Personality disorders Flashcards
Cluster A
schizoid, schizotypal, paranoid
Cluster B
antisocial, borderline, histrionic, narcissitic
Cluster C
avoidant, dependent, OCPD
histrionic
cluster B
schizotypal
cluster A
OCPD
cluster C
antisocial
cluster B
borderline
cluster B
schizoid
cluster A
paranoid
cluster A
avoidant
cluster C
narcissistic
cluster B
dependent
cluster C
What do most patients with personality disorders lack?
INSIGHT about their problem; their symptoms are ego-syntonic and viewed as immutable
4 diagnostic criteria of personality disorder
CAPRI Cognition Affect Personal Relations Impulse control
cluster A personality disorders have a familial association with which psychiatric disorder?
psychotic disorders
cluster B personality disorders have a familial association with which psychiatric disorder?
mood disorders
cluster C personality disorders have a familial association with which psychiatric disorder?
anxiety disorders
DSM diagnosis of paranoid personality disorder
pervasive distrust and suspiciousness of others
4 of the following:
- suspicion without evidence
- preoccupation with doubts of loyalty or trustworthiness
- reluctance to confide in others
- holds grudges
- inteprets benign remarks as threatening or demeaning
- perception of attacks on his/her character that are not obvious to others
- pathologically jealous (of their sexual partners/spouses)
What 4 prominent personality trait characterizes paranoid personality disorder?
suspiciousness
intimacy avoidance
hostility
unusual beliefs
common defense mxn people with paranoid personality disorder use
projection
DSM diagnosis of schizoid personality disorder
voluntary social withdrawal and restricted affect
4 of the following
- no enjoyment/desire for close relationships
- solitary activities
- little interest in sexual activity with another person
- pleasure in few activities
- few close friends or confidants
- indifferent to praise/criticism
- restricted affect
How is schizoid personality disorder different from avoidant personality disorder?
schizoid - prefers to be alone; loneliness is egoSYNtonic
avoidant - strongly desires relationships with others, but afraid to reach out; loneliness is egoDYStonic
DSM diagnosis of schizotypal personality disorder
pattern of social deficits marked by a pervasive pattern of eccentric behavior and peculiar thought patterns
5 or more must be present
- ideas of reference
- odd beliefs/magical thinking inconsistent with norms
- odd/eccentric appearance or behavior
- perceptual experiences
- suspiciousness
- restricted affect
- excessive social anxiety
- few close friends/confidants (due to discomfort w/ close relationships)
Schizotypals may experience some magical thinking - what are some experiences
belief in
- clairvoyance or telepathy
- bizarre fantasies or preoccupations
- superstitions
fill in the blank: there is a greater prevalence of Schizotypal disorder in relatives of patients with ______
schizophrenia
prognosis of patients with schizotypal personality disorder
chronic course; may develop schizophrenia
treatment for schizotypal personality disorder - 2
psychotherapy - help patients develop social skills
low-dose antipsychotic - for transient psychosis, which can happen under stress, or help decrease social anxiety and suspicion in interpersonal relationship
DSM diagnosis of schizotypal personality disorder
pattern for disregard for others/violation for right of others
>18 with a history of conduct disorder
3 of the following
- failure to conform to societal norms (breaking law)
- repeatedly lies + manipulates others for personal gain
- impulsive/failure to plan ahead
- irritable/aggressive
- irresponsible
- recklessness/disregard for safety
- lack of remorse
patients with antisocial personality disorder are frequently comorbid with what two psychiatric disorders
substance abuse
MDD
multiple somatic complaints
treatment for patients with antisocial personality disorder
DBT (same for borderline)
DSM diagnosis of borderline personality disorder
unstable mood, behaviors, interpersonal relationships; fear abandonment, have poorly formed identity
5 of the following
- desperate attempts to avoid real/imagined abandoment
- unstable, intense relationships
- unstable self-image
- impulsive (spending, sex, substance use, binge eating)
- recurrent SI/attempts, self-mutilation
- unstable mood/affect
- feelings of emptiness
- trouble controlling anger
- paranoid ideation/dissociative sx with stress
What 3 things are borderline patients known for?
increased risk of suicide (often because patients will make suicide gestures and kill themselves by accident)
brief psychotic episodes (under stress)
depression
where does the borderline name come from?
the name comes from the patient being on the borderline of NEUROSIS and PSYCHOSIS
4 common defense mechanism seen in borderline patients
splitting
idealization
devaluation
projection
when borderline patients are under stress, what can happen?
they can experience transient psychotic symptoms
treatment for borderline patients
DBT (same for antisocial patients)
DSM diagnosis of histrionic personality disorder
excessive emotionality and attention seeking
5 of the following
- uncomfortable when not the center of attn
- seductive/provocative behavior
- uses physical appearance to draw attention to self
- impressionistic speech that is lacking in detail
- theatrical, exaggerated emotions
- easily influenced by others or situation
- sees relationships as more intimate than they actually are
common defense mechanism seen in histrionic patients
dissociation
repression
DSM diagnosis of narcissitic personality disorder
sense of superiority/grandiosity, need for admiration, lack of empathy
5 or more of the following
- exaggerated sense of self-importance
- preoccupation with unlimited $$, success, brilliance
- belief that one is unique/special
- entitled
- needs excessive admiration
- takes advantage of others for self-gain
- lacks empathy
- envious of others/believes others are envious of him
- arrogant
What is the one thing that patients with narcissistic personality disorder do not handle well
AGING because of they value beauty, strength, youth
3 common defense mechanism seen in narcissistic patients
devaluation of others
idealization of self
denial
treatments for narcissistic patients
psychotherapy
group therapy - may help patients learn empathy
antidepressants - for depressive sx
lithium - for affective lability
DSM diagnosis of avoidant personality disorder
pervasive pattern of social inhibition and intense fear of rejection such that they will avoid situations in which they will be rejected; desire companionship but are extremely shy and easily injured
at least 4 criterias
- avoids or is cautious of interpersonal contact due to fear/preoccupation of criticism or rejection
- unwilling to interact unless certain of being liked
- inhibited in new social situations bc he/she feels inadequate
- believes that he/she is socially inept and inferior
- reluctant to engage in new activities for fear of embarassment
how do patients with avoidant personality disorder differ than schizoid patients?
avoidant: desires companionship but extremely shy
schizoid: no desire for companionship
how do patients with avoidant personality disorder differ than patients with social phobia?
avoidant: overall fear of rejection and sense of inadequacy
social phobia: fear of embarrassment in a particular setting
how do patients with avoidant personality disorder differ than patients with dependent personality disorder?
avoidant: slow to get involved for fear of rejection
dependent: actively and aggressively seek relationships because they are afraid to function on their own
patients with avoidant personality disorder are frequently comorbid with what 3 psychiatric symptoms?
depression
anxiety
anger
Treatment for patients with avoidant personality disorder?
psychotherapy
ß blockers and SSRIs - control autonomic sx of anxiety
Why do you want to avoid benzos in patients with avoidant personality disorder?
high potential for habit-formation
common defense mechanism seen in avoidant patients?
regression (going back to a younger age of maturity)
a
Poor self confidence and fear of separation; excessive need to be taken care of - feels helpless when left alone; requires others to make decisions for them
5 of the following:
- difficulty making decisions on a daily basis
- needs others to assume responsibility for their life
- does not express disagreement b/c of fear of loss of approval
- goes to extreme lengths to obtain support from others
- feels helpless when left alone
- serial dater - can’t be left alone
patients with dependent personality disorder are prone to this psychiatric condition
depression - esp after the loss of a person whom they are dependent
How should a physician handle a patient with dependent personality disorder
treatment?
schedule limited, but regular appointments with them, since they tend to be less proactive about their care
psychotherapy (groups and social skills training)
DSM diagnosis of dependent personality disorder
pervasive pattern of perfectionism, inflexibility, and orderliness (but ø obsessions and compulsions) at the expense of efficiency
4 of the following:
- preoccupation with details, rules, lists, organization
- perfectionism at the expense of efficiency
- excessive devotion to work/moralistic about other’s work habits
- can’t delegate tasks
- cheap and hoarder-like
- rigid and stubborn
∆ btwn OCD and OCPD
OCD: (+) obsessions & compulsions, egoDYStonic
OCPD: (-) obsessions and compulsions, egoSYNtonic
∆ btwn Narcissistic PD and OCPD
both involve assertiveness and achievement
Narcissistic PD - motivated by status
OCPD - motivated by the work itself
