Personality Disorder - collins Flashcards
how are personality disorder described
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
what are the domains of personality disorders
cognition, affectivity, interpersonal function, impulse control
impairments must be present in two of four of these domains
what are personality disordersclassified into
three clusters:
Cluster A
Cluster B
Cluster C
what are Cluster A disorders
“mad”
abnormal thinking, psychotic symptoms
disordered self-expression(eccentric), interpersonal relationships (reclusiveness)
ex. paranoid, schizoid, schizotypal
what are cluster B disorders
“bad”
dramatic, violation of social norms or others rights, impulsivity
hyper emotional, grandiose, acting out
ex. antisocial, boarderline, histrionic, narcissistic
what are cluster C disorders
“sad”
anxious, need for control, fear, isolation
ex. avoidant, dependent, obesessive-compulsive
what is paranoid PD
M>F
often with a hx of childhood trauma/abuse
some genetic etiology, rarely sole diagnosis
pervasive distrust, suspiciousness, skepticism
what is the typical presentation of Paranoid PD
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
what is the treatment of paranoid PD
first line = psychotherapy (avoid group therapy)
+/- antipsychotics for agitation (Olanzapine or Haloperidol)
+/- BZDs for anxiety (valium or Clonazepam)
what is the etiology of Schizoid PD
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
what is the clinical presentation of schizoid PD
self-absorbed
‘loners’
failed intimate relationships AND no interest in making them work
difficulty expressing/showing emotions
may appear depressive
ex. Sheldon Cooper
what is the treatment of schizoid PD
psychotherapy - may be difficult to elicit participation in group therapy
+/- antipsychotics, SSRI and BZDs for negative symptoms
What is the etiology of Schizotypal PD
?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
what is the presentation of schizotypal PD
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
what is the treatment of schizotypal PD
psychotherapy
+/- antipsychotic for anxiety, perceptual disturbances, paranoia (Risperidone or Olanzapine)
what disorders fall under Cluster A disorders
Paranoid PD
Schizoid PD
Schizotypal
What is antisocial PD etiologies
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
how does antisocial PD present
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
what are the treatment options for antisocial PD
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
what is the etiology of BPD (borderline)
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
what is the clinical presentation of BPD
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
what is the treatment of BPD
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)
What is the etiology of Histrionic PD
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
what is the presentation of histrionic PD
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
