Personality Disorders Flashcards
Cluster A
Schizoid, schizotypal, and paranoid
- pts seem eccentric, peculiar, or withdrawn
- familial assc’n with psychotic disorders
Cluster B
antisocial, borderline, histrionic, and narcisistic
- pts seem emotional dramatic or inconsistent
- familial assc’n with mood disorders
Cluster C
avoidant, dependent and obsessive-compulsive
- pts seem anxious or fearful
- familial assc’n w/ anxiety disorders
Treatment
Personality disorders are generally very difficult to treat, most pts are not aware they need help Tend to be chronic and lifelong. Pharm treatment has limited usefulness for most, except for treating coexisting symptoms of depression, anxiety, etc. Psychotherapy and group therapy are usually the most helpful.
Paranoid Personality Disorder
DSM-IV:
Dx requires a general distrust of others, beginning by early adulthood and present in a variety of contexts. At least 4 of the following must also be present:
1. suspicion (w/out evidence) that others are exploiting or deceiving him or her
2. preoccupation w. doubts of loyalty or trustworthiness of acquaintances
3. Reluctance to confide in others.
4. Interpretation of benign remarks as threatening or demeaning.
5. Persistence of grudges.
6. Perception of attacks on his or her character that are not apparent to others, quick to counterattack.
7. Recurrence of suspicions regarding fidelity of spouse or lover.
Psychotherapy is the treatment of choice. Antianxiety meds or short course antipsychotics may be helpful for transient psychosis.
Schizoid Personality Disorder
Characterized by a lifelong pattern of social withdrawal. Often perceived as eccentric and reclusive. Quiet and unsociable, constricted affect. No desire for close relationships, and prefer to be alone.
DSM-IV Dx:
Pattern of voluntary social w/drawal and restricted range of emotional expression, beginning by early adulthood and present in a variety of contexts. Must have 4/7 following:
1. Neither enjoying no desiring close realationships (incl. family)
2. Generally choosing solitary activities.
3. Little (if any) interest in sexual activity with another person.
4. Taking pleasure in few activities, if any.
5. Few close friends or confidants (if any)
6. Indifference to praise or criticism.
7. Emotional coldness, detachment or flattened affect.
Prevalence 7%, men 2X likely as women. No increased incidence in families with schizophrenia. Ddx incl. paranoid schizophrenia, and schizotypal PD. Rx similar to paranoid personality disorder–psychotherapy. Group therapy often beneficial. Short course of low dose APs for transient psychosis, or antidepressants if comorbid major depression is diagnosed.
Schizotypal Personality Disorder
Pervasive pattern of eccentric behavior and peculiar thought patterns.
DSM-IV:
PAttern of social deficits marked by eccentric behavior, cognitive or perceptual distortions and discomfort w/ close relationships beginning by early adulthood and present in a variety of contexts. 5/9 must be present:
1. ideas of reference (excluding delusions of reference)
2. Odd beliefs or magical thinking, inconsistent with cultural norms.
3. Unusual perceptual experiences, such as bodily illusions.
4. Suspiciousness.
5. Inappropriate or restricted affect.
6. Odd or eccentric appearance or behavior.
7. Few close friends or confidants.
8. Odd thinking or speech (vague, stereotyped, etc.)
9. Excessive social anxiety
(Magical thinking may include belief in clairvoyance or telepathy, bizarre fantasies or preoccupations, or belief in superstitions.)
Prevalence 3%, Ddx paranoid schizo and schizoid personality disorder. Course is chronic or pts may eventually develop schizophrenia.
Treatment is psychotherapy. Short course of low-dose APs if nec. for transient psychosis.
Antisocial Personality Disorder
Pts refuse to conform to social norms and lack remorse for their actions. They are impulsive, deceitful, and often violate the law. Often appear charming and normal to those who meet them for the first time.
DSM-IV:
Pattern of disregard for others and violation of rights of others since age 15. Pts must be at least 18 yo for this Dx. Hx of behavior as child/adolescent must be consistent with conduct disorder. 3/7 must be present:
1. failure to conform to social norms by committing unlawful acts.
2. deceitfulness/repeated lying/maniuplating others for personal gain.
3. impulsivity/failure to plan ahead.
4. Recklessness and disregard for safety of others.
6. Irresponsibility/failure to sustain work or honor financial obligations.
7. Lack of remorse for actions.
Prevalence: 3% men 1% women; some genetic component. DDx incl. drug abuse. Course is usually chronic. Comorbid substance abuse and/or major depression is common.
Psychotherapy is treatment of choice. Pharmacotherapy may be used to treat Sx of anxiety or depression but watch out for highly addictive potential of these pts.
Borderline Personality Disorder
Pts w. BPD have unstable moods behaviors and interpersonal relationships. Feel alone in the wor;d and have probs with self-esteem. Impulsive and may have a Hx of repeated suicide attempts or episodes of self-mutilation.
DSM-IV:
Pervasive pattern of impulsivity and unstable relationships, affects or self image and behaviors, present by early adulthood and in a variety of contexts. At least 5/9:
1. Desperate efforts to avoid real or imagined abandonment.
2. Unstable, intense interpersonal relationships.
3. Unstable self-image.
4. Impulsivity in at least 2 potentially harmful ways (spending, sexual activity, substance use, etc.)
5. Recurrent suicidal threats or attempts or self-mutilation.
6. Unstable mood/affect.
7. General feeling of emptiness
8. Difficulty controlling anger.
9. Transient, stress-related paranoid ideation or dissociative symptoms.
Prevalence: 1-2%, women 2X more likely than men. Ddx: schizophrenia (but BPD don’t have frank psychosis). Course is usually stable and chronic. High incidence of coexisting major depression and/or substance abuse, increase risk of suicide.
Psychotherapy is treatment of choice– behavior therapy, cognitive therapy, social skills training, etc. Pharmacotherapy to treat psychotic or depressive Sxs as nec.
Histrionic Personality Disorder
Attention-seeking behavior and excessive emotionality. Dramatic, flamboyant, extraoverted, but unable to form long-lasting, meaningful relationships. Often sexually inappropriate and provocative.
DSM-IV:
Pattern of excessive emotionality and attention seeking, present by early adulthood in a variety of contexts. At least 5/7:
1. Uncomfortable when not the center of attn
2. Inappropriately seductive or provocative behavior.
3. Uses physical appearance to draw attn to self.
4. Has speech that is impressionistic and lacking in detail.
5. Theatrical and exaggerated expression of emotion.
6. Easily influenced by others or situation.
7. Perceives rels. as more intimate than they actually are.
Prevalance: 2-3%, more women than men. Ddx: Borderline PD. But people with HPD generally are more functional. Treatment: psychotherapy, w/ pharmacotherapy if nec. to treat assc’d Sx of anxiety or depression.
Narcissistic Personality Disorder
Pts consider themselves “special” and will exploit others for their own gain. Despite grandiosity, pts often have fragile self-esteem.
DSM-IV:
Pts have a sense of superiority, need for admiration, and lack of empathy beginning by early adulthood and present in a variety of contexts. 5/9 must be present:
1. Exaggerated sense of self-importance
2. Preoccupied with fantasies of unlimited money, success, brilliance, etc.
3. Believes that he or she is a “special” or unique and can associate only with other high-status individuals.
4. Needs excessive admiration.
5. Has a sense of entitlement.
6. Takes advantage of others for self-gain.
7. Lacks empathy.
8. Envious of others or believes others are envious of him or her.
9. Arrogant or haughty
Prevalence 1%. Ddx: antisocial PD. Usually has a chronic course. Psychotherapy is Rx. Antidepressants or Li may be used as needed for mood swings if a comorbid mood disorder is Dxed.
Avoidant Personality Disorder
A pattern of social inhibition, hypersensitivity,and feelings of inadequacy since early adulthood, with at least 4/7.
- Avoids occupation that involves interpersonal contact due to a fear of criticism and rejection.
- Unwilling to interact unless certain of being liked.
- Cautious of intrapersonal relationships.
- Preoccupied w/ being criticized or rejected in social situations.
- Inhibited in new social situations b/c he/she feels inadequate.
- Believes he/ she is socially inept and inferior.
- Reluctant to engage in new activities for fear of embarrassment.
Prevalence 1-10%. Ddx: schizoid PD, social phobia/social anxiety disorder, dependent personality disorder. Course is usually chronic, increased assc’d anxiety and depressive disorders. Rx is psychotherapy, incl. assertiveness training, is most effective. Beta blockers for autonomic Sxs of anxiety, and SSRIs may be prescribed for major depression.
Dependent Personality Disorder
Pts have poor self-confidence and fear separation. Excessive need to be taken care of and allow others to make decisions for them, feel helpless when left alone.
DSM-IV:
Pattern of submissive and clinging behavior due to excessive need to be taken care of. At least 5/8:
1. Difficulty making everyday decisions without reassurance from others.
2. Needs others to assume responsibilities for most areas of his/her life.
3. Cannot express disagreement b/c of fear of loss of approval.
4. Difficulty initiating projects b/c of lack of self-confidence.
5. Goes to excessive lengths to obtain support from others.
6. Feels helpless when alone.
7. Urgently seeks another relationship when one ends.
8. Preoccupied with fears of being left to take care of self.
Prevalence: 1%, women more than men. Ddx: avoidant personality disorder, borderline and histrionic personality disorder. (But here ppl have long relationship with another person on who they are dependent). Usually chronic course. Pts prone to depression, esp, with loss of person on whom they are dependent. Rx: psychotherapy. Pharmacotherapy may be used to treat assc’d Sx of anxiety or depression.
Obsessive-Compulsive Personality Disorder
Pts have a pervasive pattern of perfectionism, inflexibility, and orderliness.
DSM-IV:
Pattern of preoccupation w/ orderliness, control and perfectionism at the expense of efficiency, present by early adulthood and in a variety of contexts. At least 4 of 8:
1. Preoccupation w/ details, rules, lists, and organization such that the major point of the activity is lost.
2. Perfectionism that is detrimental to completion of the task.
3. Excessive devotion to work.
4. Excessive conscientiousness and scrupulousness about morals and ethics.
5. Will not delegate tasks.
6. Unable to discard worthless objects.
7. Miserly.
8. Rigid and stubborn.
