Personality disorders Flashcards
General definition of personality disorders
Enduring pattern of thinking/behaving that is inflexible, maladaptive, and causes distress.
It deviates from the cultural norm.
It’s possible to have more than one.
personality disorder prevelance
10 - 20% have a PD
50% of psych patients have a PD
Etiology
Genetic component (for example schizotypal is more common when a relative has schizophrenia)
Biologic (DA and serotonin are involved)
Environment (more common in the poor and less educated)
Cluster A
(Odd, eccentric)
Schizotypal (not psychotic), weird and paranoid
Paranoid, just paranoid but not weird
Schizoid, just weird, very few relationships, but it doesn’t bother them.
Cluster B
Borderline- Stormy relationships, can’t have 2 things in their mind at the same time (you’re either good or bad), presents as dramatic, but not needing to be the center of attention more so dramatic. Might have comorbid substance abuse.
Histrionic- Dramatic also, but want to be the center of attention
Narcissistic- Falsely inflated sense of self, not much conscious and kind of rationalizes treating people poorly
Antisocial- No conscious and doesn’t even try to rationalize treating people badly. Associated with criminal activity
Cluster C
Avoidant- Avoids relationships because it increases anxiety but wishes they had them
Dependent- Wants relationships because they need someone to take care of them.
Having a PD is a predisposing factor to having
substance use disorder
mood disorder
anxiety disorder
high risk behavior
other psych disorders
Also, having the PD complicates treatment of the other disorders
PDs and defense mechanisms
Their defenses are usually very primitive and don’t work very well. Examples are fantasy, splitting, projection.
More specific criteria of personality disorder
Must have at least 2:
- ineffective cognitive capacity (distorted way of understanding things/people)
- Affect abnormality (for example, labile)
- Interpersonal functioning impaired
- Difficulties with impulse control
These things occur across different settings.
Usually begins in adolescence or early adulthood
Results in problems
Cluster A therapy
Deal with them in a straightforward, warm, and honest way.
It will be hard for them to trust you.
Be nonjudgemental about fantasies/odd beliefs
Cluster A meds
Schizotypal: Antidepressants for depression. Antipsychotic medications for delusions or illusions.
Paranoid: Treat anxiety/depression. Antipsychotics can be used for severe agitation or delusions.
Schizoid: Some benefit from small doses of antipsychotics and antidepressants
Cluster B therapy (except borderline)
Antisocial: set limits
Narcissistic: It’s hard to get them to renounce the narcissism. Group therapy can help with sharing and empathy.
Histrionic: Help them to clarify inner feelings. Psychoanalytic therapy can be good (either individual or group).
Borderline therapy
Therapy is the main approach, with meds as adjunct.
The goal is to control impulsivity and reduce sensitivity to criticism.
Social skills training can help people see how they effect others.
Inpatient or partial can be good, especially when they’re self destructive.
As the therapist, make a rapport with clear limits and roles. Be firm, but not punitive.
Cluster B meds
Treat all cluster Bs with anxiety/depression with antidepressants.
Antipsychotics can help with impulsivity, anger, hostility, and brief psychotic episodes.
Benzos and stimulants may be used (for respective purposes), but be careful because of the risk for abuse in this cluster
Cluster C therapy
Avoidant: develop rapport, be accepting of their fears. Work on social skills and assertiveness training.
Dependent: Insight-oriented therapy to develop independence. Watch for anxiety; they can get anxious when becoming independent from toxic relationships that are important to them.
OC-PD: They usually have some insight. Group and behavior therapy can be good.
