Personality Disorders

Question 1

Personality: _____

Answer 1

the enduring characteristics and
behavior that comprise a person’s unique
adjustment to life, including major traits,
interests, drives, values, self-concept, abilities,
and emotional patterns.

Question 2

Personality disorder: ____

Answer 2

an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s culture, is
pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time, and leads to distress or impairment

Question 3

Cluster A

Answer 3

(MAD): Odd or eccentric group
* Paranoid
* Schizoid
* Schizotypa

Question 4

Cluster B

Answer 4

(BAD): Dramatic, emotional, erratic group
* Antisocial
* Borderline
* Histrionic
* Narcissistic

Question 5

Cluster C

Answer 5

(SAD): Anxious and fearful group
* Avoidant
* Dependent
* Obsessive-compulsive

Question 6

Paranoid Personality Disorder presentation

Answer 6

Long-standing pattern of distrust and suspiciousness. They perceive the behavior and motives of others as malevolent and expect others to disappoint or take advantage of them. They are reluctant to confide
in others. They adopt a rigid, distanced, or guarded position. Often leaving
them without social supports

Question 7

Paranoid Personality Disorder Management Approach:

Answer 7

• Psychotherapy
• Benzodiazepines-for anxiety and agitation (for brief periods)
• Antipsychotics (agitation/quasi-delusional thinking)
  “Matter of Fact” approach?

Question 8

Schizoid Personality Disorder presentation

Answer 8

Individuals remained detached from social
relationships and exhibit a restricted range of emotional expression in their interactions with others, often appearing cold or indifferent. Often times they isolate themselves and avoid close relationships.

Question 9

Differentiating schizoid personality disorder from schizophrenia?

Answer 9

Schizoid patients do not exhibit prolonged psychotic symptoms. May suffer brief psychosis when stressed. May precede conditions such as schizophrenia or delusional disorder. Consider referral to psychiatry if
disorder progression occurs.

Question 10

Schizoid Personality Disorder Management Approach

Answer 10

• Psychotherapy
• Antipsychotics
• Antidepressants
• Psychostimulants

Question 11

Schizotypal Personality Disorder presentation:

Answer 11

:Behave in odd and eccentric manner, are socially inept and isolated, and experience cognitive or perceptual distortions.
- Distortions such as: Magical thinking, odd beliefs, ideas of reference, bodily illusions, or telepathic and clairvoyant experiences.
- These beliefs and distortions are inconsistent with cultural norms, occur frequently, and
are an important core component of the patients experience.

Question 12

Schizotypal Personality Disorder vs. Schizophrenia

Answer 12

Unlike schizophrenia, schizotypal does not include psychosis. They do may have suspiciousness and paranoia (like paranoid)
and social isolation (like schizoid)

Question 13

Schizotypal Personality Disorder Management

Answer 13

• Psychotherapy
• Antipsychotics (if severe delusions, like ideas of reference or illusions)

Question 14

Antisocial Personality Disorder patients often referred to as

Answer 14

Sociopath/Psychopaths

Question 15

Antisocial Personality Disorder presentation

Answer 15

Demonstrate a disregard for others, have behaviors that violates others’ rights, and can’t understand the feelings of others.

Question 16

Antisocial Personality Disorder differential diagnosis:

Answer 16

Antisocial can overlap with other personality
disorder traits such as narcissistic, histrionic, or borderline personality.

Question 17

Antisocial Personality Disorder clinical approach

Answer 17

Very challenging.
* Try to maintain an objective, thorough, non-authoritarian, and respectful approach.
* Communication should be direct and factual.
* Bring in data from other providers and family members when possible

Question 18

Antisocial Personality Disorder management

Answer 18

• Psychotherapy - (limits must be established)
• Pharmacotherapy - Used for other diagnosis and can be used as “chemical restraint”
• Imprisonment for legal infractions

Question 19

Borderline Personality presentation

Answer 19

Exhibit instability in their self-image, their affect, and their relationship with others.
- They can be quite impulsive and may engage in self-destructive behaviors, such as substance abuse, self-mutilation, and suicide attempts. On the other hand, patients with borderline personality disorder are often fearful of closeness.
- These patients have difficulty differentiating between real or fantasy and they tend to have an all-or-nothing thinking in their view of themselves and others, alternating between over idealization and devaluation

Question 20

Borderline Personality Suicidality

Answer 20

Suicidal threats, gestures, and attempts are common manifestations of BPD. They have a rate of suicide of 4 percent over a 10-year period

Question 21

Borderline Personality differential diagnosis:

Answer 21

• Some pts with borderline disorder may suffer brief psychotic episodes (typically auditory hallucinations) when under stress.
• The brief duration and specific association with stressor distinguishes it
  from psychotic disorders.
• They also often suffer from concurrent mood
  disorder, such as major depression or bipolar disorder.

Question 22

Borderline Personality Management

Answer 22

• Psychotherapy: treatment of choice-firm limit-setting of dramatic and intense behaviors. Dialectical behavioural therapy (DBT)
• Antipsychotics if needed for control of anger, hostility, and brief psychotic episodes
• Antidepressants: improved depressed mood if present
• Mood stabilizers
• Benzodiazepines: Not recommended. If used, only short term

Question 23

Histrionic Personality Disorder Presentation

Answer 23

Excessive attention seeking and emotionalism.
* Patients present with dramatic, theatrical show of feeling, may dress in or behave in a sexually provocative fashion in an unconscious effort to engage others and draw attention to themselves.

Question 24

Histrionic Personality Disorder Differential diagnosis

Answer 24

Difficult to distinguish from
narcissistic or borderline personality but tend to be less grandiose, arrogant, and self-absorbed then narcissistic.

Question 25

Histrionic Personality Disorder Illness experience

Answer 25

Medical illness represents a threat to emotional well being
of histrionic patients as much of their self worth is derived from their sense of
physical attractiveness.
* May be flirtatious or seductive to attempt to bond with the provider.
* Patients focus on feelings and may present with loosely connected clinical
symptoms.

Question 26

Histrionic Personality Disorder management

Answer 26

• Psychotherapy- treatment of choice
• Adjunctive when symptoms are targeted

Question 27

Narcissistic Personality Disorder Presentation

Answer 27

Long standing pattern of grandiosity, with a need for praise and admiration.
* Lack of sensitivity to the feelings of others.
* Exaggerated sense of self-importance and
social status.
* They may be envious and devaluing of others whose accomplishments
exceed their own.

Question 28

Narcissistic Personality Disorder management

Answer 28

• Psychotherapy - treatment of choice
• LIthium - Patients with mood swings
• Antidepressants may be helpful

Question 29

Avoidant Personality Disorder Presentation

Answer 29

• Excessive anxiety in social situations and in
  intimate relationships, and extreme
  hypersensitivity to what other people think
  about them.
• Desire relationships but avoid them because
  due to fear of being rejected, humiliated, or
  embarrassed.
• If they interact socially, they are preoccupied with being rejected and criticized. They generally have low self esteem, feel socially
  inept, and are shy and inhibited.

Question 30

Avoidant Personality Disorder vs. Schizoid

Answer 30

Avoidant patients strongly want relationships but avoid them because of anxiety and fears. Those with Schizoid avoid social situations but they want social isolation.

Question 31

Avoidant Personality Disorder Management

Answer 31

• Psychotherapy: Individual and group.
• Beta blockers- manage autonomic nervous system symptoms

Question 32

Dependent Personality Disorder Presentation

Answer 32

Pervasive and excessive need to be taken care of.
* They experience intense fear of separation and abandonment and feel great discomfort when they are alone.
* They have a submissive and clinging behavior in interpersonal relationships.
* Difficulty making independent decisions
without a great deal of advice and reassurance, and they are afraid of disagreeing with others.

Question 33

Dependent Personality Disorder management

Answer 33

• Psychotherapy-Insight oriented therapies
• Behavioral training: assertiveness training, family therapy, group therapy
• Imipramine (TCA): panic attacks

Question 34

Obsessive Compulsive Personality Disorder presentation

Answer 34

Preoccupied with orderliness,
perfectionism, and control. They are excessively concerned with details and rules, and are usually focused on work to the
exclusion of leisure.
* They find it difficult to adapt themselves to others and instead insist that others follow their plans.
* Their general inflexibility and restricted emotional expression betray an
underlying fear of losing control.
* Because they can be indecisive, they feel distressed when faced with the need to make decisions.

Question 35

Obsessive Compulsive Personality Disorder management

Answer 35

• Unlike most other personality disorders they are usually aware of their
  disorder and often seek help
• Psychotherapy: Group therapy
• Benzodiazepine (short term)