Personality Disorder ID Flashcards
Paranoid
Criteria
General distrust of others, beginning in early adulthood
At least 4 of the following:
*Suspicion that others are exploiting or deceiving him/her
*Preoccupation with doubts of loyalty or trustworthiness of friends
*Reluctance to confide in others
*Interpretation of benign remarks as threatning/demeaning
*Persistent grudges
*Perception of attacks on his/her character that is not apparent to others; quick to counterattack
*Suspicions regarding fidelity of spouse/partner
Paranoid
Epi
- Prev 2-4%
- Men > Women
- ↑ in family members of schizophrenics
- Misdiagnosed in minority groups and deaf individuals
Paranoid
DDX
Schizophrenia: These pts do not have any fixed delusions and are not frankly psychotic
Schizoid
Epi
- Prev 3-5%
- Men > Women
- ↑in relatives of individuals with schizophrenia
Schizoid
Criteria
Pattern of voluntary social withdrawal and restricted range of emotional expression, beginning in early adulthood
At least 4 of the following:
*Neither enjoying nor desiring close relationships
*Generally choosing solitary activities
*Little interest in sexual activity with another person
*Taking pleasure in few activities (if any)
*Few close friends or confidants (if any)
*Indifference to praise or criticism
*Emotional coldness, detachment, or flattened affect
Schizotypal
Epi
Prev 2-4%
A small minority develop schizophrenia
Schizoid
DDx
- Schizophrenia: These pts do not have any fixed delusions or hallucinations
- Schizotypal personality d/o: These pts do not have eccentric behavior or magical thinking
Schizotypal
Criteria
A pattern of social deficits marked by eccentric behavior, cognitive or perceptual distortions, discomfort with close relationships, beginning in early adulthood
At least 5 of the following
*Ideas of reference (but not delusions of reference)
*Odd beliefs or magical thinking, inconsistent with cultural norms
*Unusual perceptual experiences (bodily illusions)
*Suspiciousness
*Inappropriate or restricted affect
*Odd or eccentric appearance or behavior
* Few close friends or confidants
*Odd thinking or speech (vague, stereotyped, etc)
*Excessive social anxiety
Magical thinking may include:
- Belief in clairvoyance or telepathy
- Bizarre fantasies or preoccupations
- Belief in superstitions
- Odd behaviors may include involvement in cults or strange religious
Schizotypal
DDx
Schizophrenia: These pts are not frankly psychotic and do not have fixed delusions
Schizoid, as above
Cluster A
ECCENTRIC, PECULIAR, WITHDRAWN
- Paranoid
- Schizoid
- Schizotypal
Cluster B
EMOTIONAL, DRAMATIC, INCONSISTENT
- Antisocial
- Borderline
- Historionic
- Narcissisitic
Cluster C
ANXIOUS, FEARFUL
- Dependent
- Avoidant
- Obsessive-Compulsive
Antisocial
Epi
- 2-4% in men
- <1% in women
- Typically have history of conduct disorder as a child.
- ↑in homeless and incarcerated
Antisocial
Criteria
A pattern of disregard for and violation of rights of others, with onset before age 15 but not diagnosed before age 18
3+ of the following:
*Repeatedly breaking the law
*Deceitfulness, often for personal profit or pleasure
*Impulsivity or failure to plan ahead
*Irritable, aggressive, indicated by repeated physical assaults/fights
*Reckless disregard for safety of self or others
*Irresponsible, cannot sustain work or honor financial obligations
*Lack of remorse
Antisocial
DDX
- Schizophrenia
- Bipolar d/o
Common co-morbidities: substance use d/o, mood and anxiety d/o, ADHD, other personality d/o, gambling d/o
Borderline
Epi
- 6%
- 75% engage in deliberate self-harm (cutting, OD)
- 10% commit suicide
Borderline
Criteria
A pattern of instability of interpersonal relationships, self-image, and affects, with marked impulsivity, beginning by early adulthood
5+ of the following:
*Frantic efforts to avoid abandonment
*Unstable and intense interpersonal relationships, alternating idealization and devaluation
*Identify disturbance (unstable self-image)
*Impulsivity in at least two potentially self-damaging areas
*Suicidality or self-mutilation
*Affective instability and marked reactivity of mood
*Feeling empty
*Inappropriate or difficult to control anger/temper
*Transient stress-related paranoid ideation and dissociative sx
Borderline
DDX
Common comorbidities:
depression, anxiety, substance-use
Histrionic
Epi
- 2%
- Frequently seeking medical attention
- ?gender biased dx?
Histrionic
Criteria
A pattern of excessive emotionality and attention-seeking, beginning by early adulthood
5+ of the following:
*Needing to be center of attention
*Interaction with others is inappropriately sexual or provocative
*Rapid shifting and shallow expression of emotions
*Uses physical appearance to draw attention to self
*Speech is excessively impressionistic and lacking in detail
*Theatrical expression of emotion
*Easily influenced
*Considers relationships to be more intimate than they are
Histrionic
DDX
Associated with somatic symptom d/o and antisocial personality d/o
Narcissistic
Epi
- 6%
* Common in people with other personality disorders
Narcissistic
Criteria
A pattern of grandiosity, need for admiration, lack of empathy, beginning by early adulthood
5+ of the following:
*Grandiose sense of self-importance
*Preoccupied with fantasies of unlimited success/power/brilliance
*Believes he/she is “special” and can only associate with other high status people
*Requires excessive admiration
*Sense of entitlement
*Interpersonally exploitative
*Lacks empathy, unwilling to recognize feelings and needs of others
*Envious of others or believes others envy them
*Arrogant, haughty behavior or attitude
Narcissistic
DDX
Many sx overlap with borderline personality d/o
Dependent
Criteria
A need to be taken care of that leads to submissive and clinging behavior and fear of separation, beginning by early adulthood
5+ of the following:
*Difficulty making everyday decisions without excessive advice and reassurance from others
*Needs others to be responsible for most areas of his/her life
*Difficulty expressing disagreement with others
*Difficulty initiating projects or doing things on his/her own
*Goes to excessive lengths to obtain nurturance/support from others, to the point of volunteering to do things that are unpleasant
*Feels uncomfortable or helpless when alone
*Urgently seeks another relationship when a close relationship ends
*Is unrealistically preoccupied with fears of being left to take care of himself/herself
Dependent
DDX
Comorbid anxiety disorders are common
Avoidant
Criteria
A pattern of social inhibition, feelings of inadequacy, hypersensitivity to negative evaluation, beginning by early adulthood.
4+ of the following:
*Avoids occupational activities that involve significant interpersonal contact because of fear of criticism/rejection.
*Unwilling to get involved with people unless certain of being liked
*Restrained within intimate relationships for fear of being shamed
*Preoccupied with being criticized or rejected
*Inhibited by new interpersonal situations because of feelings of inadequcy
*Views self as socially inept, personally unappealing, or inferior
*Unusually reluctant to take personal risks or engage in new activities that may prove embarrassing
Avoidant
DDX
On the spectrum of anxiety disorders (overlaps with social anxiety d/o)
Obsessive- Compulsive
Epi
- 1-2%
* More common in people with high level of education and high income
Obsessive- Compulsive
Criteria
Preoccupation with orderliness, perfectionism, mental and interpersonal control at the expense of flexibility, openness, and efficiency beginning by early adulthood
5+ of the following:
*Preoccupation with details, rules, lists, order, schedules to the extent that the point of the activity is lost
*Perfectionism interferes with task completion
*Excess devotion to work and productivity to the exclusion of leisure and friendship
*Overconscientious and inflexible about matters of morality, ethics, or values
*Unable to discard worn-out or worthless objects even if they have no sentimental value
*Reluctant to delegate tasks or work with others
*Money is viewed as something to be hoarded for future catastrophes
*Rigidity and stubbornness
Obsessive- Compulsive
DDX
Comorbid mood and anxiety d/o common
OCD: In OCD, patients are more willing to identify their symptoms as pathological, whereas in the personality disorder people view sx as desirable
Schizotypal
Tx
Antipsychotics sometimes
Borderline Personality Disorder
Tx
- SSRI (suicidality)
* DBT (dialectical behavior therapy)
Avoidant personality
Tx
- benzo (social situations)
* CBT
Histrionic personality
Tx
CBT
Dependent personality
Tx
CBT
