Personality disorders Flashcards
Personality Disorders
Patterns of behaviours and inner experiences that deviates significantly from the expectations of an individual’s culture
Pervasive and inflexible
Typically present in adolescents to early adulthood and is life-long
Causes impairment but not necessarily destress
9-15% prevalence in general population
Amongst psychiatric patients, up to 50% have a diagnosable PD
Majority meet criteria for more than one PD
Very little insight, rarely seek help
Risk Factors:
Neglect
Childhood abuse
Genetic factors per twin studies
Personality disorders
Ego syntonic and ego dystonic
Ego syntonic - behaviors, values, and ideas that are aligned with the ideal self and current self-image.
Ego dystonic - behaviors, values, and ideas that aren’t aligned with the ideal self.
Most personality disorders are considered ego-syntonic because they do not conflict with sense of identity.
Characteristics are part of their identity and patients cannot see why they are problematic.
personality disorders
Assessments
Millon Clinical Multiaxial Inventory (MCMI)
Self-administered, true false inventory of 344 items
Minnesota Multiphasic Personality Inventory (MMPI)
Used to assess patients more globally, over 500 items
Cluster A- odd/eccentric
Schizoid Personality Disorder
Schizoid
Schizotypal
Paranoid
A pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings
Schizoid Personality Disorder - cluster A
Criteria
4 or More:
Neither desires nor enjoys close relationships, including being part of a family
Almost always chooses solitary activities
Has little, if any, interest in having sexual experiences with another person
Takes pleasure in few, if any, activities
Lacks close friends or confidants other than first-degree relatives
Appears indifferent to the praise or criticism of others
Shows emotional coldness, detachment, or flattened affectivity
Schizoid Personality Disorder
general
Does not occur exclusively during the course of psychosis or autism, and is not attributable to the effects of another condition
Usually displays a bland exterior without visible emotional reactivity and rarely reciprocate gestures or facial expressions
Can be an antecedent for delusional disorder or schizophrenia
Prevalence 3-5%
Schizotypal Personality Disorder
general
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 behavior
Does not occur exclusively during the course of psychosis or autism
Speech is often vague, digressive, and/or loose without actual derailment or incoherence
Prevalence of about 3.9%
Schizotypal Personality Disorder
criteria
5 or more:
Ideas of reference - incorrect interpretations of casual events as having a special meaning for the person
Odd beliefs or magical thinking that influences behavior and is inconsistent with subcultural normals
Unusual perceptual experiences including bodily illusions
Odd thinking and speech
Suspiciousness or paranoid ideation
Inappropriate or constricted affect
Behavior or appearance that is odd, eccentric, or peculiar
Lack of close friends or confidants other than 1st degree relatives
Excessive social anxiety that does not diminish with familiarity and tends to be associated with paranoid fears rather than negative judgments about self
Paranoid Personality Disorder
general
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
Does not occur exclusively during the course of psychosis and not attributable to effects of another condition
These patients are hard to get along with and have a difficult time with close relationships
They can seem overly argumentative, complain recurrently, and can be quietly hostile
They have an excessive need to be self-sufficient and have a strong sense of autonomy
Often litigious (sue)
2-4% prevalence
Paranoid Personality Disorder
criteria
4 or more
Suspects, without sufficient basis, that others are exploiting harming, or deceiving him or her
Is preoccupied with unjustified doubts about the loyalty or trustworthiness of friends or associated
Is reluctant to confide in others bc of unwarranted fear the the info will be used maliciously
Reads hidden demeaning or threatening meanings into benign remarks or events
Persistently bears grudges
Perceives attacks on his or her character or reputation that are not apparent to others and is quick to react angrily or to counterattack
Has recurrent suspicions, without justification, regarding fidelity of spouse or partner
Cluster B
Dramatic, emotional, impulsive
Histrionic
Borderline
Narcissistic
Antisocial
Histrionic Personality Disorder
general
A pervasive pattern of excessive emotionality and attention seeking, beginning by early adulthood and present in a variety of contexts
Have difficulty achieving emotional intimacy in romantic or sexual relationships
Can be emotionally manipulative or seductive on one level while displaying a marked dependency on them at another level
Commonly alienate friends with demands for constant attention
Prevalence of 1.8%
Histrionic Personality Disorder
criteria
Is uncomfortable in situations in which he or she is not the center of attention
Interaction with others is often characterized by inappropriate sexually seductive or provocative behavior
Displays rapidly shifting and shallow expression of emotions
Consistently uses physical appearance to draw attention to self
Has a style of speech that is excessively impressionistic and lacking in detail
Shows self-dramatization, theatricality, and exaggerated expression of emotion
Is suggestible/easily influenced
Considers relationships to be more intimate than they actually are
Borderline Personality Disorder
general
“Chronic Affective Instability Disorder”
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
May have patterns of undermining themselves at the moment a goal is to be realized
Dropping out before graduation
Breaking up after realizing that a relationship could last
Regressing right after a convo about how good therapy is going
Commonly develop psychotic features during times of stress
High suicide risk
Recurrent job loss, interrupted education, separation/divorce common
Strong history of physical/sexual abuse, neglect, hostile conflict, early parental loss
Prevalence of 6% in primary care settings, 20% among psychiatric inpatients; ¾ of diagnosed patients are female
Tx: Dialectical Behavioral Therapy (DBT)
Narcissistic Personality Disorder
general
A pervasive pattern of grandiosity, need for admiration, and lack of empathy, beginning by early adulthood and present in a variety of contexts
Although they do not show it on the outside, criticism may haunt these individuals and may leave them feeling humiliated, degraded, hollow, and empty - they often react with disdain, rage, or defiant counterattack
Associated with anorexia nervosa and substance abuse (esp cocaine).
Prevalence up to 6.2% in community samples
50-75% of diagnosed patients are male
Antisocial Personality Disorder
general
Time frame
Aka psychopathy (born) vs sociopathy (made)
A pervasive pattern of disregard for and violation of the rights of others, occurring since age 15 years
Individual is at least age 18
Evidence of conduct disorder with onset before age 15
Behavior is not exclusively during the course of psychosis or bipolar
These individuals are usually opinionated, self-assured, cocky, cynical, and callous but very charming
More likely to die prematurely by violent means (suicide, accidents, homicides)
Child abuse/neglect, unstable or erratic parenting, or inconsistent parental discipline may increase likelihood that conduct disorder will evolve into APD.
Prevalence between 0.2 and 3.3%, higher in areas of low SES
Chronic, but may become less evident or remit as an individual gets older, particularly in the 4th decade
genetic component in combination with enviro factors
Avoidant Personality Disorder
general
A pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation, beginning in early adulthood and present in a variety of contexts
The patient’s fearful/tense demeanor often elicits ridicule from others, which can in turn confirm their self-doubts
They often do not have many relationships or friends and are seen as isolated, however they DESIRE friendships and relationships
Prevalence of 2.4%
Usually becomes less evident, or even remitts, with age
Dependent Personality Disorder
general
A pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation
Characterized by pessimism and self-doubt, tend to belittle their abilities and assets, and may constantly refer to themselves as “stupid”
They take criticism as proof of their worthlessness
They may seek overprotection and dominance from others
Chronic physical illness or separation anxiety in childhood may predispose the individual to the development of this disorder
Prevalence of <1%
Obsessive Compulsive Personality Disorder
general
preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency, Commonly struggle with anxiety and angry when not in control or when they do not have structure.
Usually express affection only in highly controlled or stilted fashion and may be very uncomfortable in the presence of others who are emotionally expressive
They carefully hold themselves back until they are sure that whatever they say will be perfect
Preoccupied with logic and intellect and intolerant of affective behaviors in others
The majority of patients with OCD, do not have a pattern of behavior that meets criteria for this PD.
One of the most prevalent PD’s - up to 7.9% prevalence rate
