Personality Disorders Flashcards
General Personality Disorder Criteria
A. An enduring pattern of inner experience/behaviour that deviates markefly from expecations of the individual’s culture. This is manifested in ≥2 of the following areas:
1. Cognition
2. Affectivity
3. Interpersonal functioning
4. Impulse control
B. The pattern is inflexible and pervasive across a broad range of personal and social situations.
C. Causes clinically significant distress/functional impairment.
D. Pattern is stable and of long duration, and its onset can be traced back at least to adolescence or early adulthood.
E. Not better explained by another mental disorder.
F. Not attributable to substances or another medical condition.
Paranoid Personality Disorder Diagnostic Criteria
A. A pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent, beginning by early adulthood and present in a variety of contexts, as indicated by ≥4 of the following:
1. Suspects, without sufficient basis, that others are exploiting, harming, or deceiving them.
2. Is preoccupied with unjustified doubts about the loyalty or trustworthiness of friends or associates.
3. Is reluctant to confide in others because of unwarranted fear that the information will be used maliciously against them.
4. Reads hidden demeaning or threathing meanings into benign remarks or events.
5. Persistently bears grudges
6. Perceives attacks on their character or reputation that are not apparent to others and is quick to react angrily or counterattack.
7. Has reuccrent suspicions, without justification, regarding the fideltiy of spouse or sexual partner.
B. Does not occur exclusively during the course of schizophrenia/psychosis. Not attributable to another medical condition.
If criteria are met prior to the onset of schizophrenia, add “premorbid”, i.e., “paranoid personality disorder (premorbid)”
Schizoid Personality Disorder Diagnostic Criteria
A. A pervasive pattern of detachment from social relationships and a restricted range of expresssion of emotions in interperosnal settings, beginning in early adulthood and present in a variety of contexts, as indicated by ≥4 of the following:
1. Neither desires, nor enjoys close relationships, including being part of a family.
2. Almost always chooses solitary activities.
3. Has little, if any, interest in having sexual experiences with another person.
4. Takes pleasure in few, if any, activities.
5. Lacks close friends or confidants other than first-degree relatives.
6. Appears indifferent to praise or criticism from others.
7. Shows emotional coldness, detachment, or flattened affectivity.
B. Does not occur exclusives in the course of psychosis or ASD. Not attributable to another medical condition.
If criteria are met prior to the onset of schizophrenia, add “premorbid”, i.e., “schizoid personality disorder (premorbid)”
Schizotypal Personality Disorder Diagnostic Criteria
A. A pervasive pattern of social and interpersonal deficits marked by acute discomfort with, and reduced capacity for, close relationships as well as by cognitive or perceptual distortions and eccentricities of behaviour, beginning by early adulthood and present in a variety of contexts, as indicated by ≥5 of the following:
1. Ideas of reference (excluding delusions of reference)
2. Odd beliefs or magical thinking that influences behaviour and is inconsistent with subcultural norms
3. Unusual perceptual experiences, including bodily illusions
4. Odd thinking and speech (e.g., vague, circumstantial, metaphorical, overelaborate, or stereotyped)
5. Suspiciousness or paranoid ideation
6. Inappropriate or constricted affect
7. Behaviour or appearance that is odd, eccentric, or peculiar
8. Lack of close friends or confidants other than first-degree relatives
9. Excessive social anxiety that does not diminish with familiarity and tends to be associated with paranoid fears rather than negative judgements about self.
B. Does not occur exclusively in the course of psychosis or ASD.
If criteria are met prior to the onset of schizophrenia, add “premorbid”, i.e., “Schizotypal personality disorder (premorbid)”
Differentiation of Cluster A Personality Disorders from Psychosis
- Distinction is made based on whether there is a period of persistent psychotic symptoms
- To give an additional PD dx, the disorder must have been present before onset of psychotic sx
- When an individual has a persistent psychotic disorder that was preceded by a PD, the PD should be recorded as well, followed by “premorbid” in the dx)
Cluster A Personality Disorders
- Paranoid PD
- Schizoid PD
- Schizotypal PD
Antisocial Personality Disorder Diagnostic Criteria
A. A pervasive pattern of disregard for and violation of the rights of others, occurring since age 15, as indicated by ≥3 of the following:
1. Failure to conform to social norms wrt lawful behaviours, as indicated by repeated acts that are grounds for arrest.
2. Deceitfulness, as indicated by repeated lying, use of aliases, conning others for profit or pleasure.
3. Impulsivity or failure to plan ahead.
4. Irritability and aggressivenessm as indicated by repeated physical fights.
5. Reckless disregard for safety of self and others.
6. Consistent irresponsibility, as indicated by repeated failures to sustain consistent work behaviour or honour financial obligations.
7. Lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from others.
B. Individual is ≥18 years old.
C. Evidence of conduct disorder with onset before age 15.
D. Does not occur exclusively in the course of schizophrenia or bipolar.
Also referred to as psychopathy/sociopathy, although some have argued they are different constructs.
Differentiation of APD from CD
- Dx of APD is given only to individuals ≥18 years old and only if there is evidence of CD before age 15
- For individuals over 18, CD dx is given only if APD criteria are not met.
Differentiation of APD from Narcissistic PD
- Both include tendencies to be tough-minded, glib, superficial, exploitative, and lacking empathy
- Only APD involves impulsivity, aggression, and deceit
- APD individuals are not as needy of admiration as people with narcissistic PD
- Narcissistic PD usually lacks the presence of CD before age 15
Borderline Personality Disorder Diagnostic Criteria
A. A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity, beginning by early adulthood and present in a variety of contexts, as indicated by ≥5 of the following:
1. Frantic efforts to avoid real or imagined abandonmnent (excluding suicidal or self-mutilating behaviour covered in A5)
2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.
3. Identity disturbance: markedly and persistenyl unstable self-image or sense of self.
4. Impulsivity in ≥2 areas that are potentially self-damaging (e.g., spending, sex, substances, reckless driving, binge eating)
5. Recurrent suicidal behaviour, gestures, or threats, or self-mutilating behaviour
6. Affective instability due to marked reactivity in mood (e.g., intense episodic dysphoria, irritability, or anxiety, usually lasting a few hours and only rarely more than a few days)
7. Chronic feelings of emptiness
8. Inappropriate, intense anger or difficulty controllong anger (e.g., frequent displays of temper, constant anger, recurrent physical fights)
9. Transient stress-related paranoid ideation or severe dissociative sx
Histrionic Personality Disorder Diagnostic Criteria
A. A pervasive pattern of excessive emotionality and attention seeking, beginning by early adulthood and present in a variety of contexts, as indicated by ≥5 of the following:
1. Is uncomfortable in situations in which they are not the center of attention.
2. Interaction with others is often characterized by inappropriate sexually seductive or provocative behaviour.
3. Displays rapidly shifting and shallow expressions of emotions.
4. Consistently uses physical appearance to draw attention to self.
5. Has a style of speech that is excessively impressionistic and lacking in detail.
6. Shows self-dramatization, theatricality, and exaggerate expression of emotion
7. Is suggestible
8. Considers relationships to be more intimate than they actually are
Narcissistic Personality Disorder
A pervasive pattern of grandiosity (in fantasy or behaviour), need for admiration, and lack of empathy, beginning by early adulthood and present in a variety on contexts, as indicated by ≥5 of the following:
1. Has grandiose self of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements)
2. Is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love.
3. Believes that they are special and unique and can only be understood by, or should associate with, other special high-status people or institutions
4. Requires excessive admiration
5. Has a sense of entitlement
6. Is interpersonally exploitative
7. Lacks empathy: is unwilling to recognize or identify with the feelings and needs of others
8. Is often envious of others or believes others are envious of them
9. Shows arrogant, haught behaviours or attitudes
Cluster B PDs
- APD
- BPD
- Histrionic PD
- Narcissistic PD
Avoidant Personality Disorder Diagnostic Criteria
A pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation, beginning by early adulthood and present in a variety of contexts, as indicated by ≥4 of the following:
1. Avoids occupational activities that involve significant interpersonal contact because of fears of criticism, disapproval, or rejection
2. Is unwilling to get involved with people unless certain of being liked.
3. Shows restraint within intimate relationships because of the fear of being shamed or ridiculed.
4. Is preoccupied with being criticized or rejected in social situations.
5. Is inhibited in new interpersonal situations because of feelings of inadequacy.
6. Views self as socially inept, personally unappealing, or inferior to others
7. Is unusually reluctant to take personal risks or to engage in new activities because they may prove embarrassing.
Dependent Personality Disorder Diagnostic Criteria
A pervasive and excessive need to be taken care of that leads to submissive and clinging behaviour and fears of separation, beginning by early adulthood and present in a variety of contexts, as indicated by ≥5 of the following:
1. Has difficulty making everyday decisions without an excessive amount of advice and reassurance form others.
2. Needs others to assume responsibility for most major areas of their life.
3. Has difficulty expressing disagreement with others because of fear or loss of support or approval.
4. Has difficulty initiating projects or doing things on their own (because of lack of confidence in judgement or abilities)
5. Goes to excessive lengths to obtain nurturance and support from others, to the point of volunteering to do things that are unpleasant.
6. Feels uncomfortable or helpless when alone because of exaggerated fears of being unable to care for themselves.
7. Urgently seeks another relationship as a source of care and support when a close relationship ends.
8. Is unrealistically preoccupied with fears of being left to take care of themselves.
