Personality Disorders

Question 1

What are the 6 broad criteria for personality disorders in the DSM?

Answer 1

1. An enduring pattern of inner experience and behavior that differs from expectations of the culture
2. enduring pattern is inflexible and pervasive across a broad range of situations
3. leads to clinically significant distress or impairment
4. pattern is of long duration and stable
5. not form another mental disorder
6. not due to a substance or general med condition

Question 2

Why does discrimination tend to occur against those labeled with personality disorders?

Answer 2

especially by insurance and healthcare employees - they tend to over-use services

Question 3

If a change in personality occurs in mid-life or later, what should you consider?

Answer 3

you really should just look for other med conditions or substance abuse - if found, diagnose with personality change due to gen med condition or unrecognized substance-related disorder

Question 4

Is a personality disorder a first-step diagnosis or more of a diagnosis or exclusion?

Answer 4

exclusion - you really should diagnose only after all possible relevant disorders have been excluded

Question 5

How are the personality disorders organized in the DSM?

Answer 5

into 3 clusters
cluster a: odd/eccentric
cluster b: dramatic, emotional, erratic
cluster c: anxious, fearful

Question 6

What are the 4 cluster A personality disorders?

Answer 6

odd/eccentric: paranoid PD, schizoid PD, and schizotypal PD

Question 7

Describe paranoid personality disorder.

Answer 7

characterized by a pervasive distrust and suspiciousness of others

Question 8

Describe schizoid personality disorder.

Answer 8

pervasive pattern of DETACHMENT FROM SOCIAL RELATIONSHIPS, constricted range of emotional expression in interpersonal situations - has no desire to be close to people, takes pleasure in very few activities

Question 9

Describe schizotypal personality disorder.

Answer 9

pervasive pattern of acute discomfort with and reduced capacity for close relationships as well as perceptual distortions and eccentric behavior

Question 10

How are schizoid and schizotypal PD different?

Answer 10

schizoid: have no desire for relationships, schizotypcal: want, but are too anxious for personal relationships

Question 11

What are the treatment toals for the cluster a PDs?

Answer 11

1. social skills training to reduce isolation
2. help person accept and adjust to a solitary lifestype
3. treat obvious symptoms (like illusions with haloperidol)

Question 12

What are the cluster B disorders?

Answer 12

dramatic, emotional, erratic: antisocial personality disorder, borderline personality disorder, histrionic personality disorder, narcissistic personality disorder

Question 13

Describe antisocial personality disorder.

Answer 13

a pervasive disregard for and violation of the rights of others

Question 14

What is the age limit for antisocial PD?

Answer 14

you have to be at least 18 (younger = conduct disorder)

Question 15

Describe borderline personality disorder.

Answer 15

pervasive pattern of instability of interpersonal relationships, self-image and affects, and marked impulsivity - begins in early adulthood

Question 16

What is the treatment mainstay for BPD?

Answer 16

dialectical behavior therapy (DBT)

Question 17

what is DBT?

Answer 17

it involves individual and group therapy where you do skills training - mindfulness skills, interpersonal effectiveness skills, emotional modulation skills, and distress tolerance skills

Question 18

Describe histrionic PD?

Answer 18

it’s excessive emoitonality and attention seeking beginning by early adulthood and present in a variety of contexts - like to be the center of attention, inappropriatley seductive, uses physical appearance to draw attention

Question 19

Describe narcissistic PD?

Answer 19

pattern of grandiosity (fantasy and behavior), need for admiration, lack of empathy - begins in early adulthood

Question 20

What are the 3 cluster C PDs?

Answer 20

the fearful/anxious ones: avoidant personality disorder, dependent personality disorder, and obessive-compulsive PD

Question 21

Describe aboidant personality disorder.

Answer 21

pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation - avoids people like the plague

Question 22

Describe a dependent personality disorder.

Answer 22

pervasive need to be taken care of - leads to submissiveness and clinging behavior. fears separation

Question 23

Describe obsessive-compulsive personality disorder?

Answer 23

pervasive pattern of preoccupation with orderliness, perfectionism, and mental/interpersonal control at expense of flexibility, openness and efficiency

Question 24

Why is obsessive-compulsive PD hard to treat?

Answer 24

because these patients don’t realize the problem is them - “if everyone just did things the right way, we’d be fine.”

Question 25

What is counter-transference?

Answer 25

it’s the projections in the physician that distort perceptions and reactions to a particular patient - make the MDs feel “hooked”