Personality Disorders Flashcards
egosyntonic traits
behaviors, values, feelings that are in harmony with needs and goals of ego; consistent with one’s self-image
Diagnostic criteria for all personality disorders
A. Pattern of inner experience and behavior that deviates from expectations of individual’s culture
- Pattern manifested in 2+ areas: cognition, affectivity, interpersonal functioning, impulse control
B. Pattern inflexible and pervasive
C. Clinically significant distress or impairment
D. Pattern stable and long duration, traceable to adolescence
How old to be dx’d with personality disorder?
18 or older
Possible etiologies of personality disorders
genetics, culture and/or environmental factors (e.g. foster care, sole offspring, large family)
3 clusters of personality disorders
A: odd or eccentric (MAD)
B: dramatic, emotional, erratic (BAD)
C: anxious or fearful (SAD)
Cluster A examples
Paranoid, Schizoid, Schizotypal
Cluster B examples
Antisocial, Borderline, Histrionic, Narcissistic
Cluster C examples
Avoidant, Dependent, OCPD
Key criteria of Paranoid PD
“SUSPECT” (4/7 criteria needed)
Spousal infidelity suspected Unforgiving Suspicious of harm, deceit, exploitation Perceives attacks Enemy or friend binary Confiding in others is feared Threats perceived in benign events
Epidemiology of paranoid PD
M>F, deaf, minorities, recent immigrants
What must be r/o first before dx of Paranoid PD?
- personality change d/t medical condition or chronic substance abuse
- delusional d/o, Schizophrenia, Mood d/o with psychotic features
- consider if paranoia appropriate within culture
Key criteria for dx of Schizoid PD
“DISTANT” (four of seven criteria needed)
Detached (flat) affect Indifferent to criticism or praise Sexual experiences of little interest Tasks performed solitarily Absence of close friends Neither desires nor enjoys close relations Takes pleasure in few activities
Discriminating feature of what PD is suspicious?
Paranoid PD
Discriminating feature of what PD is socially indifferent?
Schizoid PD
Discriminating feature of what PD is eccentric?
Schizotypal
Discriminating feature of what PD is disagreeable?
Antisocial PD
Discriminating feature of what PD is unstable relationships?
Borderline PD
DDX of Schizoid PD
mild forms of Autistic and Asperger’s disorders
Key features of Schizotypal PD
“ME PECULIAR” (5+ criteria)
Magical thinking/odd beliefs Experiences unusual perceptions Paranoid ideation Eccentric behavior or appearance Constricted (or inappropriate) affect Unusual thinking and speech Lack close friends Ideas of reference Anxiety in social situations R/o psychotic disorder
“I prefer to be alone; my world is empty and that’s fine.” Describes what PD?
Schizoid
“Others are untrustworthy and they take advantage of me.” Describes what PD?
Schizoid PD
“I’d like to have friends but it’s hard because people find me pretty strange.” Describes what PD?
Schizotypal PD
“I enjoy taking advantage of people and I never feel bad about it.” Describes what PD?
Antisocial
“I need people desperately and fall apart completely when they reject me.” Describes what PD?
Borderline PD
Over 50% of patients with Schizotypal have h/o ________.
Major Depressive Episodes
Major difference between Schizoid and Schizotypal?
Schizoid are indifferent about having social relationships, but Schizotypal feel bad about lacking friends
Cultural considerations of Schizotypal PD
- Emotional turmoil during adolescence
- Spiritual and religious cultural groups beliefs and practices that may appear Schizotypal (e.g. magic beliefs, psychic abilities, talking in tongues)
Key features of Antisocial PD?
“CORRUPT” (3+ criteria)
Conformity to law is lacking Obligations ignored Reckless disregard for safety of self or others Remorseless Underhanded Planning insufficient (impulsive) Temper
Antisocial PD: after 18 yo
________: before 15 yo
Conduct Disorder
Key features of Borderline PD
I DESPAIRR (5+ criteria)
Identity disturbance
Disordered, unstable affect
Emptiness is chronic
Suicidal behavior, gestures, and/or threats
Paranoid ideation can be transient, stress-related
Avoids abandonment
Impulsivity
Rage is inappropriate and intense
Relationships are unstable, intense, extreme
Men: Antisocial
Female: _______
Borderline
“I’m an emotional and sexually charming person and I need to be the center of attention.” Describes what PD?
Histrionic
Key features of Histrionic PD?
PRAISE ME (5+ criteria)
Provocative behavior Relationships considered more intimate than really are Attention-seeking Influenced easily Speech affected, impressionistic Emotions rapidly shift and are shallow Manipulative, theatrical
suicidal behaviors to keep people close
Borderline PD
How is manipulative behavior different in histrionic vs antisocial?
Histrionic wants attention
Antisocial wants profit, power, and material gain
How is histrionic distinguished from borderline?
histrionic does not have suicidal behavior, threats, or self-mutilation like borderline does
Features of Narcissistic PD
SPEEECIAL (5+ criteria)
Special Preoccupied with fantasies of success and power Envious Entitled Excessive need for admiration Conceited Interpersonally exploitive Arrogant Lack empathy
“I’m really afraid of what people will think of me, so I avoid making new friends.” Describes what PD?
Avoidant PD
Discriminating feature of what PD is inhibited?
Avoidant
Discriminating feature of what PD is attention-seeking?
Histrionic
Discriminating feature of what PD is self-centered?
Narcissistic
“I’m talented and special. I get angry and depressed when people don’t recognize how great I am!” Describes what PD?
Narcissistic
How are Narcissistic and Histrionic different?
Narcissistic don’t care about the opinions or attention of other people
Key features of avoidant personality d/o
“CRINGES” (4+ criteria)
Certainty of being liked required
Rejection-phobic
Intimacy is avoided
New relationships are avoided
Gets around interpersonal contact
Embarrassment is expected, prevents new activities
Self viewed as inept, inferior, unappealing
Avoidant PD vs Social Phobia
Avoidant: avoid ANY opportunity to be negatively evaluated; more severe than social phobia
Social phobia: have few close friends (“safe people”)
Avoidant personality d/o closely comorbid with what?
agoraphobia
“I’m passive and dependent on others, and I go far out of my way to please those who are important to me.” Describes what PD?
Dependent PD
Key features of dependent personality d/o
RELIANCE (5+ criteria)
Require reassurance and advice Expressing disagreement is difficult Life responsibilities are assumed by others Inability to initiate projects Avoid being alone Nurturance is ultimate goal Companionship sought urgently Exaggerated fears of being left to care for self
“I keep lists, drive myself hard, and i’m very serious about life.” Describes what PD?
OCPD
“I keep lists, drive myself hard, and i’m very serious about life.” Describes what PD?
OCPD
Key features of OCPD
LAW FIRMS (4+ criteria)
Loses sight of greater picture due to rules, details
Ability to complete tasks is compromised by perfectionism
Worthless objects retained
Friends and leisure excluded in favor of work
Inflexible
Reluctant to delegate
Miserly, hoard $ for calamity
Stubborn, rigid
Discriminating feature of what PD is submissive?
Dependent
Discriminating feature of what PD is perfectionist?
OCPD
How is OCD different than OCPD?
OCD is less severe and may be focused on one/few obsessions and compulsions
OCPD is more severe and affects all arenas of life