personality disorders Flashcards

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1
Q

personality disorder: DSM criteria

A

-A. Experience and behavior that deviates from expectations of pts culture
-in at least 2 of following:
-cognition (perception and interpretation of self, others and events)
-affect (range, intensity, lability, and appropriateness of emotional response)
-interpersonal functioning
-impulse control

-B. pattern is inflexible and pervasive across a many personal and social situations.
-C. leads to impairment in social, occupational, or other important areas of functioning.
-D. pattern is stable and of long duration and its onset can be traced back at least to adolescence or early adulthood.

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2
Q

what is personality disorder

A

-Enduring, inflexible, and maladaptive behaviors that cause significant social, interpersonal, and occupational impairment
-Unlike a mood disorder -> chronic and ingrained
-Affect 10-15% of population
-Originates in childhood or adolescence and continues throughout adulthood
-As many as 25% of psychiatric pts have personality disorders

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3
Q

why are personality disorders important

A

-People with a personality disorders are more likely to:
-engage in substance abuse, self-destructive behavior, and reckless sexual behavior
-have inconsistent, detached, overemotional, abusive, or irresponsible parenting styles -> medical and psychiatric problems in their children
-suffer “mental breakdowns” from stress
-develop primary mental health illnesses (depression, anxiety, psychosis)
-disregard prescribed tx regimens
-have poor or even adversarial relationships with clinicians.

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4
Q

onset and gender distribution

A

-Usually in adolescence & established by young adulthood
-Late-onset suggest presence of major mental illness (ie., prodrome of schizophrenia), a brain disorder, or disorder due to medical illness or effects of substance
-Antisocial personality: only PD w/ age requirement specified (18 yrs) -> May be dx with conduct disorder earlier
-Male preponderance: antisocial, schizoid, obsessive-compulsive
-Female preponderance: borderline, histrionic, avoidant, dependent
-Schizotypal has a more equal distribution

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5
Q

factors associated with risk for personality D/O’s

A

-Childhood abuse or maltreatment (Borderline & Antisocial PD’s)
-Resulting trauma cause difficulty in developing trust & intimacy
-Early home environment with domestic abuse, divorce, or separation
-Parental absence or neglect

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6
Q

personality disorders: cluster A, B, C

A

-Cluster A: ODD or ECCENTRIC
-Cluster B: DRAMATIC, EMOTIONAL, or ERRATIC
-Cluster C: ANXIOUS or FEARFUL

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7
Q

cluster A

A

-eccentric d/o’s w/ pervasive pattern of abnl cognition (ie., suspiciousness), self-expression (ie., odd speech), or relating to others (ie., seclusiveness)
-ODD or ECCENTRIC

-Paranoid: Pervasive distrust and suspicion of others so that their motives are interpreted as malevolent.

-Schizoid: Lack of desire for social relationships and a restricted range of emotional expression
-dont want social interaction

-Schizotypal: Acute discomfort with social relationships. Patterns of thought, perception, and behavior suggestive of schizophrenia, without actual psychosis
-want social interaction but personality restricts them

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8
Q

cluster B

A

-dramatic d/o’s w/ pervasive pattern of violating social norms (ie., criminal behavior), impulsivity, excessive emotionality, grandiosity, or “acting out” (ie., tantrums, self-abusive behavior, angry outbursts)
-DRAMATIC, EMOTIONAL, or ERRATIC

-Antisocial: Pervasive disregard for, and violation of other people’s rights. Lack of empathy

-Borderline: Instability of interpersonal relationships, self-image, affect, and marked impulsivity

-Histrionic: Excessive emotionality and attention-seeking

-Narcissistic: Extreme self-love and self-absorption. Grandiose perception of one’s own qualities. Lack of empathy for others.
-lack emotionality^

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9
Q

cluster C

A

-anxious d/o’s w/ pervasive pattern of abnormal fears involving social relationships, separation, & need for control.
-ANXIOUS or FEARFUL
-Avoidant: Pervasive social inhibition, feelings of inadequacy, hypersensitivity to criticism
-Dependent: Excessive need to be taken care of, submissive and clingy behavior, fear of abandonment
-Obsessive-Compulsive: Preoccupation with orderliness, perfection, and control.

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10
Q

personality disorder not otherwise specified (NOS)

A

residual category for individuals w/ mixed or atypical traits that do not fit into the better-defined categories

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11
Q

paranoid personality disorder case

A

41 year-old man has quit several jobs because his coworkers “always talk about me behind my back.” He has few friends because, “people always stab you in the back.” He broke up with his last three girlfriends because he suspected them of cheating on him, even though he had no evidence.

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12
Q

paranoid personality disorder

A

-Suspects, without basis, that others are exploiting, harming, or deceiving him
-Has unjustified doubts about loyalty
-reluctant to confide in others
-Reads hidden demeaning, threatening meanings into benign remarks
-Persistently bears grudges
-Has recurrent suspicions, without justification, about the fidelity of a spouse or sexual partner

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13
Q

paranoid personality etiology

A

-Genetics: More common in families with hx of Schizophrenia or Delusional Disorder
-Psychosocial: More common in pts whose families overemphasize importance of avoiding scrutiny and failure
-More common in people who suffer actual mistreatment (prisoners, refugees, war victims)

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14
Q

schizoid personality presentation

A

42 year-old unmarried night-watchman for a warehouse engages in fishing, bird-watching, and building model ships. He has no close friends or romantic partners. While many people his age have started families, he has no interested in getting married or having children.

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15
Q

schizoid personality disorder

A

-Neither desires, nor enjoys, close relationships, including being part of a family
-Almost always chooses solitary activities
-Has little, if any, interest in sexual relations
-Takes pleasure in few, if any, activities
-Lacks close friends or confidants other than first degree relatives
-Appears indifferent to criticism or praise
-Shows emotional coldness, detachment, or flattened affect

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16
Q

schizoid personality disorder etiology

A

-Genetics: show greater prevalence in families with autism and Schizophrenia

-Psychosocial: Defense mechanism to avoid emotional distress from repeated failures in various aspects of life.

-Slightly more common in pts who grew up in a family with no emotional nurturing

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17
Q

29 year-old male lives in a studio apartment without electrical or phone service because “technology dehumanizes humans.” He has a Masters Degree from Princeton University, but works at an organic food store. He refuses to eat anything that “has been touched by a machine.” He studies all religions as a hobby. “Religion itself has opened my third eye. It allows me to drift into different states of consciousness and feel how we are all connected to each other.”

A

schizotypal personality disorder

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18
Q

schizotypal personality disorder

A

-Acute discomfort and poor functioning in social situations.
-Ideas of Reference
-Odd beliefs or magical thinking
-Unusual perceptual experiences
-Odd thinking and speech
-Inappropriate or constricted affect
-Behavior or appearance that is odd or eccentric

19
Q

29 year-old male with history of drug and alcohol abuse. Has 10+ arrests for assault, vandalism, and auto theft. He stabbed his girlfriend’s brother, who told the girlfriend that the patient was cheating on her with numerous women. When asked if he feels bad about committing the assault, patient states, “If he didn’t want to be hurt, he shouldn’t have told her.”

A

antisocial personality disorder
-you made me do this

20
Q

antisocial personality disorder

A

-Lack of conscience!!!
-Failure to conform to social norms and lawful behavior
-Deceitfulness, lying, conning for profit or pleasure
-Impulsivity, failure to plan ahead
-Aggressiveness, repeated fights and assaults
-Disregard for safety or feelings of others
-Consistent irresponsibility with work or financial obligations
-Lack of remorse, rationalizing having hurt, mistreated, or stolen from another.

21
Q

antisocial personality disorder: etiology

A

-Genetics: 5x more common in first degree relatives of men with ASPD
-Increased risk if father has alcoholism
-Adopted twin studies show concordance of antisocial behavior

-Psychosocial: Lack of consistent person for child to bond with
-Neglect and physical abuse in childhood noted.

22
Q

25 year-old female has a long history of cigarette smoking and alcohol abuse. Despite being regarded by many as physically attractive, she feels she is “ugly and stupid.” She dates men she is not interested in because “at least I won’t be alone.” Her relationships always become tumultuous, sometimes violent. She often cuts herself with a razor or burns herself with a lit cigarette “just to feel something.”

A

borderline personality disorder
-highest suicide rate -> try to kill themselves for their partner to find them

23
Q

borderline personality disorder

A

-Frantic efforts to avoid abandonment.
-Unstable, intense interpersonal relationships
-Impulsivity in spending, sex, substance abuse, reckless driving, binge eating
-Recurrent suicidal behavior, gestures, threats, or self-mutilating behavior
-Severe mood lability
-Chronic feelings of emptiness
-Inappropriate and intense anger
-See people as totally “good” or totally “bad”

24
Q

borderline personality disorder: etiology

A

-Genetics: Increased prevalence in pts with first degree relatives who have substance abuse disorders, mood disorders

-Psychosocial:
-Raised in an “invalidating” environment
-Extremely high reported rate of neglect and childhood sexual, physical, or emotional abuse
-Conflicts with maternal figure noted in childhood

25
Q

borderline personality disorder: prognosis

A

-Fair: Impulsivity get gradually better if pt survives past age 30, but interpersonal problems often persist.
-67% have comorbid substance abuse
-50% have comorbid Depression
-Nearly 10% commit suicide
-Dialectical behavior therapy (DBT)

26
Q

34 year-old female goes out to a party thrown by a coworker. She dresses very seductively. She is very flirtatious with the males, calling even her superiors by their first names. When attention is paid to someone else, she either sulks or tells stories about the “wonderful” places she has traveled and people she has met to regain the attention.

A

HISTRIONIC PERSONALITY DISORDER
-drama queen or king

27
Q

histrionic personality disorder

A

-Uncomfortable when theyre not center of attention
-Inappropriate, seductive, or provocative behavior
-Rapidly shifting and shallow expressions of emotion
-Use of physical appearance to draw attention to self
-Speech is excessively impressionistic, lacking in detail
-Self-dramatization or exaggeration of emotion
-Easily suggestible; easily influenced by others
-Considers relationships to be more intimate than they actually are

-P rovocative (or seductive) behavior
-R elationships considered more intimate than they are
-A ttention (must be at center of)
-I nfluenced easily
-S peech (style) wanting to impress, lacks detail
-E motional lability, shallowness

-M ake-up (physical appearance) used to draw attention to self
-E xaggerated emotions, theatricality

28
Q

histrionic personality disorder: etiology

A

-Psychosocial: Being ignored as a child leads to low self-esteem and belief that one must be extra special or charming to gain attention

29
Q

40 year-old impeccably dressed plastic surgeon has filed for divorce because “my wife isn’t of the same caliber of people I am used to.” He walks into his psychiatrist’s office 30 minutes late but demands to be seen immediately. When he finds out that the psychiatrist did not graduate from an ivy league school, he refuses to be seen.

A

NARCISSISTIC PERSONALITY DISORDER - PRESENTATION

30
Q

narcissistic personality disorder

A

-Grandiose sense of self-importance
-Fantasies of unlimited power, brilliance, success, beauty, love
-Believes he is “special” and can only be understood by other special or high status people
-Requires excessive admiration
-Sense of entitlement; Interpersonally exploitative
-Lacks empathy
-Envious of others; believes others are envious of him
-Arrogant, haughty, behaviors or attitudes

31
Q

narcissistic personality disorder: etiology

A

-Psychosocial: Child remains self-centered due to lack of empathy on part of parents.
-Reaction formation to combat low self esteem secondary to a lack of parental appreciation.

32
Q

35 year-old Physician Assistant rarely socializes because he feels he “will not be entertaining enough.” When he does go out, he usually sits quietly due to a fear of saying something “stupid.” At lunch time, he eats alone while reading a book. He is attracted to a nurse, but won’t ask her out because he is afraid she will reject him.

A

AVOIDANT PERSONALITY DISORDER - PRESENTATION
-imposter syndrome

33
Q

avoidant personality disorder

A

-Views self as socially inept, unappealing, inferior
-Avoids activities that involve interpersonal contact due to fear of criticism, disapproval, rejection
-Unwilling to get involved with people unless certain of being liked
-Shows restraint with intimate relationships because of fear of shame or ridicule
-Inhibition in new interpersonal situations
-Reluctant to take personal risks or engage in new activities because they may prove embarrassing

34
Q

avoidant personality disorder: etiology

A

-Psychosocial: Parental rejection or not enough early uncritical love
-Pt never took enough personal risks to realize that failing is not fatal.

35
Q

49 year-old physician tells therapist she is “trapped in a loveless marriage.” Although she is no longer in love, she stays with her husband because he makes all the financial decisions. She is afraid her friends and family would not approve of her desire to get a divorce. She chose to work in a hospital instead of opening a private practice, because she felt she was not intelligent enough to take on the added responsibilities.

A

dependent personality disorder

36
Q

dependent personality disorder

A

-Difficulty making decisions without excessive advice or reassurance
-Lets others assume responsibility for major decisions
-Difficulty expressing disagreement because of fear of disapproval or loss of support
-Difficulty initiating projects/doing things on his own
-Goes to excessive lengths to obtain nurturance and support
-Feels uncomfortable or helpless when alone
-Urgently seeks new relationship when close one ends
-Afraid of being left to care for himself.

-D ifficulty making everyday decisions
-E xcessive lengths to obtain nurturance and support
-P reoccupied with fear of being left to take care of self
-E xaggerated fear of being unable to care for oneself
-N eeds others to assume responsibility for his or her life
-D ifficulty expressing disagreement with others
-E nd of a close relationship is the beginning of another
-N oticeable difficulty in doing things on one’s own
-T Take care of me” is his or her motto

37
Q

dependent personality disorder: etiology

A

-Psychosocial: Neglect, early death of parent, rejection by caretakers leads to consistent fear of abandonment.
-Also present in patients with chronic illnesses due to forced dependence.

38
Q

37 year-old teacher lectures from precisely 9 am to 11 am every day. He practices his lecture numerous times the night before so it will be perfect. He eats lunch from 11 am until noon and grades papers from noon until 2pm. If his schedule is disrupted he becomes very anxious. He has been working on his PhD dissertation for six years. No matter how diligently he works on it, “it is never how I like it.”

A

obsessive compulsive personality disorder

39
Q

obsessive compulsive personality disorder

A

-Preoccupation with order, details, rules, lists, schedules
-Perfectionism that interferes with task completion
-Excessive devotion to work and productivity
-Is overly scrupulous, and inflexible about morality, ethics, or values
-Is unable to discard objects even when they have no sentimental value
-Is reluctant to delegate tasks or work with others
-Miserly with money; hoards for potential catastrophes
-Shows rigidity and stubbornness

40
Q

obsessive compulsive personality disorder: etiology

A

-Psychosocial: Parental reinforcement of conformity. Background of harsh discipline. Compensation for lack of control in certain areas of life.

41
Q

personality dx

A

-Clinical interview
-self-assessment tools
-Minnesota Multiphasic Personality Inventory
-DSM scales

42
Q

personality disorder tx

A

-Psychotherapy: Help identify and change dysfunctional belief systems and coping skills.

-Pharmacotherapy: To treat problems that result from the personality disorder, but not the disorder itself
-SSRI’s treatment of choice.

43
Q

management of personality disorders

A

-1. Some pts w/ PD’s are difficult, unpleasant, & manipulative
-practitioner shouldnt let it interfere w/ or affect understanding of all pts w/ PD’s
-2. Pts have enduring, long-term problems, & therapy may be long term as well
-Decades of maladaptive behavior cant be easily understood or reversed.
-3. Maintain a professional distance from the pt
-You are not a friend or collaborator.
-Avoid becoming over involved w/ pts, doing favors (i.e., giving out home phone #)
-These “boundary” issues can create enormous problems if not dealt w/ from the outset.
-4. Ground rules for therapy must be established (i.e., that you are willing to see the person regularly, @ a specified time.)
-Spell out what the pt should do or whom the pt should call in a crisis;
-the consequences of self-damaging acts-ie., hospitalization, referral to another practitioner
-5. Avoid fantasies of becoming a “savior” to the pt
-If PD is chronic, pt has undoubtedly seen other practitioners w/o success.
-6. Seek support of him/herself from peers or supervisors
-Pts w/ PD can be a handful, & you will probably need advice or consultation now & then.
-7. Support groups can be very helpful to the pt, & referral to community-based organizations is essential.