Personality Disorders Flashcards
constellation of motivations, beliefs, and interpersonal behaviors
helps organize behavior in response to stress
personality
enduring pattern of maladaptive traits that are inflexible and pervasive that case significant distress or impairment
personality disorder
onset usually in adolescence
3 cluster A: odd, eccentric
paranoid
schizoid
schizotypal
*seen among relatives of schizophrenia
4 cluster B: dramatic, emotional
antisocial
borderline
histrionic
narcissistic
3 cluster C: anxious, fearful
avoidant
dependent
obsessive-compulsive PD
Cloninger neurobiological model’s 3 dimensions of temperament
4 dimensions of character
novelty seeking (DA) reward dependence (NE) harm avoidance (5HT)
persistence
self-directedness
cooperativeness
self-transcendence
five-factor model (CANOE)
extraversion agreeableness neuroticism (5HT transporter abnormality) openness to experience conscientiousness
impulsivity/aggression assoc with abnormalities in fxn of which NT?
serotonin
physical/sexual abuse assoc w?
childhood maltreatment assoc w?
BPD
antisocial PD
cannot make dx of personality d/o during when?
acute presentation of another psychiatric d/o
medical conditions that cause a change in personality
neoplasia TBI infection endocrine autoimmune epilepsy cerebrovascular neurodegenerative (alzheimer's/Huntington's)
effects to which two areas of brain are linked to personality d/o’s?
frontal/temporal lobes
pervasive distrust/suspiciousness of others, that their motives are interpreted as malevolent
similar presentation to delusional d/o
paranoid personality d/o
pervasive detachment from social relationships and restricted range of expression of emotions
socially isolated by choice
schizoid personality d/o
sx include ideas of reference, odd beliefs, unusual perceptions, odd thinking/speech/behavior, suspiciousness or paranoia, iappropriate/constricted affect, lack of close friends, social anxiety
schizotypical personality d/o
3% prevalence
disregard for and violation of rights of others, lack of empathy, truancy, fire-setting, cruelty to animals; these folks will have met criteria for which d/o during childhood?
antisocial PD
conduct d/o: aggression to people/animals, destruction of property, deceitfulness or theft, violations of rules
higher rates of suicide and accidents, criminality, domestic violence
chronic, 10% remission over 30y
criteria for APD
A. disregard for/violation of rights of others, since age 15 via 3+ of: conform, deceitfulness/lying, impulsivity, irritability/aggressiveness, disregard for safety, irresponsibility, lack of remorse/indifference of hurting another
B. >18yo
C. conduct disorder before age 15
D. behavior not exclusive to schizo/bipolar
arising in individuals with high emotional vulnerability exposed to an invalidating environment during childhood: non-responsiveness, att to control emotions, rejection of emotions
borderline PD
(F:M 3:1)
10% complete suicide
1/2 remit 10 years after initial dx
BPD criteria
Instability of relationships. self-image, affects, impulsivity w/5+ of: 1) avoid abandonment, 2)idealization/devaluation of relationships, 3) identity disturbance (self-image), 4) impulsivity in self-damaging, 5) suicidal/self-mutilating behavior, 6) unstable affect, 7) emptiness, 8) anger, 9) stress-related paranoid ideation
excessive emotionality/attention seeking; uncomfortable in situations when not center of attention; rapidly shifting emotions; physical appearance to draw attention; theatrical/dramatic; easily influenced
histrionic PD
grandiosity; need for admiration; lack of empathy; egotistical; manipulative of others to achieve own aims
narcissistic PD
social inhibition, feelings of inadequacy, hypersensitivity to negative evaluation, socially isolated, don’t desire human contact BECAUSE of fear of embarrassment (unlike schizoid)
avoidant PD
overlaps with social phobia
need to be taken care of that leads to submissive and clinging behavior and fears of separation
dependednt PD
perfectionistic, orderliness and details, inflexible, stubborn, overly conscientious; but are pervasive, present in most situations and interfere w fxn
obessive-complusive PD
OCPD distinguished from OCD by?
level of insight
OCD folks find sx disturbing (dystonic)
personality change in mid/late life indicates?
common sx?
medical etiology
affective instability, poor impulse control, outbursts of aggression or rage, marked apathy, suspiciousness, paranoid ideation
tx for personality d/o?
dialectical behavioral therapy: 1x/wk for a yr (validation, mindfulness, emotion regulation, distress tolerance, interpersonal effectiveness skills)
antidepressants for dysphoria/anxiety
antipsychotics for dissociative/psychotic sx
anticonvulsants for mood instability/impulsivity
AVOID BZDs (cause disinhibition and abuse)
NO TCA’s due to overdose risk
recommend interpersonal tx approach: dependent:clinging O-C:insistence on rules/standards paranoid:accusations/attacks narcissistic:entitled/puts down others histrionic:theatrical/charming antisocial:exploits others borderline:idealizing/devaluating
limit-setting, reassurance logical suggestions acknowledgement of fears/encouragement collaboration consistent/stabilzing responsiveness limit-setting/legal backup validating, limit setting
