Personality Disorders Flashcards
Personality: _____
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.
Personality disorder: ____
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
Cluster A
(MAD): Odd or eccentric group
* Paranoid
* Schizoid
* Schizotypa
Cluster B
(BAD): Dramatic, emotional, erratic group
* Antisocial
* Borderline
* Histrionic
* Narcissistic
Cluster C
(SAD): Anxious and fearful group
* Avoidant
* Dependent
* Obsessive-compulsive
Paranoid Personality Disorder presentation
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
Paranoid Personality Disorder Management Approach:
- Psychotherapy
- Benzodiazepines-for anxiety and agitation (for brief periods)
- Antipsychotics (agitation/quasi-delusional thinking)
“Matter of Fact” approach?
Schizoid Personality Disorder presentation
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.
Differentiating schizoid personality disorder from schizophrenia?
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.
Schizoid Personality Disorder Management Approach
- Psychotherapy
- Antipsychotics
- Antidepressants
- Psychostimulants
Schizotypal Personality Disorder presentation:
: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.
Schizotypal Personality Disorder vs. Schizophrenia
Unlike schizophrenia, schizotypal does not include psychosis. They do may have suspiciousness and paranoia (like paranoid)
and social isolation (like schizoid)
Schizotypal Personality Disorder Management
- Psychotherapy
- Antipsychotics (if severe delusions, like ideas of reference or illusions)
Antisocial Personality Disorder patients often referred to as
Sociopath/Psychopaths
Antisocial Personality Disorder presentation
Demonstrate a disregard for others, have behaviors that violates others’ rights, and can’t understand the feelings of others.
Antisocial Personality Disorder differential diagnosis:
Antisocial can overlap with other personality
disorder traits such as narcissistic, histrionic, or borderline personality.
Antisocial Personality Disorder clinical approach
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
Antisocial Personality Disorder management
- Psychotherapy - (limits must be established)
- Pharmacotherapy - Used for other diagnosis and can be used as “chemical restraint”
- Imprisonment for legal infractions
Borderline Personality presentation
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
Borderline Personality Suicidality
Suicidal threats, gestures, and attempts are common manifestations of BPD. They have a rate of suicide of 4 percent over a 10-year period
Borderline Personality differential diagnosis:
- 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.
Borderline Personality Management
- 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
Histrionic Personality Disorder Presentation
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.
Histrionic Personality Disorder Differential diagnosis
Difficult to distinguish from
narcissistic or borderline personality but tend to be less grandiose, arrogant, and self-absorbed then narcissistic.
Histrionic Personality Disorder Illness experience
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.
Histrionic Personality Disorder management
- Psychotherapy- treatment of choice
- Adjunctive when symptoms are targeted
Narcissistic Personality Disorder Presentation
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.
Narcissistic Personality Disorder management
- Psychotherapy - treatment of choice
- LIthium - Patients with mood swings
- Antidepressants may be helpful
Avoidant Personality Disorder Presentation
- 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.
Avoidant Personality Disorder vs. Schizoid
Avoidant patients strongly want relationships but avoid them because of anxiety and fears. Those with Schizoid avoid social situations but they want social isolation.
Avoidant Personality Disorder Management
- Psychotherapy: Individual and group.
- Beta blockers- manage autonomic nervous system symptoms
Dependent Personality Disorder Presentation
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.
Dependent Personality Disorder management
- Psychotherapy-Insight oriented therapies
- Behavioral training: assertiveness training, family therapy, group therapy
- Imipramine (TCA): panic attacks
Obsessive Compulsive Personality Disorder presentation
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.
Obsessive Compulsive Personality Disorder management
- Unlike most other personality disorders they are usually aware of their
disorder and often seek help - Psychotherapy: Group therapy
- Benzodiazepine (short term)
