Question 39

what is the presentation of OCPD

Answer 39

are often serious
lack flexibility/spontaneity
perfectionists
a ‘do it myself’ type - dont trust others to do it
have trouble with relationships when others don’t adhere to their rigidness
detail oriented
intellectualize/overthink everything
apparent restricted emotions

ex. Hermine (harry potter)