personality disorders Flashcards
personality disorder: DSM criteria
-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.
what is personality disorder
-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
why are personality disorders important
-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.
onset and gender distribution
-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
factors associated with risk for personality D/O’s
-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
personality disorders: cluster A, B, C
-Cluster A: ODD or ECCENTRIC
-Cluster B: DRAMATIC, EMOTIONAL, or ERRATIC
-Cluster C: ANXIOUS or FEARFUL
cluster 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
cluster B
-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^
cluster C
-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.
personality disorder not otherwise specified (NOS)
residual category for individuals w/ mixed or atypical traits that do not fit into the better-defined categories
paranoid personality disorder case
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.
paranoid personality disorder
-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
paranoid personality etiology
-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)
schizoid personality presentation
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.
schizoid personality disorder
-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
schizoid personality disorder etiology
-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
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.”
schizotypal personality disorder
schizotypal personality disorder
-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
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.”
antisocial personality disorder
-you made me do this
antisocial personality disorder
-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.
antisocial personality disorder: etiology
-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.
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.”
borderline personality disorder
-highest suicide rate -> try to kill themselves for their partner to find them
borderline personality disorder
-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”
borderline personality disorder: etiology
-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
