Personality Disorders Flashcards
Define general personality disorder
- Enduring pattern of inner experience/behavior that deviates from cultural expectations (2 or more of cognition, affectivity, interpersonal functioning, impulse control)
- Stable over time
- Leads to distress or impairment
Which personality disorders are MC in males?
Antisocial
Paranoid
Schizoid
Which personality disorders are MC in females?
Borderline
Histrionic
Dependent
How to differentiate personality traits from disorder?
Traits are flexible, adaptive, and do not cause functional, impairment/distress
How are Cluster A PDs characterized?
Odd or eccentric behavior
Cognitive distortions
How are Cluster B PDs characterized?
Overly emotional
Dramatic and unpredictable
How are Cluster C PDs characterized?
Anxious or fearful behavior
Avoids confrontation, withdrawn
Which types are Cluster A PDs?
Paranoid
Schizoid
Schizotypal
Which types of personality disorders tend to become less evident with age?
Antisocial
Borderline
Which types of personality disorders tend to become more evident with age?
Obsessive compulsive
Schizotypal
How can someone be diagnosed with a personality disorder under the age of 18?
If features have been present for at least 1 year (EXCEPT antisocial PD)
Which PD cannot be diagnosed under the age of 18?
Antisocial
Describe paranoid PD
- Cluster A
- Distrust and suspicion of others
- Males MC
Clinical presentation of paranoid PD
- Difficult to get along with
- Problem w/close relationships
- Combative and suspicious
What factors increase the risk of paranoid PD?
Fam hx of schizophrenia, delusional disorder
How does childhood/adolescent paranoid PD present?
Poor peer relationships
Social anxiety
Underachievement in school
Tend to be teased
Describe schizoid PD
- Cluster A
- Detachment from social relationships
- Restricted range of expression of emotions in interpersonal settings
How do schizoid PD patients present?
- Socially isolated “loners”
- Lack intimacy
- Prefer mechanical/abstract tasks (computer games)
- Indifferent to approval/criticism
- Show little emotion
Who is MC affected by schizoid PD?
- Males
- Fam hx of schizophrenia or schizotypal PD
Describe schizotypal PD
- Cluster A
- Reduced capacity for close relationships
- Cognitive distortions
- Eccentricities of behavior
How do schizotypal PD patients present?
- Interpret things incorrectly with unusual meaning
- Superstitious or preoccupied w/paranormal phenomena
- Unusual mannerisms, unkempt dress
Who is MC affected by schizotypal PD?
- Males
- Fam hx of schizophrenia in 1st degree relative
Over 50% of schizotypal PD cases have:
History of at least 1 major depressive episode
Which types of PD are Cluster B?
Antisocial
Borderline
Histrionic
Narcissistic
Describe antisocial PD
- Cluster B
- Disregard for and violation of the rights of others
- Demonstrates at least 3 listed symptoms since 15 yo (conduct disorder)
- Must be 18 yo to diagnose
What is antisocial PD also known as?
“Psychopath” or “sociopath”
Clinical presentation of antisocial PD
- Failure to conform to social norms
- Deceitful, reckless disregard
- Serious violations of rules
- Lack empathy
- Superficial charm
Which patients are more likely than the general population to die at a young age d/t violence?
Antisocial PD patients
What conditions are commonly associated with antisocial PD?
- Depression, anxiety
- Substance abuse
- Gambling disorder
Who is MC affected by antisocial PD?
- Males
- Family hx and low socioeconomic status
- Highest prevalence in males with ETOH disorder and from substance abuse clinics or prisons
Describe borderline PD
- Cluster B
- Marked impulsivity in 5 or more contexts
Clinical presentation of borderline PD
- Avoid abandonment, rejection
- Unstable and intense relationships
- Sudden and dramatic shifts in self-image, moods
Who is MC affected by borderline PD?
- Females (75%)
- Hx of childhood sexual, physical and/or emotional abuse
- 5x MC among 1st degree relatives
What conditions occur MC in families with borderline PD?
Bipolar and MDD
Describe histrionic PD
- Cluster B
- Excessive emotionality and attention seeking in 5 or more contexts
How do histrionic PD patients present?
- Want to be life of the party and if they aren’t, they do something dramatic
- Wants to impress others
- Fish for compliments
Describe narcissistic PD
- Cluster B
- Grandiosity, need for admiration, lack of empathy in 5 or more contexts
Clinical presentation of narcissistic PD
- Grandiose, need for admiration
- Lack of empathy
- Sense of entitlement
- Very sensitive to criticism
What are Cluster C PDs?
- Avoidant
- Dependent
- Obsessive Compulsive
Describe avoidant PD
- Cluster C
- Social inhibition, feelings of inadequacy, hypersensitive to criticism
Clinical presentation of avoidant PD
- Often decline job promotions (fear)
- Avoid making new friends unless certain they would be liked
- Interpersonal intimacy is difficult
- Low self esteem
Who is MC affected by avoidant PD?
- Males = females
- Starts in infancy or childhood, but cautious diagnosis that young
Describe dependent PD
- Cluster C
- Excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation
Clinical presentation of dependent PD
- Believe they can’t function on their own
- Passive, lack self-confidence
- Feel helpless when left alone
- Pessimistic
What condition does dependent PD often co-occur with?
Cluster B PD
Who is MC affected by dependent PD?
Females
Describe obsessive compulsive PD
- Cluster C
- Preoccupation with orderliness, perfectionism, control
Clinical presentation of obsessive compulsive PD
- Increased need for sense of control
- Prone to repetition, attention to detail, checking for mistakes
- Oblivious to others who get annoyed with their behavior
- Reject help, do not break rules
Why is PD difficult to treat?
Patients don’t even realize they have a problem/condition
Treatment of Cluster A PD
- Psychotherapy (individual or group)
- Group/family therapy
Treatment of Cluster B PD
- Psychotherapy (individual/CBT)
- Community programs (esp antisocial, decreases criminal behavior)
- Psychopharm for borderline (Li, CBZ, VA, atypical antipsychotics, SSRIs)
What helps to decrease criminal behavior in antisocial PD patients?
Community programs
Which Cluster B PD can be treated with psychopharm?
Borderline PD - Li, CBZ, VA, atypical antipsychotics, SSRIs
Treatment of avoidant PD
- SSRIs, MAOIs, Buspirone, B blockers (social phobias)
- Psychotherapy
Treatment of dependent PD
- SSRIs and TCAs (help for anxiety, fatigue, malaise)
- Psychotherapy
Treatment of obsessive compulsive PD
- Psychopharm not shown to be effective (but SSRIs or clomipramine may help decrease ritualizing)
- Psychotherapy
