personality disorders Flashcards
cluster A
- eccentric, peculiar, w/drawn
- familial assoc with psychotic d/os
schizoid, schizotypal, paranoid
cluster B
- emotional, dramatic, inconsistent
- familial assoc with mood d/os
antisocial, borderline, narcissistic, histrionic
cluster C
- anxious, fearful
- familial assoc with anxiety d/os
avoidant, dependent, OCPD
paranoid personality do: diagnosis
- general distrust of others in variety of contexts
4+ of:
- suspicion that others are plotting to exploit/deceive
- preoccupation with doubts of loyalty/trustworthiness of acquaintances
- reluctance to confide in others
- interpretation of benign remarks as threatening or demanding
- persistence of grudges
- perception of attacks on his/her character
- recurrence of suspicions regarding fidelity of spouse
paranoid personality do: epidem
- 0.5-2.5% prevalence
- men > women
- higher incidence w/family hx of SCZ
- misdiagnosed in minority groups, immigrants, deaf people
paranoid personality do: treatment
- psychotherapy
- short term: antianxiety or antipsychotics
schizoid personality do: diagnosis
- VOLUNTARY social withdrawal and restricted range of emotional expression
4+ of:
- not desiring close relationships
- choosing solitary activities
- little interest in sex
- pleasure in few/no activities
- few close friends
- indifference to praise/criticism
- emotional coldness, detachment, flat affect
schizoid personality do: epidem
- 7% prevalence
- men»_space; women
- no increased risk with family hx of schizophrenia
schizoid personality do: treatment
- psychotherapy
- group therapy often helpful
- short term low-dose anti-psychotics
- antidepressants if comorbid MDD
schizotypal personality do
- pattern of eccentric behavior, cognitive/perceptual distortions, discomfort with close relationships
5+ of:
- ideas of reference
- odd beliefs or magical thinking
- unusual perceptual experiences
- suspiciousness
- inappropriate/restricted affect
- odd/eccentric appearance/behavior
- few close friends
- odd thinking or speech
- excessive social anxiety
schizotypal personality do: epidem
3% prevalence
schizotypal personality do: treatment
- psychotherapy
- short course of low dose antipsychotics
- risk of development of SCZ
antisocial personality do: diagnosis
- pattern of disregard for others and violation of rights of others since age 15
(conduct do in children)
3+ of:
- unlawful acts
- deceitfulness/lying/manipulation for personal gain
- impulsivity
- irritability and aggressiveness/fights
- recklessness
- irresponsibility
- lack of remorse
antisocial personality do: epidem
- 3% in men, 1% in women
- higher incidence in poor urban areas and prisoners
- 5x risk in first degree relatives
antisocial personality do: treatment
- psychotherapy INEFFECTIVE - DBT and behavioral therapy best choice
- pharmacotherapy to treat sx of anxiety/depression - CAREFUL FOR ADDICTION (high incidence of comorbid substance abuse and/or major depression)
borderline personality do: diagnosis
- pattern of impulsivity and unstable relationships, affects, self image, behaviors
5+ of:
- desperate efforts to avoid abandonment (real/imagined)
- unstable intense relationships
- unstable self image
- impulsivity in 2+ harmful ways
- recurrent suicidal threats/attempts/self-mutilation
- unstable mood/affect
- feeling of emptiness
- difficulty controlling anger
- transient, stress-related paranoid ideation or dissociative sx
BPD: epidem
- 1-2% prevalence
- women»_space; men
- suicide rate 10%
BPD: tx
- PHARMACOTHERAPY more useful than in other personality dos - treat psychotic/depressive sx as necessary
- DBT is treatment of choice
histrionic personality do: diagnosis
- excessive emotionality and attention seeking
5+ of:
- uncomfortable when not center of attn
- inappropriately seductive or provocative
- physical appearance to draw attention to self
- speech is impressionistic and lacking in detail
- theatrical and exaggerated
- easily influenced by others or situation
- perceives relationships as more intimate than they actually are
defense mechanism: regression
histrionic personality do: epidem
- 2-3% prevalence
- women > men
histrionic personality do: tx
- psychotherapy
- pharmacotherapy for assoc depressive/anxious sx
narcissistic personality do: diagnosis
- grandiosity, need for admiration, lack of empathy
5+ of:
- exaggerated sense of self importance
- preoccupation with fantasies of unlimited money, success, brilliance
- believes that he/she is special, only associate with high status individuals
- needs excessive admiration
- sense of entitlement
- takes advantage of others for self gain
- lacks empathy
- envious of others/thinks others are envious of him
- arrogant/haughty
narcissistic personality do: epidem
<1%
narcissistic personality do: tx
- psychotherapy
- group therapy may help them learn empathy
- antidepressants/lithium as needed
avoidant personality do: diagnosis
- social inhibition, hypersensitivity, feelings of inadequacy
4+ of:
- avoids occupation involving interpersonal contact
- unwilling to interact unless certain of being liked
- cautious of relationships
- preoccupied with being criticized or rejected in social situations
- inhibited in new social situations
- believes self to be socially inferior
- reluctant to engage in new activities
avoidant personality do: epidem
- 1-10%
avoidant personality do: tx
- psychotherapy, including assertiveness training
- betaBs for anxiety sx
- SSRIs for depression
dependent personality do: diagnosis
- submissive and clinging behavior
5+ of:
- difficulty making everyday decisions w/o reassurance
- needs others to assume responsibility for many aspects of life
- cannot express disagreement
- difficulty initiating projects
- goes to excessive lengths to obtain support from others
- feels helpless when alone
- urgently seeks new relationship when one ends
- preoccupied with fears of being left to take care of oneself
dependent personality do: epidem
- 1%
- women > men
dependent personality do: prognosis
- sx often decrease with age/therapy
- prone to depression
- difficulty with employment
dependent personality do: treatment
- psychotherapy, esp group and social skills training
- pharmacotherapy as adjunct
OCPD: diagnosis
- preoccupation with orderliness, control, perfectionism at expense of efficiency
4+ of:
- details, rules, lists, organization
- perfectionism that is detrimental to task completion
- excessive devotion to work
- excessive conscientiousness
- will not delegate tasks
- unable to discard worthless objects
- miserly
- rigid/stubborn
OCPD: epidem
- unknown prevalence
- men > women
- more often in first born child
- increased incidence in 1st degree relatives
OCPD: tx
- psychotherapy, esp group and behaviour
- pharmacotherapy as needed