Personality Disorders Flashcards
Personality
A relatively stable & enduring set of characteristic behavioral & emotional traits
What are the 4 determinants of personality?
How are they defined?
-
Temperament
- “nature”
- Apparent before traditional learning occurs
- 50% of personality is related to temperament
-
Development
- Effect of “nurture” on biology
- Negative events in early childhood (typically repeated, chronic abuse or neglect) can physiologically alter the limbic system & cause permanent effects on emotional arousal, etc.
- Character – “nurture”
- Psyche – self-awareness (the ability to learn, adapt, change)
What are defense mechanisms?
Unconscious mental processes that the ego uses to resolve conflicts
Defense mechanisms are between________, reality, important persons, and ___________.
When they remain rigid, despite changing, they _______ _______.
Changing it increases ______.
instinct (id)
conscience (superego)
don’t work
anxiety
What are 3 examples of defense mechanisms?
- Denial
- Dissociation
- Suppression
Ignoring reality
Adaptive dealing w/ serious illness
Can get in the way of treatment
Denial
Mentally separating part of one’s consciousness from real life events
Dissociation
Intentionally (consciously) pushing down to deal w/ now
Suppression
Define personality disorder
- Relatively stable & enduring set of characteristic behavioral & emotional traits
- Normally flexible & adaptable
- When disordered, it is maladaptive, deeply ingrained & often distressing for both the patient & significant others
Personality is “disordered” when….
- It’s ingrained & inflexible
- It gets in the way of relationships/functioning
- It’s relatively stable
- It distresses people around them
Ego-syntonic vs. Ego-dystonic
ego-syntonic > ego-dystonic
-
Ego-syntonic
- “acceptable to the ego”
- It doesn’t bother them, it bothers others
- Ego-dystonic – uncomfortable
OCPD is (ego-syntonic/ego-dystonic)
OCD is (ego-syntonic/ego-dystonic)
OCPD = ego-syntonic
OCD = ego-dystonic
Personality Disorders
______% prevalence in general population (office)
______% prevalence in psychiatric outpatient populations
>____% on inpatient psychiatric unit
10-18% prevalence in general population (office)
30-50% prevalence in psychiatric outpatient populations
>50% on inpatient psychiatric unit
What are the gender trends in personality disorders?
What diseases are more common in men? women?
Men = Women
- Females: borderline, histrionic
- Males: Narcissistic, anti-social
- Some validity, some stereotype
Personality Disorders
- Cluster A
- Cluster B
- Cluster C
- Cluster A = more detached, eccentric
- Cluster B = more dramatic, impulsive
- Cluster C = more anxious
What are some examples of Cluster A disorders?
- Schizoid PD
- Schizotypal PD
- Paranoid PD
Schizoid PD
Definition
Prevalence
Difference from Schizophrenia
- Emotionally detached, loners
- Don’t want relationships
- Prevalence – anywhere from “uncommon” to 7.5% of general population
- Males 2X as much as females
- Higher incidence of psychosis in relatives
- Differentiated from schizophrenia by absence of psychotic symptoms (hallucinations, delusions, thought disorder)
Schizotypal PD
Definition
Prevalence
- “cognitive, perceptual & behavioral eccentricities…frequently embrace beliefs, such as telepathy, clairvoyance & magical thinking, to a degree that exceeds cultural & subcultural norms”
- 3% of population
- Highly genetic
- 33% monozygotic twins
- 4% dizygotic twins
- Increased risk in biological relatives of schizophrenics
Paranoid PD
Definition
Prevalence
Differentiation from Schizophrenia
- Long-standing suspiciousness & mistrust of people
- No basis for this mistrust
- Read threats into non-threatening situations
- Pathologically jealous if in a relationship
- 0.5-2.5% of population
- Rarely seek treatment themselves
- Males > Females
- Differentiated from schizophrenia by absence of hallucinations or though disorder, higher functioning & non-bizarre paranoia
What are some examples of Cluster B disorders?
- Antisocial
- Borderline
- Histrionic
- Narcissistic
“repetitive unlawful acts & socially irresponsible behaviors that began prior to age 15…so unconcerned w/ the feelings & rights of others that they are morally bankrupt & lack of a sense of remorse”
Antisocial Disorder
Antisocial
Definition
- Deceitful, impulsive
- Irritability & aggressiveness
- Reckless disregard for safety of self or others
- Consistent irresponsibility (doesn’t honor financial obligations)
- Lack of remorse
- Often confused in lay terms, taken to mean “antisocial”
- Antisocial = sociopath
Antisocial
Prevalence
- 3% of male population, 1% of female population
- High genetic load
- 5X more common in relatives w/ disorder
Getting distraught if a spouse is 5 min late getting home from work
Placing dozens of phone calls to one’s therapist before the therapist goes on vacation
Borderline Disorder
**Borderline **
Definition
Relationships
Mood
- Frantic efforts to avoid real or imagined abandonment (interpersonal)
- A pattern of unstable & intense interpersonal relationships characterized by alternating btwn extremes of idealization & devaluation (interpersonal, affective)
- Affective instability due to marked reactivity of mood
- “mood swings”
- Argumentative one moment, depressed the next
- Later complain of having no feelings (affect)
- Chronic feelings of emptiness
- Recurrent suicidal behavior, threats or self-mutilating behavior (impulse control)
Borderline
Prevalence
- 1-2% of population
- Females > Males
- High genetic load
- More MDD & substance abuse in relatives
- Multiple suicide attempts (up to 10% complete)
Histrionic
Definition
Prevalence
- “…pervasive overconcern w/ appearance & attention, exaggerated & emotional response, poor frustration tolerance that ends in outbursts, & impressionistic speech that lacks detail”
- “View physical attractiveness as the core of their existence”
- Believed to occur in 2-3% of the population
- _Females > Males _
Narcissistic
Definition
Preoccupations
- Characterized by a heightened sense of self-importance, grandiose feelings & lack of empathy
- Preoccupied with fantasies of unlimited success, power, brilliance, beauty or ideal love
- Arrogant, entitled & often envious
- Require excessive admiration
- Take advantage of others to achieve their own ends
What are some examples of Cluster C disorders?
- OCPD
- Avoidant
- Dependent
OCPD
Definition
- Become so preoccupied w/ details & rules that the major point of an activity is lost
- Display perfectionism that interferes w/ task completion (taking hrs to do notes because it has to be perfect)
- Have inflexible values & are overly conscientious
OCPD
Prevalence
Defenses
Difference from OCD
- Males > Females
- More common among 1st degree relatives w/ OCPD
- Tend to be oldest children
- Defenses – rationalizing, intellectualizing, reaction formation, undoing, controlling
- NOT the same as OCD – ego dystonic
- However, under stress, can develop OCD symptoms
Avoidant
Definition
- Show extreme sensitivity to rejection which may lead to a socially withdrawn life
- Although shy, they have a great desire for relationships
- Differentiates from schizoid PD
Dependent
Definition
Prevalence
- Subordinate their own needs to those of others
- Lack self-confidence & can’t make decisions w/o excessive advice & reassurance
- Doesn’t speak up b/c may lose support or approval
- Uncomfortable being alone
- Urgently seeks another relationship when a close one ends
- Females > Males
- Youngest children
What are the available treatments for personality disorder?
- Psychodynamic psychotherapy to change the defenses
- Supportive if too unstable or minimal insight
- Behavioral (DBT) if self-destructive behavior
-
Psychopharm
- Target symptoms
- Serotonin – impulse control, rejection sensitivity, mood stabilizer for lability, affect dysregulation
