Personality Disorders 1 Flashcards
Define personality trait
- Flexible pattern in which we interact with others and the environment
- We are aware of our personality
(i.e. kind, confident, lazy, rude)
Define personality disorder
- Fixed/Inflexible, maladaptive pattern that causes distress or impaired function.
- The patient is unaware of this.
- Different than culturally expected & accepted range
What is the most common personality disorder in clinical settings?
Borderline PD
(2-6% of the population)
Diagnostic criteria for personality disorder
At least 2 or more of the following deviate significantly from cultural expectations:
- Cognition (e.g., perceives events, others, or self in an inappropriate way)
- Affectivity
- Interpersonal functioning
- Impulse control/need for gratification
(must also be stable and pervasive)
Personality disorder epidemiology
- 30%-50% of psychiatric outpatients
- 15% of psychiatric inpatients
- General population with 10%-13% prevalence
Greek History (Hippocrates) – four temperaments:
- Pessimistic melancholic (black bile)
- Overly optimistic sanguine (blood)
- Irritable choleric (yellow bile)
- Apathetic phlegmatic (phlegm)
Abraham believed that personality disorders originated from arrests in one of Freud’s psychosexual stages (4):
- Development → personality types
- Oral stage → dependent PD
- Anal stage → obsessive compulsive PD
- Phallic stage → hysterical type
Etiology of personality disorders (4)
- Neurobiology (5HT or DA changes)
- Nurture
- Hx of abuse (physical & sexual)
- Less mature defense mechanism (i.e. projection)
(strong genetic component)
Serotonin abnormalities are linked to _____ personalities (2).
- Borderline PD
- Antisocial PD
(appears to mediate behavioral inhibition)
Diagnostic process for personality disorder
- Hx: social & personal
- Mental Status Exam
(some will become apparent from physician/patient relationship)
What are some details to look for when obtaining a history for personality disorders?
- problems in several domains of life
- collateral information
(usually present for a different C/C. Do not rush to get a dx; it may take several visits)
Cognitive-Behavioral therapies diminish ______ and increase traits of _____.
- Impulsiveness
- Assertiveness
(Techniques include relaxation training and role-playing exercises)
Cognitive-Behavioral therapies include techniques such as relaxation training and role-playing exercises; cognitive strategies include _____ (2).
- identifying internal mental schemes that misidentify situations or aspects of themselves
- learn modification
Personality Disorders: Pharmacotherapy includes (3)
- SRI’s: decrease impulsivity or aggression
- Mood stabilizers
- Anti-psychotics
(No medications currently approved by FDA)
What are the three clusters of personality disorders
Cluster (A, B, C) remember: WWW = Weird, Wild, Worried = Eccentric, Dramatic, Anxious
Which personality disorders fall under the “Weird”/Category A?
- Paranoid
- Schizoid
- Schizotypal
(they are “strange & eccentric”)
Paranoid personality disorder: clinical features (5)
- Deep-seated distrust of others
- Guarded & suspicious
- Project unacceptable thoughts onto others (i.e. “You’re judging me!”)
- Find “evidence” by misinterpret benign events
- Think others want to harm, exploit or trick them
(projection is due to humiliation or being object of excessive parental rage)
Paranoid personality disorder: etiology (2)
- Object of excessive parental rage or repeatedly humiliated by others → vulnerability and feelings of inadequacy → project hostility and rage onto others & blame others for shortcomings
- Link to Delusional disorder
Paranoid personality disorder: Ddx (3)
- Paranoid schizophrenia
- Delusional disorder
- Schizotypal personality
(they are able to pull themselves together and appear undistressed when examined)
Paranoid personality disorder: Tx (3)
- Build trust with patient
- Antidepressants
- CBT (usually resisted)
(therapist must be respectful, straightforward and non-intrusive)
Schizoid personality disorder: clinical features
(described broadly in DSM I & II. DSM III subdivided into schizoid, avoidant and schizotypal)
- Chooses social isolation
- Few friends
- Few Hobbies
- Flat affect: cold, detached, aloof
(occupation usually req little social interaction: night guard, computer tech, lab tech, etc)
Schizoid personality disorder: clinical features
(described broadly in DSM I & II. DSM III subdivided into schizoid, avoidant and schizotypal)
- Chooses social isolation
- Few friends
- Few Hobbies
- Flat affect: cold, detached, aloof
(occupation usually req little social interaction: night guard, computer tech, lab tech, etc)
Schizoid personality disorder: prevelance
8% of population
Schizoid personality disorder: Ddx (2)
- Schizotypal disorder (must have cognitive and perceptual distortion)
- Avoidant (desires relationship; fear rejection)
(schizoid does NOT care to have relationships)
–Broadly defined in DSM I and II, subdivided into schizoid, avoidant and schizotypal in DSM III
Schizoid personality disorder treatment (3)
- CBT → social involvement
- Group therapy → social skills
- Antidepressants
(they usually avoid treatment & ask few questions; caregiver needs to respect privacy and let patient come to them)
Schizoid personality disorder: etiology
Experienced cold, neglectful and ungratifying relationships in early childhood→as adults they assume relationships are not valuable or worth pursuing
(Childhood pattern of shyness and may be inherited; genetic spectrum with schizophrenia)
Schizotypal personality disorder hold ______ beliefs that lead to ______.
- Odd beliefs or magical thinking → fear of social interaction and few friends
Schizotypal PD: etiology (3)
- Biological abnormality (increased CSF)
- Impaired executive fxn
- Schizophrenia (minus enduring psychosis)
(3% of population)
Schizotypal personality disorder: clinical features (7)
- Speech: odd & idiosyncratic
- Eccentric behavior
- Cognitive & perceptual distortions
- Affect: constricted or inappropriate
- Socially isolated
- Suspicious
- Impaired smooth pursuit (EOM)
(linked to schizophrenia)
Schizotypal personality disorder: cognitive & perceptual distortions (5)
- Ideas of reference (delusion that events are of special importance/connection to onself)
- Bodily Illusion (see something in the corner of ones eye; but the know that it isn’t real)
- Telepathy, 6th sense, etc.
- Strange or fantastical thinking
- Superstition
(open to challenges in their beliefs)
What is a key difference between schizophrenia and schizotypal personality disorder?
Schizotypal = Open to challenges in their beliefs
Schizotypal PD: eccentric behaviors (3)
- Talk to themselves in public
- Inappropriate gesturing
- Peculiar dress/unkept
Schizotypal personality disorder: Ddx (3)
- Schizoid personality disorder
- Paranoid personality disorder
- Schizophrenia spectrum (without enduring psychosis)
Schizotypal personality disorder: Trmt
- Emphasize social skills
- Low-dose antipsychotic to help with anxiety and psychotic feature
(avoidant to treatments; only come when psychotic or depressed)
Which 4 personality disorders fall under the “Wild”/Category B?
(“Dramatic” & “Erratic”)
- Antisocial PD
- Borderline PD
- Histrionic PD
- Narcissistic PD
(“Dramatic & erratic”)
Antiscocial Personality Disorder: clinical features (5)
(Older terms: “Moral Insanity” & “Psychopathic Personality”)
- Disregard for the rights of others
- Break the law
- Impulse
- Can be glib or charming
- Lack remorse (enjoy outwiting or exploiting others)
(fail in relationships; SUD)
Antiscocial Personality Disorder: etiology
- Abnormal serotonin transport
- Absent, assaultive or inconsistent parenting
- Family history of substance abuse and or anti-social members
(die early due to suicide, accident, homicide, SUD)
A subgroup of which personality disorder takes a sadistic pleasure and being harmful?
- Antisocial personality disorder
Antiscocial Personality Disorder must be ____ years old to dx; if sx appear before the age of 15, it indicates _____.
- 18
- Conduct Disorder
Antiscocial Personality Disorder: Tx
- CBT
- Mood stabilizers
- Antidepressants
(very resistant to tx)
Antiscocial Personality Disorder: Ddx
Nacissitic PD (smart enough to stay out of trouble with the law; antisocial think they are above it all and do get into trouble)
(co-morbid: ADHD)
