Personality Disorders

Question 1

Cluster A:

Answer 1

• Odd or eccentric
• -Paranoid PD (4)
• -Schizoid PD (4)
• -Schizotypal PD (5)
• “Pss Pss Pss Pss Pss”

Question 2

Cluster B:

Answer 2

• Dramatic, emotional
• -Antisocial PD (3)
• -Borderline PD (5)
• -Histrionic PD (5)
• -Narcissistic PD (5)
• “Always Be Hysterically Narcissistic”

Question 3

Cluster C

Answer 3

• Anxious, fearful
• -Avoidant PD (4 criteria)
• -Dependent PD (5 criteria)
• -Obsessive Compulsive PD (4 criteria)
• “Avoid Dependent Objects”

Question 4

General Personality Disorder S/sxs

Answer 4

• A) Enduring Pattern of inner experiences and behavior that deviated markedly from the expectations of the individuals culture:
  
  • 2+ of the following:
    
    • -Cognition
    • -Affectivity
    • -Interpersonal Functioning
    • -Impulse Control
• B) Pattern is inflexible, pervasive across personal and social situations
• C) Pattern leads to distress, impairment of social, occupation or function
• D) Pattern stable, long-duration – starts in late adolescence or early adult
• E) Not better explained by manifestation of consequence of other mental disturbances
• F) Not attributed to substance or other medical conditions

Question 5

Etiology of Personality Disorders

Answer 5

• -Familial genetic factors – moderately heritable:
  
  • -Spectrum with schizophrenia, particularly the cluster A disorders. Check family hx history
  • -Serotonergic dysregulation – Antisocial PD
• Environmental Factors:
  
  • -Trauma, abuse = higher incidence
  • -Neglect, lack of positive Role moules

Question 6

Paranoid Personality Disorder

Answer 6

• Definition:
  
  • pervasive pattern of distrust & suspiciousness of others; motives interpreted as malevolent
• Category: Cluster A (Odd, eccentric)
• DSM-V Criteria:
  
  • 4+ of the following:
    
    • -Suspects (without basis) that others exploit, harm, or deceive
    • -Preoccupied with doubts of loyalty & trustworthiness of others
    • -Reluctant to confide, fearful info will be used against them
    • -Reads hidden demeaning or threatening meaning behind remarks
    • -Persistent grudges, unforgiving of insults/slights
    • -Perceives attacks on character or reputation (not apparent to others), angry
    • -Recurrent suspicions of infidelity of spouse/partner (without justification)
• Tx:
  
  • Cognitive Behavioral Therapy = 1st line

Question 7

Schizoid Personality Disorder

Answer 7

• Definition:
  
  • pervasive pattern of detachment from social relationships and a restricted range of expression of emotion in interpersonal settings
• Category: Cluster A (Odd, eccentric)
• DSM-V Criteria:
  
  • 4+ of the following:
    
    • -Neither desires nor chooses close relationships
    • -Almost always chooses solitary activities
    • -Little interest in sexual experiences with others
    • -Takes pleasure in few (if any) activities
    • -Lacks close friends or confidants
    • -Appears indifferent to praise or criticism of others
    • -Emotional coldness, detachment, flattened affect
• Tx:
  
  • Psychotherapy = 1st line

Question 8

Schizotypal Personality Disorder

Answer 8

• Definition:
  
  • Pervasive pattern of social & interpersonal deficits marked by acute discomfort with and reduced capacity for close relationships, as well as cognitive or perceptual distortions and eccentricities of behavior
• Category: Cluster A (Odd, eccentric)
• DSM-V Criteria
  
  • 5+ of the following:
    
    • -Ideas of reverence (excluding delusions of reverence)
    • -Odd beliefs or magical thinking that influences behavior and is inconsistent with behavioral norms (ex. Belief in telepathy, bizarre fantasies or preoccupations)
    • -Unusual perceptual experiences, including bodily illusions
    • -Odd thinking speech
    • -Suspicious or paranoid ideation
    • -Inappropriate or constructed affect
    • -Behavior or appearance that is odd, eccentric, or peculiar
    • -Lack of close friends other than family
    • -Excessive social anxiety does not diminish with familiarity
• Tx:
  
  • Psychotherapy = 1st line

Question 9

Antisocial Personality Disorder

Answer 9

• Definition:
  
  • a pervasive pattern of disregard & violation of rights of others
• Pathophys:
  
  • serotonergic dysregulation
• Category: Cluster B (Dramatic, Emotional)
• DSM-V Criteria:
  
  • A pervasive pattern of disregard/violation of rights of others, occurring since age 15 & 3+ of the following:
    
    • -Failure to conform to social normal & lawful behaviors (→ prison)
    • -Deceitfulness, lying, use of aliases, or conning others for pleasure
    • -Impulsivity (failure to plan ahead)
    • -Irritability (failure to sustain work/finance)
    • -Lack of remorse
    • *need to be at least 18 yo with a hx of conduct disorder before 15 yo
• Tx:
  
  • Psychotherapy to establish limits
  • Pharmacologic therapy:
    
    • → Anticonvulsants: to reduce aggression and mood lability
    • → Antipsychotics: to reduce paranoid thinking pattern and impulsivity

Question 10

Borderline Personality Disorder

Answer 10

• Definition:
  
  • Pervasive pattern of instability with interpersonal relationships, self-image, & affect (marked impulsivity)
• Category: Cluster B (Dramatic, Emotional)
• DSM-V Criteria:
  
  • 5+ of the following:
    
    • -Frantic effort to avoid real/imagined abandonment
    • -Pattern of unstable intense relationships alternating b/w extreme idealization to devaluation
    • -Identity disturbance – unstable self-image & self of self
    • -Impulsivity ($, sex, substance, reckless driving, binge eating)
    • -Recurrent suicidal behavior, gestures, threats, self-mutilation
    • -Affective instability & marked reactivity of mood (low → high)
    • -Chronic feelings of emptiness
    • -Inappropriate, intense anger or difficulty controlling anger
    • -Transient, stress related paranoid ideation or severe dissociate sxs
• Mnemonic: Bs:
  
  • -Bat (mood swings)
  • -Black & white thinking
  • -Blown up reactions
  • -Broken relationships
  • -Breaking up (abandonment)
  • -Bad behavior (instability)
• Tx:
  
  • Dialectic Behavioral Therapy: structured type of therapy that focuses on behavior
  • -Pharm Therapy:
    
    • → anticonvulsants: to reduce aggression and mood lability
    • → Antipsychotics: to reduce paranoid thinking pattern and impulsivity

Question 11

Histrionic Personality Disorder

Answer 11

• Definition:
  
  • Pervasive pattern of excessive emotionality & attention seeking
• Category: Cluster B (Dramatic, Emotional)
• DSM-V Criteria:
  
  • 5+ of the following:
    
    • -Uncomfortable not being center of attention
    • -Interaction with others often inappropriately sexaully seductive or provocative
    • -Rapidly shifting & shallow expression of emotions
    • -Consistently uses physical appearance to draw attention to self
    • -Speech style excessively impressionistic and lacking in detail
    • -Self-dramatization, theatricality, exaggerated emotion
    • -Is suggestible
    • -Considers relationships to be more intimate than they are
• Mnemonic: H’s
  
  • -Hey look at me
  • -Hissy fits
  • -Come Hither
  • -Hype me up
  • -Hyperinflated
• Behavioral Therapy

Question 12

Narcissistic Personality Disorder

Answer 12

• Definition:
  
  • Pervasive pattern of grandiosity (fantasy & behavior), need for admiration & lack of empathy
• Category: Cluster B (Dramatic, Emotional)
• Prevalence: < 1%
• DSM-V Criteria:
  
  • 5+ of the following:
    
    • -Grandiose sense of self-importance
    • -Preoccupied with fantasies of success, power, brilliance, beauty or ideal love
    • -Belief that they are special and unique and can only be understood or should associate with other high-status people
    • -Requires excessive admiration
    • -Sense of entitlement
    • -Interpersonally exploitative
    • -Lacks empathy–unwilling to recognize feelings of others
    • -Often envious of others, believes others are envious of them
    • -Arrogant, haughty behaviors or attitude
• Tx:
  
  • Psychotherapy = 1st line

Question 13

Avoidant Personality Disorder

Answer 13

• Definition:
  
  • Pervasive pattern of social inhibition, feelings of inadequacy, hypersensitivity to negative evaluation
• Category: Cluster C (Anxious, fearful)
• DSM-V Criteria:
  
  • 4+ of the following:
    
    • -Avoids occupational activities that involve significant interpersonal contact because of fear of criticism, disapproval, or rejection
    • -Unwilling to get involved with people unless certain to be liked
    • -Restraint within intimate relationships (feel of being shamed or ridiculed)
    • -Preoccupied with being criticized or rejected in social situations
    • -Inhibited in new interpersonal situations – feelings of inadequacy
    • -Views self as socially inept, unappealing, or inferior
    • -Reluctant to take personal risks due to embarrassment
• Dx:
  
  • More tearful/frightened in avoidant vs angry/suspicious in paranoid
• Tx:
  
  • psychotherapy = 1st line

Question 14

Dependent Personality Disorder

Answer 14

• Definition:
  
  • Pervasive and excessive need to be taken care of that leads to submission & clinging behaviors and fears of separation
• Category: Cluster C (Anxious, fearful)
• DSM-V Criteria:
  
  • 5+ of the following:
    
    • -Difficulty making everyday decisions without advice or reassurance
    • -needs others to assume responsibility in major areas of life
    • -Difficulty expressing disagreement with others d/t fear of loss of support or approval
    • -Difficulty initiating projects or doing things on their own
    • -Excessive lengths to obtain nurturance or support
    • -Uncomfortable or helpless when alone (fear being unable to care for self)
    • -Urgently seeks new relationship when one ends
    • -Unrealistically preoccupied with fears of being left to care for self

Question 15

Obsessive-Compulsive Personality Disorder

Answer 15

• Definition:
  
  • Pervasive pattern of preoccupation with orderliness, perfectionism, & mental and interpersonal control (at the expense of flexibility, openness, and efficiency)
• Category: Cluster C (Anxious, fearful)
• DSM-V Criteria:
  
  • 4+ of the following:
    
    • -Preoccupied with details, rules, ists, order, organization, or schedules to the extent that the major point of activity is lost
    • -Shows perfectionism that interferes with task completion
    • -Excessively devoted to work & productivity to the exclusion of leisure activities and friendships
    • -Is overconscientious, scrupulous, and inflexible about matters of morality, ethics, and/or value
    • -Is unable to discard worn-out or worthless objects
    • -is reluctant to delegate tasks or work with others unless they submit to the exact way of doing things
    • -Miserly spending style toward self and others, money hoarded catastrophes
    • -Shows rigidity and stubbornness
  • **Absence of obsessions and compulsions
• Tx:
  
  • Psychotherapy
  • -Beta blockers for anxiety
  • -SSRIs for anxiety